Achieving and maintaining intervention fidelity using a three-component implementation model in a comprehensive school-based psychosocial treatment for children with high-functioning ASD

Children with high-functioning autism spectrum disorder (HFASD) present with core deficits in social communication and restricted, repetitive, and stereotyped behaviors and interests that significantly impact their functioning and warrant comprehensive interventions. The knowledge and resources required to provide comprehensive interventions presents a particular challenge to treatment providers in school settings. The current chapter describes a systematic model of training and support provided to school professionals in order to guide and assist their implementation of a manualized comprehensive schoolbased intervention (schoolMAX) for 6-11 year old children with HFASD across the school year. The schoolMAX program was specifically designed to target the needs of children with HFASD within a school setting via social skills groups, therapeutic activities, face-voice emotion recognition instruction, individualized daily notes, and parent training. The implementation protocol consists of a three component process that includes 1) instruction, observation, planning, and practice; 2) treatment fidelity monitoring; and 3) consultative feedback. First, didactic instruction, observation, practice, and planning are used to build school staff knowledge and proficiency and to adapt the intervention to the participating school environment. Second, treatment fidelity is monitored throughout implementation by research clinicians to ensure the intervention protocol is conducted consistently and accurately. These research clinicians monitor fidelity while also providing ongoing modeling and support. Third, regular consultative feedback on provider proficiency is delivered to school staff by the senior research team. This feedback reviews ongoing intervention fidelity, problem-solves implementation issues, and evaluates student progress. Using data from the first year of a 4-year randomized trial of schoolMAX, the current study demonstrates the success of the three component implementation model in maintaining high levels of treatment fidelity by school staff across the school year. Implications for the use of this implementation model in enhancing execution of school-based interventions are discussed.