Community Mental Health Therapist Perspectives on Changes in Clinical Practice Associated with Training and Delivery of a Mental Health Intervention for ASD

Background: Publicly-funded community and school-based mental health (MH) programs play a pivotal role in caring for children with autism spectrum disorder (ASD).  Previous research indicates that MH therapists have limited ASD training and there are gaps between evidence-based (EB) approaches for ASD and routine MH care. In response, the AIM HI (“An Individualized Mental Health Intervention for ASD”; Brookman-Frazee & Drahota, 2010) clinical intervention and corresponding training model were developed. AIM HI is a package of well-established EB strategies, developed to address challenging behaviors in children with ASD within the context of routine MH services. It was designed for delivery by MH providers with limited ASD experience.

Objectives: The purpose of the current qualitative study is to examine MH therapists’ perspectives on changes in their clinical practice associated with training and delivery of the AIM HI intervention. These qualitative data are intended to expand and complement quantitative data demonstrating changes in therapists’ clinical practice.

Methods:   Qualitative data were collected as part of an ongoing large-scale, randomized effectiveness trial of AIM HI in which MH programs were randomized to immediate AIM HI implementation or to a wait-list control/routine care observation condition. Brief, semi-structured qualitative interviews were conducted with the first cohort of therapists (n=37) from 8 MH programs after completing 6 months of AIM HI training and consultation.  AIM HI training involved attendance at an introductory workshop, participation in 11 consultation meetings over 6 months and performance feedback based on review of videos with ongoing clients. Interviews lasted an average of 18 minutes. All interviews were transcribed and two-thirds of interviews (n=25) were randomly selected for in-depth qualitative analysis. The transcripts were coded for a priori and emergent themes using a coding, consensus, and comparison methodology (Wilms et al, 1990). 

Results:   Preliminary results indicate the following themes regarding therapist perceptions on changes in their practice: (1) Increased knowledge of ASD characteristics and comfort and confidence in providing treatment to children with ASD; (2) Increased use of structure in therapy sessions (e.g., use of a session schedule); (3) Increased parent involvement and collaboration in therapy sessions; (4) Increased use of behavioral strategies (e.g., conducting functional assessments of behavior); (5) Increased focus on child and parent skill-building in treatment; and (5) Application of AIM HI intervention with non-ASD clients and settings (e.g., use with ADHD clients).

Conclusions: Therapists reported a number of positive changes in their clinical practice with children with ASD and their caregivers. These qualitative findings complement quantitative findings indicating changes in therapist practice and attitudes towards serving this population associated with AIM HI training. Taken together, this study supports the positive impact of training MH therapists, who do not specialize in ASD, to deliver a package of EB strategies for children with ASD served in publicly-funded MH settings.