Considerations in implementing evidence-based early autism spectrum disorder interventions in community settings

Abstract

Evidence-based practices (EBPs) in early intervention for autism spectrum disorder (ASD) have the potential to improve children’s developmental trajectories and address family needs. However, the successful use of EBPs in community early intervention settings requires careful attention to the context in which services are delivered. Implementation science, and specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model, provides a framework to examine context across multiple levels and identify barriers and facilitators to community EBP use. This article identifies several considerations most relevant for early intervention in ASD at the outer and inner context levels, as well as bridging and innovation factors. Outer context considerations include the policies and funding streams surrounding service delivery, the role of advocacy in shaping the service landscape, the availability of appropriate specialists to provide services, and family cultural characteristics. Inner context factors include the individual characteristics of both the children receiving the service as well as the provider delivering the service, in addition to the leadership and organizational climate surrounding the use of a particular EBP. We also discuss considerations of the specific innovation (in this case, EBP early interventions) to be deployed, as well as bridging factors.

Using Parent Target Problem Narratives to Evaluate Outcomes in Children with Autism Spectrum Disorder

“…The findings of this study are consistent with the push for moving evidence-based interventions into child community mental health settings and the emphasis on incorporating the voice of parents and, when possible, youth on the focus and evaluation of treatment (Weisz et al, 2011;Forrest et al, 2012;Warnick et al, 2014;Stahmer et al, 2019). The PTP documents the top two parental concerns that can also be used to assess change over the course of treatment.…”

Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework

“…While we argue that NDBIs can eventually be theoretically aligned with the goals of neurodiversity, the actual providers implementing NDBIs in the community determine if this aspirational objective is met. To this end, more research needs to be done to explore how NDBIs are translated from a tightly controlled research context into community-based clinical and educational settings (e.g., Stahmer et al, 2017Stahmer et al, , 2019Waters et al, 2020). Conducting this research may be challenging, especially given that clinicians in the community have highly variable levels of education and knowledge of evidence-based practices (Stahmer et al, 2005).…”

Examining the Feasibility and Fit of Family Implemented TEACCH for Toddlers in Rural Settings

“…Certainly, the assessment of these outcomes is necessary; however, this work is an important first step in moving research “from the lab into the community” as recommend by Lord et al (2005). Ensuring that practices are compatible with the local context (e.g., Part-C, rural communities, EI provider preferences) before large-scale implementation and adoption is an important initial step and could potentially improve broader uptake of community-based early ASD interventions (Stahmer et al, 2019). Finally, though FITT was implemented by local EI providers, the training and coaching were provided by research staff, potentially limiting the likelihood of long-term, sustainable use.…”

“…Various factors contribute to this limited uptake and ongoing implementation of ASD-focused intervention models in rural community settings (Stahmer et al, 2019). Children with a current diagnostic status of ASD, and those seeking a diagnosis, who live in rural versus urban areas are more likely to report significant difficulties and delays to obtaining diagnosis and therapies due to lack of available services in their geographical region (Antezana et al, 2017; Elder et al, 2016).…”