3 - (SYM 115) Iterative Redesign of an Implementation Strategy to Support a Behavioral Skills Evidence-based Intervention in Public Schools

Background: Schools are the primary setting in which autistic children receive intervention. However, evidence-based interventions (EBIs) often are unavailable in schools due to misalignment of existing implementation strategies within that setting. This project applies the Discover, Design/Build and Test (DDBT) framework, which combines human-centered design and implementation science, to redesign a multifaceted implementation strategy to support educator use of a behavioral skills EBI, Research Units in Behavioral Intervention for Educational Settings (RUBIES), for autistic children in public schools.

Methods: The original RUBIES implementation strategy comprises: 1) educational meetings (information sessions to teach RUBIES content), 2) ongoing coaching/consultation to support tailoring to specific autistic children, and 3) fidelity review (implementation review). As part of the Discover Phase, the research team conducted contextual evaluations (N=9) and cognitive walkthroughs (N=15) with administrators, teachers, and paraeducators to identify implementation usability issues of the original RUBIES implementation strategy. Implementation usability issues were rated for importance and feasibility prior to redesign.

Results: Rapid coding was used to code qualitative data and identify implementation usability issues. Three implementation usability issues were identified: 1) lack of communication across the general and education support team prevents continuity of care; 2) contextual constraints that prevent consistent RUBIES implementation across general and special education settings in a school; and 3) educational meetings may be necessary but not sufficient in supporting educators’ uptake to high-fidelity implementation of RUBIES.

Conclusion: Identifying and addressing usability issues may promote greater utility and successful implementation of RUBIES in schools. Using stakeholder-engaged methods allowed for the identification of critical implementation usability issues to enhance the potential adoption and high-fidelity use of RUBIES in schools. Proposed redesign solutions led to an implementation redesign blueprint consisting of a pre-implementation collaboration session supporting general and special education collaboration, planning, and communication around RUBIES, video vignettes, a generalization and maintenance framework for each RUBIES module, and mobile technology supports. These potential solutions will undergo usability testing prior to the Test phase.