Developing and Testing an Intervention to Reduce Challenging Behaviors within Community and School-Based Mental Health Services

Background: Publicly-funded mental health (MH) services play an important role in the treatment of behavioral issues and co-occurring psychiatric problems for school-age children with ASD.  AIM HI (“An Individualized Mental Health Intervention for ASD”) was developed in response to a lack of “implementable” intervention protocols for MH service settings. AIM HI is a package of evidence-based strategies designed to target challenging behaviors in children with ASD. Data from a large-scale community effectiveness trial of the AIM HI clinical intervention and corresponding training model provide important information about the impact of implementing evidence-based strategies in community service settings and information on the clinical characteristics of children receiving publicly-funded mental health services.

Objectives: Describe the development of the AIM HI; provide an overview of a large-scale community effectiveness trial; report initial data on the clinical presentation of children served in MH settings; and discuss preliminary outcomes associated with therapist training.

Methods: AIM HI was developed based on a systematic needs assessment of the community service context and collaboration with community stakeholders to package evidence-based strategies. The current effectiveness and implementation study uses a wait-list randomized controlled trial in which community and school-based MH programs are randomized to one of two intervention training waves: immediate AIM HI implementation and usual care/delayed AIM HI implementation. Therapist and child/parent participants are recruited from participating programs. Therapists practicing in programs during the immediate and delayed AIM HI implementation are trained to deliver the intervention to participating families over a six month intervention and training period. Child and family outcome measures are collected at baseline, 6, 12, and 18 months. The current sample of child/family participants includes 103 children (86% male) ages 5-14 (M = 8.83 years; SD = 2.51) recruited from the caseloads of 91 participant MH providers. Therapists (85% Female and 33% Hispanic) range in age from 23-58 (M=34) and represent multiple mental health disciplines.

Results: Data on child clinical characteristics from the current sample indicate that cognitive functioning is in the average range (M=88.9; SD=16.9; Range=41-139). 88% of children meet diagnostic criteria for at least one non-ASD psychiatric diagnosis based, most frequently ADHD. Sixty percent of children used psychotropic medication within the six months prior to the baseline assessment. The most commonly reported challenging behaviors endorsed by parents are perseveration (65%) and noncompliance (60%). Preliminary data on implementation outcomes indicate that most therapists who complete the AIM HI training and consultation reach fidelity.  Further, significant differences in therapist practice and attitudes between AIM HI and Usual Care therapists are observed.

Conclusions: The preliminary results from this ongoing study provide important information about the characteristics of children with ASD served in usual care MH settings. Data also suggest that it is feasible to train MH providers who are not ASD or behavioral intervention specialists to deliver evidence-based intervention strategies for children with ASD. Overall, this study has the potential to advance the science on the effectiveness and implementation of delivering interventions in community service settings for ASD.