Effectiveness and Implementation of a Mental Health Intervention for ASD

描述（由申请人提供）：本研究是一项AIM HI的随机对照试验，这是一项专门为社区精神卫生诊所设计的干预措施，旨在减少自闭症谱系障碍（ASD）学龄儿童的问题行为。CMH系统在照顾ASD学龄儿童方面发挥着重要作用，特别是那些表现出挑战性行为的儿童。不幸的是，由于治疗师缺乏专门的培训来解决ASD儿童的复杂需求，特别是行为问题，并且没有持续或密集地使用EBPs，因此CMH服务中为ASD儿童提供的护理质量受到广泛关注。针对最常见的表现问题有可能对在CMH诊所服务的大多数ASD儿童的护理产生重大影响。在CMH诊所实施现有的针对自闭症谱系障碍的EBPs，为CMH服务环境中的质量差距提供了一种创新的解决方案。我们的试点数据表明，诊所和提供者渴望学习如何有效地治疗自闭症儿童。然而，现有的ebp并不是为CMH诊所提供的。我们之前的研究开始解决缺乏易于“实施”的ebp来治疗ASD儿童的行为问题。具体而言，我们根据儿童的临床需求和治疗师的培训需求确定并打包了EBP策略，从而形成了最终的干预方案，“自闭症儿童的个性化心理健康干预”（AIM HI）。AIM HI是基于应用行为分析原则的一揽子EBP策略，旨在减少在CMH诊所服务的5至13岁ASD儿童的挑战性行为。虽然AIM HI的各个组成部分是完善的EBP策略，试点研究数据表明，当他们的CMH治疗师提供AIM HI时，儿童行为问题减少，但该方案的有效性尚未确定。因此，主要目的是测试AIM HI对儿童和家庭结果的影响，并确定儿童/家庭特征和治疗师忠诚水平如何调节治疗效果。我们的第二个目标是

DESCRIPTION (provided by applicant): The proposed study is a randomized controlled trial of AIM HI, an intervention designed specifically for implementation in community mental health clinics, to reduce problem behavior among school-age children with autism spectrum disorders (ASD). The CMH system plays an important role in caring for school-age children with ASD, especially those who exhibit challenging behaviors. Unfortunately, there are widespread concerns about the quality of care provided to children with ASD in CMH services as therapists lack specialized training to address the complex needs of children with ASD, particularly behavior problems, and do not use EBPs consistently or intensively. Targeting the most common presenting problems has potential to make a significant impact on care for most children with ASD served in CMH clinics. Implementing existing EBPs for ASD in CMH clinics offers an innovative solution to the quality gap in CMH service settings. Our pilot data indicate that clinics and providers are eager to learn how to effectively treat children with ASD. However, existing EBPs were not designed for delivery within CMH clinics. Our previous research began to address the lack of readily "implementable" EBPs to treat behavior problems in children with ASD. Specifically, we identified and packaged EBP strategies based on the clinical needs of children and training needs of therapists, resulting in the final intervention protocol, "An Individualized Mental Health Intervention for Children with ASD" (AIM HI). AIM HI is a package of EBP strategies, based on the principles of applied behavior analysis, designed to reduce challenging behaviors in children with ASD ages 5 to 13 served in CMH clinics. Although the individual components of AIM HI are well-established EBP strategies and pilot study data indicate that child behavior problems decrease when their CMH therapists deliver AIM HI, the effectiveness of the protocol has not been established. Therefore, the primary aims are to test the impact of AIM HI on child and family outcomes and determine how child/ family characteristics and level of therapist fidelity moderate treatment effects. Our secondary aim is to collect initial data on implementation outcomes and conduct exploratory analyses to identify barriers and facilitators of AIM HI implementation (e.g., intervention, organization, provider characteristics). Participants will include 29 clinics recruited from San Diego County's publicly-funded service system, 39 program managers, 223 therapists, and 301 child/ parent dyads. The study builds directly on the promising results from the PI's career development award. Our previous studies in this service system provide the empirical, methodological, and collaborative foundation to support the adoption and implementation of the intervention. It also supports the feasibility and validity of the research methods to assess the intervention's fidelity and effectiveness. Consistent with the IACC Strategic Plan for ASD research and Objective 4 of NIMH's Strategic Plan, testing the effectiveness of packages of EBP strategies in usual care settings is hypothesized to ultimately improve treatment of children with ASD in the community.