Modular Approach to Supporting Students with ASD in Classrooms: Feasibility and Preliminary Efficacy of the Saage Intervention

Background: Although behavioral strategies have been shown to be useful for teaching new skills to children with autism spectrum disorder (ASD), they are seldom implemented in public schools (Kasari & Smith, 2013). Barriers include low buy-in, inadequate training, and resource limitations that lead to poor fidelity. However, increases in teacher fidelity and improvements in children’s classroom behavior have been reported when interventions involve collaboration between school teams and ASD specialists for setting goals, adapting strategies, and providing in-vivo coaching (Iadarola et al., 2017). We incorporated these features into a framework, Students with Autism Accessing General Education (SAAGE), which aims to promote the success of students with ASD in classrooms and reduce potential barriers to less restrictive environments. Consistent with interventions that have been successful with other populations, SAAGE is organized into “modules” that address core and associated features of ASD. Each module comprises a small, targeted set of empirically supported behavioral strategies directed at a particular problem, with decision rules or assessment procedures for selecting which modules to implement and under what circumstances. SAAGE implementation is guided by a coach who assists the school team to assess student needs, identify student goals, select relevant modules, and receive in-vivo guidance on module implementation.

Objectives: Pilot SAAGE and evaluate (1) feasibility (i.e., recruitment/retention, fidelity, buy-in) and (2) preliminary outcomes.

Methods: We conducted a quasi-experimental design across three sites, participants were 14 students (12 boys, 2 girls) with ASD, M(SD) age = 9.45(2.42) years and 14 teachers. Research personnel served as coaches. Coach-teacher dyads engaged in a systematic process of (1) selecting goals and modules based on student and classroom needs, (2) participating in up to 12 hours of in-vivo coaching per module, (3) evaluating student progress and intervention buy-in. To measure student progress, an independent evaluator administered the Teacher-Nominated Target Behaviors (TNTB) interview and an observation based on the Global Assessment Scale (GAS). Buy-in was assessed from the 29-item Usage Rating Profile (URP), rated from 1 (strongly disagree) to 6 (strongly agree), and a 10-item scale of coaching quality, rated from 0 (lowest quality) to 4 (highest quality).

Results: Teacher Fidelity: Across 51 observations by study personnel, teacher adherence to intervention procedures averaged 93% (8.2%), and quality of implementation averaged 99% (4.8%). Buy-in: On the URP, teachers highly rated SAAGE acceptability, M(SD) = 5.22(.31), usability, M(SD) = 5.61(.10), and feasibility, M(SD) = 5.47(.27). The mean rating of coaching quality was 3.84(.07). Student Outcomes: On the TNTB, teachers rated 11 of 14 students as “much improved” or “very much improved” on at least one target behavior; 8 were rated as “much” or “very much improved” on all three target behaviors. On the GAS, the percentage of students who demonstrated improvement was 38% at midpoint 1 and 50% at midpoint 2.

Conclusions: SAAGE was implemented with high fidelity, and educators rated the process positively. Preliminary outcome data for the students are encouraging. These results indicate that modular interventions with in-vivo coaching may be a promising approach for schools to effectively support students with ASD.