Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery.
Eliana Hurwich-Reiss, Colby Chlebowski, Teresa Lind and 3 others
PMID 33779320WHAT IT FOUND
In usual care, therapists used evidence-based strategies diffusely, which correlated with worsening behavior.
In trained therapists, specific active teaching of skills correlated with improvement, while general engagement strategies alone did not predict better outcomes over time.
Key findings
01Usual care therapists' general use of evidence-based strategies was associated with increases in child behavior problems over 18 months.
02In the training group, active teaching strategies were associated with reductions in child behavior problems, whereas autism engagement strategies alone were not significantly associated with changes in outcomes.
03Therapists trained in the specific intervention used distinct clusters of strategies for engagement and skill teaching, unlike usual care therapists whose strategies clustered into a single general factor.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The usual care group had significantly fewer participants than the training group. Analyses could not compare the extensiveness of individual strategy delivery between groups. Child behavior outcomes were based on parent report, which has inherent limitations. Results may not generalize to therapists outside Southern California. The study was observational regarding strategy use; it cannot prove that specific strategies caused the outcomes, only that they were associated with them.
Declared interests
The study was supported by the National Institute of Mental Health. The AIM HI intervention was developed by some of the authors, which may introduce bias in the training model or coding system.
The easy way to misread this
Do not conclude that engagement strategies like using special interests or visuals are ineffective. The study found they did not independently predict long-term behavior change in this analysis, but they may be necessary to enable the active teaching that did predict improvement. Also, the association between general strategy use and worsening behavior in usual care is observational and may reflect that therapists used more strategies when behaviors were already severe, rather than the strategies causing the severity.