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Thursday, December 16, 2021

Implementation Research

In The Politics of Autism, I discuss implementation of public policy toward autism at the federal, state, and local levels, involving  education and social servicesImplementation needs far more study.

Brian A. Boyd and colleagues have an article at Autism titled 'It’s time to close the research to practice gap in autism: The need for implementation science."

Over 15 years ago, Lord and colleagues (2005) identified the challenges of evaluating interventions for autism, and Smith and colleagues (2007) subsequently proposed guidelines to generate empirical evidence for behavioral and psychosocial interventions. Since then, intervention research has proliferated (Steinbrenner et al., 2020), but the gap between research and practice remains wide (Dingfelder & Mandell, 2011; Odom et al., 2020). Implementation science has emerged as a field to promote the use and sustainment of evidence-based practices (EBPs) in routine care and practice. In this commentary, we challenge autism researchers to take the next steps on this journey that Lord, Smith, and colleagues began. In this commentary, we briefly describe (a) the history of intervention research for autistic children and youth, (b) key features of implementation science, and (c) a framework to support the use of implementation science in autism intervention research.

A basic requirement for implementation science is that there should be a clearly operationalized, conceptually sound, EBP to implement. In the last two decades, autism intervention science has accelerated rapidly, providing evidence-based comprehensive program models (e.g. the Early Start Denver Model, Pivotal Response Treatment, and the Lovaas Model), and focused intervention practices (e.g. reinforcement, prompting, and naturalistic strategies). Continued attention to discovering and validating practices that support autistic individuals will always be important. However, the variety of evidence-based intervention approaches and outcomes produced, as documented by systematic reviews and meta-analyses (Hume et al., 2021; Sandbank et al., 2020), suggests that the field is ready to move from solely a science of intervention efficacy, so well articulated by Smith et al., to a science of intervention implementation and sustainment.

Implementation science is “the scientific study of methods to promote the systematic uptake of clinical research findings and other EBPs into routine practice.” (Ogden & Fixsen, 2014, p. 4). Efforts to close the research-to-practice gap lie along a continuum from passive knowledge transfer to more active supports. At the passive end is diffusion, or the expectation that community practitioners will find EBPs on their own. Dissemination comprises more active communication about the innovation (e.g. public health smoking cessation campaigns; Learn the Signs, Act Early). Implementation is an active process that involves activities designed to motivate users and increase their ability to use an innovation (Dearing et al., 2018). Although they are important steps, diffusion and dissemination alone often do not lead to successful use of EBP. Implementation science identifies the change mechanisms (e.g. infrastructure of support, Odom et al., 2013; collaborative research culture, Stahmer et al., 2017) needed to ensure high-quality use of an innovation in practice.