|Implementing Evidence-Based Practices for Autism in Public Schools: Barriers and Recommendations|
|Monday, May 28, 2018|
|4:00 PM–5:50 PM |
|Manchester Grand Hyatt, Seaport Ballroom B|
|Area: EDC/AUT; Domain: Translational|
|Chair: Melanie Pellecchia (University of Pennsylvania)|
|Discussant: David Mandell (University of Pensylvania)|
|CE Instructor: Melanie Pellecchia, Ph.D.|
School-aged children with autism receive most of their treatment in public schools. This is especially true for children from low-resourced communities, who are much less likely to receive supplemental treatments aside from their educational program. However, evidence-based practices for students with autism are often implemented with low fidelity in schools. Efforts to improve the implementation of evidence-based practices in schools often comprise training and consultation to improve teacher's skills and use of these practices. However, barriers unrelated to teacher skill may also impede the implementation of evidence-based practice in schools. This symposium includes a series of presentations describing large-scale efforts to improve implementation of evidence-based practice in schools. The first will present a summary of qualitative interviews with autism support teachers describing their challenges with implementing evidence-based practice in their classrooms. The second will present data regarding implementation fidelity and barriers to implementation in a randomized trial of Classroom Pivotal Response Training. The third will present data regarding teachers' intentions to use discrete trial training and pivotal response training and actual use of these interventions throughout the school year. The final presentation will provide recommendations for behavior analysts consulting in schools targeted toward addressing organizational and systemic barriers to implementation through effective consultation.
|Instruction Level: Basic|
|Keyword(s): Behavioral Consultation, School-based Implementation, Treatment Fidelity|
|Target Audience: |
Behavior analysts consulting in schools
|Learning Objectives: At the conclusion of the presentation, participants will be able to: 1) Learn about teachers' perspectives regarding barriers to implementation of evidence-based practices for their students with autism; 2) Identify barriers to implementation of evidence-based practices for students with autism in public schools; 3) Discuss consultation strategies to overcome organizational barriers to implementation in schools.|
|Examining Barriers to Implementation of Evidence-Based Practices in Schools Through the Eyes of Autism Support Teachers|
|DIANA COONEY (University of Pennsylvania), Zinnia Piotrowski (University of Pennsylvania), Max Seidman (University of Pennsylvania), Carolyn Cannuscio (University of Pennsylvania), David Mandell (University of Pennsylvania)|
|Abstract: Teachers of students with autism working in public schools face many challenges while implementing evidence-based practices with their students. These challenges may be especially evident in low-resourced public schools; however, little research has examined barriers to use of evidence-based practices in these settings from teachers’ perspectives. We conducted qualitative interviews with 25 teachers of students with autism to learn about their perceived barriers to implementation of evidence-based practices in their classrooms. Themes related to implementation barriers from the interviews included a lack of self-confidence in their skills, lack of time during the school day to accomplish all that is required of them, competing priorities, difficulty with staff dynamics, challenging student behavior, and lack of administrative support. These interviews identified critical barriers to implementation that often are not addressed through traditional behavioral consultation. Recommendations for changing consultative practices to improve implementation of evidence-based practices for students with autism based on these findings will be discussed.|
Treatment Fidelity in a Randomized Clinical Trial of Classroom Pivotal Response Training
|JANICE CHAN (University of California, San Diego), Allison B. Jobin (Rady Children's Hospital San Diego), Jessica Suhrheinrich (University of California, San Diego), Sarah Reith (San Diego State University), Aubyn Stahmer (University of California, Davis)|
Teacher implementation of Classroom Pivotal Response Teaching was evaluated using a large-scale, randomized waitlist-control design. Classroom Pivotal Response Training is an evidence-based, naturalistic behavioral intervention adapted from Pivotal Response Training to be delivered by teachers in classroom settings. Teachers (n=109) and students (n=256) from 17 school districts participated. Training procedures included 12 hours of small group didactic instruction, goal setting, supervised exercises and role-playing. Individual coaching followed at weekly, then monthly intervals. Teacher fidelity of Classroom Pivotal Response Training was measured throughout the school year by coaches in vivo while teachers implemented Classroom Pivotal Response Training with their students during regular classroom activities. Fidelity was also coded by trained observers naïve to the training condition via video. Multilevel models indicated significantly higher fidelity, as coded by naïve observers, for teachers who completed training as compared to control teachers (B=0.27, p=.001). Seventy-three percent of teachers met trainer-rated fidelity after an average of 7.6 coaching sessions. Sustainment of Classroom Pivotal Response Training fidelity during the school year following training was challenging. Potential enhancements to intervention adoption and implementation may involve increased teacher engagement and organizational leadership support. Future directions include a current randomized trial testing methods of facilitating increased engagement and leadership support to promote greater teacher fidelity and subsequent positive child-level outcomes.
Paved With Good Intentions: The Challenges of Changing Teacher Behavior in Under-Resourced Schools
|MELANIE PELLECCHIA (University of Pennsylvania), Jessica Fishman (University of Pennsylvania), David Mandell (University of Pennsylvania)|
Evidence-based practices for students with autism often are implemented with low fidelity in public schools. Poor implementation may relate to characteristics of teachers or characteristics of the schools in which they work. The Theory of Planned Behavior posits that an individual's intention to perform a certain behavior is the most proximal determinant of that behavior, when individuals have the ability to act on their intentions. If teachers' intentions are low, efforts should focus on improving intentions. If teachers' intentions are high but implementation is poor, efforts should focus on removing barriers to acting on intentions. To determine the association between intentions and evidence-based practice implementation, we surveyed 64 autism support teachers at the beginning of the school year in one school district about their intentions to use discrete trial training and pivotal response training using a validated 7-point likert scale (1 = low intentions, 7 = high intentions). Use of each intervention was assessed monthly throughout the school year and rated on a 5 point likert scale (0 = no use, 4 = daily use). Teachers received training and consultation in discrete trial training and pivotal response training throughout the school year. On average teachers reported high intentions to use pivotal response training (mean = 5.8) and discrete trial training (mean = 5.9), while use of both was low (pivotal response training mean use = .48, discrete trial mean use = .69). Intentions were not correlated with use. These findings suggest that while teachers have high intentions to implement evidence-based practices, they often face barriers not addressed through traditional models of training and consultation that prevent use.
Recommendations for Behavior Analysts to Improve Consultation in Public Schools
|Zinnia Piotrowski (University of Pennsylvania), MEGHAN KANE (University of Pennsylvania), Briana Bronstein (University of Pennsylvania)|
Traditional behavioral consultation focuses on changing teachers’ behavior to improve implementation of evidence-based practices for students with autism in schools. When behavior change is limited, consultants often rely on the behavioral consultation literature to identify effective consultation strategies, including collaborative problem solving, rapport building, training, and in-vivo coaching. However, there are many organizational and systemic barriers to implementation of evidence-based practices for students with autism in public schools that are not addressed through traditional models of behavioral consultation. While a traditional model of behavioral consultation may improve teachers’ skill and motivation to implement evidence-based practices in their classrooms, failure to address systemic barriers can limit the success and sustainability of these interventions. By addressing systems-level variables that affect individual performance, behavior analysts can broaden their focus to strategies that more meaningfully modify teachers’ implementation of evidence-based practices. Here we present an overview of the system-based action plan currently implemented through consultation to teachers of students with autism in a large, under-resourced, urban school district. Recommendations for behavior analysts providing consultation to teachers in under-resourced school settings will be offered, with a focus on consultation strategies intended to overcome barriers to implementation of evidence-based practices in these settings.