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.
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