OARacle Newsletter

In November, OAR’s Board of Directors authorized funding for eight applied autism research studies in 2024. These new grants, totaling $297,569, bring OAR’s total research funding to more than $5 million since 2002. This article is the fourth of eight previews to be featured in The OARacle this year.

To address rising youth suicide rates and identify at-risk youth in need of intervention, suicide risk screening and management is recommended across pediatric care settings and mandated across inpatient and outpatient settings for youth with behavioral health challenges. Most youth and parents in the general population are supportive of suicide screening, though implementation is inconsistent.

For autistic youth, screening may occur less consistently and may be less acceptable to parents. A 2022 study found that 96% of the screening refusals in an outpatient clinic came from parents rather than patients with neurodevelopment disorders. Some parents believe screening is inappropriate, may be distressing or lead to ideas about suicide. Others declined because they believed their child lacked the ability to understand the screen, or they were not concerned that their child was at risk. Clinicians may also misperceive autistic patients as lower risk for suicidal thoughts and behaviors. They have little training and less confidence in screening and report lower use of common intervention strategies with autistic patients, according to a 2023 study.

Understanding these barriers to interventions is a critical first step to improving the identification and treatment of autistic youth at risk for suicide. In this OAR-funded, 18-month study, “Barriers and Facilitators to Suicide Risk Screening and Management for Autistic Youth,” principal investigator, Paige Cervantes, Ph.D., will evaluate obstacles to screening as well as the factors that facilitate screening. The goals of the study are to:  

• Evaluate mental health clinicians’ attitudes and perspectives to understand how they either facilitate or reduce screenings and treatment for autistic youth.
• Evaluate parent attitudes and perspectives to understand how they either facilitate or reduce screenings and treatment.
• Develop educational materials to support parents and clinicians in addressing suicide risk with autistic youth and evaluate those materials for acceptability and utility.

Dr. Cervantes is an assistant professor in the Department of Psychiatry at Virginia Commonwealth University with educational experience in evidence-based assessment and treatment of autism and related neurodevelopmental disorders. She joined the Center for Implementation-Dissemination of Evidence-Based Practices Among States after completing her doctoral studies to gain expertise in implementation science. She has studied strategies to increase family engagement, build a trained workforce to advance community mental health care, and overcome barriers of evidence-based practice implementation.

Methodology

The study will take place in New York State to capitalize on existing partnerships and relationships. Dr. Cervantes was formerly a clinical assistant professor in the Department of Child and Adolescent Psychiatry at New York University Langone, and the other members of the research team are based there.

The research team will work with an advisory committee to develop and draft the clinician and caregiver surveys. The advisory committee will be made up of two autistic individuals and one parent of an autistic child. In addition to helping with drafting the survey, the committee will provide guidance at every step of the study.

The research team will recruit participants from state-funded community mental health clinics, specialty autism clinics, and parent organizations across the state to take the surveys. They will recruit 75 mental health clinicians, 50 non-specialized and 25 who specialize in providing care to autistic people, as well as 50 parents of autistic youth ages 7 to 17 to take surveys. Dr. Cervantes is focusing on mental health clinicians because care for suicidal thoughts and behaviors is only mandated for patients with behavioral health concerns, who are more likely to be treated by those clinicians.

Parents can participate even if their children have not experienced suicidal thoughts and behaviors. Suicide screening should occur for most autistic youth because:  

• Autism is a risk factor for suicidal thoughts and behaviors. 
• Autistic youth have high rates of mental health conditions. 
• Attention to suicidal thoughts and behaviors is mandated for all patients with behavioral health concerns.  

Those factors make it important to understand how the attitudes of caregivers of youth with and without a history of suicidal thoughts and behaviors differ. The surveys, which will be distributed via email, will be open for six weeks, with biweekly reminders sent out during that period.

After the surveys close, the team will recruit 15 clinicians and 10 parents to participate in qualitative interviews. The clinician group will include clinicians who are not confident, somewhat confident, and confident screening autistic youth. The parent group will include a sampling of parents who are not, somewhat, or concerned about care for an autistic child who engages in suicidal thoughts and behaviors.

The research team will work with the advisory committee to develop educational materials addressing routine suicide risk screening for clinicians and caregivers. Those materials will be distributed to the parents and clinicians who participate in qualitative interviews so they can provide feedback. The research team will make revisions based on that feedback in consultation with the advisory committee and finalize the resources.

The educational materials for clinicians will be disseminated via a webinar and posted on the Evidence-Based Treatment Dissemination Center’s website. Dr. Cervantes and her team will also provide materials to clinicians to encourage use with their patients. The materials for caregivers will be disseminated through a webinar via the Regional Center for Autism Spectrum Disorders and available for download. Webinars will also be provided, and materials disseminated through the Autism Society of Central Virginia and Virginia Commonwealth University.

Evaluation

The research team will analyze survey data and interpret quantitative findings with the advisory committee. Both the clinician and the parent interviews will be developed based on survey data, focusing on areas where greater depth of information would be beneficial for building strategies to address barriers and promote implementation.

Practical Relevance

This study aims to contribute to a comprehensive understanding of the barriers and facilitators to the implementation of suicide risk screening and management. Dr. Cervantes will directly address findings related to modifiable attitudes and behaviors of clinicians and caregivers within the proposed study by developing clinician and caregiver resources since they serve in many cases as gatekeepers to potentially life-saving information.

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.