Implementation Science-Guided Pilot Study of Trauma-Focused Cognitive Behavioral Therapy for Autistic Youth in Community Mental Health Settings

PROJECT SUMMARY The implications of trauma exposure on children’s development and proximal and future physical and mental health outcomes are well-established. Autistic youth are at an increased risk for trauma compared to non- autistic youth, as recent research has demonstrated high rates of trauma exposure and trauma-related symptoms. Autistic individuals identify addressing trauma, including a need for trauma-focused interventions, as a top research priority, yet clinicians report lack of knowledge and low self-efficacy to treat trauma in autistic youth. Moreover, there are no evidence-based interventions (EBIs) for trauma-related symptoms that have been rigorously tested with autistic youth. The proposed study will build on current formative research I am conducting to systematically modify a well-established EBI (i.e., Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) for autistic youth to be used in community mental health centers (CMHCs). Specifically, the proposed study will involve rigorous pilot testing to assess intervention feasibility and acceptability of TF-CBT for autistic youth (TF-CBT-A) in CMHCs. In addition, while community settings are the most common context in which autistic youth receive mental health treatment, there often is limited translation of mental health EBIs for autistic youth to community-based care. Moreover, autistic youth and their families living in medically underserved areas face added barriers to service access. Therefore, the proposed implementation-guided research will engage community stakeholders to identify barriers and facilitators (i.e., determinants) of implementing TF-CBT-A and collaboratively select implementation strategies to address these determinants via implementation mapping. Autistic youth and families as well as CMHC clinicians who serve autistic youth living in medically underserved areas will be purposively sampled to identify unique determinants faced by this underserved population. This project will include collection of pilot feasibility data for TF-CBT-A and the selection of implementation strategies to support the preparation of an application for a type I hybrid effectiveness-implementation trial of TF-CBT-A and associated implementation strategies. Ultimately, this research is expected to have a positive impact by tailoring and expanding access to a trauma-focused intervention for autistic youth while also creating an implementation plan for a context in which autistic youth are likely to receive mental health intervention (i.e., CMHCs).