A Crisis Prevention Program for Youth With Autism
Condition: Autism Spectrum Disorder; Behavior Problem
MeSH terms: Autistic Disorder; Autism Spectrum Disorder; Problem Behavior
Study type: Interventional

Summary: 
      Mental health crises involve acute psychiatric states, such as aggression and/or self-injury,
      which can result in harm to self or others. There is evidence to suggest that 20% to 25% of
      autistic children are at risk of a mental health crises, however no crisis prevention
      programs exist for autistic children. The goal of this project is to evaluate, via a
      randomized design, a novel crisis prevention program.
    

Detailed description: 
      When a child or adolescent experiences a mental health crisis, it is a devastating and
      potentially life-threating event. Beyond the hazard of injury, mental health crises can have
      a life-altering impact on the child (repeated trauma, development of future psychopathology),
      family members (increased stress and poorer well-being) and society as a whole (cost and
      disability). Our inability to prevent or identify those in crisis is reflected in the rising
      rates of suicides, extensive wait times and overcrowding in emergency departments, and the
      jailing of people with mental illness.

      Mental health crises are defined as a) the presence of acute psychiatric symptoms that
      require immediate attention or intervention and b) the perceived (by the informant) lack of
      immediate resources to manage these symptoms. Similar to the concepts of impairment or
      distress, mental health crisis is a transdiagnostic construct that applies to all psychiatric
      problems, from self-injury to aggression to psychosis to substance abuse.

      The recently developed Mental Health Crisis Assessment Scale-Revised (MCAS-R), developed by a
      team of expert clinical and public health researchers, was specifically designed to address
      the current gap in crisis measurement for autistic children. The MCAS-R is a 23-item parental
      report, which takes no more than 10 minutes to complete, that measures crisis in two
      conceptually-based subscales, acuity and behavioral efficacy, reflecting both the core
      elements of crisis. Based on the cutoffs, it has been shown to accurately identify crises in
      9 out of 10 autistic children. Recent work suggests between 20-25% of children served in
      outpatient mental health are at risk of a mental health crisis, as identified by the
      validated MCAS cutoff.

      At present, no crisis prevention programs exist for autistic children. There are certainly
      numerous community-based crisis intervention programs, outpatient mental health treatment
      approaches, and parent behavioral training programs. However, no programs exist that aim to
      prevent a crisis from occurring. The goal of this study is to fill this gap by providing
      families with tools before their child's behavior becomes acute.

      The goals of this study are to examine: 1) child and parent outcomes associated with a novel
      crisis prevention program for autistic children; 2) gather survey-based feedback from
      parents, post-intervention, to understand feasibility and utility of the crisis prevention
      program.
    

Intervention name(s): Crisis Prevention Arm; Control
Intervention type(s): Other; Other
Intervention description(s): The crisis prevention program involves a 3-session model. Each session lasts up to 60 minutes. They take place via telehealth with a licensed clinical therapist. Sessions involve case formulation, provision of prevention strategies, connecting with professional and lay resources, what to do if a crisis occurs, and strategies to prevent the re-occurrence of a crisis, should one occur. Each session involves use of checklists, a community resource guide, and homework. Implementation is standardized using two different manuals, one for the parent and the other for the provider.; The control condition will involve sending families the Autism Speaks Challenging Behavior Toolkit. It offers a complimentary set of recommendations. It is freely available and can be found here: https://www.autismspeaks.org/tool-kit/challenging-behaviors-tool-kit. There is no interaction with the clinician in the controlcondition. After the study observation period, we will provide them with the crisis manual (for parents) used in the active treatment arm.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: autism; externalizing; behavior; crisis