Tschida Jessica E, Drahota Amy
Department of Psychology, Michigan State University, 316 Physics Rd, East Lansing, MI, 48824, USA.
Child and Adolescent Services Research Center (CASRC), 3665 Kearny Villa Road, Suite 200N, San Diego, CA, 92123, USA.
Implement Sci Commun. 2023 May 16;4(1):52. doi: 10.1186/s43058-023-00434-2.
Evidence-based practices (EBPs) are shown to improve a variety of outcomes for autistic children. However, EBPs often are mis-implemented or not implemented in community-based settings where many autistic children receive usual care services. A blended implementation process and capacity-building implementation strategy, developed to facilitate the adoption and implementation of EBPs for autism spectrum disorder (ASD) in community-based settings, is the Autism Community Toolkit: Systems to Measure and Adopt Research-based Treatments (ACT SMART Toolkit). Based on an adapted Exploration, Adoption decision, Preparation, Implementation, Sustainment (EPIS) Framework, the multi-phased ACT SMART Toolkit is comprised of (a) implementation facilitation, (b) agency-based implementation teams, and (c) a web-based interface. In this instrumental case study, we developed and utilized a method to evaluate fidelity to the ACT SMART Toolkit. This study responds to the need for implementation strategy fidelity evaluation methods and may provide evidence supporting the use of the ACT SMART Toolkit.
We used an instrumental case study approach to assess fidelity to the ACT SMART Toolkit during its pilot study with six ASD community agencies located in southern California. We assessed adherence, dose, and implementation team responsiveness for each phase and activity of the toolkit at both an aggregate and individual agency level.
Overall, we found that adherence, dose, and implementation team responsiveness to the ACT SMART Toolkit were high, with some variability by EPIS phase and specific activity as well as by ASD community agency. At the aggregate level, adherence and dose were rated notably lowest during the preparation phase of the toolkit, which is a more activity-intensive phase of the toolkit.
This evaluation of fidelity to the ACT SMART Toolkit, utilizing an instrumental case study design, demonstrated the potential for the strategy to be used with fidelity in ASD community-based agencies. Findings related to the variability of implementation strategy fidelity in the present study may also inform future adaptations to the toolkit and point to broader trends of how implementation strategy fidelity may vary by content and context.
循证实践（EBPs）已被证明能改善自闭症儿童的多种结局。然而，在许多自闭症儿童接受常规护理服务的社区环境中，循证实践常常被错误实施或未得到实施。为促进在社区环境中采用和实施自闭症谱系障碍（ASD）的循证实践而开发的混合实施过程和能力建设实施策略，即自闭症社区工具包：衡量和采用基于研究的治疗方法的系统（ACT SMART工具包）。基于经过改编的探索、采用决策、准备、实施、维持（EPIS）框架，多阶段的ACT SMART工具包由以下部分组成：（a）实施促进，（b）基于机构的实施团队，以及（c）基于网络的界面。在本工具性案例研究中，我们开发并运用了一种方法来评估对ACT SMART工具包的保真度。本研究回应了对实施策略保真度评估方法的需求，并可能提供支持使用ACT SMART工具包的证据。
我们采用工具性案例研究方法，在加利福尼亚州南部的六个ASD社区机构进行的试点研究中，评估对ACT SMART工具包的保真度。我们在总体和单个机构层面评估了工具包每个阶段和活动的依从性、剂量以及实施团队的响应性。
总体而言，我们发现对ACT SMART工具包的依从性、剂量和实施团队响应性较高，但在EPIS阶段、特定活动以及ASD社区机构之间存在一些差异。在总体层面，工具包准备阶段的依从性和剂量评级明显最低，而准备阶段是工具包中活动强度更大的阶段。
本对ACT SMART工具包保真度的评估采用工具性案例研究设计，证明了该策略在ASD社区机构中保真使用的潜力。本研究中与实施策略保真度变异性相关的发现也可能为该工具包未来的调整提供信息，并指出实施策略保真度可能因内容和背景而异的更广泛趋势。
