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Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study

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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.

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Acknowledgements

The authors would like to acknowledge and thank Dr. Lawrence Palinkas for consultation on the study design and data collection, analysis and interpretation, as well as the Autism Model of Implementation Collaborative Group for guidance and feedback on interpretation of these mixed methods results and on the development of the ACT SMART Implementation Toolkit.

Funding

The National Institute of Mental Health (K01MH093477, PI: Drahota) supported the design of the study and data collection, analysis and interpretation of data, and in writing the manuscript. Interpretation of data and preparation of this manuscript was also supported in part by the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25MH080916) and Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Contract, Veterans Health Administration, Office of Research & Development, Health Services Research & Development Service. Final preparation of this manuscript with supported by the Department of Psychology at Michigan State University and Michigan State University, Flint Center for Health Equity Solutions (U54MD011227).

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Authors and Affiliations

  1. Department of Psychology, Michigan State University, East Lansing, MI, USA

    Amy Drahota, Tatiana E. Bustos & Aksheya Sridhar

  2. Child and Adolescent Services Research Center, San Diego, CA, USA

    Amy Drahota, Brigitte Brikho, Aubyn C. Stahmer & Gregory A. Aarons

  3. Department of Psychology, University of Washington, Seattle, WA, USA

    Rosemary D. Meza

  4. Department of Psychology, California State University, Northridge, Northridge, CA, USA

    Jonathan I. Martinez

  5. MIND Institute, University of California, Davis, Davis, CA, USA

    Aubyn C. Stahmer

  6. Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA

    Gregory A. Aarons

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  1. Amy Drahota
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Drahota, A., Meza, R.D., Bustos, T.E. et al. Implementation-as-Usual in Community-Based Organizations Providing Specialized Services to Individuals with Autism Spectrum Disorder: A Mixed Methods Study. Adm Policy Ment Health 48, 482–498 (2021). https://doi.org/10.1007/s10488-020-01084-5

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