Translating a Social Communication Intervention for Use in Authentic Education Settings

Background:  

There is an urgent need to translate efficacious lab-based interventions into feasible, scalable, effective interventions for implementation in public preschool settings for children with ASD.  School-based implementation of interventions targeting core social and communication ASD deficits could lead to significantly improved child outcomes and reductions in long-term special education costs for students with ASD.  The ‘Early Achievements’ (EA) intervention was designed to improve interpersonal synchrony and communication functioning in toddlers with ASD and was shown to be effective within an RCT (Landa et al., 2011). Treatment gains were sustained through a 6-month post-intervention follow-up period.  We have begun the first year of a three-year process of translating the EA intervention for implementation in public schools.

Objectives:  

To define:

(1) barriers to feasible implementation of an adaptation of EA into authentic educational settings for preschoolers and pre-kindergarteners with ASD;

(2) iterative intervention and professional training development processes aimed at improving feasibility of implementation;

(3) changes in teachers’ fidelity of implementation of the adapted EA intervention and self-efficacy during the school year; and

(4) changes in children’s social and language performance from pre- to post-implementation of the adapted EA intervention.

Methods:  

(1)    Based on themes extracted from focus groups and classroom observations, barriers to implementation of the intervention were defined.

(2)    Using our objective evaluation system, focus group and advisory committee members identified whether revisions to the original EA intervention surmounted the barriers defined in #1. 

(3)    Six teachers were trained to implement the intervention.  Teachers were assessed prior to training, then monthly through the school year (dependent variables: self-efficacy and intervention fidelity scores).

(4)    Seventeen children with ASD (mean age was 4 years at study start).  Children were assessed prior to teacher training, then monthly through the school year (dependent variables: Mullen Scales of Early Learning Receptive and Expressive Language age-equivalents; frequency of initiation of joint attention and spontaneous imitation). 

Results:  

(1, 2) Specific strategic design elements in the intervention addressed barriers to feasible implementation such as:  methods of linking the new supplemental interpersonal synchrony and language curricula to existing school curricula; teacher training design and timing (aided by video examples, planning guides, and self-evaluation guides); developing needed instructional materials; and developing the needed training for school administrators.  

(3) Teachers’ self-efficacy at pre-training ranged from 45-88%; fidelity ranged from 45-67%.   (3, 4) Data acquisition is in process. Results to be obtained by, and presented at, IMFAR include changes, from the beginning of the school year (prior to teacher training) to school-year-end, in: teachers’ self-efficacy and fidelity with increasing implementation experience; and children’s performance per changes in the dependent variables listed above.

Conclusions:  

There is a major gap between existing pre-professional teacher training and ASD students’ learning needs.  Translating lab-based efficacious interventions for use in the public sector has challenges that are surmountable.  Data obtained by IMFAR will reveal, preliminarily, whether our iterative translation process was associated with improvement in teachers’ self-efficacy and fidelity, and whether children in classrooms of trained teachers gained in interpersonal synchrony and language skills.