This journal article was derived from the HSU Library. The intervention model used is based on a consumer advocacy model, which focuses on bringing families and professionals together to make well-informed choices. The article, while parents are included, is aimed more at professionals to consider forms of intervention available, least restrictive environments, and legal mandates.
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The reported prevalence of children with autism spectrum disorders (ASD) has surged in recent years (Fombonne,2005). The marked increase in children with ASD who attend public school (U.S. Department of Education, 2003) has accompanied an unprecedented discussion about how best to educate this challenging and diverse population (National Research Council, 2001). A considerable body of research has emerged, and a number of promising, evidence-based strategies have been developed (Simpson et al., 2005); however, despite need, the dynamic nature of public schools complicates the process of selecting and delivering evidence-based instruction to students with ASD. Public schools are social systems in which multiple demands compete with limited resources. Recent legislative reforms have increased pressure on schools to demonstrate learning outcomes for all students, including students with disabilities (McLaughlin & Thurlow, 2003). School systems have invested significant resources in various reform models aimed at improving academic performance (e.g., Koh & Robertson, 2003), although the impact of such reforms on students with disabilities is unclear. Under the No Child Left Behind (NCLB) Act of 2001, states are now required to assess all students’ progress in the general education curriculum. Consequently, schools must balance the academic progress of students with disabilities with the legal mandates of the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004, including least restrictive environment (LRE) provisions. Students with significant disabilities, such as autism spectrum disorders (ASD), are increasingly included in general education; however, successful inclusion is sometimes countered by resistance from general educators and lack of necessary administrative support (Dybvik, 2004). Service delivery for students with ASD is further complicated by the multidisciplinary nature of special education. In public schools, special educators, general educators, related service providers, and administrators collaborate with parents to develop a student’s Individualized Education Program (IEP). Disagreements about appropriate programming occur as professionals and parents bring differing experiences and philosophies to the process. For example, it is not uncommon for parents of children with ASD to advocate a program primarily based in applied behavior analysis (ABA) while professional team members advocate a more eclectic approach (Etscheidt, 2003). Professionals also tend to endorse strategies conforming to their philosophy and professional training, which may result in conflicts during the teaming process. For instance, an occupational therapist may endorse sensory integration (SI) therapy (Cook & Dunn, 1998) to address a student’s challenging behavior, whereas a behavior specialist may recommend a behaviorally based approach (e.g., Durand & Merges, 2001). Teachers and paraprofessionals often lack the training necessary to implement a specialized approach without considerable support from
related service providers or consultants. Without support, evidence-based interventions are unlikely to be implemented as intended. Finally, from the perspective of public school administrators, some intervention strategies are prohibitively expensive—particularly when they require outside consultants or 1:1 staffing ratios—and deplete scarce school resources. The factors that affect evidence-based intervention for students with ASD are highlighted in Figure 1. This is not intended to be an exhaustive diagram but rather a
summary of the major overlapping variables that constitute the context of intervention in public school settings. An analysis of Figure 1 suggests that educators should consider all the relevant variables when selecting and designing a student’s educational program. ASD, Intervention Selection, and the Consumer Advocacy Model Intervention selection for children with ASD has been strongly influenced by the consumer advocacy model (CAM). Implicit in the CAM is the idea that parents and professionals can make informed choices about educational strategies for children with ASD if experts provide them with accurate information about effective interventions (e.g., Green, 1996; Romanczyk & Gillis, 2004; Simpson, 2005; Simpson et al., 2005). Simpson (2005), for example, described characteristics of effective and scientifically valid interventions for students with ASD and presents three basic questions for parents and professionals to ask related to efficacy of outcomes, potential risks, and evaluation of a particular approach. The Internet is replete with Web sites that offer expert information on ASD research and recommendations for treatment (Polirstok & Lesser, 2003). The aim of books, book chapters, articles, and Web
sites is to empower consumers so that they can make informed decisions about ASD interventions based on the most accurate information available. The expectation is that professionals and parents will adopt effective strategies based on expert recommendations and analysis of the research. Although it is critical to convey accurate information
about evidence-based practice, using the CAM as the only strategy to guide intervention selection is problematic in two ways. First, it assumes that professionals and parents make free choices about intervention devoid of context. To the contrary, intervention selection in public schools is guided by myriad factors, which are summarized in Figure 1. In addition to consumers’ philosophies and values about what constitutes effective intervention, teams must FIGURE 1. Factors that affect evidence-based intervention for students with ASD in public schools. Note. ASD = autism spectrum disorders; NCLB = No Child Left Behind; IDEIA = Individuals with Disabilities Education Improvement Act; LRE = least restrictive environment. Consider the compatibility of intervention with (a) accountability reform programs in the school, (b) legal mandates of IDEIA, including LRE, (c) the capacity of staff to implement the intervention with fidelity, and (d) the availability of resources in the classroom and school needed to support the intervention. The efficacy of intervention is only one important factor to consider in the selection process. A second issue with the CAM relates to the literature on effective intervention for students with ASD. Although there is a growing body of research on validated educational practices for students with ASD (Simpson et al., 2005), much of this research has not been conducted within typical school arrangements. For example, the intervention may occur in a setting other than the student’s
general education classroom, the agents of intervention may be persons other than teachers or classroom staff, or team-based planning may not be fully incorporated into the process (Snell, Voorhees, & Chen, 2005). Moreover, many intervention studies fail to demonstrate or report maintenance of behavior change beyond completion of the
study (cf. Foxx, 1999; Sansosti & Powell-Smith, 2006). Although the CAM tells consumers which interventions work best under particular circumstances, it says much less about interventions that will succeed in dynamic public school contexts, in which durable outcomes are expected and team-based collaboration is inherent in the process. ASD and Contextual Fit An alternative to the CAM is the contextual fit approach (Albin, Luchyshyn, Horner, & Flannery, 1996). Contextual fit addresses the compatibility of the intervention plan with variables within the environment. These include (a) characteristics of the person for whom the plan is designed, (b) variables related to the people who will implement the plan, and (c) features of environments and systems within which the plan will be implemented (p. 82).
Contextual fit is central to team-based intervention, in which team members collaborate on selection of target behaviors, assessment, and intervention (Snell et al., 2005). Contextual fit considers not only the capacity of individual team members to support intervention but also the capacity of classroom, nonclassroom, and schoolwide systems to sustain intervention (Crone & Horner, 2003). Because parents provide valuable insight into the design of strategies and benefit directly from successful intervention, parent involvement is also a primary component (Vaughn, White, Johnston, & Dunlap, 2005). A critical
assumption of the contextual fit approach is that evidencebased interventions will fail if they are implemented without attention to relevant variables in the environment. A number of variables contribute to the failure of an otherwise effective intervention within a public school setting. For example, teachers or paraprofessionals do not have the skills or expertise to implement a highly specialized approach without intensive supervision and training. In the absence of such training, classroom staff will implement the intervention poorly and then abandon it when it fails to achieve the desired results. If classroom staff do not value the goals or procedures of the intervention, it is also unlikely to be procedurally effective (or, worse, it will be counter-effective). Moreover, if staff members are occupied with district-mandated curricular and assessment programs unrelated to the intervention, they will not dedicate the time and effort necessary for intervention success. Further, if administrators cannot provide needed resources, including staffing, prep time, training, consultation, and supervision, the intervention will fail to produce the desired results. Finally, if parents disagree with the intervention, they are unlikely to provide needed input or to benefit from potentially desirable effects. Conversely, when team members receive the necessary training and support, when their input is solicited and incorporated into the program, when the intervention is designed with consideration of district-mandated programs, and when administrators provide necessary resources to support the intervention, it is much more
likely to succeed. The following steps guide the process of selecting an intervention with contextual fit: 1. Establish an evidence base for potential interventions. The team should consider only interventions that have solid empirical support. Qualitative, single-subject, and group design studies constitute evidence of effectiveness (Odom et al., 2005), but it is preferable for strategies to have experimental, as opposed to anecdotal, support. In particular, potential interventions should be demonstrably effective in real classrooms under typical classroom conditions. 2. Solicit input and evaluate the compatibility of interventions with team members’ values. This requires a recognition that intervention is not a topdown process, in which experts dictate procedures to staff and parents, but a collaborative endeavor in which all team members have valuable input in decision making. Relevant questions include the following: Are the goals of intervention important to teachers, parents, and other stakeholders? Are the procedures of intervention consistent with the values of stakeholders? Conflicts among team members should be acknowledged. When a team member disagrees with the choice of a particular intervention, he or she should be given options for alternative ways to support the student’s program. The team should also recognize that parents possess differing capacities for supporting interventions, and their
input should not be devalued because they are unable or unwilling to implement procedures in the home setting (Vaughn et al., 2005).50 INTERVENTION IN SCHOOL AND CLINIC
3. Assess the capacity of team members to support the intervention. What are the skills and resources necessary to embed the intervention within the student’s environment? Are these skills and resources currently available, or must they be introduced? Successful intervention hinges on the capacity of stakeholders to implement procedures with fidelity. This requires a realistic assessment of needed resources. For example, if the team agrees on a highly
specialized intervention that requires expert consultation or intensive staffing, how will those resources be funded? In some cases, the team may preclude certain interventions that cannot be executed with current resources; in other situations, the team may discuss how to reallocate staffing or other resources to support an approach. Outside consultants can
provide valuable expertise to team members who lack specialized training; however, consultation is often very expensive and should not be viewed as a long-term solution. In addition to expertise in evidence-based strategies, outside consultants should possess demonstrable skill in assisting team members in embedding and sustaining strategies when consultation is no longer available. Specifically, during the hiring process, consultants should be asked to provide data demonstrating embedded processes and long-term outcomes for students with ASD in similar school arrangements. 4. Assess the compatibility of the intervention with school-wide programs and administrative supports. It is also important to acknowledge the broader context of intervention, including how it will fit with
programs and initiatives beyond the self-contained classroom. Consider the following scenario: Team members agree on an intensive intervention to teach
communication and social skills to a student who requires specialized 1:1 staffing; however, the student participates in a schoolwide LRE initiative and
spends the majority of her day in general education
settings in which 1:1 staffing is not available. In addition, the team has determined that the student will participate in state-mandated high-stakes testing, and the administrator is concerned that the intervention will interfere with the student’s instruction in general
education. Unfortunately, such scenarios are common in public schools and render teams hard-pressed to find appropriate solutions. First, the team should
acknowledge conflicting demands and have an open discussion about the resources needed to support proposed interventions and programs. Next, the team should create a prioritized list, separating interventions that must be implemented from those with lower
priority. Finally, considering Steps 2 and 3, the team should determine the resources necessary to implement high-priority programs and decide on an action plan. 5. Implement and evaluate the intervention. After determining an action plan, implement the intervention. The action plan should include an explicit strategy for evaluating and modifying the intervention to promote success. The evaluation strategy includes who will collect data, how data will be collected, and target dates for when the team will evaluate short-term and long-term progress (Crone & Horner, 2003).
Summary
Public schools are dynamic social systems. ASD intervention is a team-based endeavor, and the team must consider myriad factors when designing effective intervention.
Critical considerations include (a) the evidence base for intervention, (b) accountability reform programs in the school, (c) legal mandates of the IDEIA, including LRE, (d) the capacity of staff to implement the intervention with fidelity, and (e) availability of resources in the classroom and the school that are needed to support the intervention. It is hoped that these preliminary recommendations will guide collaborative teams in developing effective and comprehensive interventions for students with ASD.
ABOUT THE AUTHOR
Matt Tincani, PhD, is an assistant professor at the University of Nevada, Las Vegas. His research interests include positive behavior support, language programming for learners with severe disabilities, and instructional pacing. Address: Matt Tincani, Department of Special Education, 4505 Maryland Pkwy., Box 453014, Las Vegas, NV 89154-3014; tincanim@nevada.edu
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