The Centers for Disease Control (CDC) estimates that 1 in 68 children have autism spectrum disorder (CDC, 2014) and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. We propose to conduct two, coordinated studies testing the effectiveness of the ?Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy? (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes ? provider training completion and ASD EBI fidelity, and subsequent child outcomes. The TEAMS? LEAD module applies the LOCI (?Leadership and Organizational Change for Implementation?)1 strategies, and the TEAMS-PROV module applies MI (Motivational Interviewing) strategies to facilitate individual provider and organizational behavior change. These studies will use a randomized implementation/effectiveness Hybrid, Type 3, trial. Study #1 will test the TEAMS model with the AIM HI intervention (?An Individualized Mental Health Intervention for ASD?) in publicly-funded mental health services. Study #2 will test TEAMS with the CPRT intervention (?Classroom Pivotal Response Teaching?) in education settings.
AIM HI and CPRT data indicate that (1) provider attitudes towards EBI and (2) implementation leadership are promising targets of implementation interventions. TEAMS will target these specific mechanisms of change. This study will randomize 37 MH programs and 37 school districts to one of four groups (TEAMS PROV+LEAD; TEAMS- LEAD; TEAMS-PROV; EBI training only) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. A dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Implementation outcomes including provider training completion, fidelity and child behavior change will be examined for 295 MH providers, 295 teachers and 590 children (combined across studies). This implementation intervention has the potential to increase quality of care for ASD in publicly-funded settings by improving effectiveness of EBI implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services.
This study will test the effects of the ?Translating Evidence-based Interventions for ASD: Multi-Level Implementation Strategy? (TEAMS) model on provider training and child outcomes across two evidence-based interventions for autism spectrum disorder (ASD) and in two service systems (mental health, education). Effective methods for improving EBI implementation will increase quality of ASD care across pubic mental health and educational systems.
|Brookman-Frazee, Lauren; Stahmer, Aubyn C (2018) Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 13:66|