Ethnic Disparities in School‐Based Behavioral Health Service Use for Children With Psychiatric Disorders

Background: We examined racial/ethnic disparities in school-based behavioral health service use for children with psychiatric disorders.

Methods: Medicaid claims data were used to compare the behavioral healthcare service use of 23,601 children aged 5-17 years by psychiatric disorder (autism, attention deficit hyperactivity disorder [ADHD], conduct/oppositional defiant disorder, and “other”) and by race/ethnicity (African-American, Hispanic, white, and other). Logistic and generalized linear regression analyses were used.

Results: Differences in service use by racial/ethnic group were identified within and across diagnostic groups, both for in-school service use and out-of-school service use. For all disorders, Hispanic children had significantly lower use of in-school services than white children. Among children with ADHD, African-American children were less likely to receive in-school services than white children; however, there were no differences in adjusted annual mean Medicaid expenditures for in-school services by race/ethnicity or psychiatric disorders. Statistically significant differences by race/ethnicity were found for out-of-school service use for children with ADHD and other psychiatric disorders. There were significant differences by race/ethnicity in out-of-school service use for each diagnostic group.

Conclusions: Differences in the use of school-based behavioral health services by racial and ethnic groups suggest the need for culturally appropriate outreach and tailoring of services to improve service utilization.

Keywords: Medicaid; behavioral health; health disparity; mental health; school-based health services.

2018Alycia Halladay

Pivotal Response Treatment (PRT) is an evidence-based treatment for individuals with ASD that targets social communication skills, most notably social motivation. The aim of the current study was to map microanalytic changes in social communication during dyadic child-therapist interactions following a 16-week trial of PRT. We proposed that a microanalytic approach would allow us to meticulously outline the dynamics of the “building blocks” of children’s discourse, stressing certain aspect that might go unnoticed in global methods of coding. We hypothesized that PRT would improve measures of linguistic social communication in children.

We utilized continuous microanalysis of behavior to explore changes in social communication during PRT sessions in 20 high-functioning children with ASD (ages 4–7 years). For each child, two videotaped PRT sessions – at the beginning and end of these 16 weeks – were coded for vocalizations and verbalizations. This allowed us to compare the amount, fluency, adequacy and reciprocity of social communication between child and therapist at the early versus final stages of PRT.

Results

Compared to baseline, at endpoint, children increased their overall use of vocalizations as well as the congruency of their responses to those of the therapist. The amount of non-congruent responses also dropped significantly. Additionally, children improved in measures of conversational fluency and use of self-referential pronouns.

Conclusions

These results provide a mapping of microanalytic changes in social and linguistic communication that occur during PRT and point to children’s improvement in social communication behavior leading to greater social reciprocity and conversational synchrony following treatment.

Keywords

Autism Spectrum Disorders (ASD)
Pivotal Response Treatment (PRT)
Microanalysis
Social communication
Vocalizations
Verbalizations

Problem solving between parents and teachers is critical to maximizing student outcomes. The current study examined the associations among the different components of problem solving, as well as the relationship between various characteristics and problem solving in parents and teachers of children with autism spectrum disorder (ASD). Participants were 18 teachers and 39 parents of children with ASD. Parents and teachers completed a demographic survey, phone interview, and dyad observation. Results indicated that parent and teacher problem solving strategies were correlated with each other. Lower-income parents and parents interacting with White teachers displayed less problem solving. Findings suggest that school-based service delivery models to improve problem solving should consider both skill development, as well as the sociodemographic characteristics that parents and teachers bring to their interactions.

Keywords: autism spectrum disorder; communication; family involvement; parent–teacher relationships; problem solving.

Little research examines the best ways to improve communication between parents and teachers of children with Autism Spectrum Disorder (ASD) and its effect on child outcomes. The present study tests an innovative parent-teacher consultation model, entitled Partners in School. The goal of Partners in School is to improve parent-teacher communication aboutevidence-based practices (EBPs), and subsequently, outcomes for children with ASD. Participants were 26 teachers and 49 parents of children with ASD from a large urban public school district. Parents and teachers completed measures of their communication and child outcomes prior to and after receiving consultation through Partners in School. Results indicated that parents and teachers perceived improvements in child outcomes after participation inPartners in School. Changes in parent-teacher communication also were associated with changes in some child outcomes. Discussionhighlights the important role of communication inconsultations targeting family-school partnerships for children with ASD.

Keywords: autism; autism spectrum disorder; consultation; family-school partnerships; parent-teacher communication; parent-teacher relationships.

Little research examines the best ways to improve communication between parents and teachers of children with Autism Spectrum Disorder (ASD) and its effect on child outcomes. The present study tests an innovative parent-teacher consultation model, entitled Partners in School. The goal of Partners in School is to improve parent-teacher communication aboutevidence-based practices (EBPs), and subsequently, outcomes for children with ASD. Participants were 26 teachers and 49 parents of children with ASD from a large urban public school district. Parents and teachers completed measures of their communication and child outcomes prior to and after receiving consultation through Partners in School. Results indicated that parents and teachers perceived improvements in child outcomes after participation inPartners in School. Changes in parent-teacher communication also were associated with changes in some child outcomes. Discussionhighlights the important role of communication inconsultations targeting family-school partnerships for children with ASD.

Keywords: autism; autism spectrum disorder; consultation; family-school partnerships; parent-teacher communication; parent-teacher relationships.

Several interventions have demonstrated efficacy in improving social outcomes for children with autism; however, few have been successfully implemented in schools. This study compared two implementation strategies to improve the use of a social engagement intervention for children with autism in public schools. In total, 31 children with autism in grades K-5 and 28 school personnel participated in a randomized controlled trial. Schools were randomized to (1) training in Remaking Recess, a social engagement intervention, or (2) training in Remaking Recess with implementation support. Linear regression with random effects was used to test the intervention effects on implementation fidelity and social outcomes (peer engagement, social network inclusion, and friendship nominations). In both groups, implementation fidelity improved after training but remained low. Children in the Remaking Recess with implementation support condition had significantly higher social network inclusion and received more friendship nominations than children in the Remaking Recess-only condition (p = 0.03). Children in both groups experienced reduced solitary engagement (p < 0.001) and increased joint engagement (p < 0.001). The results suggest that implementation supports may have an effect on outcomes above and beyond the intervention, and that further research is needed into the active intervention mechanisms.

Keywords: autism spectrum disorder; implementation; school; social engagement intervention.

Keywords: Autism spectrum disorder; Oxytocin; Reward; fMRI.

Symptoms of autism spectrum disorder may influence alliance in psychotherapy. This study examined therapeutic alliance and its relationship with child characteristics and anxiety treatment outcomes in youth with autism spectrum disorder. Youth ( N = 64) with autism spectrum disorder and co-occurring anxiety (7-16 years, IQ > 70) received 16 sessions of modular cognitive-behavioral therapy. Post-treatment therapist, youth and parent ratings of alliance as well as pre- and post-treatment ratings of child behavior were gathered. Ratings of alliance were commensurate to ratings seen in children without autism spectrum disorder. Measures of treatment outcome, but not pretreatment characteristics, were significantly associated with therapist ratings of alliance strength. Data suggest that therapeutic alliance may not be impaired in anxious youth with autism spectrum disorder and may be associated with treatment outcome.

Keywords: anxiety; autism spectrum disorder; cognitive-behavioral therapy; therapeutic alliance.