Sustained Community Implementation of JASPER Intervention with Toddlers with Autism
Intervention research is increasingly conducted in community settings, however it is not clear how well practices are sustained locally or how children progress once external research support is removed. Two school-year cohorts of toddlers with autism (year 1: n = 55, year 2: n = 63) received Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) intervention from teaching assistants (TAs) with external support in year 1 and local, internal support in year 2. TAs sustained intervention strategies with more modest maintenance of high-level skills. Children in both years 1 and 2 made similar gains in initiations of joint attention during independent assessment. Year 1 children made significantly greater play gains. JASPER sustained into year 2, however advancing play may require additional supports.
KeywordsAutism Intervention Paraprofessional Community partnered Implementation Sustainability
The authors would like to thank the program staff including the teachers, paraprofessionals, and group supervisors. They also thank the leadership of the program including Michael Gordon and Evelyn Blanck. The authors acknowledge the data coding supports provided by Kiana Krolick, Alyssa Tan, Nicole Tu, and Marta Wirga.
SYS coordinated study year 2 and coordinated study year 1 with YCC. SYS draft the manuscript. YCC and SYS contributed to study outcome coding. WS conducted the randomization for both trials, all study analyses, and drafted the results sections of the manuscript. SB and MK provided on site leadership, coordination and data management for the study in both years. CK conceived of the intervention trials and helped to draft the manuscript.
The data presented in this study were collected from participants enrolled in two randomized controlled intervention trials funded by the FAR fund (to NYCCD) and in part by Autism Speaks (Grant No. 7495).
Compliance with Ethical Standards
All procedures performed in this study were in accordance with the ethical standards of the institutional review board at the University of California Los Angeles and with the 1964 Helsinki Declaration and its later amendments.
Informed consent was obtained from all individual participants included in this study.
- Bond, G. R., Drake, R. E., McHugo, G. J., Peterson, A. E., Jones, A. M., & Williams, J. (2014). Long-term sustainability of evidence-based practices in community mental health agencies. Administration and Policy in Mental Health and Mental Health Services Research, 41(2), 228–236.Google Scholar
- Brian, J., Bernardi, K., Dowds, E., Easterbrook, R., MacWilliam, S., & Bryson, S. (2017). Feasibility of training early childhood educators in a community child care setting using a caregiver-mediated intervention for toddlers with autism spectrum disorder. Journal of Education and Training Studies, 5(5), 93–102.Google Scholar
- Brookman-Frazee, L. I., Drahota, A., & Stadnick, N. (2012). Training community mental health therapists to deliver a package of evidence-based practice strategies for school-age children with autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 42(8), 1651–1661.Google Scholar
- Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8(1), 117.Google Scholar
- Chang, Y. C., Shire, S. Y., Shih, W., Gelfand, C., & Kasari, C. (2016). Preschool deployment of evidence-based social communication intervention: JASPER in the classroom. Journal of Autism and Developmental Disorders, 46(6), 2211–2223.Google Scholar
- Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155.Google Scholar
- DiMaggio, P. J., & Powell, W. W. (2000). The iron cage revisited institutional isomorphism and collective rationality in organizational fields. In F. Dobbin (Ed.), Economics meets sociology in strategic management (pp. 143–166). Bingley: Emerald Group Publishing Limited.Google Scholar
- Glasgow, R. E., Vinson, C., Chambers, D., Khoury, M. J., Kaplan, R. M., & Hunter, C. (2012). National Institutes of Health approaches to dissemination and implementation science: Current and future directions. American Journal of Public Health, 102(7), 1274–1281.Google Scholar
- Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327.Google Scholar
- Han, S. S., & Weiss, B. (2005). Sustainability of teacher implementation of school-based mental health programs. Journal of Abnormal Child Psychology, 33(6), 665–679.Google Scholar
- Kaale, A., Smith, L., & Sponheim, E. (2012). A randomized controlled trial of preschool-based joint attention intervention for children with autism. Journal of Child Psychology and Psychiatry, 53(1), 97–105.Google Scholar
- Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620.Google Scholar
- Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2012). Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 487–495.Google Scholar
- Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554.Google Scholar
- Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056.Google Scholar
- Kasari, C., Lawton, K., Shih, W., Barker, T. V., Landa, R., Lord, C., ... & Senturk, D. (2014). Caregiver-mediated intervention for low-resourced preschoolers with autism: An RCT. Pediatrics, 134(1), e72–e79.Google Scholar
- Khoo, A., Dent, M. T., & Oei, T. P. (2011). Group cognitive behaviour therapy for military service-related post-traumatic stress disorder: Effectiveness, sustainability and repeatability. Australian and New Zealand Journal of Psychiatry, 45(8), 663–672.Google Scholar
- Kolko, D. J., Iselin, A. M. R., & Gully, K. J. (2011). Evaluation of the sustainability and clinical outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) in a child protection center. Child Abuse & Neglect, 35(2), 105–116.Google Scholar
- McIntosh, K., Horner, R. H., & Sugai, G. (2009). Sustainability of systems-level evidence-based practices in schools: Current knowledge and future directions. In R. H. Horner, G. M. Sugai (Eds.), Handbook of positive behavior support, (pp. 327–352). Boston: Springer.Google Scholar
- Mullen, E. M. (1995). Mullen scales of early learning (pp. 58–64). Circle Pines, MN: AGS.Google Scholar
- Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A., & Seibert, J. (2003). Early social communication scales (ESCS). Coral Gables, FL: University of Miami.Google Scholar
- Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and developmental Disorders, 20(1), 115–128.Google Scholar
- Murza, K. A., Schwartz, J. B., Hahs-Vaughn, D. L., & Nye, C. (2016). Joint attention interventions for children with autism spectrum disorder: A systematic review and meta-analysis. International journal of language & communication disorders, 51(3), 236–251.Google Scholar
- Rabin, B. A., Brownson, R. C., Haire-Joshu, D., Kreuter, M. W., & Weaver, N. L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14(2), 117–123.Google Scholar
- Scheirer, M. A., & Dearing, J. W. (2011). An agenda for research on the sustainability of public health programs. American Journal of Public Health, 101(11), 2059–2067.Google Scholar
- Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., … McNerney, E. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428.Google Scholar
- Shire, S. Y., Chang, Y. C., Shih, W., Bracaglia, S., Kodjoe, M., & Kasari, C. (2017). Hybrid implementation model of community-partnered early intervention for toddlers with autism: A randomized trial. Journal of Child Psychology and Psychiatry, 58(5), 612–622.Google Scholar
- Shire, S. Y., Shih, W., Chang, Y. C., & Kasari, C. (2016). Short play and communication evaluation: Teachers’ assessment of core social communication and play skills with young children with autism. Autism, 22(3), 299–310.Google Scholar
- Stahmer, A. C., Suhrheinrich, J., & Rieth, S. (2016). A pilot examination of the adapted protocol for classroom pivotal response teaching. Journal of the American Academy of Special Education Professionals, 119, 139.Google Scholar
- Stirman, S. W., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7(1), 17.Google Scholar
- Sundberg, M. L. (2008). Verbal behavior milestones assessment and placement program: The VB-MAPP.Google Scholar
- Swain, K., Whitley, R., McHugo, G. J., & Drake, R. E. (2010). The sustainability of evidence-based practices in routine mental health agencies. Community Mental Health Journal, 46(2), 119–129.Google Scholar
- Ungerer, J. A., & Sigman, M. (1981). Symbolic play and language comprehension in autistic children. Journal of the American Academy of Child Psychiatry, 20(2), 318–337.Google Scholar