Bridging for success in autism: training and collaboration across medical, educational, and community systems

Community-based care for autistic youth: community providers' reported use of treatment practices in the United States

Introduction

To illustrate the landscape of community-based care for autistic youth in the United States, we identified transdisciplinary psychosocial intervention practice sets that community providers report utilizing to care for this population, and examined characteristics associated with provider-reported utilization.

Methods

The Usual Care for Autism Study (UCAS) Survey assessed provider demographics and provider-reported use of transdisciplinary practices for common ASD co-occurring problems: social difficulties, externalizing behaviors, and anxiety. Community practitioners (N = 701) from allied health, behavioral, education, medical, mental health and other disciplines who treat or work with autistic youth (7-22 years) participated.

Results

Exploratory factor analysis yielded four factors: Consequence-Based Strategies (CBS), Cognitive-Behavioral and Therapy Strategies (CBTS), Antecedent-Based Strategies (ABS), and Teaching Strategies (TS). Providers across disciplines reported utilizing ABS more often than other sets. Providers from behavioral disciplines, with less than 4-year or Master degrees, or with more experience reported the most use of ABS, CBS and CBTS. Medical and behavioral providers reported the most use of TS. Setting and child characteristics were associated with practice set use, indicating variability by disability and client socioeconomic status.

Discussion

Findings reflect the complexity and inconsistency of the service landscape for autistic youth across the U.S. Only by understanding the service landscape and predictors of practice utilization, can researchers, policymakers, provider groups, and the autistic community facilitate effective implementation strategy development and use to ultimately improve community-based care.

Addressing the Need for Training More School Psychologists to Serve Toddlers and Preschoolers with Autism Spectrum Disorders

The prevalence of autism spectrum disorder (ASD) has risen significantly in the past two decades. Unfortunately, there is a shortage of mental health providers who have specialized training in delivering evidenced-based services to this population. Early intensive behavioral intervention (EIBI) is an evidenced-based treatment recommended for toddlers with ASD, and school psychologists are uniquely positioned to help children with ASD receive it. However, many school psychologists do not receive adequate training in this subspecialty. This paper makes recommendations to school psychology training programs about how to add or improve training in this subspecialty based on the results of an Office of Special Education Programs grant-funded ASD training program which involved collaboration between a NASP-approved and APA-accredited school psychology training program and a community-based early intensive behavioral intervention (EIBI) clinic. The grant supported development of an interdisciplinary didactic and clinical training program to increase the ASD knowledge, skills, and competencies of school psychology graduate students, with the broader goals of developing a replicable training model and increasing the workforce of trained providers for this underserved population. Fifteen graduate students completed the training program. Outcomes related to trainee knowledge, skills, and competencies, trainee satisfaction, and lessons learned over time analyzed within a logic model that guided the project's development and execution can be informative for other school psychology programs undertaking training in this subspecialty.

Usual care for youth with autism spectrum disorder: Community-based providers' reported familiarity with treatment practices

OBJECTIVE

To examine patterns and predictors of familiarity with transdisciplinary psychosocial (e.g., non-pharmacologic) practices for practitioners treating youths with autism spectrum disorder (ASD) in the United States.

METHOD

Practitioners (n = 701) from behavioral, education, medical, and mental health backgrounds who worked with youth (ages 7-22) with ASD completed the Usual Care for Autism Survey, which assessed provider demographics and self-reported familiarity with transdisciplinary treatment practices for the most common referral problems of ASD. We examined relations between provider-, setting-, and client-level characteristics with familiarity of key groups of the treatment practices (practice sets). Practice sets were identified using exploratory factor analysis (EFA), and demographic predictors of practice subsets were examined using generalized estimating equations (GEE).

RESULTS

The EFA yielded a three-factor solution: (1) environmental modifications/antecedent strategies; (2) behavior analytic strategies; and (3) cognitive strategies, with overall familiarity ranked in this order. Medical providers indicated the least familiarity across disciplines. More experience with ASD and treating those with intellectual disabilities predicted greater familiarity with only environmental modifications/antecedent strategies and behavior analytic, but not cognitive strategies. Experience treating low SES clients predicted familiarity with environmental modification and behavior analytic strategies while experience treating high SES clients predicted familiarity with behavior analytic and cognitive strategies.

CONCLUSION

This is the first study to identify transdisciplinary, interpretable sets of practices for treating youth with ASD based on community providers' reported familiarity. Results highlight factors associated with familiarity with practice sets, which is essential for mapping practice availability, and optimizing training and dissemination efforts for youth with ASD.

Linking the Medical and Educational Home to Support Children With Autism Spectrum Disorder: Practice Recommendations

Children with autism spectrum disorder (ASD) present with complex medical problems that are often exacerbated by a range of other intellectual and psychiatric comorbidities. These children receive care for their physical and mental health from a range of providers within numerous child-serving systems, including their primary care clinic, school, and the home and community. Given the longitudinal nature in which care is provided for this chronic disorder, it is particularly necessary for services and providers to coordinate their care to ensure optimal efficiency and effectiveness. There are 2 primary venues that serve as a "home" for coordination of service provision for children with ASD and their families-the "medical home" and the "educational home." Unfortunately, these venues often function independently from the other. Furthermore, there are limited guidelines demonstrating methods through which pediatricians and other primary care providers (PCPs) can coordinate care with schools and school-based providers. The purpose of this article is 2-fold: (1) we highlight the provision of evidence-based care within the medical home and educational home and (2) we offer practice recommendations for PCPs in integrating these systems to optimally address the complex medical, intellectual, and psychiatric symptomology affected by autism.

Partners in School: An Innovative Parent-Teacher Consultation Model for Children with Autism Spectrum Disorder

Little research examines the best ways to improve communication between parents and teachers of children with Autism Spectrum Disorder (ASD) and its effect on child outcomes. The present study tests an innovative parent-teacher consultation model, entitled Partners in School. The goal of Partners in School is to improve parent-teacher communication aboutevidence-based practices (EBPs), and subsequently, outcomes for children with ASD. Participants were 26 teachers and 49 parents of children with ASD from a large urban public school district. Parents and teachers completed measures of their communication and child outcomes prior to and after receiving consultation through Partners in School. Results indicated that parents and teachers perceived improvements in child outcomes after participation inPartners in School. Changes in parent-teacher communication also were associated with changes in some child outcomes. Discussionhighlights the important role of communication inconsultations targeting family-school partnerships for children with ASD.

Autism awareness training for youth offending team staff members

Purpose

Many in contact with the criminal justice system (CJS) have complex needs, including autism. The purpose of this paper is to present the development, design and evaluation of a training package designed to increase awareness that Youth Offending Team (YOT) staff members in the UK have of autism in the CJS (Talbot, 2010). Training quality and effectiveness was assessed. This paper aims to highlight the need for organisations/individuals providing training services relating to autism to be transparent, evidence based and open to sharing best practice. By evaluating practice, disseminating findings and hopefully providing mutual support, trainers can create networks to enhance the value of training provision, ultimately increasing the quality of support offered to individuals with autism.

Design/methodology/approach

A training package relating to autism in forensic systems was developed and delivered to staff working within a UK YOT. Levels of self-reported knowledge and confidence in working with individuals with autism are measured by evaluation questionnaires completed pre- and post-training.

Findings

Results demonstrate a significant increase in self-reported knowledge and confidence in working with individuals with autism within the CJS following training.

Originality/value

This highlights the potential for evidence-based staff training to enhance individuals’ practice working with individuals with autism within the CJS.

Inconsistent staffing and its impact on service delivery in ASD early-intervention

BACKGROUND

Inconsistent staffing (high turnover, casual workforce) is problematic in organisations, with the potential to impact both staff and services provided. Research has primarily focused on the impacts of inconsistent staffing in child welfare and community services with little evidence surrounding their ability to impact the outcomes for children with Autism Spectrum Disorders attending early-intervention services.

AIM

The aim of this study was to explore staff views regarding the impact of staff turnover on the delivery of group based early intervention for children with ASD.

METHODS AND PROCEDURES

We conducted five focus groups involving 29 professional (e.g. teachers, behaviour therapists), para-professional (e.g. child care workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim for use in thematic analysis.

OUTCOMES AND RESULTS

Two central themes, comprising five categories emerged to encompass participants' views. "Impacts on Staff" accounted for the challenges existing staff felt when working with new and untrained staff in the centre. Participants also expressed concerns for the "Impacts on Service Delivery" that resulted from dynamic staffing, affecting fidelity of interventions and the program itself.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that lacking a consistent staffing structure is problematic when attempting to provide high quality early intervention services to children with ASD and suggest that future research should investigate the extent of inconsistent staffing, impacts of inconsistent staffing on providing intervention, and develop a range of tools to help measure these effects.

Systems of care for individuals with autism spectrum disorder and serious behavioral disturbance through the lifespan

Individuals with Autism Spectrum Disorder present with unique characteristics, and the interventions designed to address associated challenging behaviors must be highly individualized to best meet their needs and those of their families. This article reviews systems of care to support the child, adolescent, or adult with Autism Spectrum Disorder and/or Intellectual Disability. The review describes mental health/behavioral health services, Intellectual Disability and other support systems, and the systems involved in a child and adolescent's life and transition to adulthood. The types of systems and services, as well as barriers, are delineated with a brief listing of Web sites and references.

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

OBJECTIVE

To determine the relationship of motor skills and the core behaviors of young children with autism, social affective skills and repetitive behaviors, as indicated through the calibrated autism severity scores.

DESIGN

The univariate GLM tested the relationship of gross and fine motor skills measured by the gross motor scale and the fine motor scale of the MSEL with autism symptomology as measured by calibrated autism severity scores.

SETTING

Majority of the data collected took place in an autism clinic.

PARTICIPANTS

A cohort of 159 young children with ASD (n=110), PDD-NOS (n=26) and non-ASD (developmental delay, n=23) between the ages of 12-33 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary outcome measures in this study were calibrated autism severity scores.

RESULTS

Fine motor skills and gross motor skills significantly predicted calibrated autism severity (p < 0.01). Children with weaker motor skills displayed higher levels of calibrated autism severity.

CONCLUSIONS

The fine and gross motor skills are significantly related to autism symptomology. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.

Autism training in pediatric residency: evaluation of a case-based curriculum

Despite recent studies indicating the high prevalence of autism spectrum disorders (ASDs), there has been little focus on improving ASD education during pediatric residency training. The objective of this study was to evaluate a new curriculum developed in partnership with the Centers for Disease Control and Prevention and the Maternal and Child Health Bureau about ASDs. "Autism Case Training (ACT): A Developmental-Behavioral Pediatrics Curriculum" consists of 7 case-based teaching modules. Modules were facilitated by faculty at 26 pediatric residency programs and data were obtained on 114 residents. Pre- and post-test data revealed significant short-term improvements in residents' knowledge and self-assessed competence regarding ASDs. Findings suggest that the ACT curriculum is effective in enhancing training about ASDs in pediatric residency programs.

Parent and physician perceptions of medical home care for children with autism spectrum disorders in the state of Kentucky

The medical home model of care is widely accepted as the ideal for children with autism spectrum disorders (ASDs) but may be very difficult to implement. In this study, parents of children with autism and pediatricians caring for children with autism in Kentucky were surveyed to determine the current status of primary care services for children with ASDs. Results indicated that the majority of families and physicians were comfortable with the routine health care provided to children with ASDs, but had concerns about physician ability to provide information regarding community resources, address comorbid conditions associated with autism, and discuss treatment options. The need for physician education regarding available national and regional autism resources is clear. Creative strategies involving collaboration across medical, educational, and community systems appear to be essential for establishing effective medical homes for children with ASDs.

Autism in developing countries: lessons from iran

Most research into Autism Spectrum Disorders has been conducted in affluent English-speaking countries which have extensive professional support services. This paper describes a series of investigations that was undertaken in Iran, and these findings, together with reviews of research in other low-income countries, are used to identify key lessons in three areas of service provision of particular relevance to developing countries with scarce professional resources: first, the issues to be considered in establishing the prevalence of the condition nationally; second, identification of parental understanding of ASD and the impact it has on them as carers; third, the education and training that could be provided to families when professional supports are sparse. It is concluded that culturally sensitive, parental support strategies must be central to the planning and development of services. Moreover, future research should further elucidate the needs of families and evaluate the impact of culturally tailored interventions designed to promote the children's development and overall family quality of life.

Bridging the research-to-practice gap in autism intervention: an application of diffusion of innovation theory

There is growing evidence that efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and education systems. We propose applying diffusion of innovation theory to further our understanding of why this is the case. We pose a practical set of questions that administrators face as they decide about the use of interventions. Using literature from autism intervention and dissemination science, we describe reasons why efficacious interventions for autism are rarely adopted, implemented, and maintained in community settings, all revolving around the perceived fit between the intervention and the needs and capacities of the setting. Finally, we suggest strategies for intervention development that may increase the probability that these interventions will be used in real-world settings.

Teaching children with autism to read for meaning: challenges and possibilities

The purpose of this literature review is to examine what makes reading for understanding especially challenging for children on the autism spectrum, most of whom are skilled at decoding and less skilled at comprehension. This paper first summarizes the research on reading comprehension with a focus on the cognitive skills and processes that are involved in gaining meaning from text and then reviews studies of reading comprehension deficits in children on the spectrum. The paper concludes with a review of reading comprehension interventions for children on the spectrum. These children can especially benefit from interventions addressing particular cognitive processes, such as locating antecedent events, generating and answering questions, locating referents, and rereading to repair understanding.