Exploring the Role of Child Ethnicity on Community Therapist Delivery of a Mental Health Intervention for ASD

Background: Racial/ethnic disparities have been documented in access to and quality of community services for children with ASD.  It is not known, however, whether disparities exist when community providers are trained to deliver evidence-based intervention strategies. Examining the role of child race/ethnicity is critical when measuring the impact of community implementation efforts.

Objectives:  To examine the impact of child ethnicity on community therapist fidelity of a mental health intervention for ASD within the context of publicly-funded mental health services.

Methods: Preliminary data on child ethnicity and therapist fidelity were drawn from an ongoing randomized community effectiveness trial of AIM HI (“An Individualized Mental Health Intervention for ASD”) conducted in publicly-funded community and school-based MH services. AIM HI is package of evidence-based behavioral intervention strategies designed to reduce challenging behaviors in children with ASD ages 5 to 13. It was designed specifically for use in routine mental health care settings by providers who do not specialize in ASD.  MH programs were enrolled and randomized to immediate AIM HI implementation (i.e. 6 months of ongoing therapists AIM HI training and consultation) or to a wait-list control/routine care observation condition. Participants included the first 44 therapists and 52 children participating in the AIM HI implementation condition and for whom video data were available. Children were ages 5-14 (M = 8.62 years; SD= 2.54), 81% male, and 52% Hispanic. Six therapist adherence summary scores were calculated based on three reports: Observer (average over 6 months based on video recorded sessions) and Therapist and Parent (obtained by survey at 6 months post baseline).

Results: Preliminary analyses reveal no significant differences between Hispanic and Non-Hispanic children in Observer, Therapist or Parent report of the adherence scales reflecting strategies directed to children (Session Structure Strategies, Motivational Strategies, Active Teaching Strategies) or Session Structure Strategies directed to parents. Differences in Therapist and Parent Rated adherence scores were found in strategies directed to parents. Specifically, therapists and parents reported significantly higher ratings of Involvement Strategies directed to parents for Hispanic (M=4.86; SD=0.47 and M=4.57; SD=0.81, respectively) compared to Non-Hispanic children (M=3.75; SD=1.48 and M=3.74; SD=1.63; t(40)=-3.22 p=0.004 and t(42)=-2.17 p=0.04). Additionally, Therapists reported significantly higher Active Teaching Strategies directed to parents for Hispanic children (M=4.38; SD=0.71) compared to Non-Hispanic children (M=3.75; SD=0.95); t(40)=-2.46 p=0.019). 

Conclusions: The high and representative proportion of Hispanic children in this large community sample provides a unique opportunity to examine ethnic disparities in therapist fidelity. Although no differences were found in therapist adherence to strategies directed to children, therapist and parent ratings of adherence to strategies directed to parents differed by child ethnicity. Interestingly, adherence scores were higher for Hispanic children.  Future analyses will examine differences in therapist adherence based on additional diversity factors including parent ethnicity and parent and child primary language for children whose therapists receive AIM HI training.  Similar analyses of usual care mental health services will also be conducted. Future research focused on understanding ethnic differences will be critical to informing the increasing effectiveness and implementation research conducted for ASD.