Improving Substance Use Disorder Treatment Experiences and Outcomes for Autistic Adults using SkillFlix Video-based Microskills Training

ABSTRACT: The rates of diagnosed Autism Spectrum Disorder (ASD) have steadily increased in the U.S. One in 36 children was diagnosed with ASD in 2020 and ASD affects 9 million people. While it has historically been assumed that those with ASD were less likely to experience substance use disorder (SUD), recent studies have shown the frequency of SUD in those with ASD as high as 36%. A large registry study of 27,000 autistic youth and adults found that the odds of SUD in those with ASD were 3.2 times higher than non-ASD controls, with odds increasing to 7.2 times higher for those with co-occurring ASD and ADHD. Despite the increased incidence of SUD, those providing SUD treatment do not typically screen for ASD at even the most basic level of asking if someone is autistic and, if it is disclosed, do not provide specific accommodations or modification of treatment protocols. In addition, autistic individuals are often less skilled in advocating for their treatment needs or articulating their discomfort with certain treatment modalities or need for supports. These can range from simple requests (e.g., turning off florescent lights) to refusing in-patient treatment in favor of outpatient treatment to minimize disruption to daily routines. To address these challenges, this project will develop a series of demonstrative Microskills training videos (modeling videos of 30-120 seconds) designed to improve the communication skills of those working in SUD treatment with a particular focus on autistic clients. This will include communication during intake and treatment as well as knowledge-based content on accommodations and approaches addressing the support needs of autistic clients. Those with ASD experience more health related social needs than the overall population and that can negatively impact their SUD treatment and ongoing success due to stigma, unemployment, higher poverty levels, transportation challenges, and ongoing healthcare needs. To address these challenges the project, in Phase II, will also create video delivered skills training for autistic adults to advocate for their needs with SUD treatment providers and get needed support for health-related social needs. This dual approach – training providers to screen for, adjust communication, and make modifications for autistic clients and advocacy training for autistic adults—is expected to increase support and improve outcomes for autistic adults seeking treatment for SUD. The Phase I project will develop a prototype of SkillFlix ASD: Improving Substance Use Disorder Treatment Experiences and Outcomes for Autistic Adults using SkillFlix Video-based Microskills Training. Phase I development will: 1) utilize a team of expert advisors, including autistic adults who have been through the SUD treatment and recovery process; 2) conduct formative research through focus groups, interviews, and UX research; 3) develop and refine the SkillFlix video education platform; 4) develop content and complete video production for 20 Microskills training videos; and 5) conduct a small study to assess the resource’s effectiveness in changing SUD treatment staff members demonstrated communication skills, confidence, and knowledge in working with autistic clients.