4 - (SYM 122) Adaptations and Implementation of Unstuck and on Target in Community Mental Health Clinics

Background: Executive function (EF) is a key mechanism underlying autism and commonly co-occurring mental health conditions, including predicting increased mental health symptoms among autistic youth.^1–4 Mental health therapists report EF problems negatively impact psychotherapy process and effectiveness.⁵ Thus, EF represents a key treatment target and has the potential to improve mental health services for autistic youth. Yet, EF interventions have yet to be widely implemented and tested in mental health services. Context-specific considerations and modifications, especially those responsive to community needs and recommendations, are key to improving the successful translation to mental health settings. This is critical when considering translation of Unstuck and On Target, a school-based EF curriculum, to mental health settings.

Objectives: To 1) describe community-partnered adaptation process to Unstuck and On Target for implementation in children’s mental health settings and 2) present therapist perspectives and outcomes collected in a pilot a randomized pilot trial of the adapted version of Unstuck and On Target.

Methods: Applying the Framework for Reporting Adaptations and Modifications-Expanded (FRAME⁶), we describe how community perspectives were used to iteratively adapt Unstuck and On Target for delivery in community mental health settings. Following adaptations, we randomized therapists (N=16, 85% female; 31% Social Work) to deliver Unstuck to 18 clients. Using mixed-methods, we examined therapist perspectives of the adapted Unstuck and On Target; as part of this, therapists rated the acceptability, feasibility, and appropriateness on a 5-point Likert Scale from (1-Completely Disagree to 5-Completely Agree).

Results: We describe several key content (e.g., incorporating EF educational material,  incorporating a stronger emphasis on caregiver involvement) and context (e.g., adjusting intervention length, inclusion of non-group based format) adaptations to improve fit with the mental health services context. Mixed-method pilot findings indicate therapists perceive Unstuck and on Target as feasible (M=4.41), highly appropriate (M=4.50) and acceptable (M=4.63).

Conclusions: Trial findings indicate high acceptability, feasibility, and appropriateness of adapted Unstuck in mental health settings. Corresponding qualitative data also supported the feasibility, acceptability, and utility of the Unstuck and On Target in mental health settings. Future directions and next steps are discussed.