The OARacle Newsletter

In November, OAR’s Board of Directors authorized funding for eight applied autism research studies in 2022. These new grants, totaling $313,712, bring OAR’s total research funding to more than $4.7 million since 2002. This article is the first of eight previews to be featured in The OARacle this year.   

Evidence-based practices are a key way to improve symptoms associated with autism because they can help improve autistic children’s mental health and ability to be successful in their lives. Unfortunately, those practices are not always implemented by parents and teachers, due to barriers such as limited capacity, training, and experience. Alignment — that is, ensuring that the evidence-based practices are taught and reinforced the same way at home as they are in school — poses another challenge. The practices will not positively affect autistic children’s behavior and mental health unless they are implemented and aligned across home, school, and other settings.

OAR awarded funding to Gazi F. Azad, Ph.D., an assistant professor of clinical medical psychology at Columbia University Medical Center/New York State Psychiatric Institute and a licensed psychologist at the Center for Autism and the Developing Brain at New York Presbyterian Hospital, to adapt Partners in School, a program that supports parents and teachers in implementing evidence-based practices and ensures that those practices are aligned across home and school settings.

Dr. Azad’s 18-month study will add coaching to Partners in School as an additional implementation strategy. As Dr. Azad noted in her proposal, a robust body of research suggests that coaching is an effective strategy to support ongoing implementation. Dr. Azad plans to incorporate the coaching component so that it simultaneously considers both home and school settings. The goals of her study, Partners in School: Aligning Evidence-Based Practices Across Home and School through Coaching, are to:

• Co-design cross-contextual coaching through qualitative interviews with parents and teachers of children with autism.
• Test the feasibility, acceptability, and preliminary effectiveness of adding coaching to Partners in School.

Methodology

Phase 1: Co-design cross-contextual coaching through qualitative interviews with parents and teachers of children with autism.

Participants: Dr. Azad will recruit 15 parents and 15 teachers from school districts in New York State and Connecticut to participate. The teachers will be full-time teachers from preschool to fifth grade special education classrooms that serve autistic students. The parents must have an autistic child who is in any grade from preschool up to fifth grade.

Qualitative interviews: The research team will use an exploratory research design based on the principles of co-design. In co-design, the experiences of users are at the core of the design process, which fosters participant commitment, increasing the likelihood of implementation success. Each teacher and each parent will be interviewed via Zoom for one hour. Dr. Azad will ask participants about:

• Type of coaching (i.e., support with implementation, data collection, cross-context awareness)
• Frequency of coaching (i.e., how often to meet with the coach)
• Mode of coaching (i.e., in person or virtual)

The findings from those interviews will be presented to a community advisory board for feedback on how to effectively incorporate coaching into the Partners in School implementation package. That previously selected board will include two school administrators, two teachers — one that teaches in the lower grades (preschool to 2^nd grade) and one that teaches in the higher elementary grades (3^rd to 5^th grades), and two parents — one with younger autistic children and one with older autistic children.

Phase 2: Test the feasibility, acceptability, and preliminary effectiveness of adding coaching to Partners in School.

Participants: Dr. Azad will recruit 15 parents and 15 teachers from the same districts with the same criteria. Teachers will be recruited first and then a parent from each teacher’s classroom will also be recruited to participate.

Program preparation: Prior to participation in the program, Dr. Azad will interview each parent and teacher pair to identify their top three child concerns at home or school, respectively. Next, they will each complete a self-assessment questionnaire to identify problematic communication patterns. Dr. Azad will then set up a meeting with the parent and teacher together to identify a mutual concern and co-construct a student intervention plan based on evidence-based practices.

Implementation: Teachers will implement the student intervention plan in the classroom and parents will implement the same intervention plan at home for three weeks. The Partners in School program uses a combination of 10 evidence-based practices, selected based on Dr. Azad’s and her team’s prior work with Partners in School, to develop a tailored student intervention plan including:

1. Antecedent-based interventions (e.g., reminders)
2. Cognitive-behavioral/instructional strategies
3. Functional communication training
4. Modeling
5. Prompting
6. Redirecting
7. Reinforcement
8. Social narratives
9. Task analysis
10. Visual schedules

For example, a student intervention plan focusing on challenging behaviors related to transitions may include:

• A three-minute reminder using a timer
• A visual schedule showing completion of the current activity and transition to the next activity
• Social praise for engaging in the appropriate behavior

Participants will complete a daily electronic survey indicating whether they completed the steps of the intervention plan and how much progress the child made in that setting. A virtual troubleshooting meeting will be scheduled if either parent or teacher indicates that the child is not making progress for three consecutive days.

After the three-week implementation phase, Dr. Azad will meet virtually with the parent and teacher for separate interviews to discuss maintenance plans, as well as review implementation and clinical outcomes.

Evaluation

Dr. Azad will measure five implementation outcomes:

1. Adoption will be measured by examining whether an intervention plan incorporating evidence-based practices was developed and the number of days it was implemented.
2. Fidelity will be examined as the number of intervention steps completed at home or school.
3. Alignment will be assessed as the number of intervention steps completed both at home and at school.
4. Feasibility will be measured as the proportion of coaching sessions completed, mode of interaction between participants and the coach, and the content of their interactions.
5. Acceptability will be examined by asking participants to rate the coaching experience and their level of confidence in implementing the intervention plan.

In addition, Dr. Azad and her team will evaluate:

• Challenges faced by parents and teachers in aligning intervention practices
• Improvement of parent/teacher communication skills
• Child outcomes

Practical Relevance

This study provides practical findings related to the everyday challenges posed by autism in four ways:

1. Misalignment between home and school settings may be particularly challenging for the mental health of autistic children, who are often characterized by an insistence on sameness. For example, children may become dysregulated or display anxiety when parents and teachers use different strategies to facilitate transitions from preferred to non-preferred activities.
2. The negative impacts on mental health may be heightened in minority children, who are more likely to reside in communities with limited resources to align settings, resulting in widening disparities in mental health. This study will be conducted in economically and racially/ethnically diverse school districts.
3. Parents and teachers are the primary stakeholders to address the mental health challenges displayed by children with autism. Unfortunately, they are rarely trained to work together. Partners in School trains them to work together to optimize outcomes in children.
4. The everyday challenges posed by autism are manifested primarily in home and school settings because these are the contexts where children spend most of their time. Partners in School not only supports parents and teachers in their respective settings, but also encourages the alignment of those settings.

This research study has the potential to make significant contributions to the autism community. First, the results will hopefully show those involved in implementation science the usefulness of targeting alignment across both the home and school settings. Second, the research offers an innovative approach to improving access to and effectiveness of existing services.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.