Identifying Effective Organizational Climate Embedding Mechanisms for Autism Interventions

项目总结/摘要 疾病控制和预防中心估计，每44名儿童中就有1名患有自闭症。 实施循证实践（EBP）对于满足他们的需求至关重要。但有 在日常服务中为自闭症儿童提供EBP的挑战。该提案利用了来自 TEAMS（翻译自闭症的循证干预措施：多层次实施战略） III型试验。TEAMS旨在通过测试多层次实施来改进EBP的实施 儿童心理健康服务战略（研究1 PI：Brookman-Frazee，R 01-MH 111950）和学校 （研究2 PI：Stahmer，R 01-MH 111981）。具体来说，TEAMS试验应用了探索，准备， 实施、维持（EPIS）框架，并利用领导和组织变革， 实施（LOCI）战略，以测试两个多组成部分的实施战略的有效性。 TEAMS针对组织和提供者一级的机制。组织层面的实施 战略（团队领导研究所，TLI），一个改编版的领导和组织变革 实施（LOCI）战略，有针对性的组织实施领导和气候， 机制等拟议的研究将通过探索新的潜力来补充主要研究目标 TLI机制-气候嵌入机制（CEM）。CEM的结构是指领导者 利用它来教他们的组织如何感知，思考，感受和行为。这项研究旨在确定哪些 单个CEM对促进成功实施最有影响， 在TLI与执行和儿童成果之间的联系中起中介作用。 这个NRSA应用程序的目标是促进我作为一个实施科学家的发展， 侧重于组织实施因素和自闭症服务研究。拟议项目将 研究气候嵌入机制作为组织的潜在行动机制 在两项相关随机对照试验中实施策略。具体而言，目标1将确定个人 与实施（提供者）和临床（儿童）结果相关的气候嵌入机制。目的2 将利用定量方法来研究是否确定的个别气候嵌入机制， 目的1介导TLI对实施和临床结局的影响。最后，目标3将使用定性和 采用混合方法补充和扩大关于其他气候嵌入机制的定量研究结果 并解释个体机制如何促进自闭症EBP的实施。现时的建议 是进一步理解组织实施战略机制的重要一步。 在我的指导团队的支持下，这个建议将启动我的职业发展， 独立的执行科学家，侧重于组织一级的战略和机制，以改善 EBP在自闭症服务环境中的实施。

PROJECT SUMMARY /ABSTRACT The Centers for Disease Control and Prevention estimates that 1 in 44 children have autism. Implementing evidence-based practices (EBPs) is crucial for their meeting their needs. However, there are challenges to delivering EBPs for autistic children in routine services. This proposal leverages data from the TEAMS (Translating Evidence-based Interventions for Autism: A Multi-Level Implementation Strategy) Hybrid Type III trials. TEAMS aimed to improve implementation of EBPs by testing multi-level implementation strategies in children’s mental health services (Study 1 PI: Brookman-Frazee, R01-MH111950) and schools (Study 2 PI: Stahmer, R01-MH111981). Specifically, the TEAMS trials applied the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and utilized the Leadership and Organizational Change for Implementation (LOCI) strategy to test the effectiveness of two multi-component implementation strategies. TEAMS targeted organizational and provider level mechanisms. The organization level implementation strategy (TEAMS Leadership Institute, TLI), an adapted version of the Leadership and Organizational Change for Implementation (LOCI) strategy, targeted organizational implementation leadership and climate as mechanisms. The proposed study will supplement the primary study aims by exploring a new potential mechanism of TLI – climate embedding mechanisms (CEM). The construct of CEM refers to tools that leaders utilize to teach their organizations how to perceive, think, feel, and behave. This study aims to identify which individual CEM are most impactful to promote successful implementation and whether use of specific CEM mediates the associations between TLI and implementation and child outcomes. The objective of this NRSA application is to foster my development as an implementation scientist with a focus on organizational implementation factors and autism services research. The proposed project will examine climate embedding mechanisms as potential mechanisms of action of an organizational implementation strategy within two linked randomized controlled trials. Specifically, Aim 1 will identify individual climate embedding mechanisms associated with implementation (provider) and clinical (child) outcomes. Aim 2 will utilize quantitative methods to examine whether the individual climate embedding mechanisms identified in Aim 1 mediate the effects of TLI on implementation and clinical outcomes. Lastly, Aim 3 will use qualitative and mixed methods to complement and expand quantitative findings on additional climate embedding mechanisms and explain how individual mechanisms facilitated implementation of autism EBPs. The present proposal represents an important step in further understanding mechanisms of organizational implementation strategies. With support of my mentoring team, this proposal will launch my development toward a career as an independent implementation scientist focusing on organizational level strategies and mechanisms to improve EBP implementation in autism services settings.