(PS2-81) What’s the Hold Up? Slowdowns to Implementing CBT for Autistic Students in Schools

Abstract Text: Autistic youth experience high rates of anxiety (Lai et al., 2019). CBT is helpful for improving anxiety symptoms (Linden et al., 2022) but can be difficult to access (Adams & Young, 2021). Although school-based CBT for autistic students is promising (Reaven et al., 2024) and removes some barriers to clinical access (e.g., health insurance), schools face unique implementation challenges (e.g., school calendar, variability of leadership support, burnout, staff turnover). Given the benefits of CBT for autistic students in managing anxiety, it is critical to understand the factors that drive school providers’ CBT use, including the speed at which they adopt these programs. The aim of this study was to characterize and explore potential contributing factors to intervention uptake in a school-based study of two manualized CBT programs for autistic students with anxiety.

Methods: Interdisciplinary School Providers (ISPs; e.g., educators, counselors) were enrolled (N=163 ISPs; N=61 schools) in an ongoing comparative effectiveness trial of Zones of Regulation (ZOR) and Facing Your Fears in Schools (FYF-S) for autistic students ages 8-14 with anxiety. Consenting ISPs completed an initial training on autism and anxiety, after which they identified potentially eligible students to be contacted by study staff. Schools were randomly assigned to ZOR or FYF-S and completed program-specific training. Following student qualification, ISP teams delivered their intervention in small groups across 12 lessons with consultation support. A purposive subsample of ISPs from the first year (n=27) completed an exit interview with questions about implementation (e.g., “How easy is [program] to learn and implement?”). Descriptives were generated for time between (1) ISP consent and training completion, (2) training completion and initial parent outreach, and (3) student qualification and intervention start. Rapid debriefing was used to generate preliminary themes for exit interviews. Full thematic analyses will be conducted.

Results: N=135 ISPs (82%) completed training. N=21 (13%) completed training but did not begin intervention. Of those who withdrew before beginning intervention, most cited lack of time (47%) or eligible students (24%). There was high variability in days between (1) ISP consent and training completion (M=24, SD=26; Range: 1-136), (2) training completion and first parent outreach (M=19, SD=28; Range: < 1-129), and (3) student qualification and intervention start (M=24, SD=20, Range: 1-87). Preliminary themes from exit interviews indicate that the speed at which ISPs began using FYF-S or ZOR was driven by ease of identifying potentially eligible students, as well as perceptions of the programs’ compatibility and relative advantage.

Discussion: Expanding CBT for autistic students to school settings is critical but requires careful consideration of schools’ unique barriers. Addressing these barriers may include (1) proactively problem-solving time constraints; (2) additional support identifying anxiety in autism; (3) collaboratively setting training and intervention dates with a specific end date; and (4) providing training during dedicated staff training days rather than more flexible options (e.g., asynchronous).