Lessons From the Field: How Challenges From Effectiveness and Implementation Trials Can Inform Intervention and Study Design

This session presents the latest and, in some ways, most cutting edge research on improve quality of care for children with autism in community settings. The results from these studies suggest that developing and studying strategies to move efficacious interventions into communities so that they are effective and sustain, especially in traditionally under-resourced areas, will require new approaches to intervention development and field testing. In the current presentation, these issues are examined from the perspectives of community-based participatory research, implementation science, behavioral economics, and academic public partnerships.  We argue that 1) interventions must be developed and tested in partnership with the community organizations whom we hope ultimately will use them; 2) interventions must be paired down to their absolutely essential active mechanisms, which will require more rigorous dismantling designs; 3) the strategy for successful implementation must be developed hand-in-hand with the intervention, and must address practitioner and organization-level factors; 4) strategies for measuring intervention fidelity must be flexible, comprehensive, and based on highly specific behaviors or intervention components of interest; and 5) treatment-as-usual comparison conditions are increasingly unethical, not practical and potentially unscientific, requiring new designs that focus more on comparative effectiveness.