Implementation Outcomes of a Coach-Based Transition Program for Students with ASD in Urban Educational Settings

Background:  There is a gap between behavioral interventions developed within a university-based laboratory and the settings within which the interventions are likely to be executed. Barriers in school systems may impede the consistency and quality with which an evidence-based intervention can be executed. Engaging in community-partnered research to develop interventions addresses the needs and goals of the key community stakeholders with consideration to barriers that are present in the community setting. In addition to the content and outcomes of treatments, an important aspect of this type of intervention development is the evaluation of the degree to which implementers in community settings accept the intervention, and the degree to which they adhere to the components of the intervention.

Objectives:  We aimed to: a) evaluate the fidelity with which teachers executed the components of the Schedules, Tools, and Activities for Transitions (STAT) program; and b) determine the acceptability and feasibility of the STAT program in under-resourced public schools.

Methods:  

Along with our community partners, we developed the STAT program to address transition-related problem behavior commonly observed in students with ASD in self-contained classrooms. STAT was implemented in three urban school districts in Rochester NY, Los Angeles, and Philadelphia. Participating classrooms were randomized to immediate treatment (n = 73) or waitlist control (n = 77). Blind observers collected teacher Fidelity at baseline, exit, and 3-month follow-up. Teachers who received immediate treatment also completed the Implementation Climate Survey, and a Buy-in Measure at post-treatment and follow-up.

For the Buy-In Measure, teachers rated the degree to which they agreed with 21statements about the importance of the intervention on a Likert scale (1 = strongly agree; 7 = strongly disagree).

For Implementation Climate, teachers used a Likert scale (1 = not true; 5 = true) on 17 items designed to assess program quality, school support, and global perceptions of climate.

Results:  

Although preliminary results indicated that, at baseline, teachers assigned to either group were already implementing STAT components with high (88%) fidelity, there was a slight post-treatment advantage for the experimental condition. Teachers in immediate treatment improved their average fidelity score to 93% (exit), and 97% (follow-up); fidelity scores for teachers in waitlist control maintained at 89% (post) and 87% (follow-up). Teachers’ average buy-in scores were 1.73 at exit and 1.71 at follow-up, indicating high levels of intervention acceptability. For the Implementation Climate Questionnaire, teachers indicated that the STAT program was important and a priority in their schools.

Conclusions:  Given the time and resource barriers in many urban schools, implementing evidence-based interventions poses significant challenges. Preliminary results from this study suggest that, although many teachers already implement components of behavioral interventions, their performance can be enhanced through additional intervention. These effects were maintained over time, with participants continuing to adhere to the transition program. Additionally, teachers found the intervention valuable, and generally reported feeling supported by supervisors and classroom teams. This information supports the ongoing use of coach-based, packaged behavioral intervention and suggests that this model can be sustainable in public school settings.