1. Supporting the Mental Health Needs of Children with Autism Spectrum Disorders through Education, Disability & Health Partnerships Michelle Wong PhD/DCP Senior Clinical Psychologist, the Children’s Hospital at Westmead

2. Outline Mental health needs of children with Autism Education-disability-health initiatives 1)CHW School-Link 2)Emotion-based Social Skills Training 3)Mental Health and Wellbeing School Clinic 4)Professional Training in Mental Health and Autism

3. Mental Health and ASD Australian Advisory Board on Autism (2012) 100,000 Australians have ASD & mental health issues. GroupPercentage ASD70-75 Intellectual Disability40 Typically Developing14

4. Australian Mental Health Services for People with ASD “People with ASD fall between the cracks of mental health and disability service provision” (Stronger Together: A new direction for disability services 2006-16) “Mental health services tend to exclude people with ID and ASD” (We Belong, 2012)

5. Mental Health Treatment for Children with ASD “In addition to the impact of Autism on children, the mental illnesses they suffer from are of at least the same severity as that of their disability. However, unlike Autism, mental health problems are reversible and preventable.” (A/Prof Dossetor, Senior Child Psychiatrist, Sydney Children’s Hospitals Network Director Mental Health)

6. Mental Health Severity & Autism/ID Dossetor (2016) Mental Health & Well-being Challenging Behaviour Mental Health Problem Mental Illness All services Skill building, self-esteem, autonomy Education & Disability Services Aggression, Self-injury, Stereotypy Paediatrics, Disability, Specialist ASD/ID MH Services ADHD, ODD, Anxiety Mental Health Services Bipolar, Schizophrenia, Major Depression 100% 40-60% 20-40% 3% Hi level collab & expertise

7. Developmental Psychiatry Team Mental Health & Well-being Challenging Behaviour Mental Health Problem Mental Illness CHW School-Link EBSST School Clinic Professional Training Developmental Psychiatry Team

8. NSW-wide Clinical Services -Only dedicated NSW Health MH & ASD/ID team -Inpatient and outpatient quaternary mental health services -Multidisciplinary: psychiatry, psychology, paediatrics, OT, social work, pharmacy -Developmental Psychiatry Clinic (CHW-ADHC-DEC)

9. Developmental Psychiatry Team Education-Disability-Health Partnership Projects 1)CHW School-Link 2)Emotion-based Social Skills Training 3)CHW-Aspect Mental Health & Well- being Pilot School Clinic 4)Professional Training in Mental Health and ASD

10. CHW School-Link www.schoollink.chw.edu.au Promotes mental health of students with ASD/ID in schools. Complex Case Discussion Group Free journal 13 th edition Seminars – 25 per year

11. CHW School-Link www.schoollink.chw.edu.au Pathways to care: enabling local partnerships via advice and support from tertiary disability-health-education expertise TripleP Stepping Stones Evaluation –Parent intervention, 23 schools –Parents: 50% reduction in parental mental illness symptoms –Students: halved emotional & behavioural disturbance symptoms

12. CHW School-Link www.schoollink.chw.edu.au Meet Jessica >500 teachers FRIENDS adaptation for ASD/ID Prevent and treat anxiety and depression

13. Emotion-based Social Skills Training (EBSST, CHW 2010) Inclusive mental health early intervention for students with ASD 16 session therapy program for students, parents & teachers 2-day Facilitator Training Workshop and Certification Controlled trial: EBSST improves child emotional competence, with large effect sizes, at 6-month follow-up and reduces symptoms of anxiety and depression (Ratcliffe, Wong et al., 2014)

15. EBSST Research 2004-200820102012201420152016 Pilot Study HFA&AS outpatients RCT HFA&AS outpatients Pilot Study ASDMildID outpatients Controlled Trial HFA&AS school counsellors in schools Controlled Trial ASDMildID school counsellors in schools Pilot Study ASDMildID in a whole school Pilot Study ASDMildID special educators in support classes Translation Study EBSST in China

16. Aspect EBSST Pilot Study (Wong & Costley, 2016) Aim Evaluate the acceptability and feasibility of EBSST being delivered by special educators to students with ASD/ID in Aspect Schools. Method Two teachers from Aspect satellite classes delivered EBSST to 12 students Feasibility and acceptability assessed via teacher interviews

17. Key Findings EBSST fit naturally into PDHPE sessions Students love the technology (videos) and visuals “The skills in emotional recognition went from zero to large in the group” Skills generalised to the classroom and teacher skills naturally integrated into running classroom discussion, even for those students who hadn’t attended E.g. bullying: “who can think of a way we could solve that problem, about the bullying”

18. Conclusions EBSST is likely to be an acceptable and feasible program for educators to deliver in Aspect schools. Future directions 1.Larger Aspect-CHW EBSST feasibility, acceptability and efficacy study is warranted 2.Aspect-CHW Mental Health and Wellbeing School Clinic

19. Aspect-CHW School Clinic Child Mother Clinical Psychologist Father Psychiatrist/ Paediatrician Teacher Teacher’s aide School therapists Principal Caseworker Intern Clinical Psychologist Grandparent Aspect-CHW Mental Health and Well-being Pilot Clinic (Singhal, Butterworth, Dossetor, & Wong, 2016)

20. Existing NSW School Clinics CHW and NSW School for Specific Purposes Giant Steps School Clinic Kogarah Developmental Assessment Service and Aspect School Clinic www.schoolkit.org.au

21. Aspect-CHW Mental Health and Well-being Pilot Clinic Research Aim 1 Identify the resources required to conduct a monthly Mental Health and Well-being School Clinic. NDIS and Medicare funding.

22. Aspect-CHW Mental Health and Well-being Pilot Clinic Research Aim 2 Identify assessment instruments that can be used in schools to identify children’s mental health needs. Development and Well-being Assessment (DAWBA, Goodman et al. 2000) Online and non-clinical interview forms Cost-effectiveness, e.g. 10,000 children assessed by 300 non-clinical interviewers and 2 clinical raters (British Nationwide Survey, 1999)

23. Professional Training to Meet the Mental Health Needs of Children with Autism in Health, Education & Disability Sectors (Wong, Ratcliffe & Dossetor, 2016) “Lack of knowledge and lack of sector collaboration have contributed to Australia’s mental health services not taking an appropriate level of responsibility for the care of the mental health needs of people with an ASD” (Australian Advisory Board on Autism, 2012)

24. Online EBSST Facilitator Training 100 EBSST Facilitators Government & Non-government Education, Disability, Mental Health sectors EBSST Intervention 500 children 500 parents 500 teachers Efficacy Research Facilitator Research Child emotional competence - Knowledge & skills Child mental health - Collaboration Parental mental health - Embedding in practice Professional Training to Meet the Mental Health Needs of Children with Autism in Health, Education & Disability Sectors Stakeholder Panel

25. Conclusion 70-75% of children with Autism have mental health problems (AABA, 2012). There are great opportunities to improve support for the mental health needs of children with Autism. Increased recognition has led to growing partnerships between education, disability and health sectors.

26. Thank you www.schn.health.nsw.gov.au/EBSSTWestmead Autism ebsst@chw.edu.au@michegracewong Michelle_Wong21drmichellewong