Abstract
Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental disorder. ASD community-based organizations (ASD-CBOs) underutilize or inconsistently utilize evidence-based practices (ASD-EBPs) despite numerous available EBPs to treat ASD. Nonetheless, ASD-CBOs implement changes to practices regularly. Understanding ASD-CBO's implementation-as-usual (IAU) processes may assist to develop strategies to facilitate ASD-EBP adoption, implementation and sustainment. A convergent mixed methods (quan + QUAL) design was utilized. Twenty ASD-CBO agency leaders (ALs) and 26 direct providers (DPs), from 21 ASD-CBOs, completed the Autism Model of Implementation Survey Battery, including demographic and agency IAU process questions. Surveys were analyzed through descriptive and content analyses. A subset of 10 ALs provided qualitative interview data that were analyzed using coding, consensus and comparison methods to allow for a more comprehensive understanding of the IAU process within their ASD-CBOs. Quantitative analyses and qualitative coding were merged utilizing a joint display and compared. Results suggest that the IAU process follows some phases identified in the Exploration, Preparation, Implementation, Sustainment (EPIS) framework but were conducted in an informal manner-lacking specificity, structure and consistency across and within ASD-CBOs. Moreover, data suggest adding a specific adoption decision phase to the framework. Nonetheless, most ALs felt previous implementation efforts were successful. IAU processes were explored to determine whether the implementation process may be an area for intervention to increase ASD-EBP utilization in ASD-CBOs. Developing a systematized implementation process may facilitate broader utilization of high quality ASD-EBPs within usual care settings, and ultimately improve the quality of life for individuals with ASD and their families.
Highlights
Individuals with autism spectrum disorder (ASD) need comprehensive, evidence-based practices (EBPs) across their lifespan
Seventeen agency leaders (ALs) (85%) and 18 DPs (69.2%) reported that direct providers were involved in discussions related to the implementation process for new interventions, whereas 2 ALs (10%) and 8 DPs (30.8%) responded that DPs were not involved in implementation process discussions
Frequency counts by code and group revealed similarities between AL and DP responses related to ASDCBO implementation processes
Summary
Individuals with autism spectrum disorder (ASD) need comprehensive, evidence-based practices (EBPs) across their lifespan. EBPs developed for individuals with ASD (ASD-EBPs) may reduce the prevalence, severity and interference to daily life related to ASD symptoms, comorbid psychiatric disorders and cooccurring challenging behaviors, as well as substantially improving social communication and adaptive skills (National Autism Center, 2015; Wong et al, 2015). EBPs lead to positive health outcomes for many individuals receiving these practices (Wong et al, 2015), with the intended outcomes including reduced symptoms and improved quality of life among individuals with ASD and families. Evidence suggests that many individuals with ASD do not receive ASD-EBPs (Brookman-Frazee, et al, 2012; Pickard et al, 2018) This may be due to the multiple service systems involved (either sequentially or simultaneously) in the care of individuals with ASD (Dingfelder & Mandell, 2011; Hyman et al, 2020). 28 ASD-EBPs addressing a range of behavioral or health outcomes have been identified through recent large-scale systematic reviews
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