Training Mental Health Providers to Deliver Evidence Based Interventions for Autism Spectrum Disorders (ASD): Training Predictors and Outcomes

Background:   Publicly-funded mental health (MH) services play an important role in caring for school-age children with ASD. Previous research indicates that therapists providing routine MH service have limited ASD training and do not deliver strategies consistent with evidence-based (EB) interventions. To address this gap, the AIM HI (“An Individualized Mental Health Intervention for ASD”) clinical intervention and corresponding therapist-training model were developed.  AIM HI is a package of EB behavioral strategies targeting challenging behaviors in children with ASD designed specifically for the mental health services context for delivery by providers who do not specialize in ASD. The training model consists of an introductory workshop, 6 months of structured consultation with an expert trainer with performance feedback. It is currently being tested in a large-scale effectiveness/implementation trial in publicly funded community and school-based MH programs in two large counties in Southern California.  Examining the process and outcomes of training community providers is a key aim of this large-scale study. Understanding factors associated with successful training is essential to inform community implementation efforts. 

Objectives:  This presentation will report preliminary data on therapist training outcomes and factors associated with these outcomes from community providers participating in the AIM HI training condition of the ongoing community effectiveness/implementation study.

Methods:  Participants include the first 122 therapists enrolled in the training condition of the AIM HI trial.  Multiple methods, measures and informants were used to assess training outcomes: Training Completion measures included consultation attendance and whether the therapist met eligibility for AIM HI certification. Protocol Adherence was measured by a Trainer-Rated Treatment Planning rating. Session Fidelity was measured by Observed In-Session Fidelity (rated by observers blind to the training condition). The Evidence-Based Practice Attitudes Scale (EBPAS) was used to measure therapist attitudes towards EB practices. 

Results:   Training Completion was high with 100% of therapists attending the introductory workshop. Therapists attended an average of 9.55 of the 11 consultations (SD = 2.98; Range: 0-11). Seventy-four percent of enrolled therapists received AIM HI certification after the 6 month training period. Protocol Adherence was high with the average Treatment Planning Fidelity score of 25.99 (SD=4.77; Range: 0-29).  Sixty percent of therapists with complete observational coding data had Session Fidelity scores (averaged across the training period) in the acceptable range. Therapist baseline attitudes towards EBPs were associated with consultation attendance, Treatment Planning Fidelity, and Session Fidelity scores. The impact of previous training in different types of manualized intervention strategies on AIM HI training outcomes will be reported. 

Conclusions:   Preliminary data indicate that training MH providers to implement an ASD intervention is feasible; however, provider attitudes and previous experiences with EB approaches impact training success. These findings are especially relevant for an ASD population due to their complex and heterogeneous needs and the limited ASD experience of community MH providers. Future work is needed to refine training and implementation interventions to further increase the impact of implementing EB interventions in community settings.