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: 8295932
• 负责人: LAUREN BROOKMAN-FRAZEE
• 金额: $ 80.48万
• 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/8295932
• 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. PUBLIC HEALTH RELEVANCE: This study has the potential to make a significant public health impact by building local capacity to serve school-age children with ASD in routine service settings, and advancing the science on the effectiveness of packaging evidence-based practices (EBPs) for specific services settings. It will also produce generalizable knowledge about implementation that can be applied for this population/ setting. These results will make a significantly contribution to the very minimal services research conducted on school-aged children with ASD who receive mental health services for psychiatric symptoms and challenging behaviors that are associated with ASD.

描述（由申请人提供）：拟议的研究是 AIM HI 的随机对照试验，AIM HI 是一种专门为在社区心理健康诊所实施而设计的干预措施，旨在减少患有自闭症谱系障碍 (ASD) 的学龄儿童的问题行为。 CMH 系统在照顾患有 ASD 的学龄儿童方面发挥着重要作用，尤其是那些表现出挑战性行为的儿童。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使用 EBP。针对最常见的问题有可能对 CMH 诊所服务的大多数自闭症谱系障碍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，诊所和医疗服务提供者渴望了解如何有效治疗自闭症儿童。然而，现有的 EBP 并非设计用于在 CMH 诊所内提供。我们之前的研究开始解决缺乏易于“实施”的 EBP 来治疗自闭症儿童的行为问题的问题。具体来说，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“自闭症儿童个体化心理健康干预”（AIM HI）。 AIM HI 是一套 EBP 策略，基于应用行为分析的原理，旨在减少 CMH 诊所服务的 5 至 13 岁 ASD 儿童的挑战性行为。尽管 AIM HI 的各个组成部分都是完善的 EBP 策略，并且试点研究数据表明，当 CMH 治疗师提供 AIM HI 时，儿童行为问题会减少，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度水平如何调节治疗效果。我们的次要目标是 收集有关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服务系统招募的 29 家诊所、39 名项目经理、223 名治疗师和 301 名儿童/家长。该研究直接建立在 PI 职业发展奖的有希望的结果之上。我们之前对该服务系统的研究为支持干预措施的采用和实施提供了实证、方法和协作基础。它还支持评估干预的保真度和有效性的研究方法的可行性和有效性。根据 IACC ASD 研究战略计划和 NIMH 战略计划的目标 4，假设在常规护理环境中测试 EBP 策略包的有效性将最终改善社区 ASD 儿童的治疗。 公共卫生相关性：这项研究有可能通过建设当地在常规服务环境中为患有自闭症谱系障碍的学龄儿童提供服务的能力，并推进针对特定服务环境的循证实践 (EBP) 有效性的科学，从而对公共卫生产生重大影响。它还将产生可应用于该人群/环境的关于实施的普遍知识。这些结果将为对患有自闭症谱系障碍的学龄儿童进行的极简服务研究做出重大贡献，这些儿童接受与自闭症谱系障碍相关的精神症状和挑战性行为的心理健康服务。