Proactive versus Reactive: Strategies in the Implementation of School-based Services for Students with ASD.

Autism spectrum disorder (ASD) is increasingly prevalent, intervention costs are high, and long-term outcomes are poor. Proactive implementation of evidence-based practices (EBPs; Steinbrenner et al., Evidence-Based Practices for Children, Youth, and Young Adults with Autism, 2020) through an assessment or planning process can lead to more effective services (Rubin et al., Admin Policy Mental Health Mental Health Serv Res 43(6), 1023-1028, 2016). The objective of this study is (a) to identify factors associated with the use of proactive versus reactive strategies for school-based services for students with ASD and (b) to examine school personnel perceptions of the use of proactive versus reactive strategies. Data were from a larger project in which 6 semi-structured focus groups were conducted to understand school personnel perceptions of how school districts implement new programs for ASD. Transcripts were coded using an iterative coding and review process. In the present study, primary themes were identified and classified as proactive or reactive. Participants reported both proactive and reactive allocation of district resources for intervention implementation. Reactive implementation was associated with litigation or due process, escalated student behavior, and non-public school placement, whereas proactive implementation was associated with ASD-specific programming, grants, personnel experience with EBPs, and prospective needs assessment. Participants perceived the reactive strategies as disadvantageous, and yet these strategies were sometimes still employed. Understanding the role of proactive and reactive strategies and the factors that influence their use could enable more effective planning for EBP use to improve both cost savings and student outcomes. This study is an important first step to explore resource allocation for school-based services for students with ASD.

Implementation of school-based services for students with autism: Barriers and facilitators across urban and rural districts and phases of implementation.

LAY ABSTRACT: The law requires that schools use evidence-based practices to educate students with autism spectrum disorder. However, these practices are often not used, or are not used correctly in school programs. Understanding barriers and facilitators of use of evidence-based practices in schools will help improve the implementation process. This study uses focus groups to characterize how school-based providers representing urban or rural school districts perceive barriers and facilitators for implementing new practices for students with autism spectrum disorder. Guiding questions include the following: (1) Are contextual factors perceived as barriers or facilitators and how do these vary by district location? and (2) What are the key factors impacting implementation across the Exploration, Preparation, Implementation, and Sustainment phases? Focus group participants (n = 33) were service providers to children with autism spectrum disorder from urban- and rural-located school districts. Several personnel-related themes (attitudes and buy-in, knowledge and skills, staffing, and burnout) were shared by participants representing both urban and rural districts. However, some personnel-related themes and organizational factors were unique to rural or urban districts. For example, themes related to system and organizational factors (leadership approval, support and expectations, district structure, competing priorities, time for effective professional development, litigation and due process, and materials and resources) differed between the district locations. This project serves as an initial step in identifying implementation strategies that may improve the use of evidence-based practices in schools.