Open access article: (https://journals.sagepub.com/doi/full/10.1177/13623613211028000)

Abstract
Despite the high prevalence of co-occurring autism spectrum disorders and mental health condition(s), there exist substantial barriers to mental health treatment for autistic individuals. These barriers are exacerbated by a lack of mental health provider training and self-efficacy in providing adapted services to autistic individuals. One method which has been effective in mitigating similar service gaps is the Extension for Community Healthcare Outcomes (Project ECHO) Autism model, a tele-mentoring platform that connects primary care physicians to autism spectrum disorder experts to improve physicians’ knowledge, self-efficacy, and practice. This study developed and implemented a pilot mental health version of Project ECHO Autism designed to increase mental health provider knowledge, self-efficacy, and problem-solving. Community mental health providers (N = 51) participated in the 6-month Project ECHO Autism including mental health–focused didactics and provider case presentations. Analysis of pre- and post-measures revealed improvements in all domains, including significant increases in provider knowledge of autism spectrum disorders, self-efficacy, and problem-solving. Participants additionally reported high satisfaction with their experience. Taken together, preliminary results indicate that Project ECHO Autism may be a feasible, accessible, and effective method for increasing mental health provider competence and ultimately increasing access to services for autistic individuals who have co-occurring mental health diagnoses.

Citation: Dreiling, N. G., Cook, M. L., Lamarche, E., & Klinger, L. G. (2022). Mental
health Project ECHO Autism: Increasing access to community mental health services
for autistic individuals. Autism, 26(2), 434-445.

https://www.ingentaconnect.com/content/wk/dbp/2022/00000043/00000006/art00002

Abstract

Objective:
The objective of this study was to identify factors associated with parent-reported problems
accessing needed mental health services (MHS) in youth with autism spectrum disorder and anxiety.

Methods:
This study is a secondary analysis using the National Survey of Children's Health 2016 to 2017 data
sets with multivariable logistic regression. Subjects are 6 to 17 year olds with parent-reported autism
spectrum disorder (ASD) and anxiety. Outcome is parent-reported challenge accessing needed
mental health treatment, dichotomized to not a problem versus problem. Covariates included
race/ethnicity, intellectual disability, insurance, medical home, poverty level, and parent education
level.

Results:
The sample included 568 youth with ASD and anxiety—78% male subjects, mean age 12.5 years, and
63% White, non-Hispanic. Fifty-three percent of youth with ASD and anxiety had parent-reported
problems accessing needed MHS. Lack of medical home (adjusted odds ratio [aOR] 5.97, 95%
confidence interval [CI] [2.72–13.09]) and coexisting intellectual disability (aOR 2.23, 95% CI
[1.08–4.60]) were significantly associated with problems accessing MHS. Reported family incomes at
0% to 99% and 100% to 199% of the federal poverty level as compared with family income at 400%
federal poverty level or above (aOR 0.32, 95% CI [0.11–0.94] and aOR 0.35, 95% CI [0.13–0.95],
respectively) was associated with decreased problems accessing MHS.

Conclusion:
In this nationally representative study, more than half of youth with ASD and anxiety had parent-
reported problems accessing needed MHS. Lack of a medical home, co-occurring intellectual
disability, and higher socioeconomic status (SES) are associated with problems accessing MHS.
Therefore, policies to support the medical home; increase mental health supports available for those
with ASD, anxiety, and coexisting intellectual disability; and support access for all SES levels may
increase mental health access.

Citation: Conrad C., Cerda N., Harstad E., (2022). Parent-Reported Problems Accessing Mental Health
Services Among a National Sample of Youth with Autism Spectrum Disorder and Anxiety. Journal of
Developmental & Behavioral Pediatrics, 43(6): 320-326.

https://journals.sagepub.com/doi/abs/10.1177/13623613221150569 

Abstract

Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16–30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers reported fewer access barriers, and those who perceived greater caregiver burdens (daily life disruptions, financial difficulties, and worries) reported more access barriers. Caregivers whose youth lived with them reported fewer quality barriers. Greater access–but not quality–service barriers predicted greater unmet service needs. Findings have implications for service delivery to autistic youth and specific directions for future research.

Citation: Ishler, K. J., Berg, K. A., Olgac, T., Obeid, R., & Biegel, D. E. (2023). Barriers to service and
unmet need among autistic adolescents and young adults. Autism, 27(7), 1997-2010.
https://doi.org/10.1177/13623613221150569

Open access article: https://link.springer.com/article/10.1007/s11920-020-1136-7

Abstract

Purpose of Review: We review original research about services for adults on the autism spectrum published from January 2013 through December 2018. The main aim is to characterize the topical and methodological aspects of research about services. We review research on services related to employment, living in the community, and social participation. We compare our results with those from a similar review published in 2012 to assess progress and identify where new directions in research about services for adults with autism are needed.

Recent Findings We found the evidence base about services for adults on the autism spectrum remains very small and highly variable in aims and methods. There is wide variability in methods used to define sampling frames and recruit participants. Most studies focus on employment. Almost no studies examine the overall ecosystem of services serving autistic adults. Few studies use a conceptual framework for understanding access to, or improvement of, services.

Summary The small size of the extant research coupled with inconsistent quality prevents the accumulation of new knowledge in ways that would significantly inform the improvement of systems of care for the growing population of adults on the autism spectrum.

Citation: Shattuck, P.T., Garfield, T., Roux, A.M. et al. Services for Adults With Autism Spectrum Disorder: a Systems Perspective. Curr Psychiatry Rep 22, 13 (2020).

Open access article: https://pubmed.ncbi.nlm.nih.gov/31150751/

Abstract

Objective

A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, distribution, and competencies of the US workforce for autism-related child health care services, and assess studies’ strength of evidence.

Method

We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research.

Results

Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples.

Conclusion

There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.

Citation: McBain, R. K., Kareddy, V., Cantor, J. H., Stein, B. D., & Yu, H. (2020). Systematic Review: United States Workforce for Autism-Related Child Healthcare Services. Journal of the American Academy of Child and Adolescent Psychiatry, 59(1), 113–139.