In The Politics of Autism, I examine the implementation of public policy regarding autism at the federal, state, and local levels, encompassing education and social services. Implementation needs far more study.
Lay abstract:
This study looks at ways to improve how autism support programs are used in everyday community settings like schools and clinics. These programs are approaches that research has shown can help autistic individuals develop important skills, such as communication, social interaction, and managing behavior. Many of these are psychosocial programs, which means they focus on emotional, social, and behavioral support rather than medication or medical treatment. However, there is a challenge in implementing these interventions in real-world settings, especially in marginalized communities where services are often lacking or lower in quality. The field of implementation science helps bridge this gap by guiding and encouraging the use of evidence-based practices in community settings, aiming to reduce disparities. To better understand this, we did a scoping review that included 13 studies that used implementation science to support autism interventions. We looked at what types of strategies were used, how success was measured, and how well the programs fit into the communities where they were used. Most of the studies took place in schools and involved teachers, school staff, or caregivers of autistic children—altogether including data from 3488 participants. These studies tested different programs to improve outcomes of autistic individuals, such as social skills, communication, and behavior in schools.
From the article:
While school is a place where most autistic children receive services, these findings indicate the need for more efforts focused on examining various implementation phases across different settings to meet diverse needs of autistic children. Other community-based settings, such as daycare, clinics, therapy centers, recreational programs, vocational programs, and faith-based organizations, also provide services to autistic individuals, and it is therefore important to examine how EBPs may be delivered in such settings. These settings may have different structural and operational dynamics compared to schools, which may affect how EBPs are implemented. For example, community-based mental health clinics serving autistic individuals may have different resource constraints or other competing priorities compared to schools (Brookman-Frazee et al., 2010). Therefore, it is imperative to first carefully examine unique determinants (e.g. barriers, facilitators) that exist in different settings and carefully select implementation strategies that map onto these determinants (Balis & Houghtaling, 2023; Wensing & Grol, 2019). Using this intentional and careful process will allow us to avoid the pitfalls such as relying on a “one-size-fits-all” approach or choosing strategies that have little association with the identified determinants (Squires et al., 2014). Thus, it is important to not only recognize these determinants but also understand how these determinants would influence the appropriateness of implementation strategies within a specific context (Wensing & Grol, 2019). Moreover, the current political uncertainties in the United States have introduced increasing threats to publicly funded services, including special education and disability supports, which may disproportionately affect autistic individuals and their families. In this context, implementation research plays a critical role not only in bridging the research-to-practice gap but also in ensuring that effective, equitable, and sustainable interventions are embedded into systems of care, especially during times of policy uncertainty and resource instability.
