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Implementation Science at UW

Keywords: Mahima Joshi

✪ Educators’ experiences and reflections on the implementation of evidence-based practices for autistic students in public schools during the COVID-19 pandemic

Authors:

Alyssa M Hernandez, Olivia Michael, Gabriella Canning, Mahima Joshi, Anthony Osuna & Jill Locke

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: July 2023

Read the full text in the open access journal Implementation Research and Practice

Abstract:

Introduction

In 2020, the COVID-19 pandemic forced many schools to close their doors and transition to remote learning, disrupting how autistic students received school-based services and support. While school structure changes were challenging for all students, autistic students were uniquely affected, considering their reliance on predictability and routine; moreover, education settings are where most autistic children receive services. Much has been studied regarding the use of evidence-based practices (EBPs) for autistic students in traditional school settings, yet little is known about how educators use EBPs in remote learning environments in the wake of the COVID-19 pandemic.

Method

In this study, we explore educators’ experiences with EBP implementation at the height of the pandemic and educators’ reflections of its impact on autistic students and their school systems. Qualitative data were collected from 81 educators (general educators, special educators, and paraeducators) in semi-structured interviews regarding EBP use at the onset of the pandemic.

Results

Four themes emerged from interviews: (1) pandemic and remote learning environment challenges to inclusion and EBP use; (2) EBP use adaptations for remote learning environments; (3) pandemic and remote learning environment benefits for EBP use; and (4) considerations for EBP use beyond the pandemic.

Conclusion

These findings elucidate educators’ experiences using EBPs during the COVID-19 pandemic and highlight important areas of consideration for autism-focused EBP implementation as remote instruction continues to be a learning format. More research is needed to understand how to best implement EBPs for autistic students in this emerging instruction context.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy

Authors:

Aaron R. Lyon, Michael D. Pullmann, Shannon Dorsey, Carol Levin, Larissa M. Gaias, Stephanie K. Brewer, Madeline Larson, Catherine M. Corbin, Chayna Davis, Ian Muse, Mahima Joshi, Rosemary Reyes, Nathaniel J. Jungbluth, Rachel Barrett, David Hong, Michael D. Gomez & Clayton R. Cook

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: January 2021

Read the full text in the open access journal Implementation Science

Abstract:

Background

More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services—schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.

Methods

Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4–6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.

Discussion

This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS—a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation—to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.

Trial registration

ClinicalTrials.gov registration number NCT04451161. Registered on June 30, 2020.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**