Implementation readiness for evidence-based autism practices in school systems.

Background: The increase in the number of autistic children being identified has led to increased demand on public schools to provide high-quality services. Effectively scaling up evidence-based practice (EBP) use for autistic students is challenging, given the complicated organization of special education. Teachers have significant challenges implementing autism EBP with fidelity. Factors such as implementation leadership and climate and attitudes toward EBP are linked to successful EBP use and may vary at different levels of the education system. Examining mechanisms of successful implementation is a critical step to support scale-up. Method: In this observational study, conducted from September 2018 to March 2020, California school personnel (n = 2273) at multiple levels of the system completed surveys related to implementation climate, leadership, and attitudes toward EBP. Data were collected throughout California at the Special Education Local Plan Areas, County Office of Education, and district and school levels from educators and administrators working in public schools supporting autistic students. Multi-level modeling was conducted to characterize implementation readiness. Results: Overall, implementation climate and leadership scores are low across levels with regional levels rated more positively than districts or schools. Attitudes toward EBP were moderate, with those working in schools having the poorest ratings and specialists/trainers and related service providers (e.g., speech-language pathologists) having the highest ratings. Conclusions: Outcomes provide a unique opportunity to compare implementation factors across organizational levels with a large, statewide sample. These data provide guidance for developing implementation interventions at multiple levels of the education system to increase readiness for effective scale-up of autism EBP in schools. Personnel and leaders at different organizational levels may need differentiated training targeting improved implementation climate and leadership. Personnel within districts and schools may experience a particular benefit from leadership support for EBP implementation.

The increase in the number of autistic children being identified in schools is increasing. To address this, schools are trying to do a better job of using high-quality practices based on research. However, teachers have had difficulty using research-based strategies for autistic students the way the manuals indicate they should be used. This might be due to the complexity of the strategies or limited support from special education leadership and infrastructure. Research shows that leaders can be very important in helping teachers use effective strategies. Over 2200 school personnel in California, including administrators, professional development providers, teachers, and paraprofessionals completed surveys asking about how their leaders, schools, districts, and regions supported the use of research practices for autistic students. Overall, limited support is provided in special education, with regional agencies providing more support than districts or schools. These data suggest that school and district leaders need training in how to support educators in using autism-specific strategies.

Practice-driven research for statewide scale up: Implementation outcomes of the California Autism Professional Training and Information Network.

LAY ABSTRACT: Supporting use of evidence-based practice in public service programs for autistic individuals is critical. The California Autism Professional Training and Information Network (CAPTAIN) brings together best practices from intervention and implementation research to support scale up of autism services. The current study was designed to evaluate the impact of CAPTAIN on provider-level outcomes including attitude toward, knowledge, fidelity, and use of autism EBPs and overall classroom quality. Overall, results indicated variability across measures, with some significant differences between CAPTAIN-trained and non-CAPTAIN-trained providers. These preliminary findings show promise for the efficacy of the CAPTAIN model to increase dissemination and implementation of EBP at the classroom level.

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.

Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.

Understanding the factors that influence the use of evidence-based practices (EBPs) for autism spectrum disorder (ASD) in schools is critical to the selection of effective implementation strategies to support their sustained use. The current study has 2 aims: (a) evaluate the association between school leadership profiles (undifferentiated and optimal) and fidelity of EBP implementation and (b) examine the role of implementation climate as a mediator in this association. Participants included 56 principals, 90 special education teachers, and 133 classroom staff from 66 elementary schools. Participants completed the Multifactor Leadership Questionnaire and Implementation Climate Scale. Teachers and staff reported on intensity (frequency) of EBP delivery, and the research team rated the accuracy (adherence) to the components of the EBP. Schools were required to implement at least 1 of 3 EBPs for ASD (discrete trial training, pivotal response training, or visual supports). Using structural equation modeling, we found that schools with optimal leadership had higher observed ratings of teacher and staff fidelity for pivotal response training accuracy (p < .05), but not for discrete trial training or visual supports. However, this association became nonsignificant with the introduction of implementation climate into the models. Optimal leadership profiles were linked to more positive teacher/staff-reported implementation climate, compared with undifferentiated profiles (p < .01), but found no association between implementation climate and fidelity. Overall, the results of this study indicate that the role of principal leadership in EBP implementation is complex, which has implications for fostering a conducive organizational implementation context in schools. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Statewide Interagency Collaboration to Support Evidence-based Practice Scale Up: The California Autism Professional Training and Information Network (CAPTAIN).

The California Autism Professional Training and Information Network (CAPTAIN) is a statewide interagency collaboration with the goal of scaling up use of evidence-based practices (EBPs) for individuals with autism spectrum disorder (ASD). CAPTAIN began as a clinical initiative then further developed under the influence of implementation science methodology. The Exploration, Preparation, Implementation and Sustainment framework (EPIS) has impacted targeted strategy use for this statewide scale up of EBPs by informing the development of key partnerships, implementation goals, and collaborative processes within CAPTAIN. Currently, CAPTAIN has over 407 members representing 140 school and community agencies who provide training and coaching in EBP and meet regularly with regional teams. Outcome data indicate 51.9% of members provide training and coaching to more than three direct service providers/programs per year. Primary barriers to implementation of EBP were time for training (25.6%), lack of substitute teachers (16.5%), and staff lacking foundational skills (11.5%). Facilitators of implementation and sustainment of the CAPTAIN model include active participation in effective dissemination practices, creative funding and leveraging of local resources, development of the regional collaboratives with active membership, member commitment to EBP for ASD, and use of implementation science to identify and overcome barriers. The purpose of this paper is to highlight CAPTAIN as a model for statewide scale up of EBP in schools as well as other community agencies. Although these efforts have focused on EBP for ASD, the concepts, partnerships and procedures will likely be transferable to other focal issues and may be generalized across service sectors.