Adapting an Evidence Based Intervention Using an Implementation Science Framework

Background: This pilot research responds to the 2012 Interagency Autism Coordinating Committee for studies that utilize “implementation science to test methods to improve implementation of evidence-based treatments.” Applying the Consolidated Framework for Implementation Science (Damschroder, et al., 2009), we collected stakeholder perspectives on the experience of students with autism spectrum disorder (ASD) transitioning out of school and stakeholder recommendations for improvement. Findings were employed to adapt an evidence-based implementation strategy for schools called the Collaborative Model for Promoting Competence and Success (COMPASS). COMPASS, a teacher-parent consultation intervention based on a transactional framework (Ruble, Dalrymple, & McGrew, 2012), has been tested in two randomized controlled trials for young children with ASD. 

Objectives: To use an implementation science framework to identify the critical factors impacting quality implementation and intervention effectiveness in COMPASS with the long-term goal of applying this information to understand, adapt, refine, and pilot the parent-teacher consultation.

Methods: Ten focus groups were conducted with 42 participants including individuals with ASD, parents, school service providers, school administrators, adult service providers, and state policy makers from the Kentucky offices of Vocational Rehabilitation, Special Education, Medicaid, and Developmental Disabilities. Each hour-long session was recorded and transcribed.  The research team performed qualitative content analysis through composing a codebook of themes derived from the literature on transition and cross-checked all codes with themes appearing in a preliminary reading of all transcripts. Codes were discussed and refined within the team to finalize the codebook. Team members worked in pairs to test and apply codes; all codes were tested until reaching 80% agreement in inter-rater reliability. Then, each pair of coders applied codes line by line to all transcripts. Researchers reviewed coded content code-by-code to identify specific aspects of COMPASS to be adapted and revised to meet the needs of transition-age youth. 

Results: Stakeholders identified several crucial points of intervention to improve transition for young adults with ASD including  (a) adding or developing new measures of quality of life, self-determination, activation, and social support; (b) incorporating student goals for vocational and independent living skills and parent goals for obtaining services; (c) developing psychoeducational handouts on the transition process, state services, and a transition planning timeline with descriptions of different roles; (d) assessing parent perception of openness of IEP team to curricular changes; (e) involving student in completion of COMPASS forms and in the consultation; (f) inviting certain players, such as the vocational rehabilitation counselor, to consultation and coaching sessions, and offering different methods for involvement (e.g., in person, phone), (g) assessing current services prior to the consultation and assessing student interests, strengths, and skills; and (h) adapting interests questionnaires based on student abilities, such as use of visuals, and adapting COMPASS questions for age appropriateness. 

Conclusions: Focus group data were used to adapt and revise the COMPASS model for transition age youth by improving assessment, communication between key players, and involvement of students and key players in planning. Our qualitative, stakeholder-centered process may be helpful for other implementation science studies adapting autism interventions to fit specific contexts.