Factors That Influence the Adoption of Evidenced-Based Interventions in Clinical Settings

Background: Children with Autism Spectrum Disorder (ASD) are at increased risk for developing mental health disorders (Kerns & Kendall, 2012). Reaven and colleagues (2011) developed a CBT program for children with ASD and anxiety called Facing Your Fears (FYF). After establishing the initial efficacy of FYF, Reaven et al. (submitted) investigated the portability of FYF to a new clinical setting. FYF was initially implemented at the IWK Health Centre, a tertiary level children’s health centre in Nova Scotia, Canada. Initial training in FYF entailed a 2-day workshop followed by review of videotaped sessions by the program developers and bi-directional discussions regarding delivery of content and program development. Initial results yielded strong adherence to treatment fidelity and significant reductions in youth anxiety.

Objectives: To examine factors that influence the adoption of the FYF program in a new clinical setting. 

Methods: In the 2 years following the research implementation phase of FYF, the treatment program continued to be delivered at IWK. Two of the originally trained facilitators trained two additional facilitators; a well characterized sample of 13 children (5 girls, 8 boys, aged 7-12 years) with ASD and clinical anxiety have participated in FYF groups.  All child and parent participants completed the Screen for Anxiety Related Disorders (SCARED; Birmaher et al., 1995) pre-post intervention and parents completed the Social Responsiveness Scale (SRS; Constantino, 2005) pre-post.  In addition, attitudes and impressions regarding the implementation and long term adoption of FYF were obtained from administrators, group facilitators, and child/parent participants to examine whether it would be appropriate to continue to deliver FYF to youth with ASD and anxiety at IWK.

Results: FYF has been designated as the primary intervention approach for children with ASD and anxiety at the IWK Health Centre based on both qualitative as well as quantitative results. Factors that have influenced the adoption process included overall feasibility, ease of implementation and training of new facilitators, and relative advantage of the FYF program compared with existing treatment approaches. Positive treatment outcomes for the youth participants have also influenced the decision-making.  Potential barriers to implementation of FYF included challenges in conducting baseline assessments to determine goodness-of-fit to the treatment approach, managing heterogeneous group composition, and working within time constraints to train new facilitators.

Conclusions: Many interventions available in community settings for children with ASD have not been empirically validated (Stahmer et al. 2005). It is important not only to consider the efficacy of a treatment program, but the feasibility of implementing and maintaining an effective intervention program in community settings where resources are scarce (Dingfelder & Mandell, 2011). The rising rates of ASD have pressured community service providers to find creative, but also evidence-based, ways to address the mental health needs of this population. The implementation of the FYF program at the IWK Health Centre illustrates how the research-to-practice gap can be narrowed with collaboration between researchers and community clinicians.