Mixed Methods Study of Early Learning Institute (ELI) Program Implementation across Three Early Intervention Sites

Background:

Autism spectrum disorder (ASD)—affecting 1.5% of the population—is a pervasive, lifelong neuro-developmental disorder characterized by impaired social communication and repetitive behavior and/or restricted interests. Early behavioral intervention (EBI) is an effective treatment for reducing ASD symptoms and improving development for young children at-risk or diagnosed with ASD. EBI is typically delivered through community-based agencies; yet, little is known about the quality of these services. One method for ensuring quality community-based EBI is to translate efficacious curriculum into community settings that provide services to young children with ASD. The Early Learning Institute (ELI), based on the work of Maurice, Green, & Luce (1996) and Lovaas (2003), provides evidence-based curriculum to children with ASD between the ages of 2-5 years. This study aimed to better understand the implementation process of ELI delivered at three community agencies in the mid-Michigan region in order to facilitate its dissemination and implementation into broader community-based early intervention settings.

Objectives:

• Assess implementation processes and implementation outcomes (appropriateness, feasibility, acceptability, and utility) related to ELI utilization.
• Explore staff perspectives on use of implementation strategies and processes.
• Collect data on facilitators and barriers of the ELI program curriculum, training, and implementation process to facilitate further dissemination to community-based organizations.

Methods:

A sequential explanatory (QUAN --> qual) mixed methods design was utilized to evaluate facilitators and barriers to ELI implementation within and between three sites.

QUAN Phase: Twenty-five providers (4 directors/administrators, 2 BCBA and 19 behavioral technicians (BT)), completed a web-based quantitative survey, including the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, Implementation and Sustainment Strategies Survey and the Leadership Culture, Staff Culture, Leadership Behavior and Measurement Subscales of the Organization Readiness to Change Assessment (ORCA) to gather data on the organizational characteristics, provider characteristics, implementation strategy use, and implementation factors hypothesized to influence initial and sustained use of ELI.

Qual Phase: A sub-sample of 13 providers (1 administrator, 1 BCBA, 11 BT’s) participated in a semi-structured interview that was developed based on QUAN findings. The interview focused specifically on facilitators and barriers to delivering ELI in community-based settings. Qualitative coding, utilizing grounded theory, has been completed using an iterative coding, comparison and consensus methodology.

Results:

ANOVAs indicated no significant differences in ratings of acceptability, appropriateness, or feasibility by site or provider role. However, significant differences in ORCA ratings were found between provider roles in leadership culture, [F(2, 24)=6.36, p=0.007], with lower ratings from BT’s (M=3.08, SD=0.89) as compared with directors/administrators (M=4.19, SD=0.55) and BCBA’s (M=4.88, SD=0.18). No other significant differences on the ORCA were found between sites or provider roles.

Quantitative and qualitative data are being integrated through the use of joint display, and will be presented at the conference.

Conclusions:

Findings will highlight key facilitators and barriers to successful implementation of ELI that may be able to generalize to other community-based early intervention settings for children with ASD, helping to inform the process of adoption, implementation and sustainment within these contexts and facilitate broader uptake of ELI into community-based settings.