Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services: A Cluster Randomized Clinical Trial
Open accessAbstract
Importance: Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. Objective: To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. Design, Setting, and Participants: Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. Interventions: The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. Main Outcomes and Measures: Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. Results: In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = -0.38; P = .02) and ECBI Problem (B = -1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = -1.36; P < .001) relative to the usual care group (B = -0.98; P < .001) and a significantly larger decrease in ECBI Problem scores in the AIM HI group (B = -1.22; P < .001) relative to the usual care group (B = -0.20; P = .29). Therapist fidelity moderated these intervention effects. Conclusions and Relevance: The present findings support the effectiveness of training therapists to deliver the AIM HI model to children with ASD receiving publicly funded mental health services. Trial Registration: ClinicalTrials.gov identifier: NCT02416323.
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Being able to individualise the treatment increases the chances that the treatment will both get the patient to stay in the treatment and that the treatment will have the intended effect.
“Being able to individualise the treatment increases the chances that the treatment will both get the patient to stay in the treatment and that the treatment will have the intended effect (48).”
From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [48]
The outcome analyses report greater reductions in challenging behaviors for children receiving AIM HI than for those receiving usual care, supporting the intended-effect part of the claim in this setting. But the Assessments section says there was no difference between study conditions in the likelihood of remaining in treatment. The study also tested the individualized intervention and therapist training together, so it cannot isolate individualization as the cause of the improved outcomes. (LLM, conf=0.89)
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Testing a community developed training protocol for an evidence-based treatment
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“En la mayoría de las ocasiones, los programas de intervención se enfocan en el entrenamiento de respuestas sociales y en los síntomas de ansiedad (Brookman-Frazee et al., 2019; Schohl et al., 2014).”
BackgroundSpecial Populations: Youth With Developmental Disabilities and Co-occurring Mental Health Conditions
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Examination of the Provider Motivation Inventory in Autism Implementation Trials
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Self-citationEvidence-Based Intervention With Autistic Youth
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- Authors
- Brookman-Frazee, L., Roesch, S., Chlebowski, C., Baker-Ericzen, M., & Ganger, W.
- Affiliations
- University of California San Diego (US)
- San Diego State University (US)
- Child and Adolescent Services Research Center, San Diego, California
- Corresponding author
- Brookman-Frazee, Lauren
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-06-01
- Volume
- 76
- Issue
- 6
- Pages
- 574
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6551846
- OpenAlex
- W2918667423
- Cited by
- 71
- References
- 50
- Citations by year
- 2026: 4 · 2025: 14 · 2024: 6 · 2023: 3 · 2022: 17 · 2021: 9 · 2020: 12 · 2019: 4 · 2018: 1
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH094317)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, behavioral problems, therapist training, publicly funded mental health services, parent-mediated intervention, child-focused interventions, school-based mental health programs, Eyberg Child Behavior Inventory, Social Skills Improvement System
- MeSH terms
- Problem Behavior, Autism Spectrum Disorder, Adolescent, Child, Child, Preschool, Female, Financing, Government, Humans, Male, Mental Health Services, Precision Medicine
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