Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5–13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children’s therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents’ perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.     

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

Attitudes Toward Adoption of Evidence-Based Practices: A comparison of Autism Early Intervention Providers and Children's Mental Health Providers

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASD) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practice (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed.     

Referral Source Differences in Functional Impairment Levels for Children Served in the Comprehensive Community Mental Health Services for Children and Their Families Program

We report one of the first multi-site investigations into referral source variation in functional impairment for children with serious emotional disturbance served in systems of care settings. Baseline data collected as part of the national evaluation for the Comprehensive Community Mental Health Services for Children and Their Families Program was used to assess the comparability of functional status for children referred from traditional mental health versus non-mental health agencies. Results indicate that children referred from child welfare and family groups have significantly lower levels of overall dysfunction than those referred from mental health, while children referred from school and juvenile justice agencies have comparable levels. Clinical and research implications are discussed.     

The Age of Uncertainty: Parent Perspectives on the Transitions of Young People with Mental Health Difficulties to Adulthood

For young people aged 16–24, the transition from adolescence to young adulthood involves predictable and unpredictable changes and they may encounter challenges in their roles, relationships, and responsibilities. Young people with mental health difficulties face additional challenges as they and their families navigate this transition. As a result, families commonly experience anxiety, uncertainty, frustration, and turbulent relationships. After learning to become advocates to secure appropriate services for their children, in late adolescence and young adulthood, parents are likely to find themselves excluded from their children’s treatment planning and services. This article reports findings from a recent qualitative study of the experiences and perceptions of 42 family members supporting their children with mental health difficulties during the transition years. Family members described their goals for their children, their frustrations trying to access appropriate services for their children, and their strategies to provide the support their children needed. Recommendations are for service providers to connect transition age youth with practical assistance and supportive mentoring relationships. Family members requested service providers to consider them as resources and potential collaborators in supporting young people with mental health difficulties to live successful lives in the community.     

Self-Determination in Intervention With Battered Arab Women in Community Health Clinics in Israel

Many abused women from patriarchal collectivistic societies that are subjected to social control seek help in community health clinics. The article is based on a qualitative study, which consisted of 24 interviews with 12 abused Israeli Arab women who sought the help of social workers in community health clinics. A central theme that emerged from the interviews was the women’s wish to maintain their self-determination in retaining the power to determine the boundaries of the intervention within the professional relationship. The discussion focuses on the dialectical consequences of maintaining the women’s self-determination—empowering them, on one hand, and limiting them, on the other.     

Implementing a Primary Mental Health Service for Children: Administrator and Provider Perspectives

The Child Mental Health Service (CMHS) is an Australian primary care program introduced in July 2010 to provide mental healthcare to children who have, or are at risk of, developing psychological disorders. The Australian Government provided supports (e.g., training for mental health professionals), resources (e.g., funding for positions devoted to fostering inter-agency linkages or partnerships) and various flexibilities in service delivery. This study aimed to explore the processes used in the implementation of the CMHS in order to achieve its objectives of delivering a high quality standard of service, and forging linkages and support networks with other relevant health and non-health agencies. Structured interviews were conducted with 20 program administrators, six referring professionals and eight mental health professionals. Interviews were recorded, transcribed and analysed for themes using NVivo. The CMHS appears to have made good progress towards achieving its objectives by implementing processes that facilitated the delivery of a high quality service (e.g., engaging appropriately qualified, and encouraging additional training and clinical support for, mental health professionals; employing quality assurance mechanisms and clinical governance arrangements) and establishment of inter-agency linkages (e.g., devoting a professional role—Coordination and Liaison—to this purpose). Provider perspectives suggest that the CMHS has had a positive impact on children and their families. Comparable countries implementing primary mental health programs for children may benefit from considering similar additional supports (e.g., training for mental health professionals), resources (e.g., funding positions devoted to fostering service inter-agency linkages) and service delivery flexibilities as those available in the CMHS.     

Utilizing Community Partnerships to Devise a Framework for Cultural Adaptations to Evidence-Based Mental Health Practice in Diverse Communities

Mental health disparities for diverse communities (particularly immigrants and people of color) in terms of access to evidence-based treatments, lack of education/awareness about mental health symptoms and treatment options, and lack of culturally responsive treatments have been frequently documented. Hence, diversity considerations in the diagnosis, assessment, and treatment of psychological disorders remain vital and imperative in clinical practice. There is also substantial work indicating that cultural values likely play an essential role in shaping how individuals conceptualize and experience mental or emotional health. Therefore, the present study was developed for community-engaged clinicians and researchers to outline the process by which to create a culturally responsive, evidence-based treatment framework for community mental health interventions in close partnership with communities of color. This study was conceptualized and designed collaboratively with community leaders across five different communities of color: African American/Black, Latino/a, Native American, Pacific Islander, and African immigrant communities in a major U.S. city. This paper describes the mixed methods for such a community-engaged collaboration, highlighting critical elements for ongoing culturally engaged clinical work/research, and providing recommendations for culturally adapted interventions for mental health based on specific process observations made in the current example.     

The Development,Pilot, and Process Evaluation of a Parent Mental Health Literacy Intervention Through Community Sports Clubs

The mental health literacy of parents may be critical in facilitating positive child and adolescent mental health outcomes. The purpose of this study was to develop, pilot, and evaluate a targeted parent mental health literacy intervention through community sports clubs. Sixty six parents (M_age?=?44.86?±?5.2 years) participated in either a brief mental health literacy intervention workshop delivered through community sporting clubs (n?=?42) or a community-matched control group (n?=?24). Participants’ mental health literacy was assessed at baseline, post-intervention and at 1 month follow-up. A mixed methods process evaluation was conducted with intervention participants to determine the acceptability and feasibility of the intervention. Participants in the experimental group showed greater increases in depression literacy, anxiety literacy, knowledge of help seeking options and confidence to assist an adolescent experiencing a mental health disorder, compared to those in the control group. Post-intervention changes in the experimental group were maintained at 1 month follow-up. A mixed methods process evaluation revealed that parents found the intervention content engaging, relevant to their needs, and practically useful in terms of actively supporting adolescent mental health. Findings provide evidence that a brief, targeted intervention through community sports clubs might be a particularly useful method of improving parental mental health literacy and facilitating positive youth mental health outcomes.     

Intervention to Strengthen Emotional Self-Regulation in Children with Emerging Mental Health Problems: Proximal Impact on School Behavior

A model for teaching children skills to strengthen emotional self-regulation is introduced, informed by the developmental concept of scaffolding. Adult modeling/instruction, role-play and in vivo coaching are tailored to children’s level of understanding and skill to promote use of skills in reallife contexts. Two-hundred twenty-six kindergarten—3rd grade children identified with elevated behavioral and social classroom problems from a population-based screening participated in a waitlisted randomized trial of the Rochester Resilience Project derived from this model. In 14 lessons with school-based mentors, children were taught a hierarchical set of skills: monitoring of emotions; selfcontrol/ reducing escalation of emotions; and maintaining control and regaining equilibrium. Mentors provided classroom reinforcement of skill use. Multi-level modeling accounting for the nesting of children in schools and classrooms showed the following effects at post-intervention: reduced problems rated by teachers in behavior control, peer social skills, shy-withdrawn and off-task behaviors (ES 0.31–0.47). Peer social skills improved for girls but not for boys. Children receiving the intervention had a 46% mean decrease in disciplinary referrals and a 43% decrease in suspensions during the 4-month intervention period. Limitations and future directions to promote skill transfer are discussed.     

Using Parent Target Problem Narratives to Evaluate Outcomes in Children with Autism Spectrum Disorder

Research on Child and Adolescent Psychopathology - This paper examines the reliability and validity of parent target problems (PTPs) in a multi-site randomized controlled trial of parent training...     

Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder

We conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3–7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p?=?.05) and a 5.3 point difference between high and low Anxiety groups (p?=?.04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.     

儿童孤独症的类型以及家庭干预

儿童孤独症也称自闭症(autism)是一种广泛性发育障碍,其临床表现为社交功能损伤、沟通能力损伤以及存在刻板的行为、兴趣和动作。根据相关文献就孤独症分类作一综述,并提出了早期家庭干预的具体措施。