The objective of the proposed study is to develop implementation tools to facilitate an improved quality of care for school-aged youth with autism spectrum disorder (ASD) receiving services in community mental health settings. The NIMH Strategic Research Priorities call for innovative service delivery models to improve the outcomes of mental health services received in diverse communities and populations, including the use of technology-based strategies to make evidence based practices (EBPs) available, deliverable, effective, and scalable in non-specialty settings, and for service system interventions designed to improve functional outcomes for people with ASD (Objective 4). To achieve these goals, EBPs for school-aged youth with ASD need to be prepared and optimized for implementation in the community settings where most youth with ASD receive treatment. Implementation of EBPs for youth with ASD will require effective Quality Control (QC) procedures (therapist training and support procedures and QC instruments to gauge the success of the training/support procedures). As a first step towards these goals, in the proposed project we will accomplish three primary aims: (a) Develop a flexible, internet-based, video supported training and real time therapist guidance application to support clinician implementation of the Modular EBPs for Youth with ASD (MEYA), a compendium of EBPs for school-aged youth with ASD; (b) Develop the MEYA Integrity Scale, a pragmatic treatment integrity scale designed to gauge the success of the MEYA Training System and serve as a feedback tool in supervision; and (c) Assess the feasibility and promise of these MEYA QC procedures to improve therapist delivery of MEYA via key mediators (therapist knowledge, engagement) in a multiple baseline study. A panel of stakeholders comprised of end-users from community treatment centers for youth with autism will advise the research team on design features of the MEYA Training System and Integrity Scale. A software designer and videographer will work with the research team to realize the MEYA Training System, which will include multiple design features to maximize clinician engagement, motivation, and learning guided by contemporary models of implementation and learning (e.g., Proctor et al., 2011). The MEYA Integrity Scale will be refined and validated against a pre-existing archive of 1020 MEYA and comparison treatment sessions from NIH-funded clinical trials. The multiple baseline study will recruit 15 clinicians working with youth with ASD in community settings. The MEYA Training System will be assessed for acceptability and feasibility in this trial, and the primary outcome measure will be therapists' scores on the MEYA Integrity Scale following the onset of the intervention. The MEYA Training System and Integrity Scale will be refined based on stakeholder and clinician feedback and prepared for evaluation in a future R01 effectiveness trial testing the MEYA Training System in conjunction with different training and supervision approaches typically used in community settings.
The quality of care for school-aged youth with autism spectrum disorder (ASD) in community-based mental health centers is poor, with significant implications for current and future prognosis. Transporting and implementing evidence-based practices (EBP) to community-based mental health centers represents one way to improve the quality of care; however, there are inherent challenges in training clinicians in community settings to effectively use EBPs. The proposed study aims to address this problem by developing an innovative open-access internet-based system designed to help support the training of community clinicians in the use of EBPs for ASD in a cost-effective manner that clinicians and other stakeholders find acceptable and feasible.
