Identifying Implementation Usability Issues of an Evidence-Based Behavioral Intervention for Use in Schools

Educators endorse challenging behavior as a concern for autistic students, which is compounded by the lack of adequate resources for behavioral intervention use at school. The RUBI program is an evidence-based intervention, initially developed for clinicians to implement with parents of autistic children ages 3-14 with co-occurring challenging behavior in outpatient settings. Using the Discover, Design/Build, Test framework, which combines human-centered design and implementation science, implementation usability issues of RUBI were identified for redesign to ensure intervention-setting fit when used in schools.

RUBI content was collaboratively and iteratively redesigned with elementary school partners, including 41 staff members from 28 schools. During the Discover Phase, the research team conducted in-class behavioral observations (N = 8) and cognitive walkthroughs (N = 15) with educators to identify implementation usability issues in the original RUBI intervention. In the Design/Build Phase, collaborative redesign sessions (N = 6) and demonstration studies (N = 12) were conducted to develop potential solutions to these issues. Implementation usability issues were systematically rated for importance and feasibility prior to redesign to guide the adaptation process.

Conventional content analysis was used to code qualitative data and identify implementation usability issues. Two implementation usability issues were identified: (1) integration with other school-based systems of support and (2) data collection in schools.

Identifying and addressing usability issues may promote greater utility and successful implementation of RUBI in schools. Using partner-engaged methods allowed for the identification of critical implementation usability issues prior to the implementation of the redesigned intervention, RUBI in Educational Settings, or RUBIES. Implications to implementation in school settings are discussed, including potential ways to integrate RUBIES within existing school frameworks (i.e., MTSS) and streamline data collection with the use of technology.