The Centers for Disease Control and Prevention (CDC; 2012) now reports that 1 in 68 children have been identified with an ASD; an increase from the 1 in 88 statistic from 2008. In addition, the CDC currently reports that the prevalence is 1 in 42 among boys and 1 in 189 among girls, meaning that identification of an ASD diagnosis is almost 5 times more common in boys than girls (CDC; 2014). It is also important to note that many children with ASD will receive another diagnosis at some point in their development. In a 2008 study, seventy percent of a sample of children with ASD ages 10 to 14, had also been diagnosed with another disorder, including a mental health issue. Forty-one percent had been diagnosed with two or more additional disorders. In addition to the increasing incidence and complexity of ASD diagnoses, children and families today live increasingly complicated lives. Research tells us that the number of children living in single-parent homes in the United States has increased dramatically in the past several decades (Vespa, Lewis, Krieder, 2013) as has the number of children living in low-income and poor families (Jiang, Ekono, & Skinner, 2016). There are challenges associated with navigating an ASD diagnosis for any family, and many families simply do not have the tools needed to find resources on their own. Therefore, the role of schools and educators in providing quality interventions for children on the spectrum is imperative to improve outcomes for the rising number of children impacted by ASD.
In 2001, the Committee on Educational Interventions for Children with Autism, a committee formed by the National Research Council at the request of the U.S. Department of Education, published its recommendations in Educating Children with Autism. The recommendations from the committee are based on a thorough review of empirical findings from special education, general education, and developmental literature. The committee recommends that individualized, systematic, evidence-based interventions should begin as soon as a child is suspected of having an ASD (Lord & McGee, 2001). Since 2001, other national organizations have provided their support for the use of evidence- based practices (EBPs) when working with students with ASD. The National Autism Center currently supports several established evidence-based practices for children and adolescents with ASD as does the National Professional Development Center on Autism Spectrum Disorders. The National Autism Center (2015) acknowledges that the implementation of EBPs requires time and resources, but also clearly states that systemic change best occurs when educators develop teams to develop strategies and track progress.
Evidence-based educational services for students with ASD extend beyond academic interventions. There is evidence that specific interventions in social skills, language acquisition, nonverbal communication, and reductions in challenging behaviors have demonstrated substantial progress in students with ASD (Lord & McGee, 2001). Therefore, EBPs that have been developed for working with students with ASD span a wide array of skills and behaviors. A few common examples include the Picture Exchange Communication System (PECS) used to encourage nonverbal communication, or social narratives to teach social skills and behaviors. The numerous evidence-based strategies that have been developed and identified are irrelevant if educators do not know how to implement these strategies in their classroom or are not doing so in an appropriate way. Therefore, an essential piece of translating research to practice is the training and coaching of teachers in these particular strategies.
The Indiana Resource Center for Autism (IRCA) is located at the Indiana Institute on Disability and Community and is part of Indiana University. One branch of the work of IRCA is to support school districts across the state of Indiana in implementing EBPs for their students with ASD. A consultative model is used in which consultants from the IRCA are hired by school districts to train staff on the implementation of EBPs endorsed by the National Professional Development Center on Autism Spectrum Disorders (NPDC). This model was created to provide a response to the growing need for high quality professional development in autism spectrum disorders across the state of Indiana and provides a solution to the much needed support for educators working to educate a diverse group of students on the spectrum.
Funded in 2007 by the Office of Special Education Programs of the U.S. Department of Education, the National Professional Development Center on Autism Spectrum Disorders was a collective of three university centers established to promote the use of evidence-based practices for children and adolescents with ASD (Odom, Collet-Klingenberg, Rogers, & Hatton, 2010). In 2008, Indiana was part of the first cohort of three states selected through a competitive application process to participate in a two-year partnership with NPDC. As Indiana’s University Center for Excellence in Developmental Disabilities, the Indiana Resource Center for Autism collaborated with NPDC to identify schools to act as demonstration sites each year, and to provide technical assistance and coaching to schools. Although the partnership officially came to a close in 2010, the IRCA has continued utilizing the framework and coaching materials furnished by NPDC to provide training in evidence-based practices to additional schools and to build a platform for sustainable change spanning across the entire state.
In order to further illustrate the impact of this model for the statewide implementation of a model for high quality programming in autism, participants in the professional development training on evidence-based practices participated in interviews regarding their experiences. In order to illustrate the barriers, critical characteristics, and positive outcomes that came from this work, direct remarks from these interviews will be integrated as examples.
Barriers to Successful Change
There are several barriers and challenges to implementing change through a consultative relationship. Consultation and professional development are often met by some parties with skepticism or distrust. In the case of the IRCA’s work in the schools, barriers identified included lack of buy-in from teachers, communication issues between different parties, and a lack of resources. Participants interviewed shared information regarding the challenges they faced when working with the consultants as a way of understanding the nature of these challenges. Examining the barriers to success is beneficial moving forward as new consultants and schools seek to make sustainable change in their schools and communities.
The consultative relationship ideally should begin when both parties are willing and excited about taking on the challenge of improving outcomes. However, in this case, some teachers may not be receptive to professional development or training. One team leader explained how this affected the training of the team in her building: “[There were]…people who had they told me, been there, done that, as far as you know trainings were concerned. It was like some of those folks said we’ve had training before and people come in and people go, but nothing comes out of it, so I don’t know why we’re doing this… people who are afraid of change, people who felt…, threatened or felt as if their competence was being questioned because they were being trained or asked to do something different.” As this quote illustrates, teachers may be hesitant to participate in training or professional development because of the constant ebb and flow of new trends in teaching they have been exposed to across their career that have likely come and gone with almost no follow through. In addition, they may feel that a consultant coming in to their classroom reflects poorly on them. However, consultants and teachers must agree that changes being made in the classroom are in the best interest of the students. When consultants are brought in to a school, it is important for administration to make it clear that the work of the consultants is to facilitate student success.
On a related note, an additional challenge of implementing evidence-based practices into the schools was muddled communication between the consultant, the administration, and the teachers. Without a clear line of communication from all participants in the process, many obstacles can arise. As this teacher pointed out, a breakdown in communication resulted in a team that did not understand the expectations and felt threatened by their consultant: “I guess there was a lack of communication of the team – the team of teachers felt pretty threatened and… pretty caught off guard that we were even doing the program in general, the expectations were not spelled out well…” It is essential that consultants work with the administration and leaders within the building or team to set clear expectations and assure that these expectations are communicated openly to all participants in the team. Ideally, team members should be provided with an opportunity to ask questions and anticipate their role in the team before work with the consultant officially begins.
Whenever change is taking place, especially in education, there may be some stakeholders that express a lack of buy-in when it comes time for making change. In some cases, these may be individuals on a team that have limited or no experience with students on the spectrum. One teacher expressed her concern regarding some of her students moving into a general education environment where the teacher may not be as receptive to making the positive changes she had put in place for her students while working with a consultant: “Some of the general education teachers… when we share things they are not as receptive, which this year it didn't make much of a difference because they didn’t have to be, but next year when the students are placed in their class. You know, when my 5th graders move, I have two of them in 5th grade that she has been helping me with, that’s where I am concerned about that.” In the experience of these consultants, a resistance to learn from staff members that do not specialize in supporting a diverse range of learners occurred, but was not limited to general education staff. Special education teachers may be resistant to change, as well.
Finally, a barrier to almost any kind of change in education is going to be a lack of resources. Several types of resources can make implementing change in the schools difficult. Examples mentioned include money, time, and staffing. As one teacher put it: “And schools now, the way money is, the way time is, and even in some places, contracts that say you cannot work after certain hours, you know, makes it really hard for people to really work as a team to get things done.” In the beginning of the consultation, there should be a common understanding about resources available in any particular building. Team members need to make a commitment around schedules, contracts, and money to make meaningful change. There is no doubt that change will almost always require time and consultants must be sensitive to the lack of time available in a school day. One teacher noted, “A lot of strategies, particularly making visual supports take a lot of time. Teachers are so busy. Sometimes I think they would have the intentions of doing it, but just time wise it wouldn’t be a priority to them.” Therefore, what may seem as a lack of concern or effort to a consultant may truly be a lack of resources or time on the part of the team members. Discussing these challenges openly as a team is one way to be sure that these barriers are addressed.
Critical Components
Through the interviews with teachers, administrators, and consultants, several critical components necessary to ensure the successful implementation of EBPs through a consultative relationship were identified. These key components included a supportive administration, open-minded teachers, a consultant who listens to the staff while also serving as a coach, regularly scheduled and attended meetings, and high levels of trust between the consultant and the school. Respondents indicated that when these aspects were present in the school, the likelihood for successful EBP implementation greatly increased and benefitted students throughout the school.
First, help and support from members of the administration led to higher levels of success in the implementation of EBPs, both in individual classrooms as well as throughout the entire school. For instance, one individual reported, “[Our principal] was involved in the trainings like I was… He was there to support us when we had questions. He was a voice for the…whole school when we implemented it building wide, not just within our special education department. And he has always been a huge proponent of doing what’s best for all kids and this is just another way to promote that.” Similarly, another stated, “the buildings where my principals are on the team and come to the meetings, and you know, support their teachers makes a huge difference as opposed to other schools…and I think that when [the administrators] are not as involved, first your team does see that administrative support and two, you don’t get the building wide, um, impact as quickly as you want.” Administration also played a role in the providing of resources (e.g., time, substitute teachers, etc.), the determination of which EBPs would be implemented in the schools, and supported the overall effort and implementation of the program. Therefore, a first step in the process of implementing EBPs is to ensure support and involvement from administration, as this will help to build a culture of change within the school.
Another critical component for success identified through the interviews was open-minded teachers. Those schools that were least successful were those where consultants were called in to change a negative culture and schools who were always resistant to any type of change. Staff members who were willing to learn from the trainings led by the consultant and did not feel threatened by the consultant or administration helped to serve as change agents in the school. For example, a respondent stated, “I think you need to have an open-minded staff…and I know that’s something you can’t choose, per se. But, to really - I think that’s been one of the most important, like, critical things is to make sure that everyone’s on board of why we are doing this. And like, what is the benefit from this?” Teachers’ willingness to try the evidence-based practices provided a platform for the consultant to work from and facilitated the implementation of practices throughout the school. Therefore, not only teacher participation is important for successful practice, but also a willingness to make the necessary changes is a critical component.
The consultant’s readiness to listen to school staff while serving as a coach promoted successful practices, in comparison to a consultant who was demanding in their implementation efforts and unwilling to listen to the needs of the staff. Furthermore, when the consultant took time to get to know the school climate and the students within the school, the staff felt more supported in their work. The manner in which the consultant coached the team during trainings influenced the success of the program, as one consultant said, “We did not find them just reading about the practice to be helpful, they all did the online course, you know, about the evidence-based practices ahead of time. And I don’t think from in discussion with them that they retained that information. I think it kind of has to be real hands-on, showing them and saying, “Do this now. Try this now” for them to kind of remember it but also see the benefits of it and start using it.” As a result, consultants who tailored their training sessions to meet the needs of the school and teachers, rather than providing the training sessions in a one-size-fits-all manner, saw more success in the implementation of EBPs.
Through the interview process it was learned that regularly scheduled and attended meetings by the consultant and involved staff is necessary for success. For example, an individual stated, “some of the factors that have helped are the on-going meetings, because when you get practices in place or who to start using new practices, time is always an issue and if you have time set aside to meet, to either make the video for the video modeling or to develop the social story or to meet with the classroom teacher to get things in place.” Consequently, meetings held at least once a month, in addition to ongoing communication between the school and consultant, are beneficial to ensure fidelity of implementation and understanding of practices.
A final critical component identified through the interviews is the need for trust between the consultant and the school. When trust is established, the school staff is more likely to buy-in to the implementation of EBPs and the consultant will also feel as though he or she is an integral part of the school. This trust will allow practices to be implemented, as one respondent stated, “and, you know, when someone comes from the outside and you've been in it all year, I think it is helpful to get outside suggestions.”
Positive Outcomes
Overall, many of the individuals that participated in the consultation process with the IRCA were able to report several positive outcomes in their schools. These outcomes spanned not only on an individual student level, but school and district-wide. First, teachers were able to indicate that students who were specifically targeted as part of the consultation showed an improvement in their ability to function successfully in the classroom. One teacher reported: “...it’s helped tremendously; my classroom runs more smoothly because the student is on task.” Teachers felt that in working with the consultant they were able to produce improvements in behavioral and academic progress of their students with ASD. In addition, the aftermath of these improvements were often seen throughout the entire classroom. The training in evidence-based practices was often seen to extend beyond the identified target student, as well. Several teachers spoke to a realization that the training was proving beneficial for all of their students. As one teacher stated: “we’re discovering these evidence-based practices aren’t just good for kids with autism, they’re good for all kids.” While participation in the project may have seemed like it would be relevant to just a small portion of their students, teachers and administrators soon realized the impact of the training on all of their students.
Schools are always seeking to find new ways to appropriately handle challenging behaviors in the classroom. Teachers participating in consultation with the IRCA found that the training provided a new framework for addressing behavior effectively. One teacher explained: “…usually when a kid would act up then it would, it became very reactionary. Instead of becoming reactionary, we’ve become proactive now.” By providing teachers with tools to better communicate and intervene with their students, they find that they are no longer having to react to behaviors that have turned into a crisis. With training and preparation, the team is able to prevent behaviors from getting out of hand in the first place.
The IRCA model for consultation is meant to provide a way of not only supporting individual teachers, administrators, and districts, but also to provide the infrastructure for building teams and sustainable self-sufficient change over time. In many cases, consultants initially begin working with one or two buildings. After working in these buildings in a district, consultants were able to discontinue services when the district could provide their own consultation internally from well-trained team members. One teacher described their progression through this process as follows: “Right now with the one elementary that will be on year three, they are actually taking it and running with it on their own and I feel that sustainability will hold as long as they know where the money comes from to get the subs on a monthly basis... I really feel that’s a strong school. The other two schools will be on year two, that’s when we begin to fade [the consultant] out.” In addition, teachers were able to discuss a general change in the attitude of the participants that will ultimately lead to sustainable change across the district: “…the principal owns it. Administration owns it. I mean, people truly understand how this is best for all kids and it’s the expectation that we will continue to do that. ..We’ll continue to lead our staff meetings in that way. We’re going to continue…as district leaders. I mean, it, it just keeps going… Just carrying on and supporting and implementing the way we were trained.” As professional development in evidence-based practices spans across a district, the need for outside consultation is no longer present because this new approach to education will have become part of the fabric of what they do.
Lessons Learned
As a result of the consultation process with IRCA, consultants and consultees alike, have benefitted from the implementation of evidence-based practices to improve supports and outcomes for students with ASD. Comments from educators that have participated suggest that, while there are certainly challenges, there is a great potential for developing sustainable change in ASD programming in schools through training in evidence-based practices. Lessons learned from the model in Indiana include first and foremost, when you are trying to make change – it takes open-minded champions that are willing to fight to make it happen. Successes occur with individuals that are on-board from day one and know why they are on the team. In addition, when beginning the work as a team, be aware of other initiatives in the school and build on those, rather than confusing people with competing messages. Schools implementing PBIS, for example, can easily use evidence-based practices for ASD to support school-wide changes in behavior. And when you are beginning to implement change, don’t start with the hardest battle. Picking changes like implementing visual supports and positive reinforcement before tackling harder challenges promotes success. This provides a chance for the team to build buy-in as people begin to see early success through making these changes.
Also, remember that creating sustainable change functions best when working as a team. The goal is not to make everyone an expert, but rather to make a team of knowledgeable and resourceful individuals that are willing to problem solve and find answers when others need assistance. When peers are mentoring peers there is a mutual trust and respect that has the potential to be very effective. This means that consultants coming in to schools must realize that they are walking in to someone else’s “home” and they should be sensitive to this. Listening first is always the best policy.
Finally, creating a common language among a body of individuals supporting students with ASD is also essential. Everyone from the P.E. teacher to the principal should be aware of the goals of their students and the interventions that have been put in place to meet these goals. For example, creating an effective visual support for a student that may need to take breaks throughout the day only works if every teacher knows what that visual means if it is presented. Similarly, teams should look for ways that strategies can be instituted broadly across the school rather than only with particular students. Incorporating strategies into a universal design approach will help to make sure there is a consistent and common language across all classrooms and for all students. When this happens, schools can be made into demonstration sites that educators from other buildings can look to when beginning the institution of these practices in their classrooms.
Overall, the work of the IRCA, and other similar organizations, provides an important model for improving access to effective, evidence-based practices for all children with ASD. Interviews with participants in Indiana provide some insight into the complex task that creating sustainable change in autism programming, but also provide a testament to the positive change that can occur.
Resources
Centers for Disease Control and Prevention. (2012). Autism spectrum disorder (ASD). Retrieved from https://www.cdc.gov/ncbddd/autism/data.html.
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Jiang, Y., Ekono, M., & Skinner, C. (2016). Basic facts about low-income children: Children 6 through 11 years, 2014. New York: National Center for Children in Poverty, Mailman School of Public Health, Columbia University.
Lord, C., & McGee, J.P. (Eds.). (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education, National Research Council. Washington DC: National Academy Press.
National Professional Development Center on Autism Spectrum Disorder. (2016) Evidence-based practices. Retrieved from: https://autismpdc.fpg.unc.edu/evidence-based-practices.
Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure, 54, 275-282.
The National Autism Center (2015). Evidence-based practice and autism in the schools – 2nd edition. Retrieved from: http://www.nationalautismcenter.org/resources/.
Vespa, J., Lewis, J., Krider, R. (2013). America’s families and living arrangements: 2012, Current population reports, P20-570, US Census Bureau, Washington, DC.
Merrill, A., Haut, J. & Pratt, C. (2016). A model for sustainable change in ASD school programming through professional development: The Indiana Resource Center for Autism. The Reporter 20 (23).