University-Community Mental Health Training Collaboration: Teaching Criminal Legal Stakeholders About Autism

The Alabama Forensic Assessment Research and Evaluation (FARE) Project is a partnership between the University of Alabama psychology and law faculty and the Alabama Department of Mental Health’s (ADMH’s) Office of Forensic Mental Health Services (OFMHS). Established in 2019, the partnership grew from the ADMH’s focus on improving state forensic services and from university faculty’s expertise in and capacity for addressing forensic practice and policy needs. FARE is a community-based practice, research, and teaching collaboration, primarily conducted in the state’s psychiatric and forensic hospitals. FARE is funded by the ADMH (approximately $160,000 annually). Project members supervise the university’s trainee inpatient forensic clinic and hospital testing service, provide competency restoration and psychotherapy, conduct quality assurance and improvement to inform the ADMH’s expedient delivery of effective and efficient evidence-informed practice, codesign and implement programming with ADMH stakeholders, write grants to support ADMH forensic services, and conduct stakeholder trainings, all guided by the OFMHS director (V.S.-A.). This training series was FARE’s first for ADMH (i.e., nonuniversity) staff.

Training program facilitators should maximize participant access and engagement. Recorded, on-demand training materials increased accessibility for remote rural staff and for those unable to attend synchronously. Facilitators should consider this modality to reach larger audiences and should attend to evolving best practices for remote pedagogy. To incentivize participation and quality improvement, continuing education credits should be awarded following completion of all workshop activities and of postworkshop surveys.

A team approach enriched the training. FARE codirectors recognized the limitations of their expertise and the importance of including collaborators (e.g., an expert on ASD). Facilitators should also work with community partners, whose organization structure and cultural factors may influence goals, and adapt the training according to feedback. For example, following module 1, the OFMHS director prioritized immediate skill building to support current patients, specifically those patients originally identified by the treatment teams. FARE facilitators then incorporated more skill building into the curriculum, using hypothetical case patients with needs similar to those of the forensic facility’s current autistic patients. Our training team did not include additional OFMHS staff and experts by experience; overlooking lived experience was an important limitation of our training development and facilitation.

Future workshops should target behavioral health care supervisors who can continually coach providers under their purview after the training series is complete. Learning occurs through rehearsal, and providers and staff may need reminders to use specific skills during interactions with autistic patients and feedback to refine their application of ASD knowledge. Autistic people often need consistency and predictability to function well, and all facility staff should have access to training and strive to meet such needs. Staff misunderstandings about ASD can have important impacts on autistic patients. For example, if staff do not know that an individual is sensitive to sound and this individual becomes agitated in a noisy room, staff may believe that this individual requires as-needed medication rather than behavioral support. Reactions and interventions that differ across staff may exacerbate the anxiety associated with ASD. Thus, institutions may want to consider ASD-specific facility-wide practices and standards of care.

We identified a specific need for student training. Most graduate programs do not train students to translate clinical science for stakeholders outside the academic setting, such as mental health technicians. Such training is key to effective communication of implementation science, however, and we plan to provide similar experiences for future graduate trainees.

Our training program had some limitations, including its small sample size; unstructured survey responses; and lack of a diversity component, evidence-based outcome assessments, qualitative components, and follow-up training. Still, we hope our training collaboration can provide one example of how universities can engage with local stakeholders. We encourage behavioral health providers to explore local university expertise via faculty Web pages and word of mouth and to connect with like-minded professionals to facilitate services and training.

This collaboration demonstrated important steps in goal setting and team building. Two of FARE’s strengths were displayed: open communication and the ability to adapt to OFMHS’s needs. These strengths were essential for our collaboration’s training development and execution. A misstep was that faculty initially envisioned a broad ASD training, rather than one addressing immediate patient needs. FARE’s academic arm delivered the training and overlooked the OFMHS director’s prime intention: skill development that could benefit patients right away. In the future, university staff will recognize their role in facilitating system-level and case-level services with the ADMH. Another mistake was the lack of perspective from individuals with lived experience of ASD and from diverse staff during training development. FARE, as well as other collaborations interested in workforce development, must incorporate these voices in the future.

Results from this pilot program suggested that our collaborative ASD training series geared toward diverse stakeholders promoted participants’ knowledge about ASD and perceived capacity to effectively work with autistic individuals. We encourage universities to partner with criminal legal stakeholders on efforts that deliver new knowledge, enrich community-based partnerships, encourage translation of research into practice, and ultimately promote recovery for autistic individuals, a population that is disproportionately involved in the criminal legal system. Individuals motivated to pursue this work should refer to ASD organizations and other developmental disorder organizations and resources, such as the National Association of State Directors of Developmental Disabilities Services and the Administration for Community Living, for technical assistance in improving support for people with co-occurring intellectual or developmental disabilities and mental illness (10).