A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder

Nicole A Stadnick, Lauren Brookman-Frazee, David S Mandell, Cynthia L Kuelbs, Karen J Coleman, Timothy Sahms, Gregory A Aarons, Nicole A Stadnick, Lauren Brookman-Frazee, David S Mandell, Cynthia L Kuelbs, Karen J Coleman, Timothy Sahms, Gregory A Aarons

Abstract

Background: There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD). Children with ASD have many service needs, including the need to access effective mental healthcare, given high rates of co-occurring psychiatric conditions. Pediatric primary care is an ongoing point of healthcare that is well positioned to identify mental health concerns and facilitate linkage to mental health services for children with ASD. However, identifying mental health problems in children with ASD by primary care providers is complex, subject to being overlooked and may significantly vary based on primary care organizational characteristics. Efforts targeting integrated primary-mental healthcare implementation require a tailored approach for children with ASD.

Methods: This mixed methods, community-partnered study will apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011; Moullin et al., in press) to adapt and implement an integrated care model, "Access to Tailored Autism INtegrated Care" (ATTAIN), in pediatric practices within three diverse healthcare settings for children ages 4-18 years. Key inner context factors from the Exploration, Preparation, and Implementation phases of the EPIS framework will guide three objectives of this study: (1) to identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, (2) to adapt integrated care procedures to facilitate identification of mental health problems and linkage to evidence-based care for children with ASD, and (3) to examine feasibility, acceptability, and uptake of the adapted integrated mental healthcare model through a pilot study in pediatric primary care.

Discussion: Improving integrated mental healthcare for children with ASD could have a significant public health impact on mental healthcare access, child clinical outcomes, and reduction in healthcare costs. Results from this mixed methods study will inform selection of implementation strategies to conduct larger-scale implementation of tailored integrated mental healthcare for children with ASD that will ultimately help to address the high unmet mental health needs for these children.

Keywords: Autism spectrum disorder; Implementation; Integrated care; Mental health; Pediatrics; Primary care.

Conflict of interest statement

The University of California, San Diego (Protocol # 161892) and Kaiser Permanente Southern California Institutional Review Boards (Protocol #11464) approved study activities related to Aim 1.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Application of the EPIS framework (adapted from [28]). Shaded components are the focus in this study

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