Preliminary study of The Feelings Program for Autistic Adolescents with Mild Intellectual Disability delivered in Aspect Secondary School Classes to explore feasibility, participant experience and the effect on social emotional domains and mental health concurrent with delivery of the adapted Westmead Feelings Program group intervention.

The Feelings Program - Adolescent Version (TFP-A) was adapted from the Westmead Feelings Program (WFP) by the WFP author group for an adolescent target audience, with a diagnosis of autism spectrum disorder and co-occurring mild intellectual disability (ID). In this single arm, within-subjects intervention study, in 2022, TFP-A will be delivered to students enrolled in a secondary autism-specific school-based setting (selected Autism Spectrum Australia (Aspect) Secondary School Classes). Based on previous studies we have conducted in over 65 NSW schools and 8 Aspect Schools, TFP-A will be delivered in classroom groups as part of the normal PDHPE curriculum. A recent study of WFP in Aspect primary schools with children 7-12 years old indicated that it was feasible to conduct the program in the classroom setting and that it helped to fill a gap in the PDHPE curriculum. Furthermore, Aspect Schools also recognised a need for a similar program adapted for secondary school students. Aspect Schools will be asked to nominate school psychologists and teachers to assist in the implementation of TFP-A in their School secondary classes. Previous studies of WFP1 have found that teachers can facilitate the WFP. Aspect staff, including school psychologist, school coordinators and experienced educators will facilitate TFP-A. Teaching staff will also provide positive behaviour support and learning support in their role as co-facilitators. There may be between 3-10 students in each class. All members of the class will be invited to attend the TFP-A sessions. All sessions will be facilitated by a psychologist or experienced educator (with at least 5 years experience working with autistic adolescents with mild ID). The Aspect facilitators will be trained by authors of WFP to become facilitators of TFP-A. Facilitator training will include a total of 10 hours of training (via zoom) held over 3 days. Training will include 7 hours over 2 days in Term 4, 2021 and 3 hours on one day in Term 1, 2022. To pass the training, staff need to achieve 80% or above on an online quiz and demonstrate competence in delivering the program through a 10min video demonstration task. The manualised program provides step by step instructions on how to run the group and includes paper-based and computer-based visual supports and audio-video content. TFP-A consists of 18-20 sessions, each of 60 minute during, held fortnightly. It is expected that the program will start in Term 1, 2022 and will be completed in Term 4, 2022. The booster session will be held in Term 2, 2023. TFP-A is grouped into 3 modules covering 1) identifying and expressing emotions, 2) problem solving and perspective taking and 3) emotional regulation. A booster session will be held 6 months after the last clinical session and is a review and consolidation of the material already covered in the program. The booster session will be for 60 minutes. Co-facilitators will be asked to complete an implementation checklist of during the sessions as a measure of fidelity. In the group intervention sessions student participants will engage in a class lesson which includes watching videos, discussing the content of videos and completing worksheets based on their own examples. For example in lesson 1 students watch a video to learn about good and not-so-good feelings, they then have a class discussion on different good and not-so-good feelings, followed by completing a worksheet that consolidates their learning. They are then asked to complete a worksheet based on their own example. At the end of each lesson students are given takeaway tasks based on the same worksheet. It is expected that worksheet will require 15 minutes to complete, with the support of a parent / carer in the home environment. All worksheets will be reviewed by the facilitators and co-facilitators to ensure that students are completing the worksheets accurately, and that students understand the material being taught. There are consolidation sessions at the end of each module which can provide facilitators time to support additional learning. There are two versions of worksheets available for facilitators to use, a basic version and a more complex version. All students will be provided with both worksheets in the first module, however based on progress and accurate completion of the worksheet, students will be provided with the worksheet that best meets their learning needs in Module 2 and Module 3 (ie reduced cognitive content). TFP-A is held at school in class-time for students, however there is also separate online parent content. The online parent program will include videos, written resources and guidance to develop their skills as emotion coaches for their child. There will also be opportunities for parents to meet with other parents in an online session, facilitated by TFP-A facilitators. The aim of the parent sessions is also to build parent capacity and confidence in supporting their child's emotional needs in a home and community context. This will include using the strategies and language taught in TFP-A. Parents will be invited to attend a face to face session (or online session if required by general health recommendations during the global pandemic) before the commencement of the program (in Term 1, 2022). Parents will be provided training on the purpose of TFP-A and their role as an emotion coach. They will be introduced to the online training program and taught how to access the program and the elements covered over the year in TFP-A. Each fortnight over the course of TFP-A (Term 1, Term 2 and Term 3) parents will be asked to complete short online training modules, each one lasting for 10-30 minutes. There are 10 modules in total covering generalisation of skills in autism, emotion communication, recognising emotion body signs, recognising emotion-based behaviour, linking situations, thoughts and feelings, problem solving, perspective taking and a range of emotion regulation strategies. There will also be an additional 5 modules that focus on the role of the parent regarding parent attunement, modeling emotion regulation, mindfulness, parenting teenagers and trouble shooting. Each online training module will have a learning check with 2-3 questions to assess if a parent has grasped the concepts being taught. Parents will also be asked to attend a group training session at the start of each Term to provide them with additional support and opportunity to practice new skills with the facilitator. Face to face session will be for 1 hour duration. It is asked that parents complete all the online training sessions and attend the 3 face to face parent sessions. Attendance records will be kept of group sessions and progress of online material will be accessed through the learning management system (LMS).