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Wieckowski AT, Ramsey RK, Coulter K, Eldeeb SY, Algur Y, Ryan V, Stahmer AC, Robins DL. Role of Primary Care Clinician Concern During Screening for Early Identification of Autism. J Dev Behav Pediatr 2024:00004703-990000000-00163. [PMID: 38564788 DOI: 10.1097/dbp.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the added value of primary care clinician (PCC)-indicated concern during primary care universal standardized screening in early identification of autism. METHODS Toddlers were screened for autism during primary care checkups (n = 7,039, aged 14.24-22.43 months) in 2 studies. Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. For each participant, PCCs indicated whether they had autism concerns (optional in 1 study-before or after viewing screening results, required before viewing screen results in the other). Children at high likelihood for autism from screen result and/or PCC concern (n = 615) were invited for a diagnostic evaluation; 283 children attended the evaluation. RESULTS Rates of PCC-indicated autism concerns were similar whether PCCs were required or encouraged to indicate concerns. High likelihood of autism indication on both screen and PCC concern resulted in the highest positive predictive value for autism and positive predictive value for any developmental disorder, as well as the highest evaluation attendance, with no significant difference between the positive screen-only and PCC concern-only groups. Although the frequency of PCC-indicated autism concern did not differ significantly based on the child's cognitive level, PCCs were more likely to identify children with more obvious autism characteristics compared with more subtle autism characteristics as having autism. CONCLUSION The findings support the recommendation of the American Academy of Pediatrics that both screening and surveillance for autism be incorporated into well-child visits. High likelihood of autism on either screen or PCC concern should trigger a referral for an evaluation.
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Affiliation(s)
| | | | - Kirsty Coulter
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Sherief Y Eldeeb
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA; and
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA; and
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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Pellecchia M, Mandell DS, Tomczuk L, Marcus SC, Stewart R, Stahmer AC, Beidas RS, Rieth SR, Lawson GM. A mixed-methods evaluation of organization and individual factors influencing provider intentions to use caregiver coaching in community-based early intervention. Implement Sci Commun 2024; 5:17. [PMID: 38414019 PMCID: PMC10900730 DOI: 10.1186/s43058-024-00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Most psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers' intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers' intentions to implement the components of caregiver coaching. METHODS We surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors. RESULTS The associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers' attitudes toward coaching caregivers and their perceptions of caregivers' expectations for service were particularly salient themes related to their use of caregiver coaching. CONCLUSION Results highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.
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Affiliation(s)
- Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA.
| | - David S Mandell
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Liza Tomczuk
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Steven C Marcus
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Rebecca Stewart
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Aubyn C Stahmer
- University of California, Davis, Mind Institute, Sacramento, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sarah R Rieth
- College of Education, San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Gwendolyn M Lawson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Pellecchia M, Mandell DS, Beidas RS, Dunst CJ, Tomczuk L, Newman J, Zeigler L, Stahmer AC. Parent Coaching in Early Intervention for Autism Spectrum Disorder: A Brief Report. J Early Interv 2023; 45:185-197. [PMID: 37655268 PMCID: PMC10469633 DOI: 10.1177/10538151221095860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers' use of parent coaching in an early intervention system. Twenty-five early intervention sessions were coded for fidelity to established caregiver coaching techniques. We found low use of coaching techniques overall, with significant variability in use of coaching across providers. When providers did coach caregivers, they used only a few coaching strategies (e.g., collaboration and in-vivo feedback). Results indicate that targeted training and implementation strategies focused on individual coaching components, instead of coaching more broadly, may be needed to improve the use of individual coaching strategies. A focus on strengthening the use of collaboration and in-vivo feedback may be key to improving coaching fidelity overall.
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Affiliation(s)
- Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania
| | - David S. Mandell
- Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania
| | - Rinad S. Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, & Medicine; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI); Center for Health Incentives and Behavioral Economics (CHIBE);Perelman School of Medicine, University of Pennsylvania
| | | | - Liza Tomczuk
- Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania
| | - Jeannette Newman
- Philadelphia Infant and Toddler Early Intervention, Department of Behavioral Health and Intellectual DisAbility Services
| | - Lisa Zeigler
- Philadelphia Infant and Toddler Early Intervention, Department of Behavioral Health and Intellectual DisAbility Services
| | - Aubyn C. Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California Davis
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4
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de Marchena A, Wieckowski AT, Algur Y, Williams LN, Fernandes S, Thomas RP, McClure LA, Dufek S, Fein D, Stahmer AC, Robins DL. Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity. Autism Res 2023. [PMID: 37084079 DOI: 10.1002/aur.2933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current "waitlist crisis" for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12-53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n = 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result.
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Affiliation(s)
- Ashley de Marchena
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Yasemin Algur
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lashae N Williams
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sherira Fernandes
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca P Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sarah Dufek
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, California, USA
| | - Diana L Robins
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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5
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Pickard K, Wainer A, Broder-Fingert S, Sheldrick RC, Stahmer AC. Overcoming tensions between family-centered care and fidelity within Early Intervention implementation research. Autism 2023; 27:858-863. [PMID: 36317362 DOI: 10.1177/13623613221133641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
LAY ABSTRACT Early Intervention systems provide therapeutic services to families of young children birth to 3 years with developmental delays and are considered a natural access point to services for young children and their families. Research studies in the autism field have been interested in training providers to deliver evidence-based practices in Early Intervention systems to increase access to services for young children with an increased likelihood of being autistic. However, research has often overlooked that Early Intervention systems prioritize family-centered care, an approach to working with families that honors and respects their values and choices and that provides supports to strengthen family functioning. This commentary points out that family-centered care deserves greater attention in research being done in Early Intervention systems. We describe how family-centered care may shape how interventions are delivered, and discuss directions for future research to evaluate the impact of family-centered care alongside intervention delivery.
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6
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Zitter A, Rinn H, Szapuova Z, Avila-Pons VM, Coulter KL, Stahmer AC, Robins DL, Vivanti G. Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism? J Autism Dev Disord 2023; 53:1618-1628. [PMID: 34855051 PMCID: PMC9160204 DOI: 10.1007/s10803-021-05371-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
There is increasing evidence supporting the effectiveness of the Early Start Denver Model (ESDM) for children on the autism spectrum. However, substantial variability in response to the ESDM has been reported across participants. We examined the plausible yet untested hypothesis that variations in the fidelity level of therapists delivering the intervention contribute to variability in children's response to the ESDM. Videotaped sessions (n = 40) of toddlers on the autism spectrum who received the ESDM from trained therapists were coded to obtain measures of therapist fidelity and children's learning in response to the therapists' instruction. Variations in overall fidelity, along with variations in most items included in the ESDM fidelity checklist, contributed to the children's learning response during the sessions.
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Affiliation(s)
- Ashley Zitter
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Hezekiah Rinn
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Zofia Szapuova
- Lekárska Fakulta, UK Bratislava, Špitálska 24, 813 72, Bratislava, Slovakia
| | - Vanessa M Avila-Pons
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, 95817, USA
| | - Kirsty L Coulter
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, 95817, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA.
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
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Stahmer AC, Suhrheinrich J, Rieth SR, Roesch S, Vejnoska S, Chan J, Nahmias A, Wang T. A Waitlist Randomized Implementation Trial of Classroom Pivotal Response Teaching for Students With Autism. Focus Autism Other Dev Disabl 2023; 38:32-44. [PMID: 38605730 PMCID: PMC11008494 DOI: 10.1177/10883576221133486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Classroom Pivotal Response Teaching (CPRT) is a community-partnered adaptation of a naturalistic developmental behavioral intervention identified as an evidence-based practice for autistic children. The current study evaluated student outcomes in a randomized, wait-list controlled implementation trial across classrooms. Participants included teachers (n = 126) and students with autism (n = 308). Teachers participated in 12 hours of didactic, interactive training and additional in-classroom coaching. Generalized Estimating Equations accounted for clustering. Adjusted models evaluated the relative effects of training group, CPRT fidelity, and classroom quality on student outcomes. Results indicate higher CPRT fidelity was associated with greater increases in student learning. Having received CPRT training predicted increased student engagement and greater decreases in reported approach/withdrawal problems. These differences may be linked to the theoretical foundations of CPRT of increasing student motivation and engagement and collaborative adaptation to increase feasibility in schools. Overall, results suggest CPRT may be a beneficial approach for supporting autistic students.
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Affiliation(s)
- Aubyn C. Stahmer
- UC Davis MIND Institute, Sacramento, CA, USA
- Child and Adolescent Services Research Center, CA, USA
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | - Sarah R. Rieth
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | - Scott Roesch
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | - Sarah Vejnoska
- UC Davis MIND Institute, Sacramento, CA, USA
- Child and Adolescent Services Research Center, CA, USA
| | - Janice Chan
- Child and Adolescent Services Research Center, CA, USA
- San Diego State University, CA, USA
| | | | - Tiffany Wang
- Child and Adolescent Services Research Center, CA, USA
- University of California, San Diego, USA
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Aranbarri A, Aizpitarte A, Arranz-Freijo E, Fano E, de Miguel MS, Stahmer AC, Ibarluzea JM. What influences early cognitive development? Family context as a key mediator. Journal of Applied Developmental Psychology 2023. [DOI: 10.1016/j.appdev.2022.101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Stahmer AC, Suhrheinrich J, Yu Y, Melgarejo M, Schetter P, Young GA. Implementation readiness for evidence-based autism practices in school systems. Implement Res Pract 2023; 4:26334895231199465. [PMID: 37790182 PMCID: PMC10486229 DOI: 10.1177/26334895231199465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background The increase in the number of autistic children being identified has led to increased demand on public schools to provide high-quality services. Effectively scaling up evidence-based practice (EBP) use for autistic students is challenging, given the complicated organization of special education. Teachers have significant challenges implementing autism EBP with fidelity. Factors such as implementation leadership and climate and attitudes toward EBP are linked to successful EBP use and may vary at different levels of the education system. Examining mechanisms of successful implementation is a critical step to support scale-up. Method In this observational study, conducted from September 2018 to March 2020, California school personnel (n = 2273) at multiple levels of the system completed surveys related to implementation climate, leadership, and attitudes toward EBP. Data were collected throughout California at the Special Education Local Plan Areas, County Office of Education, and district and school levels from educators and administrators working in public schools supporting autistic students. Multi-level modeling was conducted to characterize implementation readiness. Results Overall, implementation climate and leadership scores are low across levels with regional levels rated more positively than districts or schools. Attitudes toward EBP were moderate, with those working in schools having the poorest ratings and specialists/trainers and related service providers (e.g., speech-language pathologists) having the highest ratings. Conclusions Outcomes provide a unique opportunity to compare implementation factors across organizational levels with a large, statewide sample. These data provide guidance for developing implementation interventions at multiple levels of the education system to increase readiness for effective scale-up of autism EBP in schools. Personnel and leaders at different organizational levels may need differentiated training targeting improved implementation climate and leadership. Personnel within districts and schools may experience a particular benefit from leadership support for EBP implementation.
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Affiliation(s)
- Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis Health Center, Sacramento, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Jessica Suhrheinrich
- Department of Special Education, San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Yue Yu
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis Health Center, Sacramento, CA, USA
| | - Melina Melgarejo
- Department of Special Education, San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Patricia Schetter
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis Health Center, Sacramento, CA, USA
- California Autism Professional Training and Information Network (CAPTAIN)
| | - Greg A Young
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis Health Center, Sacramento, CA, USA
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10
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Suhrheinrich J, Nahmias AS, Yu Y, Melgarejo M, Schetter P, Holt TC, Stahmer AC. Practice-driven research for statewide scale up: Implementation outcomes of the California Autism Professional Training and Information Network. Autism 2022; 26:727-736. [PMID: 35021914 PMCID: PMC8934253 DOI: 10.1177/13623613211068224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Scaling up the use of evidence-based practice (EBP) for autism across service sectors and regions has presented a considerable challenge indicating a clear need for continued development. The California Autism Professional Training and Information Network (CAPTAIN) integrates implementation drivers into specific procedures and methodology as an implementation strategy to support statewide scale up. The current study was designed to evaluate the impact of CAPTAIN on provider-level outcomes including attitude toward, and knowledge, fidelity and use of autism EBPs, and overall classroom quality. Overall, results indicated variability across measures, with some significant differences between CAPTAIN-trained and non-CAPTAIN-trained providers. CAPTAIN-trained providers reported more openness to EBP. Significantly more CAPTAIN-trained direct service providers reported collecting fidelity of implementation data (χ2(2, N = 1515) = 10.95, p = 0.004), collecting student data (χ2(2, N = 1509) = 14.19, p = 0.001), and reported using their primary EBP with “most or all students” (χ2(2, N = 1514) = 11.41, p = 0.003) than providers not trained by CAPTAIN. In summary, these preliminary findings show promise for the efficacy of the CAPTAIN model to increase dissemination and implementation of EBP at the classroom level. Lay abstract Supporting use of evidence-based practice in public service programs for autistic individuals is critical. The California Autism Professional Training and Information Network (CAPTAIN) brings together best practices from intervention and implementation research to support scale up of autism services. The current study was designed to evaluate the impact of CAPTAIN on provider-level outcomes including attitude toward, knowledge, fidelity, and use of autism EBPs and overall classroom quality. Overall, results indicated variability across measures, with some significant differences between CAPTAIN-trained and non-CAPTAIN-trained providers. These preliminary findings show promise for the efficacy of the CAPTAIN model to increase dissemination and implementation of EBP at the classroom level.
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Affiliation(s)
- Jessica Suhrheinrich
- San Diego State University, USA
- Child and Adolescent Services Research Center, USA
| | | | - Yue Yu
- University of California, Davis, USA
| | - Melina Melgarejo
- San Diego State University, USA
- Child and Adolescent Services Research Center, USA
| | | | - Tana C Holt
- San Diego State University, USA
- Child and Adolescent Services Research Center, USA
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11
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Rieth SR, Dickson KS, Ko J, Haine-Schlagel R, Gaines K, Brookman-Frazee L, Stahmer AC. Provider perspectives and reach of an evidence-based intervention in community services for toddlers. Autism 2022; 26:628-639. [DOI: 10.1177/13623613211065535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Best-practice recommendations for young children at high likelihood of autism include active involvement of caregivers in intervention. However, the use of evidence-based parent-mediated interventions in community practice remains limited. Preliminary evidence suggests that Project ImPACT for Toddlers demonstrates positive parent and child outcomes in community settings. Project ImPACT for Toddlers was adapted specifically for toddlers and teaches parents of young children strategies to build their child’s social, communication, and play skills in daily routines. This study reports implementation outcomes from the initial community rollout of Project ImPACT for Toddlers and examines the system-wide intervention reach, with the goal of informing continued community sustainment and scale-up. Participants include 38 community providers who participated in a Project ImPACT for Toddlers’ training study who completed an implementation survey and semi-structured interviews after approximately 3 months of community implementation. Participants perceived the training model as acceptable and appropriate, and identified several strengths of the approach. Interview themes also supported the feasibility, acceptability, and utility of the intervention in community settings. Quantitative findings complemented the thematic results from interviews. Intervention reach data indicate an increasing number of agencies delivering and families receiving Project ImPACT for Toddlers. Efforts to scale-up evidence-based interventions in early intervention should continue to build upon the model of the Bond, Regulate, Interact, Develop, Guide, and Engage Collaborative. Lay abstract Expert recommendations for toddlers who are likely to develop autism include caregivers being actively involved in the services children receive. However, many services available in the community may not follow these recommendations. Evidence suggests that an intervention named Project ImPACT for Toddlers demonstrates positive parent and child outcomes for families in the community. Project ImPACT for Toddlers was designed specifically for toddlers by a group of parents, clinicians, researchers, and funders. It teaches parents of young children strategies to support their child’s development in daily routines. This study reports the perspectives of early intervention providers who learned to use Project ImPACT for Toddlers on whether the intervention was a good fit for their practice and easy to use. The study also examines how many agencies are using Project ImPACT for Toddlers and how many families have received the intervention in the community. The goal of the study is to inform the continued use of Project ImPACT for Toddlers in the community and support offering the intervention in other regions. Participants include 38 community providers who participated in a training study of Project ImPACT for Toddlers and completed a survey and semi-structured interview after approximately 3 months of using Project ImPACT for Toddlers with families. Participants perceived the training model as acceptable and appropriate, and identified the group-based model of training, comprehensive materials, and agency support as strengths of the approach. Survey findings complemented the results from the interviews. Data indicate an increasing number of agencies and families accessing Project ImPACT for Toddlers. Efforts to expand evidence-based intervention in early intervention should continue to build upon the model used for Project ImPACT for Toddlers.
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Affiliation(s)
- Sarah R Rieth
- San Diego State University, USA
- Child and Adolescent Services Research Center (CASRC), USA
| | - Kelsey S Dickson
- San Diego State University, USA
- Child and Adolescent Services Research Center (CASRC), USA
| | - Jordan Ko
- Child and Adolescent Services Research Center (CASRC), USA
| | - Rachel Haine-Schlagel
- San Diego State University, USA
- Child and Adolescent Services Research Center (CASRC), USA
| | | | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center (CASRC), USA
- University of California, San Diego, USA
- Autism Discovery Institute, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Aubyn C Stahmer
- Child and Adolescent Services Research Center (CASRC), USA
- University of California, Davis, USA
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12
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Boyd BA, Stahmer AC, Odom SL, Wallisch A, Matheis M. It's time to close the research to practice gap in autism: The need for implementation science. Autism 2021; 26:569-574. [PMID: 34913394 DOI: 10.1177/13623613211064422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Aranbarri A, Stahmer AC, Talbott MR, Miller ME, Drahota A, Pellecchia M, Barber AB, Griffith EM, Morgan EH, Rogers SJ. Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation. Front Psychiatry 2021; 12:786138. [PMID: 34975582 PMCID: PMC8716593 DOI: 10.3389/fpsyt.2021.786138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022] Open
Abstract
As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.
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Affiliation(s)
- Aritz Aranbarri
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- Child and Adolescent Mental Health Area, Psychiatry and Psychology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
- Child and Adolescent Mental Health Research Group, Psychiatry and Psychology, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Aubyn C. Stahmer
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Meagan R. Talbott
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Marykate E. Miller
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Angela B. Barber
- Department of Communicative Disorders, University of Alabama, Tuscaloosa, AL, United States
| | | | - Elizabeth H. Morgan
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- College of Education, California State University, Sacramento, CA, United States
| | - Sally J. Rogers
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
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Lombardo MV, Busuoli EM, Schreibman L, Stahmer AC, Pramparo T, Landi I, Mandelli V, Bertelsen N, Barnes CC, Gazestani V, Lopez L, Bacon EC, Courchesne E, Pierce K. Pre-treatment clinical and gene expression patterns predict developmental change in early intervention in autism. Mol Psychiatry 2021; 26:7641-7651. [PMID: 34341515 PMCID: PMC8872998 DOI: 10.1038/s41380-021-01239-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022]
Abstract
Early detection and intervention are believed to be key to facilitating better outcomes in children with autism, yet the impact of age at treatment start on the outcome is poorly understood. While clinical traits such as language ability have been shown to predict treatment outcome, whether or not and how information at the genomic level can predict treatment outcome is unknown. Leveraging a cohort of toddlers with autism who all received the same standardized intervention at a very young age and provided a blood sample, here we find that very early treatment engagement (i.e., <24 months) leads to greater gains while controlling for time in treatment. Pre-treatment clinical behavioral measures predict 21% of the variance in the rate of skill growth during early intervention. Pre-treatment blood leukocyte gene expression patterns also predict the rate of skill growth, accounting for 13% of the variance in treatment slopes. Results indicated that 295 genes can be prioritized as driving this effect. These treatment-relevant genes highly interact at the protein level, are enriched for differentially histone acetylated genes in autism postmortem cortical tissue, and are normatively highly expressed in a variety of subcortical and cortical areas important for social communication and language development. This work suggests that pre-treatment biological and clinical behavioral characteristics are important for predicting developmental change in the context of early intervention and that individualized pre-treatment biology related to histone acetylation may be key.
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Affiliation(s)
- Michael V Lombardo
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy.
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.
| | - Elena Maria Busuoli
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Laura Schreibman
- Department of Psychology, University of California, San Diego, La Jolla, CA, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | - Tiziano Pramparo
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA
| | - Isotta Landi
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - Veronica Mandelli
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Natasha Bertelsen
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Cynthia Carter Barnes
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA
| | - Vahid Gazestani
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA
| | - Linda Lopez
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA
| | - Elizabeth C Bacon
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA
| | - Eric Courchesne
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA
| | - Karen Pierce
- Department of Neurosciences, Autism Center of Excellence, University of California, San Diego, La Jolla, CA, USA.
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16
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Gomez E, Drahota A, Stahmer AC. Choosing strategies that work from the start: A mixed methods study to understand effective development of community-academic partnerships. Action Res (Lond) 2021; 19:277-300. [PMID: 34539247 PMCID: PMC8447887 DOI: 10.1177/1476750318775796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Community-academic partnerships are believed to increase the effectiveness and feasibility of action research. While factors facilitating and hindering community-academic partnerships have been identified, their influence on the collaborative process is unknown, especially during community-academic partnership initiation and development. This explanatory sequential mixed methods study (quantitative→QUALITATIVE) evaluated perspectives of members in an autism community-academic partnership to determine frequently endorsed and influential factors facilitating and hindering the collaborative process during the community-academic partnership's development. Participants (n = 11; community stakeholders, implementation scientist, and researchers) endorsed and ranked the importance of factors present in the formation of the community-academic partnership then completed a semi-structured qualitative interview to elaborate on survey responses. Interviews were coded using a coding, comparison, and consensus method and analyzed using the Rapid Assessment Process for frequency and salience of themes across interviews. Integrating mixed methods yielded ranked factors that were perceived to facilitate and hinder the development of the community-academic partnership, and highlighted the relative influence of interpersonal factors on the facilitation of community-academic partnership processes and organizational factors on the hindrance of community-academic partnership processes during development. Some discrepancies emerged between community and academic partners. Results may assist to improve the development of community-academic partnerships, which is becoming increasingly important in healthcare services research, dissemination, and implementation.
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Affiliation(s)
- Emily Gomez
- Department of Psychology, Child and Adolescent Services Research Center, San Diego, USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, USA; Child and Adolescent Services Research Center, San Diego, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Health, UC Davis MIND Institute, University of California, Sacramento, USA; Child and Adolescent Services Research Center, San Diego, USA
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Drahota A, Meza RD, Bustos TE, Sridhar A, Martinez JI, Brikho B, Stahmer AC, Aarons GA. Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study. Adm Policy Ment Health 2021; 48:482-498. [PMID: 32948963 PMCID: PMC8120738 DOI: 10.1007/s10488-020-01084-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Rosemary D Meza
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Tatiana E Bustos
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Jonathan I Martinez
- Department of Psychology, California State University, Northridge, Northridge, CA, USA
| | - Brigitte Brikho
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Aubyn C Stahmer
- Child and Adolescent Services Research Center, San Diego, CA, USA
- MIND Institute, University of California, Davis, Davis, CA, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Abstract
The Early Start Denver Model (ESDM) is an evidence-based early intervention approach for young children with autism spectrum disorder. Although the ESDM is described by its authors as being rooted in applied behavior analysis (ABA), some states, agencies, and scholars consider the ESDM to qualify as ABA practice, whereas others do not. The purpose of this article is to examine the status of the ESDM in relation to the 7 dimensions established by Baer, Wolf, and Risley ("Some Current Dimensions of Applied Behavior Analysis," Journal of Applied Behavior Analysis, 1(1): 91-97, 1968) to define applied behavior-analytic research and intervention, as well as to discuss implications for the field.
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Affiliation(s)
- Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, 3020 Market St., Suite 560, Philadelphia, PA 19104-3734 USA
| | - Aubyn C. Stahmer
- UC Davis MIND Institute, University of California, Davis, 2825 50th St, Sacramento, CA 95817 USA
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Stahmer AC, Rieth SR, Dickson KS, Feder J, Burgeson M, Searcy K, Brookman-Frazee L. Project ImPACT for Toddlers: Pilot outcomes of a community adaptation of an intervention for autism risk. Autism 2020; 24:617-632. [PMID: 31565955 PMCID: PMC7102932 DOI: 10.1177/1362361319878080] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study reports child and family outcomes from a community-based, quasi-experimental pilot trial of Project ImPACT for Toddlers that is a parent-mediated, naturalistic, developmental behavioral intervention for children with or at-risk for autism spectrum disorder developed through a research-community partnership. Community early interventionists delivered either Project ImPACT for Toddlers (n = 10) or Usual Care (n = 9) to families based on Part C assigned provider. Twenty-five families participated, with children averaging 22.76 months old (SD = 5.06). Family and child measures were collected at intake, after 3 months of service, and after a 3-month follow-up. Results indicate significantly greater improvements in positive parent-child interactions for Project ImPACT for Toddlers than usual care families, as well as large, but non-significant, effect sizes for Project ImPACT for Toddlers families in children's social and communication skills.
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Affiliation(s)
- Aubyn C Stahmer
- University of California, Davis, Department of Psychiatry and Behavioral Science, UC Davis Health, MIND Institute
- Child and Adolescent Services Research Center (CASRC)
| | - Sarah R Rieth
- Child and Adolescent Services Research Center (CASRC)
- San Diego State University, Department of Child and Family Development
| | - Kelsey S. Dickson
- Child and Adolescent Services Research Center (CASRC)
- San Diego State University, Department of Child and Family Development
| | - Josh Feder
- Fielding Graduate University, School of Leadership Studies, PhD Program in Infant and Early Childhood Development
- University of California, San Diego, Department of Psychiatry
| | | | - Karyn Searcy
- TERI Crimson Center for Speech & Language
- San Diego State University, School of Speech, Language, and Hearing Sciences
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center (CASRC)
- University of California, San Diego, Department of Psychiatry
- Autism Discovery Institute, Rady Children’s Hospital-San Diego
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Pellecchia M, Beidas RS, Mandell DS, Cannuscio CC, Dunst CJ, Stahmer AC. Parent empowerment and coaching in early intervention: study protocol for a feasibility study. Pilot Feasibility Stud 2020; 6:22. [PMID: 32082608 PMCID: PMC7020349 DOI: 10.1186/s40814-020-00568-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children’s cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-mediated early interventions for ASD is clinician use of parent coaching and occurs when a clinician actively teaches the parent techniques to improve their child’s functioning. Available evidence suggests that community-based EI clinicians rarely coach parents when working with families of these children, although specific barriers to coaching are unknown. This consistent finding points to the need to develop strategies to improve the use of parent coaching in community EI programs. The purpose of this community-partnered study is to iteratively develop and pilot test a toolkit of implementation strategies designed to increase EI clinicians’ use of parent coaching. Methods This study has four related phases. Phase 1: examine how EI clinicians trained in Project ImPACT, an evidence-based parent-mediated intervention, coach parents of children with ASD. Phase 2: identify barriers and facilitators to clinician implementation of parent coaching by administering validated questionnaires to, and conducting semi-structured interviews with, clinicians, parents, and agency leaders. Phase 3: partner with a community advisory board to iteratively develop a toolkit of implementation strategies that addresses identified barriers and capitalizes on facilitators to improve clinician implementation of evidence-based parent coaching. Phase 4: pilot test the feasibility and effectiveness of the implementation strategy toolkit in improving EI clinicians’ use of parent coaching with nine EI clinicians and parent-child dyads using a multiple-baseline-across-participants single-case design. Discussion Completion of these activities will lead to an in-depth understanding of EI clinicians’ implementation of parent coaching in usual practice following training in an evidence-based parent-mediated intervention, barriers to their implementation of parent coaching, a toolkit of implementation strategies developed through an iterative community-partnered process, and preliminary evidence regarding the potential for this toolkit to improve EI clinicians’ implementation of parent coaching. These pilot data will offer important direction for a larger evaluation of strategies to improve the use of parent coaching for young children with ASD.
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Affiliation(s)
- Melanie Pellecchia
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA
| | - Rinad S Beidas
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA.,2Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.,3Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, USA
| | - David S Mandell
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA
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Maddox BB, Rump KM, Stahmer AC, Suhrheinrich J, Rieth SR, Nahmias AS, Nuske HJ, Reisinger EM, Crabbe SR, Bronstein B, Mandell DS. Concordance between a U.S. Educational Autism Classification and the Autism Diagnostic Observation Schedule. J Clin Child Adolesc Psychol 2020; 49:469-475. [PMID: 30892948 PMCID: PMC6754325 DOI: 10.1080/15374416.2019.1567345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
States in the United States differ in how they determine special education eligibility for autism services. Few states include an autism-specific diagnostic tool in their evaluation. In research, the Autism Diagnostic Observation Schedule (ADOS for first edition, ADOS-2 for second edition) is considered the gold-standard autism assessment. The purpose of this study was to estimate the proportion of children with an educational classification of autism who exceed the ADOS/ADOS-2 threshold for autism spectrum (concordance rate). Data were drawn from 4 school-based studies across 2 sites (Philadelphia, Pennsylvania, and San Diego, California). Participants comprised 627 children (2-12 years of age; 83% male) with an autism educational classification. Analyses included (a) calculating the concordance rate between educational and ADOS/ADOS-2 classifications and (b) estimating the associations between concordance and child's cognitive ability, study site, and ADOS/ADOS-2 administration year using logistic regression. More San Diego participants (97.5%, all assessed with the ADOS-2) met ADOS/ADOS-2 classification than did Philadelphia participants assessed with the ADOS-2 (92.2%) or ADOS (82.9%). Children assessed more recently were assessed with the ADOS-2; this group was more likely to meet ADOS/ADOS-2 classification than the group assessed longer ago with the ADOS. Children with higher IQ were less likely to meet ADOS/ADOS-2 classification. Most children with an educational classification of autism meet ADOS/ADOS-2 criteria, but results differ by site and by ADOS version and/or recency of assessment. Educational classification may be a reasonable but imperfect measure to include children in community-based trials.
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Affiliation(s)
- Brenna B. Maddox
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - Keiran M. Rump
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - Aubyn C. Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Davis, CA,Child and Adolescent Services Research Center, San Diego, CA
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center, San Diego, CA,San Diego State University, San Diego, CA
| | - Sarah R. Rieth
- Child and Adolescent Services Research Center, San Diego, CA,San Diego State University, San Diego, CA
| | - Allison S. Nahmias
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Davis, CA
| | - Heather J. Nuske
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - Erica M. Reisinger
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - Samantha R. Crabbe
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - Briana Bronstein
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - David S. Mandell
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
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Nahmias AS, Pellecchia M, Stahmer AC, Mandell DS. Effectiveness of community-based early intervention for children with autism spectrum disorder: a meta-analysis. J Child Psychol Psychiatry 2019; 60:1200-1209. [PMID: 31206690 DOI: 10.1111/jcpp.13073] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Research trials of early intervention (EI) programs for children with autism spectrum disorder (ASD) generally demonstrate medium-to-large gains, on average, compared with "treatment as usual," in different developmental domains. Almost all children with ASD receive their treatment through community-based services, however, and studies suggest that evidence-based interventions rarely make their way into community practice. Understanding the effectiveness of community-based EI and factors associated with these effects is the first step in developing strategies for wide-scale implementation of effective EI. METHODS Studies of community-based EI for children with ASD were identified through a systematic search. Changes in cognitive, communication, social, and adaptive functioning from pre-treatment to post-treatment were assessed using standardized mean gain scores. Effect sizes were estimated using random effects models. Moderators of interest included type of community EI program, year of publication, intervention duration, and sample selection. Moderator effects were assessed using analysis of variance of mixed-effects models and meta-regression analyses. RESULTS Forty-six groups from 33 studies met inclusion criteria (1,713 participants, mean age 37.4 months, 81.1% male). There were small but statistically significant gains in each of the four domains. Hedges's g ranged from 0.21 for adaptive behavior to 0.32 for communication outcomes, after removing outliers and correcting for publication bias. EI programs associated with universities and hospitals were superior, on average, to other community EI programs for cognitive and adaptive behavior outcomes. Intervention duration was negatively associated with effect sizes for communication and adaptive behavior outcomes. CONCLUSIONS These results indicate that there remains a large gap between outcomes observed in community settings and those reported in efficacy trials.
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Affiliation(s)
- Allison S Nahmias
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Melanie Pellecchia
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - David S Mandell
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Stahmer AC, Vejnoska S, Iadarola S, Straiton D, Segovia FR, Luelmo P, Morgan EH, Lee HS, Javed A, Bronstein B, Hochheimer S, Cho E, Aranbarri A, Mandell D, Hassrick EM, Smith T, Kasari C. Caregiver Voices: Cross-Cultural Input on Improving Access to Autism Services. J Racial Ethn Health Disparities 2019; 6:752-773. [PMID: 30859514 PMCID: PMC6936957 DOI: 10.1007/s40615-019-00575-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/17/2019] [Accepted: 02/12/2019] [Indexed: 01/16/2023]
Abstract
Decades of research have established that racial ethnic minority, low-income, and/or non-English speaking children with autism spectrum disorder (ASD) are diagnosed later than white children, and their families experience greater difficulty accessing services in the USA. Delayed access to timely diagnosis and early intervention may impact child outcomes and family quality of life. Despite their cognition of these disparities and their significant impact on the lives of those affected, explanations for the barriers experienced by underserved families are elusive, likely due to the complex interaction between structural and family factors. This study used qualitative methods to gather family and provider perspectives of perceived barriers and facilitators to obtaining an ASD diagnosis and accessing ASD-related services for underserved families. Themes from focus groups and interviews with families from three cultural groups (black, Hispanic/Latino, and Korean) and three primary languages (English, Korean, and Spanish) highlight specific barriers related to family, community, and systemic challenges as well as facilitators to accessing care for these populations. Family experiences are expanded upon with viewpoints from the providers who work with them. Recommendations are made for reducing disparities in the existing ASD service system including increasing professional, family, and community education; increasing culturally responsive care; improving provider-family partnerships; and addressing practical challenges to service access.
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Affiliation(s)
- Aubyn C Stahmer
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA.
| | - Sarah Vejnoska
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
| | - Suzannah Iadarola
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Diondra Straiton
- Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Rm. 3100, Philadelphia, PA, 19104, USA
- Department of Psychology, Michigan State University, 316 Physics, Rd., East Lansing, MI, 48824, USA
| | - Francisco Reinosa Segovia
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
| | - Paul Luelmo
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
- Department of Special Education, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Elizabeth H Morgan
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
| | - Hyon Soo Lee
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
| | - Asim Javed
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Briana Bronstein
- Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Rm. 3100, Philadelphia, PA, 19104, USA
| | - Samantha Hochheimer
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - EunMi Cho
- College of Education, California State University, Sacramento, 6000 J St., Sacramento, CA, 95819, USA
| | - Aritz Aranbarri
- Departments of Psychiatry, Psychology & Human Development, University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
- Mental Health Department, Sant Juan de Deu Barcelona Children's Hospital, Itaka Building 1st floor, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - David Mandell
- Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Rm. 3100, Philadelphia, PA, 19104, USA
| | - Elizabeth McGhee Hassrick
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street | Suite 560, Philadelphia, PA, 19104, USA
| | - Tristram Smith
- Division of Developmental and Behavioral Pediatrics & Strong Center for Developmental Disabilities, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Connie Kasari
- Department of Psychiatry, University of California, Los Angeles Graduate School of Education & Information Studies & Center for Autism Research & Treatment, UCLA Semel Institute 68-268, Los Angeles, CA, 90024, USA
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Stahmer AC, Suhrheinrich J, Roesch S, Zeedyk SM, Wang T, Chan N, Lee HS. Examining relationships between child skills and potential key components of an evidence-based practice in ASD. Res Dev Disabil 2019; 90:101-112. [PMID: 31031082 PMCID: PMC8109189 DOI: 10.1016/j.ridd.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Research in autism spectrum disorders (ASD) has identified a need to understand key components of complex evidence-based practices (EBP). One approach involves examining the relationship between component use and child behavior. AIMS This study provides initial evidence for identifying key components in a specific EBP, Pivotal Response Training (PRT). We examined which components were related to child response and evaluated relationships between provider characteristics, child characteristics and component intensity. METHODS Trained coders reviewed archival videos (n = 278) for PRT fidelity and child behavior. We completed multi-level regression and latent profile analysis to examine relationships between intensity of individual or combinations of PRT components and child behavior, and moderators of component use. RESULTS Analyses indicated differential relationships between specific components and child behaviors which may support methods of altering intensity of components to individualize intervention. Profile analysis suggested relatively intensive use of most PRT components, especially antecedent strategies, may maximize child responsivity. Providers with postgraduate education trended toward higher intensity component use. Child characteristics did not moderate use. IMPLICATIONS Careful examination of key components of ASD interventions may helps clarify the mechanisms of action. Recommendations specific to PRT implementation and use of the methodology for other interventions are discussed.
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Affiliation(s)
- Aubyn C Stahmer
- University of California, Davis MIND Institute and Department of Psychiatry and Behavioral Sciences, 2825 50thSt., Sacramento, CA, 95817, United States; Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States.
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States; San Diego State University, Special Education Department, United States.
| | - Scott Roesch
- Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States; San Diego State University, Psychology Department, United States.
| | - Sasha M Zeedyk
- Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States; California State University, Fullerton, Department of Child and Adolescent Studies, United States.
| | - Tiffany Wang
- Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States; University of California, Psychology Department, San Diego, United States.
| | - Neilson Chan
- Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States.
| | - Hyon Soo Lee
- Child and Adolescent Services Research Center, 3020 Children's Way, MC5033, San Diego, CA 92123, United States.
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Pellecchia M, Iadarola S, Stahmer AC. How meaningful is more? Considerations regarding intensity in early intensive behavioral intervention. Autism 2019; 23:1075-1078. [PMID: 31169024 DOI: 10.1177/1362361319854844] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Stahmer AC, Dababnah S, Rieth SR. Considerations in implementing evidence-based early autism spectrum disorder interventions in community settings. Pediatr Med 2019; 2:18. [PMID: 31565699 PMCID: PMC6764452 DOI: 10.21037/pm.2019.05.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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.
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Brookman-Frazee L, Stahmer AC. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 2018; 13:66. [PMID: 29743090 PMCID: PMC5944167 DOI: 10.1186/s13012-018-0757-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, 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. This project includes 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 intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. METHODS A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. DISCUSSION This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
| | - Aubyn C. Stahmer
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, UC Davis MIND Institute, 2825 50th Street, Sacramento, CA 95817 USA
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Abstract
Cross-informant ratings of are considered gold standard for child behavioral assessment. To date, little work has examined informant ratings of adaptive functioning for youth with autism spectrum disorder (ASD). In a large, diverse sample of youth with ASD, this study evaluated parent-teacher concordance of ratings of adaptive functioning and ASD-specific symptomatology across time. The impact of child clinical characteristics on concordance was also examined. Participants included 246 children, their caregivers and teachers. Parent-teacher concordance was variable but generally consistent across time. Concordance was significantly impacted by autism severity and child cognitive abilities. Findings inform the broader concordance literature and support the need to consider child clinical factors when assessing child functioning in samples of children with ASD.
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Affiliation(s)
- Kelsey S Dickson
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive MC0812, La Jolla, San Diego, CA, 92093, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA.
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA
- San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Sarah R Rieth
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA
- San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Aubyn C Stahmer
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA
- University of California, Davis MIND Institute, 2825 50th Street, Sacramento, CA, 95817, USA
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Abstract
A common theory of autism spectrum disorder (ASD) symptom onset includes toddlers who do not display symptoms until well after age 2, which are termed late-onset ASD cases. Objectives were to analyze differences in clinical phenotype between toddlers identified as ASD at initial evaluations (early diagnosed) versus those initially considered nonspectrum, then later identified as ASD (late diagnosed). Two hundred seventy-three toddlers recruited from the general population based on a failed developmental screening form or parent or physician concerns were followed longitudinally from 12 months and identified as early- and late-diagnosed cases of ASD, language delayed, or typically developing. Toddlers completed common standardized assessments and experimental eye-tracking and observational measures every 9-12 months until age 3. Longitudinal performance on standardized assessments and experimental tests from initial evaluations were compared. Delay in social communication skills was seen in both ASD groups at early-age initial assessment, including increased preference for nonsocial stimuli, increased stereotypic play, reduced exploration, and use of gestures. On standardized psychometric assessments, early-diagnosed toddlers showed more impairment initially while late-diagnosed toddlers showed a slowing in language acquisition. Similar social communication impairments were present at very early ages in both early-detected ASD and so-called late-onset ASD. Data indicate ASD is present whether detected or not by current methods, and development of more sensitive tools is needed.
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Stahmer AC, Suhrheinrich J, Schetter PL, Hassrick EM. Correction to: Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol. Implement Sci 2018; 13:59. [PMID: 29685159 PMCID: PMC5911968 DOI: 10.1186/s13012-018-0750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Aubyn C Stahmer
- University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95819, USA. .,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA. .,Center of Excellence in Developmental Disabilities, University of California, Davis, Sacramento, USA. .,Child and Adolescent Services Research Center, San Diego, USA.
| | - Jessica Suhrheinrich
- College of Education, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA.,Child and Adolescent Services Research Center, San Diego, USA
| | - Patricia L Schetter
- University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA, 95819, USA.,Center of Excellence in Developmental Disabilities, University of California, Davis, Sacramento, USA
| | - Elizabeth McGhee Hassrick
- Life Course Outcomes Research Program at AJ Drexel Autism Institute, Drexel University, 3020 Market St, St 560, Philadelphia, PA, 19104, USA
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Rieth SR, Haine-Schlagel R, Burgeson M, Searcy K, Dickson KS, Stahmer AC. Integrating a Parent-Implemented Blend of Developmental and Behavioral Intervention Strategies into Speech-Language Treatment for Toddlers at Risk for Autism Spectrum Disorder. Semin Speech Lang 2018; 39:114-124. [PMID: 29558767 DOI: 10.1055/s-0038-1627483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Naturalistic developmental behavioral interventions include an explicit focus on coaching parents to use therapy techniques in daily routines and are considered best practice for young children with autism. Unfortunately, these approaches are not widely used in community settings, possibly due to the clinical expertise and training required. This article presents the work of the Bond, Regulate, Interact, Develop, Guide, Engage (BRIDGE Collaborative), a multidisciplinary group of service providers (including speech-language pathologists), parents, funding agency representatives, and researchers dedicated to improving the lives of young children with autism spectrum disorder and their families. The group selected and adapted a parent coaching naturalistic developmental behavioral intervention specifically for use with toddlers and their families for community implementation. Lessons learned from the implementation process include the importance of therapist background knowledge, the complexity of working with parents of young children, and needed supports for those working closely with parents, including specific engagement strategies and the incorporation of reflective practice.
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Affiliation(s)
- Sarah R Rieth
- Child and Adolescent Services Research Center, San Diego.,Department of Child and Family Development; San Diego State University
| | - Rachel Haine-Schlagel
- Child and Adolescent Services Research Center, San Diego.,Department of Child and Family Development; San Diego State University
| | | | - Karyn Searcy
- TERI Crimson Center for Speech and Language.,Speech, Language, and Hearing Sciences, San Diego State University
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego.,Department of Psychiatry, University of California, San Diego
| | - Aubyn C Stahmer
- Child and Adolescent Services Research Center, San Diego.,UC Davis MIND Institute.,Department of Psychiatry and Behavioral Sciences, University of California, Davis
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Stahmer AC, Suhrheinrich J, Schetter PL, McGee Hassrick E. Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol. Implement Sci 2018; 13:3. [PMID: 29310683 PMCID: PMC5759305 DOI: 10.1186/s13012-017-0698-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. METHODS/DESIGN Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure, teachers' ASD experience). Finally, a dynamic social network approach will be used to map EBP-related connectivity across all levels of the system for selected regions. Dynamic network analysis will be used to gauge the degree to which and ways that EBP trainings, resources, and interventions are shared (or not shared) among school staff. DISCUSSION Results are expected to inform the development of system-wide interventions to improve the school-based implementation of EBPs for students with ASD.
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Affiliation(s)
- Aubyn C. Stahmer
- University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA 95819 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA
- Center of Excellence in Developmental Disabilities, University of California, Davis, Sacramento, USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Jessica Suhrheinrich
- College of Education, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182 USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Patricia L. Schetter
- University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA 95819 USA
- Center of Excellence in Developmental Disabilities, University of California, Davis, Sacramento, USA
| | - Elizabeth McGee Hassrick
- Life Course Outcomes Research Program at AJ Drexel Autism Institute, Drexel University, 3020 Market St, St 560, Philadelphia, PA19104 USA
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33
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Stahmer AC, Aranbarri A, Drahota A, Rieth S. Toward a more collaborative research culture: Extending translational science from research to community and back again. Autism 2017; 21:259-261. [DOI: 10.1177/1362361317692950] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, The MIND Institute, University of California Davis, CA, USA
| | - Aritz Aranbarri
- Department of Psychiatry and Behavioral Sciences, The MIND Institute, University of California Davis, CA, USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, MI, USA
| | - Sarah Rieth
- Department of Child and Family Development, San Diego State University, CA, USA
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34
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Stahmer AC, Brookman-Frazee L, Rieth SR, Stoner JT, Feder JD, Searcy K, Wang T. Parent perceptions of an adapted evidence-based practice for toddlers with autism in a community setting. Autism 2016; 21:217-230. [PMID: 27121242 DOI: 10.1177/1362361316637580] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although data from parent-implemented Naturalistic Developmental Behavioral Interventions have shown positive effects on decreasing core symptoms of autism, there has been limited examination of the effectiveness of Naturalistic Developmental Behavioral Interventions in community settings. In addition, parent perspectives of their involvement in parent-implemented early intervention programs have not been well studied. Using both qualitative and quantitative data to examine parent perspectives and the perceived feasibility of parent training by community providers, 13 families were followed as they received training in the Naturalistic Developmental Behavioral Intervention, Project ImPACT. Data indicate that parent training by community providers is feasible and well received, and parents find value in participating in intervention and perceive benefit for their children. Recommendations for adaptation of program elements and future research are discussed.
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Affiliation(s)
- Aubyn C Stahmer
- 1 UC Davis MIND Institute, USA.,2 Child and Adolescent Services Research Center
| | - Lauren Brookman-Frazee
- 2 Child and Adolescent Services Research Center.,3 University of California, San Diego, USA
| | - Sarah R Rieth
- 2 Child and Adolescent Services Research Center.,4 San Diego State University, USA
| | | | - Joshua D Feder
- 2 Child and Adolescent Services Research Center.,3 University of California, San Diego, USA
| | - Karyn Searcy
- 2 Child and Adolescent Services Research Center.,5 Crimson Center for Speech & Language, USA
| | - Tiffany Wang
- 2 Child and Adolescent Services Research Center.,3 University of California, San Diego, USA
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35
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Abstract
A variety of techniques grounded in behavioral psychology, and more specifically in applied behavior analysis, have been established to increase and improve play skills in children with autistic spectrum disorders. This article introduces a set of efficacious methods, which range from highly structured techniques to more naturalistic strategies. It focuses on object play as other authors in the issue discuss social play in greater depth. Behavioral techniques that are reviewed include: discrete trial training, use of stereotyped behaviors to increase play skills, pivotal response training, reciprocal imitation training, differential reinforcement of appropriate behavior, in vivo modeling and play scripts, and video modeling. A discussion of expanding behavior techniques to teach more complex play as well as training in varied environments is also presented. References are provided to allow the reader to obtain more in-depth information about each technique.
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Affiliation(s)
- Aubyn C Stahmer
- Children's Hospital and Health Center, San Diego, USA. astahmer@casrc. org
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36
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Lewis C, Darnell D, Kerns S, Monroe-DeVita M, Landes SJ, Lyon AR, Stanick C, Dorsey S, Locke J, Marriott B, Puspitasari A, Dorsey C, Hendricks K, Pierson A, Fizur P, Comtois KA, Palinkas LA, Chamberlain P, Aarons GA, Green AE, Ehrhart MG, Trott EM, Willging CE, Fernandez ME, Woolf NH, Liang SL, Heredia NI, Kegler M, Risendal B, Dwyer A, Young V, Campbell D, Carvalho M, Kellar-Guenther Y, Damschroder LJ, Lowery JC, Ono SS, Carlson KF, Cottrell EK, O’Neil ME, Lovejoy TL, Arch JJ, Mitchell JL, Lewis CC, Marriott BR, Scott K, Coldiron JS, Bruns EJ, Hook AN, Graham BC, Jordan K, Hanson RF, Moreland A, Saunders BE, Resnick HS, Stirman SW, Gutner CA, Gamarra J, Vogt D, Suvak M, Wachen JS, Dondanville K, Yarvis JS, Mintz J, Peterson AL, Borah EV, Litz BT, Molino A, McCaughan SY, Resick PA, Pandhi N, Jacobson N, Serrano N, Hernandez A, Schreiter EZ, Wietfeldt N, Karp Z, Pullmann MD, Lucenko B, Pavelle B, Uomoto JA, Negrete A, Cevasco M, Kerns SEU, Franks RP, Bory C, Miech EJ, Damush TM, Satterfield J, Satre D, Wamsley M, Yuan P, O’Sullivan P, Best H, Velasquez S, Barnett M, Brookman-Frazee L, Regan J, Stadnick N, Hamilton A, Lau A, Regan J, Hamilton A, Stadnick N, Barnett M, Lau A, Brookman-Frazee L, Stadnick N, Lau A, Barnett M, Regan J, Roesch S, Brookman-Frazee L, Powell BJ, Waltz TJ, Chinman MJ, Damschroder L, Smith JL, Matthieu MM, Proctor EK, Kirchner JE, Waltz TJ, Powell BJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MJ, Proctor EK, Kirchner JE, Matthieu MM, Rosen CS, Waltz TJ, Powell BJ, Chinman MJ, Damschroder LJ, Smith JL, Proctor EK, Kirchner JE, Walker SC, Bishop AS, Lockhart M, Rodriguez AL, Manfredi L, Nevedal A, Rosenthal J, Blonigen DM, Mauricio AM, Dishion TD, Rudo-Stern J, Smith JD, Locke J, Wolk CB, Harker C, Olsen A, Shingledecker T, Barg F, Mandell D, Beidas RS, Hansen MC, Aranda MP, Torres-Vigil I, Hartzler B, Steinfeld B, Gildred T, Harlin Z, Shephard F, Ditty MS, Doyle A, Bickel JA, Cristaudo K, Fox D, Combs S, Lischner DH, Van Dorn RA, Tueller SJ, Hinde JM, Karuntzos GT, Monroe-DeVita M, Peterson R, Darnell D, Berliner L, Dorsey S, Murray LK, Botanov Y, Kikuta B, Chen T, Navarro-Haro M, DuBose A, Korslund KE, Linehan MM, Harker CM, Karp EA, Edmunds SR, Ibañez LV, Stone WL, Andrews JH, Johnides BD, Hausman EM, Hawley KM, Prusaczyk B, Ramsey A, Baumann A, Colditz G, Proctor EK, Botanov Y, Kikuta B, Chen T, Navarro-Haro M, DuBose A, Korslund KE, Linehan MM, Harker CM, Karp EA, Edmunds SR, Ibañez LV, Stone WL, Choy-Brown M, Andrews JH, Johnides BD, Hausman EM, Hawley KM, Prusaczyk B, Ramsey A, Baumann A, Colditz G, Proctor EK, Meza RD, Dorsey S, Wiltsey-Stirman S, Sedlar G, Lucid L, Dorsey C, Marriott B, Zounlome N, Lewis C, Gutner CA, Monson CM, Shields N, Mastlej M, Landy MSH, Lane J, Stirman SW, Finn NK, Torres EM, Ehrhart MG, Aarons GA, Malte CA, Lott A, Saxon AJ, Boyd M, Scott K, Lewis CC, Pierce JD, Lorthios-Guilledroit A, Richard L, Filiatrault J, Hallgren K, Crotwell S, Muñoz R, Gius B, Ladd B, McCrady B, Epstein E, Clapp JD, Ruderman DE, Barwick M, Barac R, Zlotkin S, Salim L, Davidson M, Bunger AC, Powell BJ, Robertson HA, Botsko C, Landes SJ, Smith BN, Rodriguez AL, Trent LR, Matthieu MM, Powell BJ, Proctor EK, Harned MS, Navarro-Haro M, Korslund KE, Chen T, DuBose A, Ivanoff A, Linehan MM, Garcia AR, Kim M, Palinkas LA, Snowden L, Landsverk J, Sweetland AC, Fernandes MJ, Santos E, Duarte C, Kritski A, Krawczyk N, Nelligan C, Wainberg ML, Aarons GA, Sommerfeld DH, Chi B, Ezeanolue E, Sturke R, Kline L, Guay L, Siberry G, Bennett IM, Beidas R, Gold R, Mao J, Powers D, Vredevoogd M, Unutzer J, Schroeder J, Volpe L, Steffen J, Dorsey S, Pullmann MD, Kerns SEU, Jungbluth N, Berliner L, Thompson K, Segell E, McGee-Vincent P, Liu N, Walser R, Runnals J, Shaw RK, Landes SJ, Rosen C, Schmidt J, Calhoun P, Varkovitzky RL, Landes SJ, Drahota A, Martinez JI, Brikho B, Meza R, Stahmer AC, Aarons GA, Williamson A, Rubin RM, Powell BJ, Hurford MO, Weaver SL, Beidas RS, Mandell DS, Evans AC, Powell BJ, Beidas RS, Rubin RM, Stewart RE, Wolk CB, Matlin SL, Weaver S, Hurford MO, Evans AC, Hadley TR, Mandell DS, Gerke DR, Prusaczyk B, Baumann A, Lewis EM, Proctor EK, McWilliam J, Brown J, Tucker M, Conte KP, Lyon AR, Boyd M, Melvin A, Lewis CC, Liu F, Jungbluth N, Kotte A, Hill KA, Mah AC, Korathu-Larson PA, Au JR, Izmirian S, Keir S, Nakamura BJ, Higa-McMillan CK, Cooper BR, Funaiole A, Dizon E, Hawkins EJ, Malte CA, Hagedorn HJ, Berger D, Frank A, Lott A, Achtmeyer CE, Mariano AJ, Saxon AJ, Wolitzky-Taylor K, Rawson R, Ries R, Roy-Byrne P, Craske M, Simmons D, Torrente C, Nathanson L, Carroll G, Smith JD, Brown K, Ramos K, Thornton N, Dishion TJ, Stormshak EA, Shaw DS, Wilson MN, Choy-Brown M, Tiderington E, Smith BT, Padgett DK, Rubin RM, Ray ML, Wandersman A, Lamont A, Hannah G, Alia KA, Hurford MO, Evans AC, Saldana L, Schaper H, Campbell M, Chamberlain P, Shapiro VB, Kim BE, Fleming JL, LeBuffe PA, Landes SJ, Lewis CC, Rodriguez AL, Marriott BR, Comtois KA, Lewis CC, Stanick C, Weiner BJ, Halko H, Dorsey C. Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science : Seattle, WA, USA. 24-26 September 2015. Implement Sci 2016; 11 Suppl 1:85. [PMID: 27357964 PMCID: PMC4928139 DOI: 10.1186/s13012-016-0428-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships Cara Lewis, Doyanne Darnell, Suzanne Kerns, Maria Monroe-DeVita, Sara J. Landes, Aaron R. Lyon, Cameo Stanick, Shannon Dorsey, Jill Locke, Brigid Marriott, Ajeng Puspitasari, Caitlin Dorsey, Karin Hendricks, Andria Pierson, Phil Fizur, Katherine A. Comtois A1: A behavioral economic perspective on adoption, implementation, and sustainment of evidence-based interventions Lawrence A. Palinkas A2: Towards making scale up of evidence-based practices in child welfare systems more efficient and affordable Patricia Chamberlain A3: Mixed method examination of strategic leadership for evidence-based practice implementation Gregory A. Aarons, Amy E. Green, Mark. G. Ehrhart, Elise M. Trott, Cathleen E. Willging A4: Implementing practice change in Federally Qualified Health Centers: Learning from leaders’ experiences Maria E. Fernandez, Nicholas H. Woolf, Shuting (Lily) Liang, Natalia I. Heredia, Michelle Kegler, Betsy Risendal, Andrea Dwyer, Vicki Young, Dayna Campbell, Michelle Carvalho, Yvonne Kellar-Guenther A3: Mixed method examination of strategic leadership for evidence-based practice implementation Gregory A. Aarons, Amy E. Green, Mark. G. Ehrhart, Elise M. Trott, Cathleen E. Willging A4: Implementing practice change in Federally Qualified Health Centers: Learning from leaders’ experiences Maria E. Fernandez, Nicholas H. Woolf, Shuting (Lily) Liang, Natalia I. Heredia, Michelle Kegler, Betsy Risendal, Andrea Dwyer, Vicki Young, Dayna Campbell, Michelle Carvalho, Yvonne Kellar-Guenther A5: Efficient synthesis: Using qualitative comparative analysis and the Consolidated Framework for Implementation Research across diverse studies Laura J. Damschroder, Julie C. Lowery A6: Establishing a veterans engagement group to empower patients and inform Veterans Affairs (VA) health services research Sarah S. Ono, Kathleen F. Carlson, Erika K. Cottrell, Maya E. O’Neil, Travis L. Lovejoy A7: Building patient-practitioner partnerships in community oncology settings to implement behavioral interventions for anxious and depressed cancer survivors Joanna J. Arch, Jill L. Mitchell A8: Tailoring a Cognitive Behavioral Therapy implementation protocol using mixed methods, conjoint analysis, and implementation teams Cara C. Lewis, Brigid R. Marriott, Kelli Scott A9: Wraparound Structured Assessment and Review (WrapSTAR): An efficient, yet comprehensive approach to Wraparound implementation evaluation Jennifer Schurer Coldiron, Eric J. Bruns, Alyssa N. Hook A10: Improving the efficiency of standardized patient assessment of clinician fidelity: A comparison of automated actor-based and manual clinician-based ratings Benjamin C. Graham, Katelin Jordan A11: Measuring fidelity on the cheap Rochelle F. Hanson, Angela Moreland, Benjamin E. Saunders, Heidi S. Resnick A12: Leveraging routine clinical materials to assess fidelity to an evidence-based psychotherapy Shannon Wiltsey Stirman, Cassidy A. Gutner, Jennifer Gamarra, Dawne Vogt, Michael Suvak, Jennifer Schuster Wachen, Katherine Dondanville, Jeffrey S. Yarvis, Jim Mintz, Alan L. Peterson, Elisa V. Borah, Brett T. Litz, Alma Molino, Stacey Young McCaughanPatricia A. Resick A13: The video vignette survey: An efficient process for gathering diverse community opinions to inform an intervention Nancy Pandhi, Nora Jacobson, Neftali Serrano, Armando Hernandez, Elizabeth Zeidler- Schreiter, Natalie Wietfeldt, Zaher Karp A14: Using integrated administrative data to evaluate implementation of a behavioral health and trauma screening for children and youth in foster care Michael D. Pullmann, Barbara Lucenko, Bridget Pavelle, Jacqueline A. Uomoto, Andrea Negrete, Molly Cevasco, Suzanne E. U. Kerns A15: Intermediary organizations as a vehicle to promote efficiency and speed of implementation Robert P. Franks, Christopher Bory A16: Applying the Consolidated Framework for Implementation Research constructs directly to qualitative data: The power of implementation science in action Edward J. Miech, Teresa M. Damush A17: Efficient and effective scaling-up, screening, brief interventions, and referrals to treatment (SBIRT) training: a snowball implementation model Jason Satterfield, Derek Satre, Maria Wamsley, Patrick Yuan, Patricia O’Sullivan A18: Matching models of implementation to system needs and capacities: addressing the human factor Helen Best, Susan Velasquez A19: Agency characteristics that facilitate efficient and successful implementation efforts Miya Barnett, Lauren Brookman-Frazee, Jennifer Regan, Nicole Stadnick, Alison Hamilton, Anna Lau A20: Rapid assessment process: Application to the Prevention and Early Intervention transformation in Los Angeles County Jennifer Regan, Alison Hamilton, Nicole Stadnick, Miya Barnett, Anna Lau, Lauren Brookman-Frazee A21: The development of the Evidence-Based Practice-Concordant Care Assessment: An assessment tool to examine treatment strategies across practices Nicole Stadnick, Anna Lau, Miya Barnett, Jennifer Regan, Scott Roesch, Lauren Brookman-Frazee A22: Refining a compilation of discrete implementation strategies and determining their importance and feasibility Byron J. Powell, Thomas J. Waltz, Matthew J. Chinman, Laura Damschroder, Jeffrey L. Smith, Monica M. Matthieu, Enola K. Proctor, JoAnn E. Kirchner A23: Structuring complex recommendations: Methods and general findings Thomas J. Waltz, Byron J. Powell, Matthew J. Chinman, Laura J. Damschroder, Jeffrey L. Smith, Monica J. Matthieu, Enola K. Proctor, JoAnn E. Kirchner A24: Implementing prolonged exposure for post-traumatic stress disorder in the Department of Veterans Affairs: Expert recommendations from the Expert Recommendations for Implementing Change (ERIC) project Monica M. Matthieu, Craig S. Rosen, Thomas J. Waltz, Byron J. Powell, Matthew J. Chinman, Laura J. Damschroder, Jeffrey L. Smith, Enola K. Proctor, JoAnn E. Kirchner A25: When readiness is a luxury: Co-designing a risk assessment and quality assurance process with violence prevention frontline workers in Seattle, WA Sarah C. Walker, Asia S. Bishop, Mariko Lockhart A26: Implementation potential of structured recidivism risk assessments with justice- involved veterans: Qualitative perspectives from providers Allison L. Rodriguez, Luisa Manfredi, Andrea Nevedal, Joel Rosenthal, Daniel M. Blonigen A27: Developing empirically informed readiness measures for providers and agencies for the Family Check-Up using a mixed methods approach Anne M. Mauricio, Thomas D. Dishion, Jenna Rudo-Stern, Justin D. Smith A28: Pebbles, rocks, and boulders: The implementation of a school-based social engagement intervention for children with autism Jill Locke, Courtney Benjamin Wolk, Colleen Harker, Anne Olsen, Travis Shingledecker, Frances Barg, David Mandell, Rinad S. Beidas A29: Problem Solving Teletherapy (PST.Net): A stakeholder analysis examining the feasibility and acceptability of teletherapy in community based aging services Marissa C. Hansen, Maria P. Aranda, Isabel Torres-Vigil A30: A case of collaborative intervention design eventuating in behavior therapy sustainment and diffusion Bryan Hartzler A31: Implementation of suicide risk prevention in an integrated delivery system: Mental health specialty services Bradley Steinfeld, Tory Gildred, Zandrea Harlin, Fredric Shephard A32: Implementation team, checklist, evaluation, and feedback (ICED): A step-by-step approach to Dialectical Behavior Therapy program implementation Matthew S. Ditty, Andrea Doyle, John A. Bickel III, Katharine Cristaudo A33: The challenges in implementing muliple evidence-based practices in a community mental health setting Dan Fox, Sonia Combs A34: Using electronic health record technology to promote and support evidence-based practice assessment and treatment intervention David H. Lischner A35: Are existing frameworks adequate for measuring implementation outcomes? Results from a new simulation methodology Richard A. Van Dorn, Stephen J. Tueller, Jesse M. Hinde, Georgia T. Karuntzos A36: Taking global local: Evaluating training of Washington State clinicians in a modularized cogntive behavioral therapy approach designed for low-resource settings Maria Monroe-DeVita, Roselyn Peterson, Doyanne Darnell, Lucy Berliner, Shannon Dorsey, Laura K. Murray A37: Attitudes toward evidence-based practices across therapeutic orientations Yevgeny Botanov, Beverly Kikuta, Tianying Chen, Marivi Navarro-Haro, Anthony DuBose, Kathryn E. Korslund, Marsha M. Linehan A38: Predicting the use of an evidence-based intervention for autism in birth-to-three programs Colleen M. Harker, Elizabeth A. Karp, Sarah R. Edmunds, Lisa V. Ibañez, Wendy L. Stone A39: Supervision practices and improved fidelity across evidence-based practices: A literature review Mimi Choy-Brown A40: Beyond symptom tracking: clinician perceptions of a hybrid measurement feedback system for monitoring treatment fidelity and client progress Jack H. Andrews, Benjamin D. Johnides, Estee M. Hausman, Kristin M. Hawley A41: A guideline decision support tool: From creation to implementation Beth Prusaczyk, Alex Ramsey, Ana Baumann, Graham Colditz, Enola K. Proctor A42: Dabblers, bedazzlers, or total makeovers: Clinician modification of a common elements cognitive behavioral therapy approach Rosemary D. Meza, Shannon Dorsey, Shannon Wiltsey-Stirman, Georganna Sedlar, Leah Lucid A43: Characterization of context and its role in implementation: The impact of structure, infrastructure, and metastructure Caitlin Dorsey, Brigid Marriott, Nelson Zounlome, Cara Lewis A44: Effects of consultation method on implementation of cognitive processing therapy for post-traumatic stress disorder Cassidy A. Gutner, Candice M. Monson, Norman Shields, Marta Mastlej, Meredith SH Landy, Jeanine Lane, Shannon Wiltsey Stirman A45: Cross-validation of the Implementation Leadership Scale factor structure in child welfare service organizations Natalie K. Finn, Elisa M. Torres, Mark. G. Ehrhart, Gregory A. Aarons A46: Sustainability of integrated smoking cessation care in Veterans Affairs posttraumatic stress disorder clinics: A qualitative analysis of focus group data from learning collaborative participants Carol A. Malte, Aline Lott, Andrew J. Saxon A47: Key characteristics of effective mental health trainers: The creation of the Measure of Effective Attributes of Trainers (MEAT) Meredith Boyd, Kelli Scott, Cara C. Lewis A48: Coaching to improve teacher implementation of evidence-based practices (EBPs) Jennifer D. Pierce A49: Factors influencing the implementation of peer-led health promotion programs targeting seniors: A literature review Agathe Lorthios-Guilledroit, Lucie Richard, Johanne Filiatrault A50: Developing treatment fidelity rating systems for psychotherapy research: Recommendations and lessons learned Kevin Hallgren, Shirley Crotwell, Rosa Muñoz, Becky Gius, Benjamin Ladd, Barbara McCrady, Elizabeth Epstein A51: Rapid translation of alcohol prevention science John D. Clapp, Danielle E. Ruderman A52: Factors implicated in successful implementation: evidence to inform improved implementation from high and low-income countries Melanie Barwick, Raluca Barac, Stanley Zlotkin, Laila Salim, Marnie Davidson A53: Tracking implementation strategies prospectively: A practical approach Alicia C. Bunger, Byron J. Powell, Hillary A. Robertson A54: Trained but not implementing: the need for effective implementation planning tools Christopher Botsko A55: Evidence, context, and facilitation variables related to implementation of Dialectical Behavior Therapy: Qualitative results from a mixed methods inquiry in the Department of Veterans Affairs Sara J. Landes, Brandy N. Smith, Allison L. Rodriguez, Lindsay R. Trent, Monica M. Matthieu A56: Learning from implementation as usual in children’s mental health Byron J. Powell, Enola K. Proctor A57: Rates and predictors of implementation after Dialectical Behavior Therapy Intensive Training Melanie S. Harned, Marivi Navarro-Haro, Kathryn E. Korslund, Tianying Chen, Anthony DuBose, André Ivanoff, Marsha M. Linehan A58: Socio-contextual determinants of research evidence use in public-youth systems of care Antonio R. Garcia, Minseop Kim, Lawrence A. Palinkas, Lonnie Snowden, John Landsverk A59: Community resource mapping to integrate evidence-based depression treatment in primary care in Brazil: A pilot project Annika C. Sweetland, Maria Jose Fernandes, Edilson Santos, Cristiane Duarte, Afrânio Kritski, Noa Krawczyk, Caitlin Nelligan, Milton L. Wainberg A60: The use of concept mapping to efficiently identify determinants of implementation in the National Institute of Health--President’s Emergent Plan for AIDS Relief Prevention of Mother to Child HIV Transmission Implementation Science Alliance Gregory A. Aarons, David H. Sommerfeld, Benjamin Chi, Echezona Ezeanolue, Rachel Sturke, Lydia Kline, Laura Guay, George Siberry A61: Longitudinal remote consultation for implementing collaborative care for depression Ian M. Bennett, Rinad Beidas, Rachel Gold, Johnny Mao, Diane Powers, Mindy Vredevoogd, Jurgen Unutzer A62: Integrating a peer coach model to support program implementation and ensure long- term sustainability of the Incredible Years in community-based settings Jennifer Schroeder, Lane Volpe, Julie Steffen A63: Efficient sustainability: Existing community based supervisors as evidence-based treatment supports Shannon Dorsey, Michael D Pullmann, Suzanne E. U. Kerns, Nathaniel Jungbluth, Lucy Berliner, Kelly Thompson, Eliza Segell A64: Establishment of a national practice-based implementation network to accelerate adoption of evidence-based and best practices Pearl McGee-Vincent, Nancy Liu, Robyn Walser, Jennifer Runnals, R. Keith Shaw, Sara J. Landes, Craig Rosen, Janet Schmidt, Patrick Calhoun A65: Facilitation as a mechanism of implementation in a practice-based implementation network: Improving care in a Department of Veterans Affairs post-traumatic stress disorder outpatient clinic Ruth L. Varkovitzky, Sara J. Landes A66: The ACT SMART Toolkit: An implementation strategy for community-based organizations providing services to children with autism spectrum disorder Amy Drahota, Jonathan I. Martinez, Brigitte Brikho, Rosemary Meza, Aubyn C. Stahmer, Gregory A. Aarons A67: Supporting Policy In Health with Research: An intervention trial (SPIRIT) - protocol and early findings Anna Williamson A68: From evidence based practice initiatives to infrastructure: Lessons learned from a public behavioral health system’s efforts to promote evidence based practices Ronnie M. Rubin, Byron J. Powell, Matthew O. Hurford, Shawna L. Weaver, Rinad S. Beidas, David S. Mandell, Arthur C. Evans A69: Applying the policy ecology model to Philadelphia’s behavioral health transformation efforts Byron J. Powell, Rinad S. Beidas, Ronnie M. Rubin, Rebecca E. Stewart, Courtney Benjamin Wolk, Samantha L. Matlin, Shawna Weaver, Matthew O. Hurford, Arthur C. Evans, Trevor R. Hadley, David S. Mandell A70: A model for providing methodological expertise to advance dissemination and implementation of health discoveries in Clinical and Translational Science Award institutions Donald R. Gerke, Beth Prusaczyk, Ana Baumann, Ericka M. Lewis, Enola K. Proctor A71: Establishing a research agenda for the Triple P Implementation Framework Jenna McWilliam, Jacquie Brown, Michelle Tucker A72: Cheap and fast, but what is “best?”: Examining implementation outcomes across sites in a state-wide scaled-up evidence-based walking program, Walk With Ease Kathleen P Conte A73: Measurement feedback systems in mental health: Initial review of capabilities and characteristics Aaron R. Lyon, Meredith Boyd, Abigail Melvin, Cara C. Lewis, Freda Liu, Nathaniel Jungbluth A74: A qualitative investigation of case managers’ attitudes toward implementation of a measurement feedback system in a public mental health system for youth Amelia Kotte, Kaitlin A. Hill, Albert C. Mah, Priya A. Korathu-Larson, Janelle R. Au, Sonia Izmirian, Scott Keir, Brad J. Nakamura, Charmaine K. Higa-McMillan A75: Multiple pathways to sustainability: Using Qualitative Comparative Analysis to uncover the necessary and sufficient conditions for successful community-based implementation Brittany Rhoades Cooper, Angie Funaiole, Eleanor Dizon A76: Prescribers’ perspectives on opioids and benzodiazepines and medication alerts to reduce co-prescribing of these medications Eric J. Hawkins, Carol A. Malte, Hildi J. Hagedorn, Douglas Berger, Anissa Frank, Aline Lott, Carol E. Achtmeyer, Anthony J. Mariano, Andrew J. Saxon A77: Adaptation of Coordinated Anxiety Learning and Management for comorbid anxiety and substance use disorders: Delivery of evidence-based treatment for anxiety in addictions treatment centers Kate Wolitzky-Taylor, Richard Rawson, Richard Ries, Peter Roy-Byrne, Michelle Craske A78: Opportunities and challenges of measuring program implementation with online surveys Dena Simmons, Catalina Torrente, Lori Nathanson, Grace Carroll A79: Observational assessment of fidelity to a family-centered prevention program: Effectiveness and efficiency Justin D. Smith, Kimbree Brown, Karina Ramos, Nicole Thornton, Thomas J. Dishion, Elizabeth A. Stormshak, Daniel S. Shaw, Melvin N. Wilson A80: Strategies and challenges in housing first fidelity: A multistate qualitative analysis Mimi Choy-Brown, Emmy Tiderington, Bikki Tran Smith, Deborah K. Padgett A81: Procurement and contracting as an implementation strategy: Getting To Outcomes® contracting Ronnie M. Rubin, Marilyn L. Ray, Abraham Wandersman, Andrea Lamont, Gordon Hannah, Kassandra A. Alia, Matthew O. Hurford, Arthur C. Evans A82: Web-based feedback to aid successful implementation: The interactive Stages of Implementation Completion (SIC)TM tool Lisa Saldana, Holle Schaper, Mark Campbell, Patricia Chamberlain A83: Efficient methodologies for monitoring fidelity in routine implementation: Lessons from the Allentown Social Emotional Learning Initiative Valerie B. Shapiro, B.K. Elizabeth Kim, Jennifer L. Fleming, Paul A. LeBuffe A84: The Society for Implementation Research Collaboration (SIRC) implementation development workshop: Results from a new methodology for enhancing implementation science proposals Sara J. Landes, Cara C. Lewis, Allison L. Rodriguez, Brigid R. Marriott, Katherine Anne Comtois A85: An update on the Society for Implementation Research Collaboration (SIRC) Instrument Review Project
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Affiliation(s)
- Aubyn C Stahmer
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, USA
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center and Department of Psychiatry, School of Medicine, University of California, San Diego, USA
| | - David S Mandell
- Center for Mental Health Policy and Services Research & Department of Psychiatry and Pediatrics, Perlman School of Medicine, University of Pennsylvania, USA
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Drahota A, Meza RD, Brikho B, Naaf M, Estabillo JA, Gomez ED, Vejnoska SF, Dufek S, Stahmer AC, Aarons GA. Community-Academic Partnerships: A Systematic Review of the State of the Literature and Recommendations for Future Research. Milbank Q 2016; 94:163-214. [PMID: 26994713 PMCID: PMC4941973 DOI: 10.1111/1468-0009.12184] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
POLICY POINTS Communities, funding agencies, and institutions are increasingly involving community stakeholders as partners in research, to provide firsthand knowledge and insight. Based on our systematic review of major literature databases, we recommend using a single term, community-academic partnership (CAP), and a conceptual definition to unite multiple research disciplines and strengthen the field. Interpersonal and operational factors that facilitate or hinder the collaborative process have been consistently identified, including "trust among partners" and "respect among partners" (facilitating interpersonal factors) and "excessive time commitment" (hindering operational factor). Once CAP processes and characteristics are better understood, the effectiveness of collaborative partner involvement can be tested. CONTEXT Communities, funding agencies, and institutions are increasingly involving community stakeholders as partners in research. Community stakeholders can provide firsthand knowledge and insight, thereby increasing research relevance and feasibility. Despite the greater emphasis and use of community-academic partnerships (CAP) across multiple disciplines, definitions of partnerships and methodologies vary greatly, and no systematic reviews consolidating this literature have been published. The purpose of this article, then, is to facilitate the continued growth of this field by examining the characteristics of CAPs and the current state of the science, identifying the facilitating and hindering influences on the collaborative process, and developing a common term and conceptual definition for use across disciplines. METHODS Our systematic search of 6 major literature databases generated 1,332 unique articles, 50 of which met our criteria for inclusion and provided data on 54 unique CAPs. We then analyzed studies to describe CAP characteristics and to identify the terms and methods used, as well as the common influences on the CAP process and distal outcomes. FINDINGS CAP research spans disciplines, involves a variety of community stakeholders, and focuses on a large range of study topics. CAP research articles, however, rarely report characteristics such as membership numbers or duration. Most studies involved case studies using qualitative methods to collect data on the collaborative process. Although various terms were used to describe collaborative partnerships, few studies provided conceptual definitions. Twenty-three facilitating and hindering factors influencing the CAP collaboration process emerged from the literature. Outcomes from the CAPs most often included developing or refining tangible products. CONCLUSIONS Based on our systematic review, we recommend using a single term, community-academic partnership, as well as a conceptual definition to unite multiple research disciplines. In addition, CAP characteristics and methods should be reported more systematically to advance the field (eg, to develop CAP evaluation tools). We have identified the most common influences that facilitate and hinder CAPs, which in turn should guide their development and sustainment.
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Affiliation(s)
- Amy Drahota
- San Diego State University
- Child and Adolescent Services Research Center
| | - Rosemary D Meza
- Child and Adolescent Services Research Center
- University of Washington, Seattle
| | - Brigitte Brikho
- San Diego State University
- Child and Adolescent Services Research Center
| | | | | | - Emily D Gomez
- San Diego State University
- Child and Adolescent Services Research Center
| | - Sarah F Vejnoska
- Child and Adolescent Services Research Center
- University of California, San Diego
| | | | - Aubyn C Stahmer
- Child and Adolescent Services Research Center
- University of California, Davis, MIND Institute
| | - Gregory A Aarons
- Child and Adolescent Services Research Center
- University of California, San Diego
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Schreibman L, Dawson G, Stahmer AC, Landa R, Rogers SJ, McGee GG, Kasari C, Ingersoll B, Kaiser AP, Bruinsma Y, McNerney E, Wetherby A, Halladay A. Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J Autism Dev Disord 2016; 45:2411-28. [PMID: 25737021 PMCID: PMC4513196 DOI: 10.1007/s10803-015-2407-8] [Citation(s) in RCA: 499] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. “Naturalistic Developmental Behavioral Interventions (NDBI)” are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.
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Kratz HE, Locke J, Piotrowski Z, Ouellette RR, Xie M, Stahmer AC, Mandell DS. All Together Now: Measuring Staff Cohesion in Special Education Classrooms. J Psychoeduc Assess 2015. [PMID: 26213443 DOI: 10.1177/0734282914554853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to validate a new measure, the Classroom Cohesion Survey (CCS), designed to examine the relationship between teachers and classroom assistants in autism support classrooms. Teachers, classroom assistants, and external observers showed good inter-rater agreement on the CCS and good internal consistency for all scales. Simple factor structures were found for both teacher- and classroom assistant-rated scales, with one-factor solutions for both scales. Paired t tests revealed that on average, classroom assistants rated classroom cohesion stronger than teachers. The CCS may be an effective tool for measuring cohesion between classroom staff and may have an important impact on various clinical and implementation outcomes in school settings.
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Affiliation(s)
| | - Jill Locke
- University of Pennsylvania, Philadelphia, USA
| | | | | | - Ming Xie
- University of Pennsylvania, Philadelphia, USA
| | - Aubyn C Stahmer
- Rady Children's Hospital, San Diego, CA, USA ; University of California, San Diego, USA
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Bush RA, Stahmer AC, Connelly CD. Exploring perceptions and use of the electronic health record by parents of children with autism spectrum disorder: A qualitative study. Health Informatics J 2015; 22:702-11. [PMID: 25989804 DOI: 10.1177/1460458215581911] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative project used structured interviews with nine parents to examine perceptions of the electronic health record (EHR) and associated patient portal in the treatment of their child's autism spectrum disorder. Thematic analysis identified six complementary themes including: Familiarity and exposure to the EHR, changing experience of care (streamlining appointments, providing more rapid medical record access, increasing clinician awareness of the complexity of their child's medical treatment, and facilitating prescriptions), portal use, patient/EHR/portal interaction, interoperability, and mother as care coordinator. While aware of the patient portal, only one-third had registered to use it and these parents reported only limited use. In general, perceptions of the electronic health record are positive, but the patient portal has yet to have needed consumer adoption. Further research and functionality are needed to increase portal registration and greater portal integration in patient care.
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Affiliation(s)
- Ruth A Bush
- Rady Children's Hospital-San Diego, USA; University of San Diego, USA
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Donaldson AL, Stahmer AC. Team collaboration: the use of behavior principles for serving students with ASD. Lang Speech Hear Serv Sch 2015; 45:261-76. [PMID: 25091620 DOI: 10.1044/2014_lshss-14-0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/30/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Speech-language pathologists (SLPs) and behavior analysts are key members of school-based teams that serve children with autism spectrum disorders (ASD). Behavior analysts approach assessment and intervention through the lens of applied behavior analysis (ABA). ABA-based interventions have been found effective for targeting skills across multiple domains for children with ASD. However, some SLPs may be unfamiliar with the breadth of ABA-based interventions. The intent of this tutorial is to briefly introduce key ABA principles, provide examples of ABA-based interventions used within schools, and identify strategies for successful collaboration between behavior analysts and SLPs. METHOD This tutorial draws from empirical studies of ABA-based interventions for children with ASD within school settings, as well as discussions in the extant literature about the use of behavior principles by SLPs and strategies for interdisciplinary collaboration. CONCLUSION Given the prevalence of ASD at 1 in 68 children (Centers for Disease Control and Prevention, 2014) and the high cost of serving these children within schools (an average cost of 286% over regular education; Chambers, Shkolnik, & Perez, 2003), the need for effective, comprehensive service provision and efficiency within interdisciplinary teams is paramount. Communication, mutual understanding, and recognition of common ground between SLPs and behavior analysts can lead to successful collaboration.
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Stahmer AC, Reed S, Lee E, Reisinger EM, Connell JE, Mandell DS. Training Teachers to use Evidence-Based Practices for Autism: Examining Procedural Implementation fidelity. Psychol Sch 2014; 52:181-195. [PMID: 25593374 DOI: 10.1002/pits.21815] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to examine the extent to which public school teachers implemented evidence-based interventions for students with autism in the way these practices were designed. Evidence-based practices for students with autism are rarely incorporated into community settings, and little is known about the quality of implementation. An indicator of intervention quality is procedural implementation fidelity (the degree to which a treatment is implemented as prescribed). Procedural fidelity likely affects student outcomes. This project examined procedural implementation fidelity of three evidence-based practices used in a randomized trial of a comprehensive program for students with autism in partnership with a large, urban school district. Results indicate that teachers in public school special education classrooms can learn to implement evidence-based strategies; however they require extensive training, coaching, and time to reach and maintain moderate procedural implementation fidelity. Procedural fidelity over time, and across intervention strategies is examined.
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Affiliation(s)
- Aubyn C Stahmer
- Child and Adolescent Services Research Center & Autism Discovery Institute, Rady Children's Hospital, San Diego, 3020 Children's Way, MC5033, San Diego, CA 92123 ; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0812, La Jolla, CA 92073-0812
| | - Sarah Reed
- Child and Adolescent Services Research Center & Autism Discovery Institute, Rady Children's Hospital, San Diego, 3020 Children's Way, MC5033, San Diego, CA 92123 ; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0812, La Jolla, CA 92073-0812
| | - Ember Lee
- Child and Adolescent Services Research Center & Autism Discovery Institute, Rady Children's Hospital, San Diego, 3020 Children's Way, MC5033, San Diego, CA 92123
| | - Erica M Reisinger
- Penn Medicine, Dept. of Psychiatry, The Children's Hospital of Philadelphia Center for Autism Research, 3535 Market Street, 8th floor, Philadelphia, PA 19104
| | - James E Connell
- AJ Drexel Autism Institute, 3020 Market Street, Suite 560, Philadelphia, PA 19104
| | - David S Mandell
- Penn Medicine, Dept. of Psychiatry, The Children's Hospital of Philadelphia Center for Autism Research, 3535 Market Street, 8th floor, Philadelphia, PA 19104
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Rieth SR, Stahmer AC, Suhrheinrich J, Schreibman L. Examination of the prevalence of stimulus overselectivity in children with ASD. J Appl Behav Anal 2014; 48:71-84. [PMID: 25418837 DOI: 10.1002/jaba.165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 05/07/2014] [Indexed: 11/12/2022]
Abstract
Many individuals with autism spectrum disorders (ASD) display stimulus overselectivity, wherein a subset of relevant components in a compound stimulus controls responding, which impairs discrimination learning. The original experimental research on stimulus overselectivity in ASD was conducted several decades ago; however, interventions for children with ASD now typically include programming to target conditional discriminations in ways that might minimize the prevalence of stimulus overselectivity. The present study assessed 42 children who had been diagnosed or educationally identified with ASD using a discrimination learning assessment. Of these 42 children, 19% displayed overselective responding, which is a lower percentage than that seen in early research. Possible explanations for this decreased percentage, implications for intervention, and future directions for research are discussed.
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Suhrheinrich J, Stahmer AC, Reed S, Schreibman L, Reisinger E, Mandell D. Implementation challenges in translating pivotal response training into community settings. J Autism Dev Disord 2014; 43:2970-6. [PMID: 23619949 DOI: 10.1007/s10803-013-1826-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Implementing evidence-based practices (EBPs) for children with autism is challenging for teachers because these practices are often complex, requiring significant training and resources that are not available in most school settings. This brief investigation was designed to identify areas of strength and difficulty for teachers implementing one such EBP, pivotal response training (PRT). Observational data were gathered from 41 teachers participating in two separate investigations involving PRT. Despite differences in training procedures, teachers demonstrated similarities in areas of strength (clear opportunities/instruction and child choice) and difficulty (turn taking and multiple cues). These findings suggest next steps toward systematic adaptation of PRT for classroom use. The research may serve as a model for the process of adapting EBPs for practice settings.
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Affiliation(s)
- Jessica Suhrheinrich
- Child and Adolescent Services Research Center, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5033, San Diego, CA, 92123, USA,
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Reed SR, Stahmer AC, Suhrheinrich J, Schreibman L. Stimulus overselectivity in typical development: implications for teaching children with autism. J Autism Dev Disord 2014; 43:1249-57. [PMID: 23065100 DOI: 10.1007/s10803-012-1658-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stimulus overselectivity is widely accepted as a stimulus control abnormality in autism spectrum disorders and subsets of other populations. Previous research has demonstrated a link between both chronological and mental age and overselectivity in typical development. However, the age at which children are developmentally ready to respond to discriminations involving simultaneous multiple cues has not been established. Thirty-seven typically developing preschoolers completed a task requiring response to simultaneous cues (color and shape) to establish the age at which typically developing children can successfully respond to multiple cues. Results demonstrate that typically developing children under 36 months of age have difficulty responding to multiple cues. Implications for behavioral treatment for autism are discussed.
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Affiliation(s)
- Sarah R Reed
- Child and Adolescent Services Research Center, Rady Children's Hospital, 3020 Children's Way, MC 5033, San Diego, CA 92123, USA.
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Abstract
This randomized field trial comparing Strategies for Teaching based on Autism Research and Structured Teaching enrolled educators in 33 kindergarten-through-second-grade autism support classrooms and 119 students, aged 5-8 years in the School District of Philadelphia. Students were assessed at the beginning and end of the academic year using the Differential Ability Scales. Program fidelity was measured through video coding and use of a checklist. Outcomes were assessed using linear regression with random effects for classroom and student. Average fidelity was 57% in Strategies for Teaching based on Autism Research classrooms and 48% in Structured Teaching classrooms. There was a 9.2-point (standard deviation = 9.6) increase in Differential Ability Scales score over the 8-month study period, but no main effect of program. There was a significant interaction between fidelity and group. In classrooms with either low or high program fidelity, students in Strategies for Teaching based on Autism Research experienced a greater gain in Differential Ability Scales score than students in Structured Teaching (11.2 vs. 5.5 points and 11.3 vs. 8.9 points, respectively). In classrooms with moderate fidelity, students in Structured Teaching experienced a greater gain than students in Strategies for Teaching based on Autism Research (10.1 vs. 4.4 points). The results suggest significant variability in implementation of evidence-based practices, even with supports, and also suggest the need to address challenging issues related to implementation measurement in community settings.
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Abstract
BACKGROUND Longitudinal research studies have demonstrated that experienced clinicians using standardized assessment measures can make a reliable diagnosis of autism spectrum disorders (ASDs) in children under age 3. Limited data are available regarding the sensitivity and specificity of these measures in community settings. The aims of this study were to determine how well a standardized diagnostic observational measure (Autism Diagnostic Observation Schedule - ADOS) functions alone, and with a brief parent measure within a community setting when administered by community clinicians. METHODS Clinical records for 138 children between the ages of 24 and 36 months of age who were evaluated for possible ASD or social/language concerns at a hospital-based developmental evaluation clinic were examined. Evaluations were conducted by community-based clinical psychologists. Classification results obtained from standardized diagnostic measures were compared with case reviewer diagnosis, by reviewers blind to scores on diagnostic measures, using The Records-based Methodology for ASD Case Definition that was developed by the Metropolitan Atlanta Developmental Disabilities Surveillance Program. RESULTS When compared with case review diagnosis, the ADOS demonstrated strong sensitivity and specificity for both Autism versus Not Autism and ASD versus Nonspectrum (NS) diagnoses in this young sample. The Social Communication Questionnaire (SCQ), using the lower cutoff of ≥12, had adequate sensitivity when differentiating Autism from Not Autism, but weak sensitivity when differentiating ASD from NS, missing about 80% of the children with pervasive developmental disorder - not otherwise specified. Using either the Modified Checklist for Autism in Toddlers or the SCQ in combination with the ADOS did not result in improved specificity over the ADOS alone and led to a drop in sensitivity when differentiating ASD from NS disorders. CONCLUSIONS These results demonstrate that following best practice guidelines, the ADOS can be successfully incorporated into clinical practice with relatively good sensitivity and specificity, and worked well with a referred sample of 2-year-olds. A parent questionnaire did not lead to any improvement in diagnostic classification above the ADOS used in isolation.
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Affiliation(s)
| | - Natacha Akshoomoff
- University of California, San Diego and Rady Children’s Hospital San Diego
| | - Aubyn C. Stahmer
- Rady Children’s Hospital San Diego and University of California, San Diego
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