The growing population of individuals on the autism spectrum who have co-occurring mental health conditions necessitates a workforce of mental health professionals who are competent and confident in working with these individuals. Unfortunately, the current research depicts a large gap between that demand and the current state of the field. Evidence-based mental health treatments like Cognitive Behavioral Therapy have been validated and adapted in the treatment of anxiety, depression, and trauma in autistic individuals (Steinbrenner et al., 2020; Walters et al., 2016; Stack & Lucyshyn, 2019). Yet, many mental health providers report receiving little or no training to adapt mental health treatment to the unique needs of individuals on the spectrum (Williams & Haranin, 2016). Related to this lack of autism-specific training among mental health care professionals, many mental health providers experience low levels of self-efficacy in working with this population (Crane et al., 2019).
This lack of training and lack of confidence in treating this population presents a major barrier for autistic individuals seeking mental health services. In a recent study of 462 parents of autistic children with a mental health condition, 32% of parents reported a mental health crisis within the past month, and 25% of parents reported that their children did not receive mental health treatment to address this crisis (Vasa et al., 2019). Statistics like these reflect the dire need for the elimination of barriers to treatment, including accessibility to a competent and confident workforce of mental health clinicians capable of treating individuals on the spectrum.
One model that has been used to effectively and efficiently address this gap is the Project ECHO model. Project Extension for Community Healthcare Outcomes is a flexible model of education developed by the University of New Mexico (Zhou et al., 2016). It was initially developed to disseminate information from experts to community-based health professionals in rural areas through teleconferencing technology (Zhou et al., 2016). It follows a hub and spoke model in which a team of expert specialists, the hub, collaborate with a group of community-based health professionals, the spokes, in an “all teach all learn” format (Komaromy et al., 2016). This format includes a brief didactic lecture by a specialist and an individual case presentation by the participants of the program (Moody et al., 2020). Project ECHO has been expanded and modified to be used not only with physicians but also with other health professionals, teachers, and even parents (Moody et al., 2020).
The University at Albany has used the Project ECHO model to disseminate information and best practices regarding the treatment of co-occurring mental health concerns with individuals on the autism spectrum. Participants in this program ranged from licensed clinical social workers to doctorate-level clinical psychologists. Preliminary data indicate that this use of the model is a feasible and acceptable approach to helping clinicians access information related to treating autistic clients. In the three sessions that have been conducted, on average, 94% of participants found the didactic presentation useful to them, 91% of participants found the case presentation portion of the program useful to them, 89% of participants reported that they had better knowledge upon which to base their actions in their clinical setting, and 89% of participants reported that they would be able to use their new skills in their setting. While this data is self-reported and from a small sample of clinicians who participated in this program, it suggests that, at the very least, the majority of clinicians who participate in an ECHO Autism session feel better equipped to work with an individual on the spectrum as a result of the program.
While there is still quite a bit of research that needs to be done to determine whether this increased confidence translates to better mental healthcare outcomes for autistic individuals, spreading awareness of programs like these is the first step towards beginning to eliminate barriers to mental healthcare access amongst autistic individuals. The convenient collaboration with other healthcare professionals made feasible by Project ECHO can not only enhance the care of autistic individuals but also offer great support to providers. Through public health programs like Project ECHO, we can begin to work towards ensuring that the clinicians working with this population are well-trained and confident in their abilities.
Dan Magin, BA, Hanna Kent, BS, and Krista Drapalik, MA, are Graduate Assistants, Melissa Rinaldi, PhD, is Clinical Investigator, and Kristin Christodulu, PhD, is Director at Center for Autism and Related Disabilities at the University at Albany. For more information on programming and training opportunities at the Center for Autism and Related Disabilities at the University at Albany, please visit the Center’s website.
References
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Stack, A., & Lucyshyn, J. (2019). Autism spectrum disorder and the experience of traumatic events: review of the current literature to inform modifications to a treatment model for children with autism. Journal of Autism and Developmental Disorders, 49(4), 1613-1625.
Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., … & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with autism. FPG Child Development Institute.
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Walters, S., Loades, M., & Russell, A. (2016). A systematic review of effective modifications to cognitive behavioural therapy for young people with autism spectrum disorders. Review Journal of Autism and Developmental Disorders, 3, 137-153.
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Zhou, C., Crawford, A., Serhal, E., Kurdyak, P., & Sockalingam, S. (2016). The impact of project ECHO on participant and patient outcomes: a systematic review. Academic Medicine, 91(10), 1439-1461.
