Identifying Effective Organizational Climate Embedding Mechanisms for Autism Interventions

项目摘要/摘要 疾病控制和预防中心估计，每44名儿童中就有一名患有自闭症。 实施循证做法(EBP)对满足他们的需求至关重要。然而，有一些 在常规服务中为自闭症儿童提供EBPS面临的挑战。该提案利用了来自 团队(翻译自闭症的循证干预措施：多层次实施战略)混合 III型试验。旨在通过测试多层次实施来改进EBPS实施的团队 儿童心理健康服务的策略(研究1：Brookman-Frazee，R01-MH111950)和学校 (研究2，PI：Stahmer，R01-MH111981)。具体地说，团队的试验应用了探索、准备、 实施、可持续发展(EPIS)框架，并利用领导力和组织变革 实施(LOCI)战略，以测试两种多组件实施战略的有效性。 团队的目标是组织和提供者级别的机制。组织级实施 战略(团队领导力学院，TLI)，领导力和组织变革的改编版本 实施(Loci)战略，有针对性的组织实施领导力和环境，如 机械装置。拟议的研究将通过探索新的潜力来补充主要的研究目标 TLI的机制--气候嵌入机制。CEM的构建指的是领导者 用来教他们的组织如何感知、思考、感觉和行为。这项研究的目的是确定哪些 个别CEM对促进成功实施以及是否使用特定CEM最具影响力 调解TLI与执行和儿童结果之间的关联。 这个NRSA应用程序的目标是促进我作为一名实现科学家的发展 专注于组织实施因素和自闭症服务研究。拟议的项目将 考察气候嵌入机制作为组织的潜在行动机制 两个相互关联的随机对照试验的实施策略。具体地说，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。目标2 将利用定量方法来检查在 目的1调节TLI对TLI实施和临床结果的影响。最后，目标3将使用定性和 补充和扩展关于额外气候嵌入机制的量化结果的混合方法 并解释个别机制如何促进自闭症EBPS的实施。目前的建议 代表着进一步了解组织执行战略的机制的重要一步。 在我的指导团队的支持下，这项提议将启动我向职业生涯的发展 独立实施科学家，专注于组织层面的战略和机制以改进 在自闭症服务环境中实施EBP。

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.