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

项目摘要。修订后的K23指导以患者为导向的研究生涯的目的 发展奖旨在帮助申请者获得独立职业生涯所需的技能 针对自闭症谱系障碍青少年心理健康护理的服务和实施研究 (ASD)。患有自闭症的儿童是一个快速增长的人口，有着巨大而复杂的服务需求 据估计，美国每年的成本为2360亿美元(CDC，2014)。精神疾病的共病比率高达 70%的人，有证据表明，执行功能(EF)在潜在的 包括自闭症和各种精神健康状况。有鉴于此，心理健康服务是一个重要的来源 为患有自闭症的青少年提供医疗保健。然而，患有自闭症的儿童有大量未得到满足的心理健康需求。 尽管服务机构努力为这些年轻人开发基于证据的心理健康干预措施，但仍有 在社区精神卫生环境中存在严重的执行缺陷。这在一定程度上是由于 在制定这些干预措施时纳入对最佳“适合性”和覆盖面至关重要的因素。许多. 这些干预措施是针对疾病的，不针对有效的交叉诊断机制，如EF， 从而降低了他们在满足这些青年的一系列心理健康需求方面的适宜性和有效性。至 解决这一关键需求领域，本提案旨在系统地调整ASD EF干预措施，以 在精神卫生服务中的实施。在劳伦·布鲁克曼-弗雷齐博士的指导下。 (主要导师和赞助人)和Gregory Aarons博士(联合导师)以及导师和顾问 在实施和服务研究方面的专业知识，申请者将获得以下方面的培训：1)实施 适用于心理健康服务背景的科学；2)针对青少年自闭症的专门针对EF的干预； 3)实施科学方法论方法。这些培训目标将通过 以下项目目标：1)进行需求和背景评估，以告知系统地适应 ASD EF干预(非固定和在目标上[UOT]；Cannon，Kenworth，Alexander&Werner，2011) 在儿童心理健康服务中的实施；2)系统地适应UOT并制定相应的 执行计划，题为“加强以社区为基础的治疗的行政职能” ASD，或ASD的效果；以及3)在社区心理中进行ASD效果的可行性先导测试 运行状况设置。这一建议与NIMH战略计划非常一致，该战略计划旨在“制定方法，以适应现有的 干预措施以优化结果“(目标3.2)和”提高心理健康的效率和效果“ 保健服务“(目标4.1)，并有可能满足改善精神健康的迫切需要 为自闭症儿童提供的服务。与研究活动相结合的强有力的培训计划将有效地支持 这位申请者转变为一位在儿童心理方面具有特殊专长的独立实施科学家 医疗服务。

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.