Abstract
While youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates, general psychiatric settings are not designed to meet their unique needs. Previous evaluations of an ASD-Care Pathway (ASD-CP) on a general psychiatric unit revealed sustained reductions in crisis interventions (intramuscular medication use, holds/restraints; Cervantes et al. in J Autism Dev Disord 49(8):3173–3180, https://doi.org/10.1007/s10803-019-04029-6, 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082–4089, https://doi.org/10.1007/s10803-018-3666-y, 2018). The current study investigated staff perceptions of the ASD-CP (N = 30), and examined rates of ASD-CP implementation fidelity in relation to patient outcomes (N = 28). Staff identified visual communication aids and reward strategies as most helpful. The number of days of reward identification early in the inpatient stay was associated with fewer crisis interventions later in a patient’s stay.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aarons, G. A., Sommerfeld, D. H., & Walrath-Greene, C. M. (2009). Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice. Implementation Science, 4(1), 83. https://doi.org/10.1186/1748-5908-4-83.
Allinder, R. M., & Oats, R. G. (1997). Effects of acceptability on teachers’ implementation of curriculum-based measurement and student achievement in mathematics computation. Remedial and Special Education: RASE, 18(2), 113–120. https://doi.org/10.1177/074193259701800205.
Cervantes, P., Kuriakose, S., Donnelly, L., Filton, B., Marr, M., Okparaeke, E., et al. (2019). Sustainability of a care pathway for children and adolescents with autism spectrum disorder on an inpatient psychiatric service. Journal of Autism and Developmental Disorders, 49(8), 3173–3180. https://doi.org/10.1007/s10803-019-04029-6.
Chang, Y.-C., & Locke, J. (2016). A systematic review of peer-mediated interventions for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 27, 1–10. https://doi.org/10.1016/j.rasd.2016.03.010.
Corrigan, P. W., Williams, O. B., Mccracken, S. G., Kommana, S., Edwards, M., & Brunner, J. (1998). Staff attitudes that impede the implementation of behavioral treatment programs. Behavior Modification, 22(4), 548–562. https://doi.org/10.1177/01454455980224006.
Croen, L. A., Najjar, D. V., Ray, G. T., Lotspeich, L., & Bernal, P. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118(4), e1203–e1211. https://doi.org/10.1542/peds.2006-0127.
Doehring, P., Reichow, B., Palka, T., Phillips, C., & Hagopian, L. (2014). Behavioral approaches to managing severe problem behaviors in children with autism spectrum and related developmental disorders. Child and Adolescent Psychiatric Clinics of North America, 23(1), 25–40. https://doi.org/10.1016/j.chc.2013.08.001.
Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52(9), 1179–1189. https://doi.org/10.1176/appi.ps.52.9.1179.
Kalb, L. G., Stuart, E. A., Freedman, B., Zablotsky, B., & Vasa, R. (2012). Psychiatric-related emergency department visits among children with an autism spectrum disorder. Pediatric Emergency Care, 28(12), 1269–1276. https://doi.org/10.1097/PEC.0b013e3182767d96.
Klintwall, L., Gillberg, C., Bölte, S., & Fernell, E. (2012). The efficacy of intensive behavioral intervention for children with autism: A matter of allegiance? Journal of Autism and Developmental Disorders, 42(1), 139–140. https://doi.org/10.1007/s10803-011-1223-z.
Koski, S., Gabriels, R. L., & Beresford, C. (2016). Interventions for paediatric surgery patients with comorbid autism spectrum disorder: A systematic literature review. Archives of Disease in Childhood, 101(12), 1090–1094. https://doi.org/10.1136/archdischild-2016-310814.
Kuriakose, S., Filton, B., Marr, M., Okparaeke, E., Cervantes, P., Siegel, M., et al. (2018). Does an autism spectrum disorder care pathway improve care for children and adolescents with ASD in inpatient psychiatric units? Journal of Autism and Developmental Disorders, 48(12), 4082–4089. https://doi.org/10.1007/s10803-018-3666-y.
Lange, A. M. C., van der Rijken, R. E. A., Busschbach, J. J. V., Delsing, M. J. M. H., & Scholte, R. H. J. (2017). It’s not just the therapist: Therapist and country-wide experience predict therapist adherence and adolescent outcome. Child & Youth Care Forum, 46(4), 455–471. https://doi.org/10.1007/s10566-016-9388-4.
Lawton, K., & Kasari, C. (2012). Teacher-implemented joint attention intervention: Pilot randomized controlled study for preschoolers with autism. Journal of Consulting and Clinical Psychology, 80(4), 687. https://doi.org/10.1037/a0028506.
Mandell, D. S., Stahmer, A. C., Shin, S., Xie, M., Reisinger, E., & Marcus, S. C. (2013). The role of treatment fidelity on outcomes during a randomized field trial of an autism intervention. Autism: The International Journal of Research and Practice, 17(3), 281–295. https://doi.org/10.1177/1362361312473666.
McGuire, K., Erickson, C., Gabriels, R. L., Kaplan, D., Mazefsky, C., McGonigle, J., et al. (2015). Psychiatric hospitalization of children with autism or intellectual disability: Consensus statements on best practices. Journal of the American Academy of Child & Adolescent Psychiatry, 54(12), 969–971. https://doi.org/10.1016/j.jaac.2015.08.017.
National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author.
Novins, D. K., Green, A. E., Legha, R. K., & Aarons, G. A. (2013). Dissemination and implementation of evidence-based practices for child and adolescent mental health: A systematic review. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1009–1025.e18. https://doi.org/10.1016/j.jaac.2013.07.012.
Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2013). Therapist characteristics predict discrete trial teaching procedural fidelity. Intellectual and Developmental Disabilities, 51(4), 263–272. https://doi.org/10.1352/1934-9556-51.4.263.
Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., et al. (2012). Effects of a Brief Early Start Denver Model (ESDM)—based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1052–1065. https://doi.org/10.1016/j.jaac.2012.08.003.
Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division, 37(1), 8–38. https://doi.org/10.1080/15374410701817808.
Safran, S. P., & Oswald, K. (2003). Positive behavior supports: Can schools reshape disciplinary practices? Exceptional Children, 69(3), 361–373. https://doi.org/10.1177/001440290306900307.
Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8.
Siegel, M. (2018). The severe end of the spectrum: Insights and opportunities from the Autism Inpatient Collection (AIC). Journal of Autism and Developmental Disorders, 48(11), 3641–3646. https://doi.org/10.1007/s10803-018-3731-6.
Siegel, M., & Gabriels, R. L. (2014). Psychiatric hospital treatment of children with autism and severe behavioral disturbance. Child and Adolescent Psychiatric Clinics of North America, 23(1), 125–142. https://doi.org/10.1016/j.chc.2013.07.004.
Strauss, K., Vicari, S., Valeri, G., D’Elia, L., Arima, S., & Fava, L. (2012). Parent inclusion in Early Intensive Behavioral Intervention: The influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes. Research in Developmental Disabilities, 33(2), 688–703. https://doi.org/10.1016/j.ridd.2011.11.008.
Suhrheinrich, J., Rieth, S. R., Dickson, K. S., Roesch, S., & Stahmer, A. C. (2019). Classroom pivotal response teaching: Teacher training outcomes of a community efficacy trial. Teacher Education and Special Education. https://doi.org/10.1177/0888406419850876.
Verschuur, R., Huskens, B., Korzilius, H., Bakker, L., Snijder, M., & Didden, R. (2020). Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation. Autism, 24(2), 499–514. https://doi.org/10.1177/1362361319876213.
Acknowledgments
The training and implementation of the ASD Care Pathway was supported by the New York City Department of Health and Mental Hygiene’s City Council Autism Initiative (Contract Number: 816-1515-0436.A01). The authors would like to thank Mollie Marr, Katherine Voorheis, and Jonathan Creem for assistance with research design and the Bellevue staff for study participation. We would also like to express our gratitude to all of the patients and families who participated in this study.
Author information
Authors and Affiliations
Contributions
LD oversaw the ASD-CP implementation, participated in the study design, performed statistical analyses, and helped to draft the manuscript. PC participated in the design of the study, performed statistical analyses, and helped to draft the manuscript. EO helped coordinate ASD-CP implementation, performed staff interviews, assisted with data collection, helped perform statistical analyses, and helped to draft the manuscript. CS participated in the design of the study and helped to draft the manuscript. BF coordinated the intervention implementation, participated in the study design and coordination, and helped to draft the manuscript. SK designed the intervention, participated in the study design, and helped to draft the manuscript. JH oversaw the implementation, participated in its design and coordination, and helped to draft the manuscript. SH designed the study, participated in the interpretation of the data, and helped to draft the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
A waiver for authorization was granted for this study by the Institutional Review Boards of both institutions.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Donnelly, L.J., Cervantes, P.E., Okparaeke, E. et al. Staff Perceptions and Implementation Fidelity of an Autism Spectrum Disorder Care Pathway on a Child/Adolescent General Psychiatric Inpatient Service. J Autism Dev Disord 51, 158–168 (2021). https://doi.org/10.1007/s10803-020-04509-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-020-04509-0