Mental Health Support Intervention Shows Promise | Organization for Autism Research

Research Review

In 2021, Vanessa Bal, Ph.D., an associate professor and the Karmazin & Lillard Chair in Adult Autism at Rutgers, and Evan Kleiman, Ph.D., an assistant professor in the psychology department, led a one-year OAR-funded study, Developing Supports to Address Mental Health Needs of Autistic Students in Postsecondary Education, that examined an intervention to help autistic students prepare for potential stressors and provide them with online coping tools and strategies. The goals of the study were to: 

  • Identify mental health needs of autistic students. 
  • Develop resources to inform and guide mental health care of autistic students. 
  • Pilot an intervention for autistic students that enables them to regulate stress and negative emotions and promotes awareness of supports to alleviate distress. 
Methodology

The researchers conducted focus groups with six autistic students in the Rutgers College Support Program and four parents/caregivers to better understand the mental health needs of autistic college students and inform the adaptation of resources that could be used to provide mental health care specifically for autistic students. Based on the information they received from the focus group, they developed an intervention with a version for clinicians that included risk protocols and a self-guided version for students, as well as a mental health guide. 

The Emotional Support Plan (ESP) is designed to help students anticipate stressful situations and proactively equip them with strategies to regulate negative emotions and promote awareness of different types of supports to mitigate distress. The ESP also includes contact information for social and professional supports, with the expectation that making resources known and contact information accessible, the ESP may also promote more timely access to psychological services if they are needed. 

To determine the efficacy of the ESP intervention, Drs. Bal and Kleiman recruited 15 students, also from the Rutgers College Support Program, to participate in their study. Nine students worked with a clinician using the clinician-guided intervention and six used the self-guided intervention. All students completed telehealth visits and questionnaires to gather information about their current emotional functioning.  

The students working with a clinician participated in a telehealth visit that lasted between 60 and 90 minutes to complete their emotional support plans. The other six students were sent links to videos and other electronic materials to complete a self-guided version of an emotional support plan on their own. All 15 students were then monitored for 15 weeks, weekly for the first six weeks and biweekly for the remaining nine weeks. For those students working with a clinician, monitoring included online questionnaires and brief telehealth check-in meetings with a study team member. For the self-guided students, monitoring included an online questionnaire and prompts to complete brief questions about their emotional states four times per day for the first six weeks and bi-weekly questionnaires for the remaining nine weeks.  

Participants in both groups were asked to complete questionnaires about their emotional functioning and a telehealth outcome visit, during which they were asked questions about their experiences with the ESP intervention. 

Findings

Focus group 

The focus groups highlighted that while half of the students seemed to be aware of the university counseling center, none were aware of how to access its services. Students had generally not heard of most other local mental health services. Three students reported awareness of the national suicide prevention lifeline and crisis text line, though only one reported knowing how to access them.  

Only one parent was aware of university counseling and how to access services. The parents also noted that they had heard of state and national support but did not know about specific services or how to access them.  

While this was a small sample, the findings highlighted the need for resources for students and families that describe available mental health supports and services. Based on those findings and the experiences of the students who participated in the intervention, the research team developed a mental health guide for autistic college students. 

Clinician-led intervention 

  • Eight of the nine students completed their telehealth visits and the monitoring questionnaires.  
  • All of them completed outcome visits and questionnaires.  
  • Two-thirds of participants agreed they would recommend the intervention to another person.
  • At the start of the study, five of the nine had scores for anxiety and/or depression in the clinical range of concern. By the end of the study, three fell below the range of concern. Of the remaining two, one was already receiving treatment and the other was referred to therapy. 

When asked to rate the intervention on a five-point scale (five being most positive), participants indicated that the ESP intervention was helpful (3.8) and that the content of the intervention was relevant to them (4.1). When asked about the specific sections of the ESP, participants rated the section on coping strategies as most helpful.   

Self-guided Intervention  

  • Five of the six students completed the monitoring questionnaires. 
  • Four of the six completed the outcome questionnaires and visits.   
  • Of five participants, two had scores in the clinical range of concern of depressive or anxiety symptoms at baseline; both showed some reduction in symptoms by week 14. The remaining three had minimal anxiety at either timepoint. 

The participants reported that creating an emotional support plan with the provided materials was fairly easy and found the resources very helpful. They gave neutral to positive ratings for the self-guided intervention as a whole and their feedback indicated that for some of them having someone to walk them through the process would have been more helpful. Two students indicated that creating the ESP (and reminders through questionnaires) was helpful (e.g., “created a muscle memory to do it later”) and that they used stress reduction strategies more because their mental health was on their mind as a result of the intervention.  

The researchers offered three main takeaways: 

  • Make sure that guides offering resources for mental health support are available for both students and parents since they have a critical need for them. 
  • The ESP intervention may be a useful tool to prepare students to cope with stressors, based on the feedback from students in both groups, though the clinician-led intervention may be more effective. 
  • The timing of the intervention and the effort required by students is a critical consideration.  

To access the mental health college guides, go to OAR’s College Central, and check out next month’s Resource Spotlight to learn more about the resources.


Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.  


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