Community-based care for autistic youth: community providers' reported use of treatment practices in the United States.
Across U.S. community clinics, antecedent strategies are the go-to move for autistic youth, but usage splits along job role, training, and client traits.
01Research in Context
What this study did
Drahota et al. (2023) asked 701 U.S. community providers how they actually treat autistic youth. The team sent an online survey to mental-health, medical, and education staff who see kids outside of schools.
Providers checked which practices they use and gave details about their job, training, and clients. The goal was to map real-world care, not lab care.
What they found
Four groups of practices showed up. Antecedent-based strategies came out on top. These are front-loaded moves like giving warnings, choices, or visual cues to stop problems before they start.
Who used what depended on the worker. Doctors picked different tools than teachers. Years of experience, college major, and even client age shifted the menu.
How this fits with other research
Lerner et al. (2022) used the same 701 people one year earlier. They asked, “Do you know these practices?” Now Drahota asks, “Do you use them?” The jump from knowing to doing is small for some tools, big for others.
Rubenstein et al. (2019) found that four in ten preschoolers with autism get zero community services. Drahota shows when kids do get seen, front-loaded strategies lead the pack. The gap is access, not method choice.
Pitchford et al. (2019) saw schools short on behavior plans. Drahota finds community clinics also lean on antecedent tricks. Together the papers say the same hole exists inside and outside school walls.
Why it matters
If you supervise community staff, check their antecedent game first. It is already their top move, so shape it with solid training and data. Pair it with missing pieces like consequence plans or social-skills groups to round out care. Push for parent advocacy too—Marroquin et al. (2014) showed coached families pull in more hours. Target doctors and new grads; they report the least use and need the most help.
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02At a glance
03Original abstract
To illustrate the landscape of community-based care for autistic youth in the United States, we identified transdisciplinary psychosocial intervention practice sets that community providers report utilizing to care for this population, and examined characteristics associated with provider-reported utilization. The Usual Care for Autism Study (UCAS) Survey assessed provider demographics and provider-reported use of transdisciplinary practices for common ASD co-occurring problems: social difficulties, externalizing behaviors, and anxiety. Community practitioners (N = 701) from allied health, behavioral, education, medical, mental health and other disciplines who treat or work with autistic youth (7–22 years) participated. Exploratory factor analysis yielded four factors: Consequence-Based Strategies (CBS), Cognitive-Behavioral and Therapy Strategies (CBTS), Antecedent-Based Strategies (ABS), and Teaching Strategies (TS). Providers across disciplines reported utilizing ABS more often than other sets. Providers from behavioral disciplines, with less than 4-year or Master degrees, or with more experience reported the most use of ABS, CBS and CBTS. Medical and behavioral providers reported the most use of TS. Setting and child characteristics were associated with practice set use, indicating variability by disability and client socioeconomic status. Findings reflect the complexity and inconsistency of the service landscape for autistic youth across the U.S. Only by understanding the service landscape and predictors of practice utilization, can researchers, policymakers, provider groups, and the autistic community facilitate effective implementation strategy development and use to ultimately improve community-based care.
Frontiers in Psychiatry, 2023 · doi:10.3389/fpsyt.2023.1212084