We seek to conduct a pilot effectiveness trial within an implementation trial for improving educational outcomes of children with autism spectrum disorder (ASD). Modeled after a Hybrid Trial Type 2 design [1], our study aims to (a) to create a valid, and locally adapted implementation training strategy leveraging the mechanisms underlying the intervention effects and delivered in priority educational settings located in urban and underserved rural contexts while also (b) considering implementation and maintenance factors impacting training, sensitivity to mechanisms, and adoption/uptake of COMPASS. The study addresses a significant research-to-practice gap that less than 10% of educational strategies for children with ASD are based on evidence [2, 3]. Importantly, consultation methods have a multiplier effect in the efficient and broad dissemination of best practices. This proposal responds to recommendations from the Interagency Autism Coordinating Committee for studies that utilize ?implementation science to test methods to improve implementation of evidence-based treatments (p.41)? and develop and evaluate ?quality measures to help monitor progress in improving care and outcomes for people with ASD (p.41) [4].? Our approach aligns with recommendations from the Institute of Medicine framework for establishing evidence based standards [5] and the goals of this RFA for effectiveness research on therapeutic interventions with previously demonstrated efficacy for use in community settings. The proposed study builds on two completed NIH funded randomized controlled studies (RCTs) [6, 7], a recently published treatment manual [8] and a monograph-length scientific review [9]. The RCTs provided strong support for the efficacy of consulting delivered by the research team to assist public school special educators and parents via face-to-face interactions and through videoconferencing technology [10]. High quality ecological assessments, research-informed goal development, and guided decision-making for individualizing evidence-based interventions for children with ASD are accomplished using the consultation intervention, the Collaborative Model for Promoting Competence and Success (COMPASS) [8]. COMPASS consists of an initial parent-teacher session (3 hours) occurring near the start of the school year, followed by four 1-hour teacher coaching sessions evenly spaced through the rest of the school year. COMPASS assists in creating (1) individualized educationally appropriate, well-constructed, psychometrically- sensitive goals and (2) effective educational plans to meet the goals. Goals and teaching plans take into account the personalized context within which the evidence based interventions will be delivered. The objectives of the current proposal are to evaluate the effectiveness of training local consultants/trainers, including how well the training engages the mechanisms of change (e.g., fidelity) that have been identified and replicated in two RCTs [6,7]. The long-term goal is to improve the quality of services and overall functional and social outcomes of children with ASD when COMPASS is delivered by practitioners.
Our aims are framed with the Replicating Effective Programs (REP) [11] Framework for implementation in community settings.
This application is pilot research that responds to the Interagency Autism Coordinating Committee for studies that utilize ?implementation science to test methods to improve implementation of evidence-based treatments.? High quality ecological assessments, research-informed goal development, and decision-making for individualizing evidence-based interventions for children with ASD is accomplished using the consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS). Specifically, we will create a valid, and locally adapted COMPASS training package; pilot the trainer package; and identify implementation and maintenance factors impacting training, ongoing quality (including mechanisms), and adoption/uptake of COMPASS when delivered by nonexperts.
