Effectiveness and Implementation of a Mental Health Intervention for ASD

自闭症谱系障碍心理健康干预措施的有效性和实施

• 批准号: 8896136
• 负责人: LAUREN BROOKMAN-FRAZEE
• 金额: $ 6.89万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-05 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8896136
• 关键词: Address; Adoption; Age; Aggressive behavior; Autistic Disorder; Behavior; Build-it; Caregivers; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Child Behavior; Clinic; Clinical; Collaborations; Communities; Community Mental Health Services; Community Services; Competence; Complex; County; Data; Disease; Effectiveness; Evidence based practice; Exhibits; Family; Family Characteristics; Foundations; Funding; Future; Goals; Health Services Research; Health system; Healthcare; Individual; Intervention; K-Series Research Career Programs; Knowledge; Learning; Measures; Mental Health; Mental Health Services; Methods; Modeling; Outcome; Parents; Participant; Phase; Pilot Projects; Play; Population; Prevalence; Problem behavior; Protocols documentation; Provider; Public Health; Quality of Care; Randomized Controlled Trials; Recruitment Activity; Research; Research Methodology; Research Personnel; Role; School-Age Population; Science; Self-Injurious Behavior; Services; Solutions; Staging; Strategic Planning; Symptoms; System; Testing; Training; Translational Research; autism spectrum disorder; base; control trial; cost; design; follow-up; improved; innovation; meetings; non-compliance; novel; programs; therapy design; treatment as usual; treatment effect

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.

描述（由申请人提供）：拟议的研究是一项AIM HI的随机对照试验，AIM HI是一种专门设计用于社区精神卫生诊所实施的干预措施，旨在减少自闭症谱系障碍（ASD）学龄儿童的问题行为。CMH系统在照顾患有ASD的学龄儿童，特别是那些表现出挑战性行为的儿童方面发挥着重要作用。不幸的是，人们普遍担心CMH服务中为ASD儿童提供的护理质量，因为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EBP。针对最常见的问题有可能对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ASD EBP为CMH服务环境中的质量差距提供了创新的解决方案。我们的试点数据表明，诊所和提供者都渴望了解如何有效地治疗ASD儿童。然而，现有的电子鼻不是为在CMH诊所内提供而设计的。我们以前的研究开始解决缺乏容易“实施”的EBP来治疗ASD儿童的行为问题。具体来说，我们确定和包装EBP策略的基础上，儿童的临床需求和治疗师的培训需求，导致最终的干预方案，“自闭症儿童的个性化心理健康干预”（AIM HI）。AIM HI是一套EBP策略，基于应用行为分析的原则，旨在减少CMH诊所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，并且初步研究数据表明，当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对儿童和家庭结局的影响，并确定儿童/家庭特征和治疗师忠诚度水平如何调节治疗效果。我们的第二个目标是 收集关于实施结果的初始数据，并进行探索性分析，以确定AIM HI实施的障碍和促进因素（例如，干预、组织、提供者特征）。参与者将包括从圣地亚哥县公共资助的服务系统招募的29个诊所，39个项目经理，223个治疗师和301个儿童/父母二人组。这项研究直接建立在PI职业发展奖的可喜成果之上。我们以前在这个服务系统的研究提供了经验，方法和协作的基础，以支持通过和实施的干预。这也支持了研究方法的可行性和有效性，以评估干预的保真度和有效性。与IACC ASD研究战略计划和NIMH战略计划目标4一致，假设在通常的护理环境中测试EBP策略包的有效性，以最终改善社区ASD儿童的治疗。