Evaluation of implementation factors for ASD services in school settings

 描述（由申请人提供）：该指导研究科学家发展奖（K 01）将为申请人提供实现短期和长期职业目标所需的高级培训和技能;具体地说，制定一项独立的研究计划，重点是通过提高证据的质量来提高自闭症谱系障碍儿童（ASD）接受的服务质量，由ASD社区提供商提供的基于实践的服务。该项目产生的经验、培训和数据预计将导致更大规模的研究，重点是完善和评估以学校为基础的实施干预措施的有效性、普遍性和可持续性。 背景和意义。学校是为ASD儿童提供心理健康和教育服务的最大提供者，因此，他们必须为ASD学生提供高质量，有效的干预。与正常发育的儿童相比，患有ASD的儿童每年的额外支出估计为8610美元（5），估计每年用于照顾ASD患者的总成本为2360亿美元（6）。然而，目前为自闭症学生选择和实施校本课程的方法并不奏效。在这种情况下，缺乏可行的程序和支持，以促进实施可能会导致有限的循证实践（EBP）的使用，以学校为基础的服务ASD。与初步采用、积极实施和持续提供基本建设项目有关的一个因素是支持性领导（25）。虽然领导干预措施已被发现在社区心理健康设置有效的修改是必要的学校的独特背景。特殊教育服务中的领导结构可以被描述为“分布式领导”，多个人参与管理特殊教育服务（38，39）。检查分布式领导的影响和关键人员的角色将告知有针对性的领导干预的适应。拟议的项目将评估自闭症谱系障碍学校服务实施的当前角色和资源，并利用混合方法来适应基于领导的实施模式。结果也将允许领导的评价作为一种机制的变化，在EBP实施以学校为基础的ASD服务。研究计划。拟议研究的具体目标包括：目标1。评估领导对学校环境中ASD EBP实施的影响。至于以学校为本的自闭症服务的推行情况，则未有评估。目标1将采用混合方法，数据收集和分析，以评估各级学校人员如何参与实施过程，以及现有资源和领导实践如何影响实施。我们会采用问卷调查及焦点小组的方法，从多个角度评估校本自闭症服务的推行情况。结果将显示关键的人员和资源在实施过程中和变化的实施因素在各学区。目标2.适应领导和组织变革的实施（LOCI）以学校为基础的ASD服务。目标1的数据将用于制定校本LOCI或SLOCI，其目标是在学校环境中培养第一级专家的领导能力，以促进有效实施EBP。SLOCI的重点将是利用学校现有的领导结构，以促进ASD的EBP的实施过程。将通过将目标1的成果与现有的实施模式和LOCI实践相结合来制定干预措施。目标3：研究研究兴建港岛通道的可行性和可接受性。一项小规模的试点研究将评估a）SLOCI与不同学区的10名一级领导人的可行性，B）SLOCI的效用和相关性，由关键人员在组织层面进行评估，c）SLOCI实施的保真度。培训目标。为了实现这些研究目标，需要以下培训：1）发展实施研究的理论和实践以及领导对实施过程的影响方面的专业知识。2)发展以学校为基础的ASD服务的专业知识，3）发展定量和混合方法分析的专业知识。培训活动将包括：（a）与Aarons博士磋商（实施科学，领导力），Brookman-Frazee（ASD社区服务），Mandell（ASD服务，差异），奥多姆（ASD校本服务），Willging（混合方法）和Roesch（定量方法）; B）综合关于领导对学校执行的影响的文献; c）应用于国际教育研究所; d）课程作业（即SDSU高级统计学统计课程）; e）应用培训活动（即，混合方法和定量数据分析），f）参加专业组织和会议（IMFAR，AOM，CRIEI），g）积极参加结构化培训活动（即，IRI，VA QUERI网络研讨会，参加并领导实施科学研讨会）;和h）手稿写作。

 DESCRIPTION (provided by applicant): This Mentored Research Scientist Development Award (K01) will provide the applicant with the advanced training and skills necessary to achieve immediate and long term career goals; specifically, developing an independent program of research focusing on improving the quality of services received by children with autism spectrum disorders (ASD) by increasing the quality implementation of evidence- based practices delivered by ASD community providers. The experience, training and data generated by this project are expected to lead to larger scale studies focusing on refining and assessing the effectiveness, generalizability, and sustainability of a school-based implementation intervention. Background and Significance. Schools are the largest provider of mental-health and educational services for children with ASD therefore it is critical that they are equipped to provide high-quality, effective intervention for students with ASD. Per pupil additional expenditure for a child with ASD as compared to a typically developing child is an estimated $8610 more annually (5) and the total estimated yearly cost for caring for individuals with ASD is $236 billion (6). However, current methods for selecting and implementing school- based programs for students with ASD are not working. The absence of feasible processes and supports to facilitate implementation within this context likely contribute to limited evidence-based practice (EBP) use in school-based services for ASD. One factor that has been linked to initial adoption, active implementation and sustained delivery of EBPs is supportive leadership (25). Although leadership interventions have been found effective in community mental health settings modifications are needed for the unique context of schools. The structure of leadership within special education services can be characterized as "distributed leadership," with multiple individuals involved in managing special education services (38,39). Examining the influences of distributed leadership and roles of key personnel will inform adaptation of a targeted leadership intervention. The proposed project will assess current roles and resources for implementation in school-based services for ASD and utilize mixed-methods to adapt a leadership-based implementation model. Outcomes will also allow for evaluation of leadership as a mechanism of change in EBP implementation for school-based ASD services. Research Plan. The specific aims of the proposed research include: Aim 1. Assess the influence of leadership on the implementation of EBPs for ASD in school settings. The implementation context for school-based services for ASD has not been assessed. Aim 1 will employ mixed methods data collection and analysis to evaluate how school-based personnel across levels engage with implementation processes and how available resources and leadership practices impact implementation. Survey and focus group methodology will be used to evaluate implementation of school-based services for ASD from multiple perspectives. Results will indicate key personnel and resources in implementation processes and variability in implementation factors across school districts. Aim 2. Adapt the Leadership and Organizational Change for Implementation (LOCI) for school-based ASD services. Data from Aim 1 will be used to develop School-based LOCI, or SLOCI, which will target leadership development of first-level specialists in school settings to facilitate effective EBP implementation. The focus of SLOCI will be to harness current leadership structures in schools to facilitate implementation processes of EBPs for ASD. The intervention will be developed by integrating Aim 1 outcomes with existing implementation models and LOCI practices. Aim 3. Examine the feasibility and acceptability of the SLOCI. A small-scale pilot study will evaluate a) the feasibility of the SLOCI with 10 first-level leaders across diverse school districts, b) SLOCI utility and relevance as evaluated by key personal across organizational levels, c) fidelity of implementation of the SLOCI. Training Goals. To accomplish these research aims, the following training is needed: 1) Develop expertise in the theory and practice of implementation research and leadership influence on the implementation process. 2) Develop expertise school-based services for ASD, 3) Develop expertise in quantitative and mixed-methods analyses. Training activities will include: a) consultation with Drs. Aarons (implementation science, leadership), Brookman-Frazee (ASD community services), Mandell (ASD services, disparities), Odom (ASD school-based services), Willging (mixed methods), and Roesch (quantitative methods); b) synthesizing literature of leadership influences on implementation in schools; c) application to the IRI; d) coursework (i.e. SDSU statistical classes in advanced statistics); e) applied training activities (i.e., mixed methods an quantitative data analyses), f) participating in professional organizations and conferences (IMFAR, AOM, CRIEI), g) actively participating in structured training activities (i.e., IRI, VA QUERI Cyber Seminars, attend and lead Implementation Science Seminar); and h) manuscript writing.