Disseminating an Evidence-Based ASD Intervention: Predictors of Community Providers' Likelihood of Implementation

Background: Individuals with ASD often require intensive and specialized intervention, yet significant barriers, including insufficient provider training and support, have impeded their access to evidence-based services. Given the significant service-need discrepancy for this population (Sperry et al. 1999; Stahmer and Gist 2001), recent efforts have focused on developing and improving strategies for dissemination and implementation of evidence-based ASD intervention, particularly in community settings (Brookman-Fraze, Drahota, & Stadnick, 2011, Vismara, 2009). However, the extant research has largely focused on the extent to which community providers can be trained to successfully implement evidence-based treatments for ASD with fidelity. Factors directly influencing community providers’ decision regarding whether or not to implement an evidence-based treatment for ASD are still largely unknown. This is important to consider given research indicating that implementation is affected by factors such as provider experience and sense of competence, organizational functioning, and perceived program barriers (Durlak & DuPre, 2008; Turner, Nicholson, & Sanders, 2011).  Better understanding of these constructs as they pertain to community-based providers of ASD services would allow the field to more effectively train practitioners in evidence-based interventions and increase availability of evidence-based programming for this population.

Objectives: This study examined the training of community-based mental health providers in an evidence-based ASD parent training intervention (Project ImPACT), and their subsequent implementation of the program. We sought to assess the effect of training on participant knowledge of intervention techniques and likelihood of implementing the intervention post training. A secondary aim was to evaluate the extent to which participant demographics, participant characteristics, and potential barriers to implementation uniquely predict likelihood to implement the program following training.

Methods: Individuals attending community-based trainings in Project ImPACT (an evidence-based ASD parent training intervention) were invited to participate in the study. Those who consented to participate completed surveys before the workshop and after completing training. Surveys assessed participant demographics, sense of competence, perceived acceptability of treatment, self-efficacy in implementation, barriers to treatment implementation, and likelihood of implementation.

Results: Community providers significantly increased their knowledge of intervention techniques and expressed a greater likelihood of implementing the intervention after receiving training in Project ImPACT. Correlational analyses indicated that level of education, mandatory attendance at training, general sense of competence, acceptability of treatment, and efficacy in ability to implement the intervention were all related to likelihood of implementing the evidence-based intervention by community members. Multiple hierarchical linear regression was used to evaluate the unique impact of these factors in predicting likelihood of implementing Project ImPACT. While demographic variables accounted for a significant amount of variance in implementation of the intervention, program acceptability emerged as a unique predictor of implementation over and above other variables entered into the model.

Conclusions: These results indicate that training influences community practitioners’ understanding of and intent to use an evidence-based treatment for ASD.  The perceived acceptability of the intervention is strongly associated with providers' reported likelihood of using the intervention. Results underscore the importance of designing and disseminating evidence-based treatments in a way that maximizes program acceptability for community practitioners.