Effectiveness and Implementation of a Mental Health Intervention for ASD

描述(申请人提供)：这项拟议的研究是一项针对AIM HI的随机对照试验，AIM HI是一种专门为在社区精神卫生诊所实施的干预措施，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系统在照顾患有自闭症的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学龄儿童。不幸的是，在CMH服务中向ASD儿童提供的护理质量受到广泛关注，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，并且没有始终如一地或集中使用EBPS。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ASD的EBPS为解决CMH服务设置中的质量差距提供了一个创新的解决方案。我们的试点数据表明，诊所和提供者渴望了解如何有效地治疗患有自闭症的儿童。然而，现有的循证医学计划并不是为在CMH诊所内提供而设计的。我们之前的研究开始解决缺乏容易“实施”的EBPS来治疗ASD儿童的行为问题。具体地说，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，即《针对ASD儿童的个性化心理健康干预》(AIM HI)。目的HI是一套基于应用行为分析原理的EBP策略，旨在减少在CMH诊所接受治疗的5-13岁ASD儿童的挑战行为。尽管AIM HI的各个组成部分都是成熟的EBP策略，而且试点研究数据表明，当他们的CMH治疗师提供AIM HI时，儿童行为问题会减少，但该方案的有效性尚未建立。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/家庭的特征和治疗师的忠诚度水平如何调节治疗效果。我们的次要目标是 收集关于实施成果的初步数据，并进行探索性分析，以确定实施AIM HI的障碍和促进者(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家诊所，39名项目经理，223名治疗师，以及301名儿童/父母二人组。这项研究直接基于PI职业发展奖的令人振奋的结果。我们之前对这一服务系统的研究为采用和实施干预措施提供了经验、方法论和协作基础。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的ASD研究战略计划和NIMH战略计划的目标4一致，假设在常规护理环境中测试EBP策略包的有效性，以最终改善社区ASD儿童的治疗。

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.