Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spect
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ORIGINAL ARTICLE
Implementation‑as‑Usual in Community‑Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study Amy Drahota1,2 · Rosemary D. Meza3 · Tatiana E. Bustos1 · Aksheya Sridhar1 · Jonathan I. Martinez4 · Brigitte Brikho2 · Aubyn C. Stahmer2,5 · Gregory A. Aarons2,6 Accepted: 9 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Implementation · Implementation-as-usual · Health disparities · Mixed methods · Autism spectrum disorder · Evidence-based practice
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10488-020-01084-5) contains supplementary material, which is available to authorized users. * Amy Drahota [email protected] 1
Department of Psychology, Michigan State University, East Lansing, MI, USA
2
Child and Adolescent Services Research Center, San Diego, CA, USA
3
Department of Psychology, University of Washington, Seattle, WA, USA
Individuals with autism spectrum disorder (ASD) need comprehensive, evidence-based practices (EBPs) across their lifespan.
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