ABSTRACT
This study reaffirms our previous work documenting a higher number of Emergency Department (ED) visits by adolescent females with Autism Spectrum Disorder (ASD) as compared to adolescent males with ASD, as well as significantly more ED visits by older adolescents than younger adolescents with ASD. Combined externalizing and internalizing psychiatric co-morbidities as well as internalizing conditions alone predict a higher number of ED visits in this study. Illness severity as demonstrated by patterns of visits to primary care physicians and psychiatric referrals prior to ED visits and the prescription of two or more classes of psychotropic medications also predict higher number of ED visits. Finally, as expected, previous ED visits predict future ED visits. The identification of these factors may prove helpful in determining adequacy of current supports and resources for teens with ASD navigating the challenges of adolescence.
Subject(s)
Autism Spectrum Disorder/epidemiology , Emergency Service, Hospital/statistics & numerical data , Severity of Illness Index , Adolescent , Autism Spectrum Disorder/drug therapy , Autism Spectrum Disorder/psychology , Comorbidity , Female , Humans , Male , Psychotropic Drugs/therapeutic use , Risk FactorsABSTRACT
Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.
Subject(s)
Community Mental Health Services/organization & administration , Mental Disorders/therapy , Quality of Health Care/organization & administration , Case Management , Community Mental Health Services/standards , Costs and Cost Analysis , Evidence-Based Practice , Female , Humans , Male , Quality of Health Care/economics , Quality of Health Care/standards , Reproducibility of Results , Telephone/economics , United States , United States Department of Veterans AffairsABSTRACT
Assertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources.
