PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：循证实践（EBPs）被证明可以改善自闭症儿童的各种结局。然而,在许多自闭症儿童接受常规护理服务的社区环境中，EBP经常被错误实施或未实施。混合实施过程和能力建设实施战略，旨在促进在社区环境中采用和实施针对自闭症谱系障碍（ASD）的EBP，是自闭症社区工具包：测量和采用基于研究的治疗方法的系统（ACTSMART工具包）。根据改编的探索，收养决定，准备工作,实施,可持续性(EPIS)框架，多阶段ACTSMART工具包包括(A)实施促进，(b)以机构为基础的执行小组，和(c)基于网络的界面。在这个工具案例研究中，我们开发并使用了一种方法来评估ACTSMARTToolkit的保真度。这项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ACTSMART工具包使用的证据。
方法：我们在与位于南加州的六个ASD社区机构进行的试点研究中，使用了一种工具案例研究方法来评估ACTSMARTToolkit的保真度。我们评估了依从性，剂量,以及实施团队对工具包的每个阶段和活动的总体和单个机构级别的响应能力。
结果：总体而言，我们发现坚持，剂量,实施团队对ACTSMART工具包的响应能力很高，EPIS阶段和具体活动以及ASD社区机构的一些可变性。在聚合级别，在工具包的准备阶段，依从性和剂量被评为最低，这是工具包中活动更加密集的阶段。
结论：对ACTSMART工具包的保真度评估，利用仪器案例研究设计，证明了该策略在ASD社区机构中与保真度一起使用的潜力。本研究中与实施策略保真度的可变性有关的发现也可能为将来对工具包的适应提供信息，并指出实施策略保真度如何随内容和上下文而变化的更广泛趋势。
方法：我们在与位于南加州的六个ASD社区机构进行的试点研究中，使用了一种工具案例研究方法来评估ACTSMARTToolkit的保真度。我们评估了依从性，剂量,以及实施团队对工具包的每个阶段和活动的总体和单个机构级别的响应能力。
结果：总体而言，我们发现坚持，剂量,实施团队对ACTSMART工具包的响应能力很高，EPIS阶段和具体活动以及ASD社区机构的一些可变性。在聚合级别，在工具包的准备阶段，依从性和剂量被评为最低，这是工具包中活动更加密集的阶段。
结论：对ACTSMART工具包的保真度评估，利用仪器案例研究设计，证明了该策略在ASD社区机构中与保真度一起使用的潜力。本研究中与实施策略保真度的可变性有关的发现也可能为将来对工具包的适应提供信息，并指出实施策略保真度如何随内容和上下文而变化的更广泛趋势。
