Iterative Redesign of a Multifaceted Implementation Strategy for a School-based Behavioral Skills Intervention

摘要 虽然对自闭症青少年进行干预的证据基础有所增加，但这些干预措施中很少有 在公立学校实施，自闭症儿童接受干预的主要环境，由于 现有的执行战略与这一背景不相适应。需要与环境相适应的 用于支持外行提供者学习和使用这些干预措施的实施战略。这 为期三年的项目将应用本地的发现、设计、构建和测试(DDBT)框架来重新设计，然后 试点多方面实施战略，以支持副教育者使用基于证据的行为技能 对公立学校中的自闭症儿童的干预，RUBI for Education Setting(RUBI For Education Setting)。建议进行的研究 目的是：1)从目前用于支持RUBI临床医生的实施战略中确定重新设计的目标 实施以最大限度地在学校中使用副教育者的红宝石；2)反复调整现有的RUBI 实施战略；以及3)在教育环境中测试新设计的RUBI(RUIPS) DDBT机制上RUBI实施策略与非适应性RUBI实施策略的比较 (参与度、可用性、适当性)、近期实施成果(采用率、保真度、适应性、 和儿童行为(破坏性行为、功能、顶级问题)，40名准教育者支持80名 小学生自闭症儿童。成功完成拟议的研究将产生一套完善的 实施战略，以支持在公立学校的非专业提供者中使用红宝石，并具有强大的 有可能告知如何在学校更广泛地实施循证做法。知识 从这项研究中收集到的有可能改善公立学校服务的自闭症儿童的生活质量 在全国各地。

ABSTRACT While the evidence base has grown for interventions for autistic youth, few of these interventions are being implemented in public schools, the primary setting in which autistic children receive intervention, due to misalignment of existing implementation strategies with that setting. There is a need for contextually appropriate implementation strategies to be used to support lay providers in learning and using these interventions. This three-year project will apply the local Discover, Design, Build, and Test (DDBT) framework to redesign and then pilot a multifaceted implementation strategy to support paraeducator use of a behavioral skills evidence-based intervention, RUBI for Educational Settings (RUBIES), for autistic children in public schools. The proposed study aims to: 1) identify targets for redesign from implementation strategies currently used to support RUBI clinician implementation to maximize paraeducators’ RUBIES use in schools; 2) iteratively adapt the existing RUBI implementation strategies; and 3) test the newly-redesigned RUBI in Educational Settings (RUBIES) implementation strategy compared to the unadapted RUBI implementation strategy on DDBT mechanisms (engagement, usability, appropriateness), proximal implementation outcomes (adoption, fidelity, adaptation, reach), and child behaviors (disruptive behavior, functioning, top problems) with 40 paraeducators supporting 80 elementary-school autistic children. Successful completion of the proposed study will result in a refined set of implementation strategies to support RUBIES use among lay providers in public schools and has the strong potential to inform how evidence-based practices can be implemented in schools more broadly. Knowledge gleaned from this study has the potential to improve the quality of life for autistic children served in public schools across the country.