Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2018

Open Access 01-12-2018 | Study protocol

Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials

Authors: Lauren Brookman-Frazee, Aubyn C. Stahmer

Published in: Implementation Science | Issue 1/2018

Login to get access

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.
Literature
1.
Baio J, Wiggins L, Christensen DL, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ 2018;67(No. SS-6):1–23. https://​doi.​org/​10.​15585/​mmwr.​ss6706a1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Aarons GA, Ehrhart MG, Torres E. Linking team level implementation leadership and implementation climate to individual level provider attitudes, behaviors, and implementation outcomes.  Proceedings from the 8th Annual Conference on the Science of Dissemination & Implementation; Implement Sci. 2016;11(Suppl 2):100. https://​doi.​org/​10.​1186/​s13012-016-0452-0. 
15.
16.
17.
18.
19.
20.
21.
22.
23.
Humphries TL. Effectiveness of pivotal response training as a behavioral intervention for young children with autism spectrum disorders. Bridges: Practice-Based Research Syntheses. 2003;2(4):1–9.
24.
25.
26.
27.
28.
29.
30.
31.
Stahmer AC. Teaching symbolic play skills to children with autism using pivotal response training. J Autism Dev Disord. 1995;25(2):123–41.PubMedCrossRef
32.
33.
34.
35.
36.
37.
Montes G, Halterman JS, Magyar CI. Access to and satisfaction with school and community health services for children with autism: national overview. Pediatrics. 2009;124:S407–S13.PubMedCrossRef
38.
39.
40.
Dyson MW, Chlebowski C, Wright BM, Brookman-Frazee L. Implementing a package of evidence-based strategies in community mental health programs for children with autism spectrum disorder: Therapist perspectives on training and delivery. under review.
41.
Stahmer AC, Suhrheinrich J, Reith S. A pilot examination of the adapted protocol for classroom pivotal response teaching. Journal of the American Academy of Special Education Professionals. 2016;Win 2016:119–39.
42.
43.
44.
Brookman-Frazee L, Drahota A. An individualized mental health intervention for children with autism spectrum disorders (AIM HI): a model to address challenging behaviors in children with ASD—A therapist manual. San Diego: University of California, San Diego; 2010.
45.
46.
47.
48.
49.
50.
51.
52.
53.
Lyon AR, Ludwig K, Romano E, Leonard S, Stoep AV, McCauley E. “If it’s worth my time, I will make the time”: school-based providers’ decision-making about participating in an evidence-based psychotherapy consultation program. Admin Pol Ment Health. 2013;40(6):467–81. https://​doi.​org/​10.​1007/​s10488-013-0494-4.CrossRef
54.
Aarons GA, Ehrhart MG, Farahnak LR, Hurlburt MS. Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implement Sci. 2015;10(1):1–11. https://​doi.​org/​10.​1186/​s13012-014-0192-y.CrossRef
55.
Bass BM, Avolio BJ. The implications of transformational and transactional leadership for individual, team, and organizational development, in research in organizational change and development. Greenwich, CT: JAI Press; 1990.
56.
Stogdill RM. Handbook of leadership: a survey of theory and research. New York: The Free Press; 1974. p. 81.
57.
58.
59.
60.
61.
62.
63.
Schein EH. Organizational culture and leadership. San Francisco: John Wiley & Sons; 2010.
64.
Priestland A, Hanig R. Developing first-level leaders. Harv Bus Rev. 2005;83(6):112–20.PubMed
65.
Klein KJ, Conn AB, Smith DB, Sorra JS. Is everyone in agreement? An exploration of within-group agreement in employee perceptions of the work environment. J Appl Psychol. 2001;86(1):3–16.PubMedCrossRef
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
McCormick JA. Inclusive elementary classroom teacher knowledge of and attitudes toward applied behavior analysis and autism Spectrum disorder and their use of applied behavior analysis [doctoral dissertation]. Ann Arbor: Dowling College; 2011.
77.
78.
79.
Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3):S110–S27.PubMedCrossRef
80.
81.
Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.PubMed
82.
83.
84.
Magnus M, Jones K, Phillips G, Binson D, Hightow-Weidman LB, Richards-Clarke C, et al. Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of National Significance Initiative. J Acquir Immune Defic Syndr. 2010;53(4):529–36. https://​doi.​org/​10.​1097/​QAI.​0b013e3181b56404​.PubMedCrossRef
85.
86.
Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305–12.PubMedPubMedCentral
87.
88.
Miller CE, Johnson JL. Motivational interviewing. Can Nurse. 2001;97(7):32–3.PubMed
89.
90.
91.
92.
93.
94.
95.
National Research Council. Educating children with autism. Washington: National Academy Press; 2001.
96.
Bush RN. Effective staff development. San Francisco: Far West Laboratory for Educational Research and Development; 1984.
97.
Cornett J, Knight J. Research on coaching. In: Knight J, editor. Coaching: approaches and perspectives. Thousand Oaks: Corwin Press; 2009. p. 192–216.
98.
99.
100.
101.
102.
Naar S, Flynn H. Motivational interviewing and the treatment of depression. In: Arkowitz H, Miller W, Rollnick S, editors. Motivational interviewing in the treatment of psychological problems. 2nd ed. New York: Guilford Press; 2015. p. 170–92.
103.
104.
105.
106.
Little RJA, Rubin DB. Statistical analysis with missing data 2nd ed. New York: John Wiley; 2002. 408 p.CrossRef
107.
108.
MacKinnon DP. Introduction to statistical mediation analysis. New York: Lawrence Erlbaum Associates; 2008.
109.
110.
111.
112.
113.
114.
115.
116.
117.
Metadata
Title
Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials
Authors
Lauren Brookman-Frazee
Aubyn C. Stahmer
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2018
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-018-0757-2

Other articles of this Issue 1/2018

Implementation Science 1/2018 Go to the issue

Methodology

Contextualization of psychological treatments for government health systems in low-resource settings: group interpersonal psychotherapy for caregivers of children with nodding syndrome in Uganda

Research

“I had to somehow still be flexible”: exploring adaptations during implementation of brief cognitive behavioral therapy in primary care

Research

‘Around the edges’: using behaviour change techniques to characterise a multilevel implementation strategy for a fall prevention programme

Methodology

Standardising evidence strength grading for recommendations from multiple clinical practice guidelines: a South African case study

Systematic review

Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

Study protocol

Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation