Implementation evaluation of an early intensive behavioral intervention program across three agencies serving young children with Autism: A mixed methods study

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.