Coordinated Care and Implementation of Evidence-Based Practices during the Transition from Inpatient Care back to Home and Community Settings
This project was in collaboration with an inpatient care setting that provided medicine and behavioral stabilization for clients with autism spectrum disorder (ASD) or other developmental disabilities exhibiting severe behavior problems and/or low level of functioning in their daily lives.
My group specifically worked with clients’ family, school, and community providers to prepare for the client to transition back to their home and community; we followed the clients’ support system for one year following discharge. My group not only provided knowledge and training of evidence-based practices, but also assistance in utilizing needed resources and services within the local community. Data collection and analysis played a significant role in tracking progress and identifying the unique needs for each client, allowing for customizing the intervention and providing the best support and training possible.
Participants: 105 adolescents between 12 and 17 years of age, along with their family, school and community systems.
Procedures: Respondents completed surveys about client functioning and behavior prior to inpatient admission, as well as 1 week, 1 month, 3 months, 6 months, and 12 months following discharge from the inpatient care setting. Observational data on the implementation of evidence-based practices was collected weekly during home and school visits for the first 3 months, and then monthly for the remainder of the year.
Analytical Software: Participant data was collected and managed using REDCap. Data mining was conducted in Cerner, and Microsoft Excel, SPSS, Python, and Power BI were used for data analysis.
Sample Analysis 1 examined how client behavior and functioning was prior to admission and one year following discharge. While data was examined on an individual client level, the following data visualizations provided insight into how the intervention was progressing overall.
The Aberrant Behavior Checklist (2nd Ed) is standardized assessment to measure problem behaviors of individuals with ASD and other developmental disabilities on 5 domains: Irritability, Social Withdrawal, Stereotypic Behavior, Noncompliance, and Inappropriate Speech.
The aggregated ABC-2 scores indicated that clients exhibited a reduction in problem behaviors across all 5 domains compared to pre-admission levels.
The Developmental Disabilities Modifications of Children’s Global Assessment Scale (DD-CGAS) measures overall functioning in different domains: Self-care, Communication, Social Behavior, and School/Academics. This was completd by trained observers who visited the client’s home, school, and community settings.
The aggregated DD-CGAS scores indicated an increase in functioning overall and across the four domains; this improvement was sustained post discharge.
The ABC-2 and DD-CGAS assessments were in combination with other surveys, observations, and interviews to guide the implementation of evidence-based practices, as well as identify and address any obstacles or limitations faced by the home, school, or community systems.
Sample Analysis 2 focused on data mining electronic medical records to contextualize and elaborate client profile. Information gleamed included co-morbid clinical and medical diagnoses, pregnancy and birth complications, family medical history, and home environment.
This information was combined with the surveys, observations and interviews to present compelling client narrative and success stories to diverse stakeholders and potential collaborators.
Key Takeaways:
The current project did yield positive results for a subset of clients, but there were others who continued to struggle throughout the intervention. There was also high attrition rate in survey responses, perhaps to the reported burden of families already under a great deal of stress with the client integrating themselves into the family, school and community systems. This project illustrated some of the obstacles of working with a vulnerable population and the significant role data-driven insights and recommendations in community-based research projects.
Check out the following poster presentation to dive deeper into how this project examined client problem behavior geospatially and specifically in home and school settings: