1 - (SYM 22) Using Community Engagement to Adapt Anxiety Cognitive Behavioral Therapy for Minoritized Autistic Youth Receiving Services in Community-based Settings

Background: Behavioral Interventions for Anxiety in Children with Autism (BIACA) is a manualized, modular evidence-based cognitive behavioral therapy with demonstrated efficacy in reducing or fully remitting anxiety symptoms and improving overall adaptive functioning for autistic youth (Wood et al., 2020). BIACA has been developed and tested in research laboratories and certain characteristics (e.g., length, complexity) will require adaptation to facilitate use in the community. Importantly, community-based settings are where autistic youth, often from minoritized groups, are likely to receive care (Drahota et al., 2020; Wood et al., 2015).

Methods: A community-engaged intervention adaptation method was used to develop an adapted version of BIACA for community use (Chen et al., 2013; Yingling et al., 2020). A Community Advisory Board (CAB; N=4) oversaw study procedures and a complex intervention adaptation mixed methods design was used to obtain community members’ (N=10) implementation ratings and perspectives regarding the original BIACA intervention (Creswell & Clark, 2018). Purposive nonprobability sampling was used such that 100% of CAB members and 90% of participants identified as holding one or more minoritized identities. Both the CAB and community participants included autistic adults, caregivers, community providers, and agency leaders.

Results: On average, community members rated the acceptability, feasibility, appropriateness, usability, and intent to use for the original BIACA intervention as moderate. Autistic individuals and caregivers gave lower ratings than community providers and agency leaders. Facilitators included research validity, low provider burden, flexibility, manualized approach, and online training platform. Barriers included negative prior therapy experiences, misalignment of some intervention techniques with co-occurring autism and anxiety, and lack of adequate provider training. Adaptations were suggested to intervention content, delivery, and training.

Conclusion: Adaptations are needed to enhance the potential for BIACA to be equitably implemented in community-based settings. Future research will test the community adapted BIACA intervention with intended intervention recipients. A large sample of community providers will also comparatively evaluate the original and community adapted BIACA.