Abstract
BackgroundThere 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.MethodsThis 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.DiscussionImproving 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.
Highlights
There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD)
Pediatric primary care is a principal point of care for children with ASD, so it is an ideal setting for early identification and ongoing monitoring of mental health needs and linkage to needed mental healthcare [8, 9]
This study offers several important innovations that contribute to the field of implementation science
Summary
The study design and methods are presented by study aim. Aim 1 Aim 1 is to use a quantitative concurrent with qualitative (QUAN+QUAL) mixed methods design [31, 32] to identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD. The focus group guides will be designed to support a semi-structured approach to include pre-selected interview questions to promote active participation of participants who have experience with or directed perspectives on mental health screening practices in their pediatric primary care setting for children with ASD [37, 38]. Aim 2 Aim 2 is to adapt integrated care procedures to facilitate identification of mental health problems and linkage to evidence-based care for youth with ASD The design of this aim is to capitalize on the collaborative process of the ATTAIN Advisory Group to use the findings from the first aim to refine the components of ATTAIN and prepare for the pilot trial in the subsequent and final aim of the study. Given the pilot study design with explicit focus on feasibility, effect size estimation based on commonly used guidelines [46] will be emphasized
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