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Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental disorder. ASD community-based organizations (ASD-CBOs) underutilize or inconsistently utilize evidence-based practices (ASD-EBPs) despite numerous available EBPs to treat ASD. Nonetheless, ASD-CBOs implement changes to practices regularly. Understanding ASD-CBO's implementation-as-usual (IAU) processes may assist to develop strategies to facilitate ASD-EBP adoption, implementation and sustainment. A convergent mixed methods (quan + QUAL) design was utilized. Twenty ASD-CBO agency leaders (ALs) and 26 direct providers (DPs), from 21 ASD-CBOs, completed the Autism Model of Implementation Survey Battery, including demographic and agency IAU process questions. Surveys were analyzed through descriptive and content analyses. A subset of 10 ALs provided qualitative interview data that were analyzed using coding, consensus and comparison methods to allow for a more comprehensive understanding of the IAU process within their ASD-CBOs. Quantitative analyses and qualitative coding were merged utilizing a joint display and compared. Results suggest that the IAU process follows some phases identified in the Exploration, Preparation, Implementation, Sustainment (EPIS) framework but were conducted in an informal manner-lacking specificity, structure and consistency across and within ASD-CBOs. Moreover, data suggest adding a specific adoption decision phase to the framework. Nonetheless, most ALs felt previous implementation efforts were successful. IAU processes were explored to determine whether the implementation process may be an area for intervention to increase ASD-EBP utilization in ASD-CBOs. Developing a systematized implementation process may facilitate broader utilization of high quality ASD-EBPs within usual care settings, and ultimately improve the quality of life for individuals with ASD and their families.

Anti-Black racism is a pervasive issue in the autism field that affects the autism service pathway, which ranges from identification of concerns to ongoing service navigation. In this short report, we provide a working model of the autism service pathway and highlight ways in which anti-Black racism affects all components of the pathway. We summarize the literature that demonstrates the effects of racism within autism assessment, treatment, and quality of care. We end with six recommendations for systemic change that clinicians can take: (1) including and amplifying Black autistic voices within their organization, (2) continuously learning about and acknowledging the ways in which their discipline perpetuates anti-Black racism, (3) recognizing that cultural humility is a lifelong process, (4) being mindful of the complex pathway that families must navigate to receive autism services, particularly when working with Black individuals, and (5) advocating for system-level changes within their organization and refining changes that are made. Lay abstract Black autistic people experience anti-Black racism when interacting with service systems and the clinicians in those systems. In this article, we describe the various steps families take to get services and how anti-Black racism makes that process even harder. We discuss research that shows the negative effects of anti-Black racism in autism assessment, treatment, and quality of care. We then provide five recommendations that clinicians should follow to reduce anti-Black racism in the autism field: (1) find Black autistic people and listen to their opinions about your organization, (2) always keep learning about how your profession promotes anti-Black racism, (3) recognize that the process of a clinician learning to be culturally humble takes time and is never “complete,” (4) pay attention to all of the steps that families must take to receive autism services and how these steps are even harder for Black individuals, and (5) advocate for your organization to make systems-level changes in their policies and procedures.

Introduction Autism evidence-based practices (EBPs), including early intensive behavioral interventions (EIBIs), are associated with improved and sustained positive outcomes for children with autism spectrum disorder (ASD). However, little is known about the quality of EIBIs delivered within community-based behavioral health systems, where many children with ASD receive services. These systems vary in their use and delivery of EBPs. Barriers and facilitators play a role in EIBI implementation within these settings. Therefore, this study sought to examine the naturally occurring implementation of the Early Learning Institute (ELI) program across three sites over a one-year period, in order to understand the implementation processes, identify barriers and facilitators to implementation, and explore staff perspectives of implementation outcomes. Methods A multi-phase mixed methods (QUAN → QUAL) design was utilized to: (1) examine implementation outcomes of acceptability, appropriateness, and feasibility of the EIBI; (2) explore staff perspectives of implementation strategy use; and (3) identify areas of strength and growth to deliver EIBIs in community-based settings. Twenty-three participants at time-point 1 and 29 participants at time-2, including behavioral technicians and directors/supervisors (n = 4) from three implementation sites participated in the study. All participants completed the Acceptability of Intervention, Intervention Appropriateness, Feasibility of Intervention measures, and Organizational Readiness for Change Context Subscale, at two time-points. Informed by QUAN findings at time-point 1, semi-structured interviews were conducted with a sub-sample of participants (n = 13) who completed the surveys at time-point 1. Thematic analysis was completed with a comparison and consensus methodology. Quantitative and qualitative data were then integrated using a joint display to provide an in-depth assessment of implementation outcomes. Results Quantitative results indicated positive endorsements of implementation outcomes over time; notably, these results aligned with the qualitative data suggesting that the majority of staff shared positive attitudes about the implementation of this EIBI within their organizations. Qualitative results also highlighted key facilitators and barriers to implementation that fell within two major themes: inner contextual factors and innovation factors. Conclusions Findings highlighted several determinants to the naturally occurring implementation of ELI across three settings. These findings may be generalized to inform the implementation processes of EIBIs in usual-care settings thereby facilitating uptake in organizations providing services to children with ASD.