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Implement Sci. 2019 Mar 13;14(1):29. doi: 10.1186/s13012-019-0877-3.

Individual and organizational factors that affect implementation of evidence-based practices for children with autism in public schools: a cross-sectional observational study.

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Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA.
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
Department of Psychiatry, University of California San Diego, San Diego, CA, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St, Bldg. 29, St. 100, Seattle, WA, 98115, USA.
Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2825 50th Street, Sacramento, CA, 95817, USA.
Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA.
Department of Psychology, University of Washington, Guthrie Hall, Seattle, WA, 98195, USA.



Children with autism receive most of their intervention services in public schools, but implementation of evidence-based practices (EBPs) for autism varies. Studies suggest that individual (attitudes) and organizational characteristics (implementation leadership and climate) may influence providers' use of EBPs, but research is relatively limited in this area. This study examined individual and organizational factors associated with implementation of three EBPs-discrete trial training, pivotal response training, and visual schedules-for children with autism in special education classrooms in public elementary schools.


Participants included 67 autism support teachers and 85 other classroom staff from 52 public elementary schools in the northeastern United States. Participants reported their attitudes toward EBPs (e.g., intuitive appeal, willingness if required, openness, and divergence), implementation leadership and climate of their school, and the frequency with which they deliver each of three EBPs. Linear regression was used to estimate the association of attitudes about EBPs with organizational characteristics and intensity of EBP use. Demographic covariates with a bivariate association with EBP use significant at p < .20 were entered into the adjusted models.


There were significant findings for only one EBP, discrete trial training. Teachers who reported higher perceived divergence (perceived difference of usual practice with academically developed or research-based practices) between EBPs and current practices used less discrete trial training (f2 = .18), and teachers who reported higher appeal (willingness to adopt EBPs given their intuitive appeal) of EBPs used more discrete trial training (f2 = .22). No organizational factors were significantly associated with implementation with any of the three EBPs.


Attitudes toward EBPs may affect teachers' decisions to use EBPs; however, implementation leadership and climate did not predict EBP use. Future implementation efforts ought to consider the type of EBP and its fit within the context in terms of the EBP's similarities to and differences from existing practices and programs in the setting. Implementation strategies that target individual attitudes about EBPs may be warranted in public schools.


Attitudes; Autism; Fidelity; Implementation; Organizational factors; Schools

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