Now That We Know What to Do, How Do We Do It? Implementation Science and Applied Behavior Analysis
Samuel L. Odom, Ph.D., University of North Carolina
The purpose of this presentation is to describe the origins of evidence-based practices, propose criteria for identifying practices from behavioral research with learners having autism spectrum disorders (ASD), discuss the role of implementation, and suggest approaches to promote implementation. The presentation is based on three papers that are either in press or under review and the reader is referred to those papers for more specific discussion of these topics with references (Odom, in press; Odom, Boyd, Hall, & Hume, 2009; Odom, Collet-Klinkinberg, & Roger, in press).
Evidence-based practice has become a standard for service provisions for learners with ASD and their families. Emerging from the field of evidence-based medicine, a great emphasis is now placed on establishing the research evidence for both comprehensive treatment models and focused intervention practices. Applied behavior analysis techniques have been identified as some of the most promising and efficacious intervention and instructional practices. To date, however, there has not been a uniformly agreed upon approach for identifying EBP. Drawing from the precedents set by professional associations that have established criteria for assessing quality of research articles and levels of evidence needed to verify a focused intervention practice as evidence-based, colleagues from the National Professional Development Center on Autism Spectrum Disorders (NPDC) proposed criteria for evidence needed. To be established as evidence-based, there needs to be at least (a) two experimental or quasi-experimental studies, (b) five single-subject design studies, or (c) a combination of one group design and three single subject design studies. The research must be conducted by two or three different research groups and all studies have to meet acceptable criteria for quality. Using this process, investigators with the NPDC reviewed the research literature and identified 24 focused intervention practices. The specific practices may be found in Odom et al. (in press) and are listed on the NPDC website:
(http://www.fpg.unc.edu/~autismpdC/)
The identification of EBP is only one factor in the process of moving science to practice. An issue that looms as large as the identification of practice is service providers’ implementation of the practices. Implementation science reveals the complexities of establishing and manualizing an intervention well enough to be used by others. A common phenomenon that occurs after initial training is that providers adapt intervention practices to fit their specific content and learners, which may well affect the implementation defined by the researchers. Factors that are likely to positively affect implementation are ongoing coaching, video feedback, administrative and organizational support for using the practice, peer support, and the development of a community of practice.
Although the identification of evidence-based practices from the research literature is essential, it is not sufficient for moving science into practice. Factors associated with ongoing support for implementation is a critical feature of the science to practice process.
References
Odom, S. L. (in press). The tie that binds: Evidence-based practice, implementation science, and outcomes for children. Topics in Early Childhood Special Education.
Odom, S. L., Boyd, B, Hall, L., & Hume K. (2009). Meta-evaluation of comprehensive treatment models for learners with Autism Spectrum Disorders. Paper submitted for publication.
Odom, S. L., Collet-Klingenberg, L. L., & Rogers, S. J. (in press). Evidence-based practices for children and youth with Autism Spectrum Disorders. Preventing School Failure.