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Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.

ABSTRACT: Understanding the factors that influence the use of evidence-based practices (EBPs) for autism spectrum disorder (ASD) in schools is critical to the selection of effective implementation strategies to support their sustained use. The current study has 2 aims: (a) evaluate the association between school leadership profiles (undifferentiated and optimal) and fidelity of EBP implementation and (b) examine the role of implementation climate as a mediator in this association. Participants included 56 principals, 90 special education teachers, and 133 classroom staff from 66 elementary schools. Participants completed the Multifactor Leadership Questionnaire and Implementation Climate Scale. Teachers and staff reported on intensity (frequency) of EBP delivery, and the research team rated the accuracy (adherence) to the components of the EBP. Schools were required to implement at least 1 of 3 EBPs for ASD (discrete trial training, pivotal response training, or visual supports). Using structural equation modeling, we found that schools with optimal leadership had higher observed ratings of teacher and staff fidelity for pivotal response training accuracy (p < .05), but not for discrete trial training or visual supports. However, this association became nonsignificant with the introduction of implementation climate into the models. Optimal leadership profiles were linked to more positive teacher/staff-reported implementation climate, compared with undifferentiated profiles (p < .01), but found no association between implementation climate and fidelity. Overall, the results of this study indicate that the role of principal leadership in EBP implementation is complex, which has implications for fostering a conducive organizational implementation context in schools. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

SUBMITTER: Melgarejo M

PROVIDER: S-EPMC8202724 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundImplementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. This study tests whether empirically identifiable culture and climate profiles emerge in a sample of organizations and examines how these profiles relate to EBP fidelity and work attitudes that support EBP sustainment, focusing on three EBPs for youth with autism delivered in schools as an example.MethodsThe study included 65 elementary schools in the U.S. that implemented three EBPs-discrete trial training, pivotal response training, and visual schedules-for youth with autism. Organizational culture and climate and work attitudes were assessed using the Organizational Social Context measure at the beginning of the school year. Observations of EBP fidelity occurred mid school-year. We used bias-adjusted stepwise latent profile modeling to (1) identify subpopulations of schools that share similar culture and climate profiles, and (2) test for mean differences across profiles in observed EBP fidelity and teacher and staff work attitudes.ResultsControlling for region, four profiles best characterized the organizational cultures and climates of schools. Teachers and staff in schools with a comprehensive profile (high proficiency culture, positive climate) exhibited higher fidelity to two of three EBPs (d's?=?.95 to 1.64) and reported superior work attitudes (d's?=?.71 to 1.93) than teachers and staff in all other schools. Teachers and staff in supportive schools (low rigidity culture, positive climate) had better work attitudes, but not better fidelity, than those in schools with indifferent (low culture/climate, elevated stress) and constrained (high rigidity and resistance, high stress) profiles.ConclusionsOrganizational culture and climate profiles are a strong predictor of EBP fidelity and work attitudes that support EBP sustainment, highlighting the importance of an organization's overarching social context when developing implementation theory and strategies. Strategies that foster a comprehensive profile may improve EBP implementation.

Project description:BackgroundThe literature on perceptual differences between managers and staff regarding social dynamic factors (e.g., leadership, climate) in nursing settings is sparse. Addressing this gap in knowledge is critical for informing implementation efforts and improving patient and organizational outcomes. The purpose of this study was to test the perceptual differences regarding implementation leadership and implementation climate between nursing staff and their managers.MethodsThis study was a secondary analysis of cross-sectional survey data collected in 2016-2017. The setting included 22 adult medical-surgical units nested in 7 acute care hospitals in the Eastern and Midwestern United States. Participants were registered nurses (N = 261) and nurse managers (N = 22) who completed an electronic survey consisting of the Implementation Leadership Scale (ILS), the Implementation Climate Scale (ICS), and demographic items. Differences in perception were analyzed at the unit level using structural equation modeling to develop latent difference score models (LDS). We assessed associations of the LDSs with manager ILS and ICS scores, years of nursing experience, and years of experience working on the current unit. The association of ILS LDS with the observed nursing staff ICS scores was also analyzed.ResultsHigher manager scores on the ILS and ICS were associated with greater perceptual differences in implementation leadership and implementation climate. Greater years of experience as a nurse were associated with greater perceptual differences in ILS and ICS scores. Greater tenure on the unit was associated with smaller differences on the ILS knowledge domain. Greater perceptual differences regarding implementation leadership were associated with worse staff ratings of implementation climate.ConclusionsAlthough this study observed significant relationships among manager ILS and ICS scores, staff-manager perceptual differences, and staff ratings of implementation climate in nursing settings, it is still unclear why perceptual differences in implementation leadership and climate exist and how to address them. Future studies are warranted to test the effect of perceptual differences on implementation and patient outcomes.

Project description:BackgroundUntil now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods.MethodsStudies published between January 2001-October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4-18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (>?75% positive), moderate (50-75%) or low (<?50%).ResultsOf the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N =?50), followed by responsiveness (N =?36), adherence (N =?26) and quality of delivery (N =?8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n =?77).ConclusionsThere is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective.

Project description:Background"We Act" is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils' dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5-6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools.MethodsThe Medical Research Council's new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation.ResultsA total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils' presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the school-year plan and weak management support.ConclusionsAlthough 'We Act' was designed to comply with evidence- and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools' preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.Trial registrationISRCTN85203017.

Project description:IntroductionThe health-promoting school (HPS) approach was developed by the World Health Organization to create health promotion changes in the whole school system. Implementing the approach can be challenging for schools because schools are dynamic organizations with each a unique context. Many countries worldwide have a health promotion system in place in which healthy school (HS) advisors support schools in the process of implementing the HPS approach. Even though these HS advisors can take on various roles to provide support in an adaptive and context-oriented manner, these roles have not yet been described. The current study aims to identify and describe the key roles of the HS advisor when supporting schools during the dynamic process of implementing the HPS approach.MethodsThe study was part of a project in which a capacity-building module was developed for and with HS advisors in the Netherlands. In the current study, a co-creation process enabled by participatory research was used in which researchers, HS advisors, national representatives, and coordinators of the Dutch HS program participated. Co-creation processes took place between October 2020 and November 2021 and consisted of four phases: (1) a narrative review of the literature, (2) interviews, (3) focus groups, and (4) a final check.ResultsFive roles were identified. The role of "navigator" as a more central one and four other roles: "linking pin," "expert in the field," "critical friend," and "ambassador of the HPS approach." The (final) description of the five roles was recognizable for the HS advisors that participated in the study, and they indicated that it provided a comprehensive overview of the work of an HS advisor in the Netherlands.DiscussionThe roles can provide guidance to all Dutch HS advisors and the regional public health organizations that employ them on what is needed to provide sufficient and context-oriented support to schools. These roles can inspire and guide people from other countries to adapt the roles to their own national context.

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Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.

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