Context Matters: A Mixed Methods Study of Organizational Factors That Affect Implementation of Interventions for Children with Autism in Public Schools

Background: The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and sustained in schools, the primary setting in which children with ASD receive services. Organizational factors such as culture and climate have been shown to predict the implementation of evidence-based interventions (EBIs) for the prevention and treatment of other mental disorders in schools, and may be potential targets to improve implementation of autism EBIs in schools.

Objectives:  The purpose of this study was to examine the organizational factors associated with the implementation of EBIs (i.e., discrete trial training, pivotal response training, and visual schedules) for children with ASD in public schools.

Methods: We applied the Domitrovich and colleagues (2008) framework of organizational and other contextual factors (e.g., leadership, implementation climate) that influence intervention implementation in schools. We quantitatively tested whether these factors (organizational culture and climate) were associated with the implementation of autism EBIs. Participants included 37 principals, 50 teachers and 75 classroom staff from 37 under-resourced public schools. We used qualitative methods (semi-structured interviews) to more comprehensively understand the strategies used to achieve successful implementation and sustainment of these interventions (26 principals and 28 teachers from the highest- and lowest-performing classrooms based on their fidelity data). Qualitative data will be analyzed using an integrated approach to conduct a detailed exploration of the intervention-setting fit, and observe similarities and differences in organizational-level factors among high and low performing classrooms. Independent observers rated implementation fidelity (i.e., adherence, dose, and competence) using a fidelity checklist. Participants completed ratings of organizational culture (behavioral expectations that members of an organization are required to meet in their work environment) and climate (individual employees’ perceptions of the psychological impact of their work environment on their own function and well-being) using the Organizational Social Context measure.

Results: Data cleaning and coding are underway. Preliminary descriptive analyses indicate that the organizational culture and organizational climate were within average norms. A linear regression with random effects for classroom and school (to account for classrooms nested within schools) will be conducted to estimate individual associations between each organizational-level factor (i.e., organizational culture and climate) and key components of intervention fidelity (adherence, dose, and competence).

Conclusions: The results of this study will provide an in-depth understanding of organizational-level factors that influence the successful implementation of EBIs for children with ASD in under resourced public schools. These data will inform potential implementation targets and tailoring of strategies that will help schools overcome barriers to implementation and ultimately improve the services and outcomes for children with ASD.