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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH094317-02
Application #
8454459
Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
Program Officer
Pintello, Denise
Project Start
2012-04-05
Project End
2017-01-31
Budget Start
2013-02-01
Budget End
2014-01-31
Support Year
2
Fiscal Year
2013
Total Cost
$627,203
Indirect Cost
$153,682
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Chlebowski, Colby; Magaña, Sandy; Wright, Blanche et al. (2018) Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families. Cultur Divers Ethnic Minor Psychol 24:552-563
Brookman-Frazee, Lauren; Stahmer, Aubyn C (2018) Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 13:66
Brookman-Frazee, Lauren; Stadnick, Nicole; Chlebowski, Colby et al. (2018) Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism 22:938-952
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Stadnick, Nicole; Chlebowski, Colby; Baker-Ericzén, Mary et al. (2017) Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview. Autism 21:841-851
Brookman-Frazee, Lauren; Stahmer, Aubyn; Stadnick, Nicole et al. (2016) Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children's Community Services. Adm Policy Ment Health 43:93-104
Stadnick, Nicole A; Stahmer, Aubyn; Brookman-Frazee, Lauren (2015) Preliminary Effectiveness of Project ImPACT: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program. J Autism Dev Disord 45:2092-104
Stadnick, Nicole; Brookman-Frazee, Lauren; Williams, Katherine Nguyen et al. (2015) A Pilot Study Examining the Use of the Autism Diagnostic Observation Schedule in Community-Based Mental Health Clinics. Res Autism Spectr Disord 20:39-46
Drahota, Amy; Stadnick, Nicole; Brookman-Frazee, Lauren (2014) Therapist perspectives on training in a package of evidence-based practice strategies for children with autism spectrum disorders served in community mental health clinics. Adm Policy Ment Health 41:114-25
Stadnick, Nicole A; Drahota, Amy; Brookman-Frazee, Lauren (2013) Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics. J Child Fam Stud 22:414-422