Elsevier

Behavior Therapy

Volume 46, Issue 1, January 2015, Pages 54-67
Behavior Therapy

A Tangled Web: The Challenges of Implementing an Evidence-Based Social Engagement Intervention for Children With Autism in Urban Public School Settings

https://doi.org/10.1016/j.beth.2014.05.001Get rights and content

Highlights

  • A social engagement intervention was piloted for children with autism in schools.

  • Qualitative fieldnotes were used to explore barriers to successful implementation.

  • Several consistent school-level barriers to implementation and sustainability emerged.

  • Potential school-level strategies to address these barriers are discussed.

Abstract

There is growing evidence that efficacious autism-related interventions rarely are adopted or successfully implemented in public schools, in part because of the lack of fit between the intervention and the needs and capacities of the school setting. There is little systematic information available regarding the barriers to implementation of complex interventions such as those addressing social engagement for children with autism.The present study used fieldnotes from an implementation trial to explore barriers that emerged during the training of school personnel and subsequent implementation of a social engagement intervention. A number of barriers at the individual (training) and school levels (policies surrounding recess, staffing, prioritization of competing demands, level of respect and support, and availability of resources) interfered with the continued use and sustainment of the intervention. We offer potential strategies to overcome these barriers and provide directions for future research in this critical area.

Section snippets

Participants

Nine children with autism, 9 school staff members (5 one-to-one assistants, 3 noon-time aides, and 1 bus attendant), and 100 typically developing peers from six classrooms in two schools participated. Both schools were located in a large (149,535 students), urban, ethnically and racially diverse district, where nearly 14% of students have a disability and 82% are considered economically disadvantaged. Children with autism were included in this study if they:

  • had a documented diagnosis of autism

Implementation fidelity

Fidelity of implementation was mixed in session notes used to identify barriers to implementation. The average number of completed steps of the intervention as rated by an independent observer (during one recess period when the interventionist was not present) is presented in Figure 1. While school personnel used more components of the intervention as time progressed (adherence), their overall observer-rated quality of program delivery was approximately 50%. The average observer-rated

Discussion

This study used quantitative and qualitative data to (a) describe the implementation fidelity and quality of a social engagement intervention for children with autism; and (b) identify important barriers to implementation in an urban public school district. The results indicated that average implementation adherence fidelity ranged from 0–4 steps out of 7 total; however, over the course of intervention, quality of implementation fidelity improved. The training of the school personnel over the 6 

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

References (44)

  • M. Kretzmann et al.

    Improving peer engagement of children with autism on the school playground: A randomized controlled trial

    Behavior Therapy

    (2015)
  • H.S. Adelman et al.

    Reframing mental health in schools an expanding school reform

    Educational Psychology

    (1998)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • M.S. Atkins et al.

    School-based mental health services in urban communities

  • N. Bauminger et al.

    Loneliness and friendship in high-functioning children with autism

    Child Development

    (2000)
  • N. Bauminger et al.

    Predicting friendship quality in autism spectrum disorders and typical development

    Journal of Autism and Developmental Disorders

    (2010)
  • M. Callegaro

    Social desirability

  • Centers for Disease Control and Prevention.

    Guidelines for school and community programs to promote lifelong physical activity among young people

    Morbidity and Mortality Weekly Report Recommendations and Reports

    (1997)
  • B. Chamberlain et al.

    Involvement or isolation? The social networks of children with autism in regular classrooms

    Journal of Autism and Developmental Disorders

    (2007)
  • K. Charmaz

    Constructing grounded theory: A practical guide through qualitative analysis

    (2006)
  • Council on School Health

    The crucial role of recess in school

    Pediatrics

    (2013)
  • I. Dey

    Grounding grounded theory: Guidelines for qualitative inquiry

    (1999)
  • H.E. Dingfelder et al.

    Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory

    Journal of Autism and Developmental Disorders

    (2011)
  • C.E. Domitrovich et al.

    Maximizing the implementation quality of evidence-based preventive interventions in schools: A conceptual framework

    Advances in School Mental Health Promotion

    (2008)
  • C.D. Elliott

    Differential Ability Scales-Second Edition (DAS-II)

    (2007)
  • S.J. Ferraioli et al.

    Effective educational inclusion of students on the autism spectrum

    Journal of Contemporary Psychotherapy

    (2011)
  • S.G. Forman et al.

    Evidence-based interventions in schools: Developers’ views of implementation barriers and facilitators

    School Mental Health

    (2009)
  • S.G. Forman et al.

    Implementation science and school psychology

    School Psychology Quarterly

    (2013)
  • B.G. Glaser et al.

    The discovery of grounded theory

    (1967)
  • C.B. Harper et al.

    Recess is time-in: Using peers to improve social skills of children with autism

    Journal of Autism and Developmental Disorders

    (2008)
  • J. Henley et al.

    Robbing elementary students of their childhood: The perils of No Child Left Behind

    Education

    (2007)
  • C. Hill et al.

    Consensual qualitative research: An update

  • Cited by (77)

    View all citing articles on Scopus

    This study was funded by an Autism Science Foundation postdoctoral fellowship (Grant # 11-1010), Autism Science Foundation (Grant # 13-ECA-01L) and FARFund Early Career Award granted to the first author as well as grant UA3 MC 11055 AIR-B from the Maternal and Child Health Research Program, Maternal and Child Health Bureau (Combating Autism Act Initiative), Health Resources and Services Administration, Department of Health and Human Services awarded to the sixth author. We thank the children, parents, school personnel and schools who participated and the two research associates who contributed countless hours of assessments and data collection: Laura Macmullen Freeman and Emily Cross.

    View full text