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11/30/2016
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Moving Evidence‐based Practices into the Classroom: Implementation Science and
Professional Development
Samuel L. OdomFrank Porter Graham Child Development
InstituteUniversity of North Carolina at Chapel Hill
Autism Mystique
• Probably more than any disability, or unique set of abilities, autism has been shrouded in a treatment mystique
• Treatments are more diverse than any known disabilities
• Treatment claims range from amelioration to recovery
• Defense against the dark arts!
https://www.youtube.com/watch?v=2htMZ3Vmc8w
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Cutting Edge Interventions for Autism (Seri & Lyons, 2014)
• Antifungal treatment
• Aquatic therapy
• Auditory Integration Therapy
• Chelation Removal of Toxic Metals
• Craniosacral and chiropractic therapy
• Dietary interventions
• Hyperbaric oxygen therapy
• Medicinal marijuana
• Neuroimmune dysfunction and antiviral therapy
• Rapid Prompting
• Sensory gym
• Traditional and indigenous healing
• Stem cell therapy
• Transcranial Direct Current Stimulation
Pack a Wound With Sugar
The Research‐Practice Gap
• Not a new lament (Carnine, 1999)
• Evidence‐based medicine movement dating back to the 1960s (Cochrane’s work)
• Clinical psychology work from the 1980s
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http://www.cochrane.org/
Model for Evidence‐Based Medicine and Education
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The What and the How
• The What: Evidence‐based programs
• The How: Strategies for supporting use of EBPs in educational contexts (schools and classes)
Wandersman et al. (2008)
The What
• Early screening and diagnosis
• Naturalistic Developmental Behavioral Intervention– Early Start Denver Model
– Pivotal Response Treatment
– Walden Program
• Lovaas Model and variation
• LEAP
• Visual Supports
• Reinforcement
• Prompting
• Time Delay
• Peer‐Mediated Intervention
• Modeling
• Social narratives
• Social skills training
From Wandersman, 2011
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If we keep on doing what we have been doing, we are going to keep on getting what we have been getting. Abe Wandersman
Systems are perfectly designed to produce the outcomes they generate. Dean Fixsen
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From Wandersman, 2011Interactive Systems Framework for Dissemination and Implementation
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Stages of Implementation Process (Fixsen et al., 2013)
• Exploration
• Installation
• Initial Implementation
• Final Implementation
Two Synthesis Reviews
Damschroeder et al. (2009)
• Consolidated Framework for Implementation Research
• Examined 18 IS Models
• Features– Intervention
– Outer setting
– Inner setting
– Characteristics of individuals involved
– Implementation process (plan, evaluate, reflect)
Meyers, Durlak, & Wandersman (2012).
• Quality Implementation Framework
• Examined 25 IS Models
• Phases– Initial consideration by host
– Creating a Structure for Implementation
– Ongoing structure once implementation begins
– Improving future application
Meyers, Durlak, and Wandersman (2012)
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References
• Meyers, D. C., Durlak, J. A., & Wandersman, A. (2012). The Quality Implementation Framework: A synthesis of critical steps in the implementation process. American Journal of Community Psychology, 50, 462‐480.
• Hamre, B. K., & Hatfield, B. E. (2015). Moving evidence‐based professional development into the field: Recommendations for policy and research. In. C. Howes, B. Hamre, & R. Pianta (Eds.), Effective early childhood professional development: Improving teacher practice and outcomes (pp. 213‐228), Baltimore, MD: Brookes.
State Implementation & Scaling‐up of Evidence‐based Practices Center (SISEP)
NIRN (2015)
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Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014).Organizational readiness for implementing change: a psychometric assessment of a new measure. Implementation Science, 9 (7). Online. http://www.implementationscience.com/content/9/1/7
Readiness for Organization Change Change Assessment
• Holt, D. T., Armenakis, A. A., Field, H. S., Harris, S. G. (2007). Readiness for Organizational Change: The systematic development of a scale. The Journal of Applied Behavioral Science, 43, 232‐255.
• 27 item rating scale
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Themes from These Scales
• Belief the problem is important
• Commitment of wanting to do something about the problem.
• Staff’s belief they can actually implement change that will make a difference
• Belief the evidence is strong
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Stages AND Drivers
Drivers
Drivers
Drivers
“DRIVERS”
Metz (2013)
Essential Feature: Leadership
• Who is the leader most likely to be the catalyst?
– Mid‐level administrators
– Director of Special Education
– Supervisor of autism programs
– Principal or Assistant Principal in Schools
• Leadership at the grassroots level
– Parent groups
– Teachers/Related Service Personnel
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Characteristics of a Good Leader
Aarons, G. A., Ehrhart, M., & Farahnak, L. (2014). Implementation leadership scale. https://static‐content.springer.com/esm/art%3A10.1186%2F1748‐5908‐9‐45/MediaObjects/13012_2013_751_MOESM1_ESM.pdf
What Does A Good Leaders Look Like?
https://www.youtube.com/watch?v=5L8Em5vU0FU
NIRN (2015)
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http://autismpdc.fpg.unc.edu/
Evidence‐Based Practices
• Wong et al. 2014 recently updated Odom et al. (2010) EBP review http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/2014‐EBP‐Report.pdf
• Began with pool of 29,105+ articles and reduced to 456
• 27 EBPs identified
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EBPsFundamental Applied Behavior Analysis Practices
• Reinforcement
• Prompts
• Time delay
• Modeling
• Task analysis
Positive Behavior Intervention and Support
• Functional assessment
• Antecedent‐based intervention
• Extinction
• Response interruption/redirection
• Differential reinforcement of alternative/other behavior
• Functional communication training
EBPsSocial Communication
Interventions
• Social skills training
• Peer‐mediated interventions and instruction
• Social narratives
• Structured play groups
• Picture Exchange Communication System (PECS®)
Broad Teaching Strategies
• Visual supports
• Discrete trial training
• Naturalistic interventions
• Pivotal response training
• Parent implemented interventions
• Scripting
• Exercise
EBPs
Cognitive Behavior
• Self management
• Cognitive behavior interventions
Technology Oriented
• Technology‐assisted instruction and intervention
• Video modeling
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Identified Practices
Research Based
Replicable Practices
Practitioner Friendly
Bridging the Gap
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AFIRM Goals
1. To develop online modules that translate the 27 EBPs for children and youth with ASD into engaging self‐learning modules and resources
2. To evaluate the modules for quality, usefulness, and relevance by monitoring access by learners, reviewing evaluation by users, and soliciting feedback on how the information has been applied in classrooms (Fall 2016)
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http://afirm.fpg.unc.edu/
AFIRM Features
Case examples
Audio clips
Video clips
Interactive assessments
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NIRN (2015)
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Train and Hope
One Shot Workshop Without Follow‐up
• May introduce content
• Not likely to lead to effective use of practices in classrooms
• Could be one tool in a package
Web‐based Training Alone Will Not Work
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Technical Assistance
• Training
– Summer institute
– Online course
– Training as needed
• Consultation
– Connections with TA Providers
• Coaching
Direct
Facilitated
Classic Coaching Model
https://www.youtube.com/watch?v=0Cd7Bsp3dDo
Our Coaching Resourceshttp://autismpdc.fpg.unc.edu/
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3 Components Of CyclicalCoaching Process
Coaching Components
Preobservation Conference
Select coaching target, obs plan, data collection
plan
Postobservation Conference
Discuss obs, discuss ways to change behavior, plan for ongoing support
Observation
Collect data for meaningful
discussion and planning
Feedback & Support from NPDC
Challenges to the Coaching Model?
• Time
• Roles and Responsibility
• Personalities
• Training for coaches
• Constantly changing staff
– Have to build a model of innovation on the assumption that staff will turn over and professional development is an ongoing process
NIRN (2015)
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Preparing the Context: Building a Foundation of Quality
• Two versions: PE and MHS
• APERS‐PE: 59 items across 10 domains/subdomains
• Administered by research staff at two time points: Early fall and late spring.
• Yields information that identifies program strengths and areas in need of improvement; measure of change in program quality
Autism Program Environment Rating Scale: What is it?
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APERS Profile in Report
To Use In Your Program: APERS Self‐Assessment
• Draft version on PDF for you
• Self‐assessment design to give formative feedback to improve your program
• Read over items completely before rating
• Complete self‐assessment as a team
• Come to consensus on items where there is disagreement
• Use self‐assessment to develop an action plan
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Future Directions
• Technology may allow us new models for coaching.
• Identification of EBPs will be ongoing
• Teacher will need a new “supervision” skill set
– Training for paraprofessionals will become more important than ever.
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In Conclusion
• Learning the EBPs is an important accomplishment
• Implementation with fidelity is a challenge
• Key elements
– Leadership
– Motivation
– Resources
– Will to defend against the dark arts