Adapting and Implementing an Integrated Care Model for Youth with Autism Spectrum Disorder and Psychiatric Comorbidity

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Project Summary. The purpose of this revised K23 Mentored Patient-Oriented Research Career Development Award is to assist the applicant in acquiring the skills needed for an independent research career in implementation and sustainment of pediatric integrated mental health care for children with Autism Spectrum Disorder (ASD). Children with ASD represent a rapidly growing, high-priority clinical population with multiple service needs including access to effective mental health treatment given high rates of psychiatric comorbidity when using structured research assessments. Pediatric primary care is a critical and ongoing point of health care access for children with ASD and thus represents an ideal setting for services linkage and identification of additional service needs. However, children with ASD have high unmet mental health needs due, in part, because identifying MH problems in these children is complex, under-identified, and subject to diagnostic overshadowing in which comorbid mental health problems are overlooked due to a more pronounced condition like ASD. Given this, efforts to improve integrated primary-mental health care with specific focus on mental health screening and linkage to mental health care requires a tailored approach for children with ASD. Under the mentorship of Gregory Aarons, Ph.D. (primary sponsor and mentor) and expert implementation and services research consultants, the applicant will pursue training in: 1) implementation science theory and methodology to apply to pediatric integrated health care service delivery models for children with ASD, 2) pediatric cross-systems research for children with ASD, 3) electronic health record technology in pediatric primary care to facilitate improved integrated care for children with ASD, and 4) adaptive randomized designs for large-scale effectiveness and implementation services research. These training goals will facilitate pursuit of the following research aims: 1) identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, 2) adapt integrated care procedures into “Access To Tailored Autism INtegrated Care,” ATTAIN, to facilitate identification of mental health problems and linkage to evidence-based care for youth with ASD, and 3) conduct an open trial feasibility pilot test in pediatric primary care with providers and caregivers of children with ASD. This proposal strongly aligns with Objective 4.1 of the NIMH Strategic Plan “improve the efficiency and effectiveness of existing mental health services” and research priorities identified by the HHS Interagency Autism Coordinating Committee through its targeted focus on the urgent need to improve mental health services access and coordination for children with ASD. The strong training and research experience will effectively position the applicant for an independent research career that intersects implementation science and pediatric integrated services research for children with ASD and additional psychiatric comorbidities.