Fidelity of Implementation of Evidence-Based Practices by Paraprofessionals In Community Classrooms

Background:  The evidence from efficacy trials supporting interventions for children with autism has increased dramatically in the past decade. There are few studies, however, that examine whether community-based educators can implement these sometimes complicated interventions with fidelity to the manual, even when extensive training and support are provided. In particular, the capabilities of paraprofessionals, who often are the educators spending the most time with these children, have been essentially ignored. Understanding whether teachers and paraprofessionals trained in a specific approach can effectively implement the intervention is essential for translating evidence-based programs (EBPs) into schools.

The Strategies for Teaching based on Autism Research (STAR) program is a comprehensive curriculum that uses EBPs to teach academic and social skills. Strategies include the highly structured discrete trial teaching (DTT), and the more naturalistic behavioral strategy, pivotal response training (PRT). STAR was developed specifically for classrooms and is starting to be widely disseminated; however treatment integrity among classroom educators has not been systematically examined.

Objectives:  To examine fidelity of implementation of the STAR program components, including DTT and PRT, among teachers and paraprofessionals after training.

Methods:  STAR was implemented in K-2 autism support classrooms in one large urban school district as part of a randomized trial. Teachers and paraprofessionals in 42 classrooms participated.  Participating teachers agreed to attend training in STAR strategies and paraprofessionals were offered the opportunity to attend. Classroom teachers and paraprofessionals were videotaped monthly using DTT and PRT. Videotapes were coded for fidelity of implementation by undergraduate research assistants blind to the study hypotheses. Reliability of data coding was greater than 80% on all measures.

Results:  Fifteen paraprofessionals and 40 teachers were observed to implement DTT; 18 paraprofessionals and 35 teachers were observed during PRT implementation. By the end of the school year, 86% of both groups were implementing DTT with fidelity. Both groups were good at providing clear cues and immediate consequences, and struggled with using appropriate cues, giving immediate prompts and following prompting rules. Paraprofessionals struggled more than teachers using appropriate cues and gaining children’s attention. At the end of the year, 71% of teachers and 39% of paraprofessionals were implementing PRT with fidelity. Both groups were proficient at providing children a choice of activity, using clear cues and finding effective reinforcers. Both had difficulty with differential and direct reinforcement. Paraprofessional staff had significantly greater difficulty with having clear goals and using contingent reinforcement. Teacher and paraprofessional fidelity in PRT was not correlated within classrooms, but there was a significant correlation (.40) in fidelity of DTT within classrooms. 

Conclusions:  Implementing DTT may be an appropriate role for paraprofessionals.  Compared with teachers, paraprofessionals had difficulty implementing PRT, perhaps due to limited education in teaching strategies in general (which overlap with PRT). Given the specific strategies posing difficulty, paraprofessionals may need more specific training on how to target individual children’s goals, and how to determine how to use strategies that require differential responding, such as prompting and reinforcement.