Evaluating Intervention Fidelity and Adaptation Within Context: A Mixed-Methods Study of Implementation Practice...

Area of Science:

• Autism Spectrum Disorder interventions
• Early Intervention services
• Implementation Science

Background:

• Limited research exists on how context influences intervention fidelity and adaptation.
• Understanding these factors is crucial for effective autism evidence-based practices (EBPs).

Purpose of the Study:

• To characterize the delivery of Project ImPACT, an autism EBP, within an Early Intervention (EI) system.
• To examine how contextual factors shape intervention adaptation and provider coaching fidelity.

Main Methods:

• 21 EI providers were trained in Project ImPACT.
• Session videos were scored for fidelity, adaptation, and supplemental content.
• Post-session surveys captured provider-reported delivery and adaptations.

Main Results:

• Provider-reported delivery often misaligned with observed adaptations.
• Project ImPACT fidelity was variable, influenced by integrating other therapeutic content (17% of session time).
• Increased integration of other content correlated with reduced core Project ImPACT activities and lower fidelity.

Conclusions:

• Context critically shapes provider coaching fidelity in Project ImPACT delivery.
• Findings question current fidelity benchmarks in community-based EI settings.
• Need for holistic fidelity tools and training addressing child, family, and system factors is emphasized.