Identifying Effective Organizational Climate Embedding Mechanisms for Autism Interventions

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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.