Adapting an ASD Executive Functioning Intervention for Implementation in Children's Mental Health Services

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Project Summary. The purpose of this revised K23 Mentored Patient-Oriented Research Career Development Award is to facilitate the applicant acquiring the skills needed for an independent career in services and implementation research specific to mental health care for youth with autism spectrum disorder (ASD). Children with ASD are a rapidly expanding population with immense and complex service needs estimated to cost $236 billion annually in the U.S (CDC, 2014). Rates of psychiatric comorbidity are as high as 70% among this population and evidence suggests a significant role of executive functioning (EF) underlying both ASD and various mental health conditions. Given this, mental health services represent a critical source of health care for youth with ASD. However, children with ASD have significant unmet mental health needs. Despite services efforts to develop evidence-based mental health interventions for these youth, there are significant implementation deficits in community mental health settings. This is in part due to limited incorporation of factors key to the optimal “fit” and coverage in the development of these interventions. Many of these interventions are disorder specific, which do not target potent, cross-diagnostic mechanisms such as EF, thereby reducing their fit and effectiveness in addressing the range of mental health needs for these youth. To address this critical area of need, this proposal aims to systematically adapt an ASD EF intervention for implementation in mental health services. Under the mentorship of Drs. Lauren Brookman-Frazee, Ph.D. (primary mentor and sponsor) and Gregory Aarons, Ph.D. (co-mentor) and mentors and consultants with expertise in implementation and services research, the applicant will obtain training in: 1) implementation science for application to the mental health services context; 2) interventions for youth with ASD specific to EF; and 3) implementation science methodological approaches. These training goals will be executed through the following project aims: 1) conduct a needs and context assessment to inform the systematic adaptation of an ASD EF intervention (Unstuck and on Target [UOT]; Cannon, Kenworthy, Alexander & Werner, 2011) for implementation in child mental health services; 2) systematically adapt UOT and develop a corresponding implementation plan, together entitled “Executive Functioning for Enhancing Community-based Treatment for ASD,” or EFFECT for ASD; and 3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings. This proposal strongly aligns with the NIMH Strategic plan to “develop ways to tailor existing interventions to optimize outcomes” (Objective 3.2) and to “improve the efficiency and effectiveness of mental health services” (Objective 4.1) and has the potential to address the urgent need to improve mental health services for children with ASD. The strong training plans yoked with research activities will effectively support this applicant's transition to an independent implementation scientist with particular expertise in child mental health services.