It is estimated that 70% of autistic adolescents have at least one co-occurring mental health condition such as anxiety, depression, or OCD. Although schools are the primary setting where autistic adolescents are served, only 11% of high school educators report using evidence-based practices (EBPs) with autistic students. This lack of supports contributes to poor postsecondary outcomes, including persistent mental health challenges and high levels of loneliness and suicidality. Educators often disclose a lack of training in a variety of EBPs to support autistic students and report a desire for training on more comprehensive approaches. Systematic reviews have identified 27 EBPs for autistic youth, which resulted in the creation of Autism Focused Intervention Resources and Modules (AFIRM), a set of online modules for each EBP, spanning a broad set of target areas. Preliminary examination of AFIRM in elementary schools demonstrated increases in educator fidelity to EBPs, as well as student progress; however, the modules have yet to be adapted for the unique needs of autistic adolescents and do not contain components to address the increasing co-occurring mental health concerns present in this population. This project utilizes the DDBT framework to redesign AFIRM content for use in middle and high schools. Iterative quantitative and qualitative methods will be used with n=44 stakeholders to identify usability issues and targets for redesign, and recommendations will be provided for modifications to AFIRM to address the needs of autistic adolescents and educators. This tool would help address the myriad challenges autistic adolescents face, improving their quality of life in secondary education, as well as the likelihood of a positive trajectory throughout adulthood. 

This project has the potential to contribute to more immediate translational benefits for autistic adolescents and educators. Specifically, the redesigned AFIRM aims to provide middle and high school educators with a more comprehensive intervention framework to address the needs of autistic students with co-occurring challenges, while supporting educators’ autonomy in tailoring strategies to individual students. If shown to be feasible and effective, the redesigned AFIRM could help address gaps frequently reported by autistic adolescents, who often describe “falling through the cracks” between the supports they need and those available in schools.  By incorporating a focus on mental health challenges within AFIRM, educators may be better equipped to provide support that goes beyond surface-level views of behaviors of concern. For example, heightened anxiety or frustration may manifest as disruptive behavior in the classroom or difficulty coping with changes in routine. Incorporating a mental health lens may contribute to a more comprehensive and empathetic understanding of the experiences of autistic students. Second, this project employs a user-centered design and implementation science framework, both of which aim to directly meet the needs of key stakeholders, thereby increasing the usability of the intervention in schools. Lastly, the redesigned AFIRM will be readily and freely accessible on an existing, widely utilized website hosted by UNC Chapel Hill.