Two Sides of the Same Coin: A Qualitative Study of Multiple Stakeholder Perspectives on Factors Affecting Implementation of Evidence-Based Practices for Children with Autism in Elementary Schools.

Schools are the primary setting in which autistic youth receive intervention, yet fidelity to implementation of evidence-based practices (EBPs) for autism spectrum disorder (ASD) in schools varies. Fidelity is an important metric to determine whether educators are delivering EBPs as designed, and there are many different factors that predict fidelity to EBP implementation. This qualitative study used Domitrovich and colleagues' multi-level framework to explore individual- and school-level factors that facilitated or impeded implementation of EBPs for autistic students in schools. Semi-structured interviews with 26 special education teachers with high and low fidelity implementation of three EBPs for ASD (discrete trial training, pivotal response training, and visual schedules) and 26 administrators in schools explored multiple stakeholders' perspectives of the implementation process. Thematic analysis revealed factors from the individual- to the macro-level that influenced teachers' implementation fidelity. Many of these factors are malleable and represent targets for implementation strategies to improve the implementation of EBPs for autistic students in schools.