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Changes in Attitudes and Knowledge after Trainings in a Clinical Care Pathway for Autism Spectrum Disorder

Donnelly, Lauren J; Cervantes, Paige E; Guo, Fei; Stein, Cheryl R; Okparaeke, Eugene; Kuriakose, Sarah; Filton, Beryl; Havens, Jennifer; Horwitz, Sarah M
Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.
PMID: 33201422
ISSN: 1573-3432
CID: 5086822

Staff Perceptions and Implementation Fidelity of an Autism Spectrum Disorder Care Pathway on a Child/Adolescent General Psychiatric Inpatient Service

Donnelly, Lauren J; Cervantes, Paige E; Okparaeke, Eugene; Stein, Cheryl R; Filton, Beryl; Kuriakose, Sarah; Havens, Jennifer; Horwitz, Sarah M
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,, 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082-4089,, 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.
PMID: 32394312
ISSN: 1573-3432
CID: 4438022

Sustainability of a Care Pathway for Children and Adolescents with Autism Spectrum Disorder on an Inpatient Psychiatric Service

Cervantes, Paige; Kuriakose, Sarah; Donnelly, Lauren; Filton, Beryl; Marr, Mollie; Okparaeke, Eugene; Voorheis, Katherine; Havens, Jennifer; Horwitz, Sarah
Children with autism spectrum disorder (ASD) are frequently hospitalized within general psychiatric settings, which are not usually designed to meet their needs. An initial evaluation of a care pathway developed for youth with ASD receiving services in a general psychiatric inpatient unit (ASD-CP) showed promise in improving outcomes while using few resources (Kuriakose et al. in J Autism Dev Disord 48:4082-4089, 2018). As sustainability of inpatient psychiatric initiatives is imperative but rarely investigated, this study examined the stability of ASD-CP outcomes during an 18-month follow-up period (n = 15) compared to the 18-month initial evaluation (n = 20) and 18-month pre-implementation (n = 17) periods. Decreased use of crisis interventions, including holds/restraints and intramuscular medication use, was sustained in the 18 months after the initial implementation period. Implications and limitations are discussed.
PMID: 31065864
ISSN: 1573-3432
CID: 3908872

Does an Autism Spectrum Disorder Care Pathway Improve Care for Children and Adolescents with ASD in Inpatient Psychiatric Units?

Kuriakose, Sarah; Filton, Beryl; Marr, Mollie; Okparaeke, Eugene; Cervantes, Paige; Siegel, Matthew; Horwitz, Sarah; Havens, Jennifer
Youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates. Though specialized psychiatric units are effective, few specialized units exist. The ASD Care Pathway (ASD-CP) was developed as a scalable approach to improving care in general psychiatric units through staff training and a package of autism-specific intervention strategies. An evaluation of the effectiveness of the ASD-CP in a public hospital child psychiatric service compared 18 months (n = 17) versus 18 months (n = 20) post implementation. Average length of hospital stay decreased 40% (22.4-13.4 days) and use of crisis interventions decreased 77% (holds/restraints; 0.65/day to 0.15/day), though each result only approached statistical significance (p = 0.07; 0.057). This study provides preliminary evidence for improved outcomes after implementation of an ASD-CP.
PMID: 29971653
ISSN: 1573-3432
CID: 3185622

A clinical pathway for children with autism spectrum disorder in a general child psychiatry unit: Implementation and evaluation [Meeting Abstract]

Kuriakose, S; Filton, B; Marr, M; Osasah, V; Siegel, M; Havens, J
Objectives: This clinical perspectives session presents preliminary data on the outcomes of a clinical pathway (CP) for children and adolescents with autism spectrum disorder (ASD) or intellectual disability (ID) who were hospitalized in a general child psychiatric unit at a public hospital. Methods: Children with ASD are at greater risk of psychiatric hospitalization than their neurotypical peers. Although care in specialized psychiatry units has preliminary evidence for positive outcomes, the vast majority of children in the United States are treated in general units that are not designed for this challenging population. Review of best practices and expert consensus was used to design and implement a CP in three child and adolescent inpatient units at Bellevue Hospital Center. Fidelity to the CP was examined by use of a checklist. Retrospective chart review was used to identify patients eligible for the CP in the 18 months before implementation and compare outcomes (mean length of stay, use of intramuscular medications, and use of restraint) of patients exposed to the CP in the first 18 months of implementation. Results: Treatment fidelity to the CP was acceptable based on checklist review. Record review identified over 70 patients with ASD who were admitted in the 18 months before implementation. Of these patients, approximately 50 percent met CP eligibility criteria. Outcomes for these admissions were compared with outcomes for 30 admissions to the CP. Preliminary analysis indicated improved outcomes post-CP implementation. Conclusions: Expert consensus has indicated that expanded, targeted admission assessment; basic supports for functional communication; predictable routines; developmentally appropriate milieu of activities, including physical activities; and increased density of positive reinforcement are critical elements for effective inpatient care of children with ASD or ID. The design and pilot implementation of a clinical pathway using these elements at Bellevue Hospital Center over 18 months showed that it is feasible to incorporate these principles in a general inpatient child psychiatry unit and may improve outcomes
ISSN: 1527-5418
CID: 2924262

Caring for youth with autism in a child and adolescent psychiatric emergency service [Meeting Abstract]

Filton, B; Gerson, R
Objectives: Most staff in a psychiatric emergency service, even CAPs, have little experience with the emergency evaluation, crisis management, and behavioral treatment of patients with autism. This presentation will teach participants about the evaluation and behavioral management of patients with autism in a child/adolescent psychiatric emergency setting through staff training to improve care for these patients. Methods: This presentation will cover autism-specific evaluation strategies and tools geared to a psychiatric emergency setting for children and adolescents. This evaluation, as well as behavioral interventions and staff trainings, part of a larger Autism Clinical Care Pathway, will be described in depth. Results: Knowledge of specific evaluation concepts and strategies can be extremely useful in a child/adolescent psychiatric emergency setting, both in terms of acquiring a better understanding of patients' immediate treatment needs and strategies for behaviorally managing this population. Multidisciplinary staff training on the basics of autism, behavioral management, and staff collaboration is an important part of promoting improved care for youth with autism in a psychiatric emergency service setting. Conclusions: Given the difficulties managing patients with autism in an emergency setting, specific evaluation procedures and behavioral interventions can be beneficial. Moreover, this information can be conveyed through staff training in a way that is feasible and promotes safety
ISSN: 1527-5418
CID: 2401632

Patterns in blame attributions in maltreated youth: Association with psychopathology and interpersonal functioning

Sharma-Patel, Komal; Filton, Beryl; Tebbett, Alison; Tahilani, Kavita; Swiecicki, Carole L; Brown, Elissa J
This investigation explored patterns of blame attributions in 128 youth, primarily (87%) female, with maltreatment histories. Second, the study also evaluated the relative variance in posttraumatic stress disorder (PTSD) symptom severity, emotional distress, and interpersonal functioning outcomes, accounted for by age, abuse characteristics, and blame attribution patterns. Cluster analyses revealed distinctive blame profiles: high perpetrator blame, moderate perpetrator blame, high self-blame, high perpetrator/high self-blame, and low perpetrator/low self-blame. Regression analyses yielded significant models, accounting for 15% to 34% of the variance of outcomes. Most notably, youth endorsing a high perpetrator/high self-blame (i.e., compounded blame) attribution pattern reported poorer outcomes as compared to youth presenting with other blame profiles. Maltreatment type and age differences were not demonstrated across clusters. Implications and limitations are discussed.
ISSN: 1545-083x
CID: 1307792

Identity consolidation and health risk behaviors in college students

Schwartz, Seth J; Forthun, Larry F; Ravert, Russell D; Zamboanga, Byron L; Umana-Taylor, Adriana J; Filton, Beryl J; Kim, Su Yeong; Rodriguez, Liliana; Weisskirch, Robert S; Vernon, Michael; Shneyderman, Yuliya; Williams, Michelle K; Agocha, V Bede; Hudson, Monika
OBJECTIVES: To investigate the protective role of personal identity consolidation against health risk behaviors in college-attending emerging adults. METHODS: A multisite sample of 1546 college students completed measures of personal identity consolidation and recent risk behavior engagement. RESULTS: Multivariate Poisson regression indicated that personal identity consolidation was negatively related to binge drinking, illicit drug use, sexual risk behaviors, and risky driving. These findings were consistent across gender, ethnicity, and place of residence. CONCLUSIONS: A consolidated sense of personal identity may protect college-attending emerging adults from health-compromising behaviors. Health professionals could incorporate an identity development component into college health programming.
PMID: 19814601
ISSN: 1087-3244
CID: 539022

From efficacy to effectiveness: the trajectory of the treatment literature for children with PTSD

Nikulina, Valentina; Hergenrother, Jeanean M; Brown, Elissa J; Doyle, Megan E; Filton, Beryl J; Carson, Gabrielle S
This review summarizes efficacious treatments for preschoolers, children and adolescents with post-traumatic stress disorder, with a focus on the advances made within the last 5 years. There is considerable support for the use of trauma-specific cognitive-behavioral interventions, in both individual and group formats. The research on psychopharmacological treatments lags behind that of psychotherapy and is currently inconclusive. Limitations of the studies are discussed and treatments that warrant further consideration are reviewed. The authors also review current advances in effectiveness and suggest future directions that are important in generalizing the interventions to underserved and hard to reach populations. The article concludes with the authors' projections for the evolution of the field within the upcoming 5 years
PMID: 18671667
ISSN: 1744-8360
CID: 95225