Serving Youths with Autism Spectrum Disorder in Community Mental Health: Understanding Provider Knowledge, Clinical Self-Efficacy, and Perspectives on Evidence-Based Care



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Background: Emotional and behavioral (E/B) comorbidities are common among youths with autism spectrum disorder (ASD). These individuals often experience difficulties across settings, and lack of appropriate intervention predicts poor outcomes throughout the lifespan. However, specialized behavioral health services often are difficult for families to access. Therefore, youths with ASD and E/B comorbidities increasingly present to community-based settings, such as community mental health clinics (CMHCs), for services. Critically, CMHC providers frequently report feeling underconfident and underprepared to serve this population. Provider perspectives often are linked to their treatment implementation behaviors and understanding malleable cognitive factors may be a critical first step toward better preparing CMHC providers to implement evidence-based practices (EBP) for their clients who have ASD. Purpose: The primary purpose of the present study was to address gaps in the literature by examining CMHC provider clinical self-efficacy, knowledge about ASD, attitudes regarding evidence-based care, and perspectives on an ASD-specific teleconsultation series as a step toward closing the research-to-practice gap in ASD. Methods: CMHC providers participated in a two-phase teleconsultation collaboration between the University of Houston and a CMH agency (Phase I n= 54; Phase II n= 10). Phase I participants self-reported demographic characteristics, general and ASD-specific attitudes toward EBP, general and ASD-specific clinical self-efficacy, and knowledge about ASD. Phase II participants participated in a focus group after the completion of the teleconsultation collaboration. Results: Cronbach’s alpha coefficients indicated acceptable to excellent internal consistency of all measures developed for this project. Pearson coefficients revealed statistically significant and positive but weak correlations between providers’ knowledge about ASD and (a) general attitudes toward EBP, (b) ASD-specific attitudes toward EBP, and (c) ASD-specific clinical self-efficacy. There was no significant correlation between provider knowledge about ASD and general clinical self-efficacy. Paired-samples t tests revealed significant differences in (a) attitudes toward EBP for general clients and clients with ASD, and (b) clinical self-efficacy for general clients and clients with ASD. An exploratory qualitative analysis revealed that providers reported a variety of strengths (i.e., open communication) and areas for improvement (i.e., technology barriers) following their participation in the ASD-specific teleconsultation series. Conclusions: Findings provide initial support for the technical adequacy of measures of CMHC provider perspectives that were previously unavailable. Results suggest a positive relationship between knowledge about ASD and ASD-specific attitudes toward EBP. Additionally, amount of ASD knowledge was associated with both general and ASD-specific clinical self-efficacy. The results offer novel information regarding the potential domain-specificity of both clinical self-efficacy and provider perspectives about EBP, which has conceptual, measurement, and practical implications. Moreover, focus group findings are discussed within the context of future directions for university-community partnerships.



autism spectrum disorder, community mental health