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AIM HI

Topic Areas
Scientific Rating
Child Welfare Relevance
Developmental and Autism Spectrum Disorder Interventions (Child & Adolescent)
2  — Supported by Research Evidence
Medium

About This Program

Target Population: School-aged children with autism with behaviors of concern and their parents

For children/adolescents ages: 5 – 13

For parents/caregivers of children ages: 5 – 13

Program Overview

AIM HI (An Individualized Mental Health Intervention for Autism) is a caregiver and child skill-building intervention and therapist training model for children 5 to 13 years old with autism receiving mental health services.

The AIM HI protocol includes identifying functional patterns of a target behavior and actively teaching (through modeling, behavioral rehearsal, and in-home practice) positive alternative skills for children and complementary strategies for caregivers to structure the environment to reduce the likelihood of interfering behaviors, as well as promote the child’s use of alternative skills (e.g., communication skills, emotion regulation, self-help skills).

AIM HI components include:

  • Mental health therapists teach caregivers to identify functional patterns in their child’s behaviors and collaborate to develop a behavior plan
  • Therapists actively teach positive alternative skills to children and complementary strategies to the caregiver to structure the environment to reduce the likelihood of interfering behaviors, as well as promote the child’s use of alternative skills
  • Strategies designed to assist in adaptation of psychotherapy sessions to maximize engagement and skill building among children with autism:
    • Inclusion of the child’s special interests in treatment sessions
    • Maximization of in-session predictability through the use of schedules and visuals
  • Delivery within the context of mental health/psychotherapy services with adaptation for telehealth, as needed

Program Goals

The goals of AIM HI are:

For children:

  • Reduce interfering behaviors
  • Increase use of positive alternative skills

For caregivers:

  • Increase understanding of autism and relationship to child’s behaviors
  • Learn to identify patterns in child’s behaviors
  • Use strategies to structure the environment to reduce the likelihood of interfering behaviors and to promote the child’s use of alternative skills
  • Increase caregiver self-efficacy

Logic Model

The program representative did not provide information about a Logic Model for AIM HI.

Essential Components

The essential components of AIM HI include:

  • Individual family intervention delivered by one therapist
  • Collaborative parent psychoeducation:
    • An initial structured discussion between the therapist and parent(s) takes place to identify the child’s current autism characteristics and how they relate to current behaviors with the following goals:
      • Establish a collaborative relationship with the parent
      • Learn about the parent’s perceptions of the child and their treatment priorities
      • Begin to help the parent understand and reframe the child’s behaviors in the context of the autism
    • The therapist uses a case vignette to facilitate the discussion about the child and works with the parent to complete an activity named, “Viewing Behavior through an Autism Lens.”
  • Behavior tracking and developing a behavior plan:
    • The therapist teaches the parent to track one or more prioritized behaviors using the Behavior Tracking worksheet:
      • The Behavior Tracking worksheet provides a structure/checklist for tracking:
        • Antecedents
        • Behaviors
        • Consequences/outcomes
        • Potential purposes/functions of multiple occurrences of the child’s behavior(s)
      • The therapist models and provides feedback on the parent’s use of the Behavior Tracking worksheet over the course of multiple sessions.
    • After the therapist and parent have identified patterns in the child’s behaviors (i.e., common settings and purposes/functions), they work together to develop an initial behavior plan which includes the use of:
      • Two types of skills to serve as alternatives to the behaviors:
        • Short-term
        • Broader coping and tolerance
      • Complementary caregiver skills aimed at:
        • Preventing the occurrence of behaviors (e.g., environmental modifications)
        • Promoting the use of alternative skills (e.g., prompting, priming/pre-teaching, rewards)
  • Active teaching of parent and child skills:
    • The therapist teaches skills listed on the behavior plan to both the child and the parent in sessions with the parent-child dyad or the family.
      • Active teaching strategies include:
        • Introducing the skill
        • Providing psychoeducation
        • Demonstrating/modeling the skill
        • Observing the child and/or parent practice the skill in session
        • Providing positive reinforcement to child for practicing the skill
        • Providing feedback to the child/parent while they practice the skill
        • Forming a plan to practice the skill outside of session (“between session practice”)
  • Generalization of child skills:
    • Different strategies are used by the therapist to promote the child’s generalization of skills to other settings and contexts. These may include:
      • Assigning between-session practice in multiple settings
      • Using multiple examples and role plays to practice skills and self-management
  • Structuring sessions for engagement and skill building:
    • Sessions are structured to facilitate skill building and engagement by:
      • Ensuring that sessions are predictable through:
        • Agendas
        • Warnings
        • Routines
      • Using visual aids to teach concepts
      • Incorporating child-preferred interests throughout sessions
      • Concluding sessions with a fun activity

Program Delivery

Child/Adolescent Services

AIM HI directly provides services to children/adolescents and addresses the following:

  • Interfering behaviors, which includes a broad range of behaviors which interfere with the child’s functioning in specific environments (e.g., daily routines, social interactions); including physical or verbal aggression, not responding to adult instructions or social interactions, tantrums/meltdowns, self-injury, and elopement

Parent/Caregiver Services

AIM HI directly provides services to parents/caregivers and addresses the following:

  • Parent/caregiver of a child with autism and interfering behaviors (e.g., physical or verbal aggression, not responding to adult instructions or social interactions, tantrums/meltdowns, self-injury, and elopement).
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Although not required, a provider can include other support systems (e.g., other caregivers, aides, school support personnel, etc.) who can also implement strategies and support skill building from the Behavior Plan

Recommended Intensity:

Weekly 50-minute sessions to align with typical outpatient psychotherapy services, but session length and frequency can vary to align with the service model.

Recommended Duration:

Approximately 4-6 months

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

AIM HI includes a homework component:

AIM HI includes between session practice. The therapist works with the child and caregiver to complete an AIM HI Session Summary worksheet at the end of every session.

The Session Summary worksheet asks the child and caregiver to summarize session activities, identify goals that they will target, and activities for practice over the upcoming week. The caregiver is asked to document their experience with the between session practice to discuss in an upcoming session.

Languages

AIM HI has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Space for conducting weekly therapy sessions
  • AIM HI protocol forms

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Providers must be eligible to deliver psychotherapy services to children. Disciplines may include psychologists, marriage and family therapists, clinical social workers, psychiatrists, and licensed clinical counselors. There are no licensure or previous experience with autism requirements.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Program Manual Information:

  • Brookman-Frazee, L., Drahota, A., & Chlebowski, C (2016). An Individualized Mental Health Intervention for children with autism spectrum disorder (AIM HI): Therapist manual. (Vol. 2). University of California, San Diego.

Manual is provided to individuals participating in AIM HI training. It cannot be obtained on its own (outside of training).

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Provided on-site or virtually to community organizations based on trainer availability.

Number of days/hours:

Introductory workshop: Providers complete a 14-hour interactive workshop. Workshops can be delivered over 2 full-days or 3 half-days

Structured Consultation. After completing the Introductory Workshop, providers receive 6 months of consultation (12 sessions) while delivering the intervention to a current client. Consultation consists of both group and individual consultation. Consultation includes didactic review of AIM HI components, discussion of application of each component, and feedback to therapists on their delivery of AIM HI.

  • Group consultation: Groups of 4 to 5 providers participate in 1-hour group consultation meetings twice a month to support implementation of AIM HI. There are ten group consultation sessions. Sessions can be held virtually or in person.
  • Individual consultation: Provider attends 2, 1-hour consultation meetings with an AIM HI Trainer. Sessions can be held virtually or in person.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for AIM HI.

Formal Support for Implementation

There is formal support available for implementation of AIM HI as listed below:

Prior to initiating training, the AIM HI team will consult with the organizational leaders to determine fit of the intervention with the organization and identify specific providers to participate in the training.

Fidelity Measures

There are fidelity measures for AIM HI as listed below:

Fidelity is assessed through observations of therapist use of strategies in treatment sessions. Fidelity is documented through trained observations using a checklist based on video review of recorded sessions. Fidelity measures for the intervention and training are available in the training materials. More information can be obtained by the program contact listed at the bottom of this page.

Implementation Guides or Manuals

There are no implementation guides or manuals for AIM HI.

Implementation Cost

There are no studies of the costs of AIM HI.

Research on How to Implement the Program

Research has been conducted on how to implement AIM HI as listed below:

Brookman-Frazee, L., Chlebowski, C., Suhrheinrich, J., Finn, N., Dickson, K. S., Aarons, G. A., & Stahmer, A. (2020). Characterizing shared and unique implementation influences in two community services systems for autism: Applying the EPIS framework to two large-scale autism intervention community effectiveness trials. Administration and Policy in Mental Health and Mental Health Services Research, 47(2), 176–187. https://doi.org/10.1007/s10488-019-00931-4

Brookman-Frazee, L., & Stahmer, A. C. (2018). Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implementation Science, 13, Article 66. https://doi.org/10.1186/s13012-018-0757-2

Dyson, M. W., Chlebowski, C., & Brookman-Frazee, L. (2019). Therapists’ adaptations to intervention to reduce challenging behaviors in children with autism spectrum disorder in publicly funded mental health services. Journal of Autism and Developmental Disorders, 49(3), 924–934. https://doi.org/10.1007/s10803-018-3795-3

Stahmer, A., & Brookman-Frazee, L. (2019). Utilizing community-based implementation trials to advance understanding of service disparities in autism spectrum disorder. Global Pediatric Health, 6. https://doi.org/10.1177/2333794X19854939

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Brookman-Frazee, L., Roesch, S., Chlebowski, C., Baker-Ericzen, M., & Ganger, W. (2019). Effectiveness of training therapists to deliver An Individualized Mental Health Intervention for children with autism spectrum disorder in publicly funded mental health services: A cluster randomized trial. JAMA Psychiatry, 76(6), 574–583. https://doi.org/10.1001/jamapsychiatry.2019.0011

Type of Study: Randomized controlled trial
Number of Participants: 202

Population:

  • Age — Mean=9.1–9.4 years
  • Race/Ethnicity — 121 Hispanic/Latinx, 51 White, 11 African American, 9 Multiracial, 8 Asian/Pacific Islander, and 2 American Indian/Alaskan Native
  • Gender — 170 Male
  • Status — Participants were children from participant therapists’ caseloads.

Location/Institution: 29 publicly funded outpatient and school-based mental health programs in Southern California

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the effectiveness of training community therapists in An Individualized Mental Health Intervention for Autism (AIM HI) on challenging behaviors among children with autism spectrum disorder (ASD) and identify moderators and mediators of any intervention effects. Participating programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) or the Social Responsiveness Scale, Second Edition (SRS-2), the Wechsler Abbreviated Scale of Intelligence-Second Edition or the Differential Ability Scales (DAS-II) and the Social Skills Improvement System (SSIS) Competing Problem Behaviors scales. Results indicate that statistically significant group by time interactions for the ECBI Intensity and ECBI problem scales were observed, with significantly larger decreases in ECBI intensity scores in the AIM HI group relative to the usual care group and a significantly larger decrease in ECBI problem scores in the AIM HI group relative to the usual care group. Therapist fidelity moderated these intervention effects. Limitations include the outcomes measured were limited to parent report of child challenging behaviors; there were a number of missing data points, particularly in the usual care group; the researchers conducting the outcome assessments were blinded to the condition, but clients/caregivers were not; and it was not possible to disentangle the effectiveness of the intervention from that of the training.

Length of controlled postintervention follow-up: 6 and 12 months.

Brookman-Frazee, L., Chlebowski, C., Villodas, M., Roesch, S., & Martinez, K. (2020). Training community therapists to deliver a mental health intervention for ASD: Changes in caregiver outcomes and mediating role on child outcomes. Journal of the American Academy of Child and Adolescent Psychiatry 60(3), 355–366. https://doi.org/10.1016/j.jaac.2020.07.896

Type of Study: Randomized controlled trial
Number of Participants: 404 (202 children, 202 caregivers)

Population:

  • Age — Children: Mean=9.1–9.4 years; Caregivers: Mean=38.76–40.55 years
  • Race/Ethnicity — Children: 121 Hispanic/Latinx, 51 White, 11 African American, 9 Multiracial, 8 Asian/Pacific Islander, and 2 American Indian/Alaskan Native; Caregivers: 53% Hispanic/Latinx, 33% Non-Hispanic White, and 14% Other Minority/Multiracial
  • Gender — Children: 170 Male; Caregivers: 95% Female
  • Status — Participants were therapists from enrolled programs and children from participant therapists’ caseloads.

Location/Institution: 29 publicly funded outpatient and school-based mental health programs in Southern California

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Brookman-Frazee et al. (2019). The purpose of the study was to examine the impact of training therapists to deliver An Individualized Mental Health Intervention for Autism (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes. Participant programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) or the Social Responsiveness Scale, Second Edition (SRS-2), the Wechsler Abbreviated Scale of Intelligence-Second Edition or the Differential Ability Scales (DAS-II), the Parenting Sense of Competence (PSOC) and the Caregiver Strain Questionnaire (CGSQ). Results indicate that a significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months. Limitations include the outcomes measured were limited to caregiver report of strain and competence and caregiver report of child behaviors, and clients/caregivers were not blinded to the condition.

Length of controlled postintervention follow-up: None.

The following studies were not included in rating AIM HI on the Scientific Rating Scale...

Dickson, K. S., Chlebowski, C., Haine-Schlagel, R., Ganger, B., & Brookman-Frazee, L. (2020). Impact of therapist training on parent attendance in mental health services for children with ASD. Journal of Clinical Child and Adolescent Psychology, 51(2), 230–241. https://doi.org/10.1080/15374416.2020.1796682

The study used the same sample as Brookman-Frazee et al. (2019). The purpose of the study was to explore the impact of training therapists in a mental health intervention for children with autism spectrum disorder (ASD) [now called An Individualized Mental Health Intervention for Autism (AIM HI)] on parent attendance in their children’s therapy sessions. Family, therapist, and program factors were also examined as potential moderators. Data were drawn from a cluster-randomized community effectiveness trial of AIM HI. Participant programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Measures utilized include the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) or the Social Responsiveness Scale, Second Edition (SRS-2), the Parenting Sense of Competence (PSOC) and the Caregiver Strain Questionnaire (CGSQ). Results indicate that parents attended a higher percentage of sessions in the AIM HI training condition compared to the usual care condition. Program service setting moderated the effect of AIM HI training, with higher parent attendance in non-school (mostly outpatient) settings compared to school settings and a significantly smaller difference between the settings in the AIM HI condition. Limitations include there is an uneven number of participants by service setting between AIM HI and usual care conditions; no observer reports of parents’ actual level of participation within session, nor any indicators of homework completion; and did not obtain information for the sample as to why the child was served in outpatient vs school-based mental health services. Note: This article was not used for rating An Individualized Mental Health Intervention for Autism (AIM HI) since it does not discuss outcomes relevant to the Developmental and Autism Spectrum Disorder Interventions (Child & Adolescent) topic area.

Hurwich-Reiss, E., Chlebowski, C., Lind, T., Martinez, K., Best, K., & Brookman-Frazee, L. (2021). Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health for children with ASD: Differentiating practice patterns in usual care and AIM HI delivery. Autism 25(6), 1709–1720. https://doi.org/10.1177/13623613211001614

The study used the same sample as Brookman-Frazee et al. (2019). The purpose of the study was to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder within publicly funded mental health services and compare patterns for therapists delivering usual care to those trained in An Individualized Mental Health Intervention for Autism (AIM HI). Participant programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) or the Social Responsiveness Scale. Results indicate that among therapists in the usual care condition, strategies loaded onto the single factor - general strategies, whereas for therapists in the AIM HI training condition, strategies grouped onto two factors - autism engagement strategies, and active teaching strategies. Among usual care therapists, general strategies were associated with an increase in child behavior problems, whereas for AIM HI therapists, active teaching strategies were associated with reductions in child behavior problems over 18 months. Limitations include reliance on self-reported measures, lack of generalizability of results to therapists outside of the current participants. Note: This article was not used for rating An Individualized Mental Health Intervention for Autism (AIM HI) since it does not discuss outcomes relevant to the Developmental and Autism Spectrum Disorder Interventions (Child & Adolescent) topic area.

Brookman-Frazee, L., Chlebowski, C., Villodas, M., Garland, A., McPherson, J., Koenig, Y., & Roesch, S. (2022). The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services. Autism, 26(3), 678–689. https://doi.org/10.1177/13623613211067844

The study used the same sample as Brookman-Frazee et al. (2019). The purpose of the study was to examine therapist outcomes and therapist experience as a moderator of training effects for An Individualized Mental Health Intervention for Autism (AIM HI). Participant mental health programs were randomized to immediate AIM HI training or usual care. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) or the Social Responsiveness Scale. Results indicate that therapists receiving AIM HI training were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more extensively pursued skill building. Therapist licensure moderated some training outcomes. Limitations include may not generalize to child and adolescent mental health services in other geographic areas. Note: This article was not used for rating An Individualized Mental Health Intervention for Autism (AIM HI) since it does not discuss outcomes relevant to the Developmental and Autism Spectrum Disorder Interventions (Child & Adolescent) topic area.

Additional References

Chlebowski, C., Hurwich-Reiss, E., Wright, B., & Brookman-Frazee, L. (2019). Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study. Journal of Community Psychology, 48(4), 1194-1214. https://doi.org/10.1002/jcop.22296

Chlebowski, C., Magaña, S., Wright, B., & Brookman-Frazee, L. (2018). Implementing an Intervention to address challenging behaviors for autism spectrum disorders in publicly funded mental health services: Therapist and parent perceptions of delivery with Latinx families. Cultural Diversity and Ethnic Minority Psychology, 24(4), 552–563. https://doi.org/10.1037/cdp0000215

Dyson, M. W., Chlebowski, C., Wright, B., & Brookman Frazee, L. (2017). How do certified and uncertified therapists differ in their perceptions of a mental health intervention for ASD? Evidence-Based Practice in Child & Adolescent Mental Health, 2(3-4), 179–194. https://doi.org/10.1080/23794925.2017.1389319

Contact Information

Colby Chlebowski, PhD
Agency/Affiliation: University of California, San Diego
Email:
Phone: (858) 966-7703

Date Research Evidence Last Reviewed by CEBC: June 2024

Date Program Content Last Reviewed by Program Staff: August 2022

Date Program Originally Loaded onto CEBC: August 2022