What Happens after the Workshop? Factors Associated with Sustained Use of an Evidence-Based Intervention for Children with ASD in Community Practice

Background: State-implemented early intervention (EI) programs are a first line of treatment for many children with, or at risk for ASD, making them an ideal setting for implementing ASD-specialized evidence-based interventions (EBIs) such as Reciprocal Imitation Training (RIT). However, sustained use of EBIs requires that the setting supports their delivery (Chambers et al., 2013). Implementation climate, the extent to which users perceive an intervention as supported and rewarded in their work setting (Klein & Sorra, 1996), is associated with intervention use (e.g., Dingfelder, 2012), as are the intervention’s acceptability and feasibility (Proctor et al., 2011). Little is known about how these factors change over time, and how these changes influence providers’ use of EBIs. One-day professional development workshops are the norm in training community-based providers; however, few studies track provider use of interventions after trainings are delivered. Even fewer track providers’ sustained use of interventions over time.

Objectives: The specific objectives were to examine changes in ratings of RIT acceptability, feasibility, and implementation climate over three time points (post-training, 3-month follow-up, and 6-month follow-up) between providers who are and are not using RIT at follow-up.   

Methods: EI providers attended one-day RIT workshops. Providers (n=116) rated the acceptability and feasibility of RIT and the implementation climate of their work setting (Usage Rating Profile-Intervention, selected items; Chafouleas, 2009) at three time points: immediately post-training and at 3- and 6-month follow-ups. Providers also reported at the 6-month follow-up whether they had used RIT (Use Group=79). Report of RIT use at 3-months was used when 6-month data were missing.  

Results: Three hierarchical linear models were conducted to examine changes in provider ratings of RIT acceptability, feasibility, and implementation climate over time (see Table 1 for raw means) and handle missing data using Maximum Likelihood estimation. RIT use at follow-up was a predictor of the intercept for acceptability, B₀₁ =. 29, p <. 01, feasibility, B₀₁ = .22, p = .03, and implementation climate, B₀₁ = .31, p <. 01. RIT use was also a predictor of linear change for acceptability, B₁₁ = .13, p < .01, feasibility, B₁₁ = .12, p < .01, and implementation climate, B₁₁ = .11, p < .01. Ratings declined for all providers between post-training and follow-up, but declined more steeply for providers not using RIT at follow-up.  

Conclusions: These findings suggest that though providers find RIT to be acceptable and feasible and rate their work climate as supportive immediately after the workshop, real world application of the intervention may present challenges that temper these ratings and providers’ subsequent use of RIT. Community providers may require additional support within their work settings (e.g., supervisor encouragement, resources, incentives) in order to facilitate their use of EBIs with children in their caseload.