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

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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.