(PS9-36) Partnering with Community Providers to Understand the Barriers to Implement Naturalistic Developmental Behavioral Interventions in Applied Behavioral Analysis (ABA) Settings

Naturalistic developmental behavioral interventions (NDBIs) support early social communication skills in young autistic children using developmental and naturalistic behavioral teaching strategies (Schreibman et al., 2015). Given their emphasis on child-led learning opportunities, NDBI approaches are thought to be aligned with neurodiversity affirming care when rated by autistic adults (Schuck et al., 2021).  Existing research suggests an alignment of implementing NDBIs within ABA community settings (Dueñas et al., 2023). Applied Behavior Analysis (ABA) practices could be an ideal setting to increase access to NDBIs for autistic toddlers given that 78 percent of autistic children qualify for intensive ABA services prior to the age of three (Shaw et al., 2023). However, current ABA services continue to use Discrete Trial Training (DTT) strategies, which have been criticized for their intensity, limitations in skill generalization, and possible harms to autistic children (e.g. Koegel et al., 1998; Schreibman, 2005). While there is growing interest in translating NDBI into ABA settings (e.g., D’Agostino et al., 2022), there are also likely multifaceted implementation challenges, including the need to de-implement or transition away from DTT approaches in order to integrate NDBI.

The current study aims to understand the perspectives of ABA supervisors and frontline staff about integrating NDBI approaches within their clinical practice. The specific study aims were to 1) understand ABA providers’ perspectives using NDBI strategies within ABA clinical settings; and 2) examine the multi-level factors that impact the de-implementation of DTT approaches to effectively integrate NDBI.

Semi-structured interviews were conducted with 22 ABA frontline and supervising clinicians across several ABA organizations. Interviews were transcribed and rapid qualitative and thematic analysis was used to analyze data. All qualitative data was member checked with participants and presented to a neurodiversity taskforce consisting of autistic and non-autistic staff, caregivers, and providers for feedback. Results indicated that ABA clinicians generally viewed NDBI positively. However, a number of implementation themes emerged including: 1) the relative ease of NDBI and DTT; 2) the relative effectiveness of NDBI and DTT; 3) client, caregiver, and staff perceptions of NDBI; and 4) clinical decision-making around what types of clients might benefit from NDBI. Barriers to implementing NDBI included the need to unlearn existing DTT strategies, limited training and self-efficacy delivering NDBI, limited buy-in towards NDBI, as well as challenges around data collection and billing. Findings underscore the importance of understanding and integrating ABA frontline clinicians’ perspectives and suggest the need for targeted strategies to integrate NDBI strategies in ABA clinical settings.