Project Description

Approximately 50% of children with autism spectrum disorder (ASD) exhibit disruptive behaviors such as tantrums, aggression, and noncompliance that significantly impact social, adaptive, and academic functioning. The RUBI program is an evidence-based parent-mediated intervention that improves disruptive behavior in children with ASD. RUBI is offered to caregivers in specialty mental health clinics, which requires families to overcome access barriers such as provider referrals, transportation, wait lists, and health insurance. Considering schools serve as the primary intervention setting for children with ASD, and teachers and school staff often struggle to address challenging behavior, there is an opportunity to meaningfully improve care by adapting RUBI for delivery in schools. As a low-intensity treatment model, RUBI in Educational Settings (RUBIES) would be responsive to barriers to implementation commonly seen in many school-based practices for children with ASD – namely their high resource demands (i.e. materials, staff, training, data collection).

SettingElementary schools
PopulationChildren with autism spectrum disorder (ASD) who exhibit disruptive behaviors, teachers, and school staff

Intervention and/or Implementation Strategy Designed or Redesigned

InterventionAdaptation of RUBI for delivery in schools as RUBI in Educational Settings (RUBIES), transitioning the program from clinic to school delivery and from parent to school staff implementation. The intervention uses the Discover, Design/Build, Test (DDBT) framework leveraging user-centered design and implementation science.
Implementation StrategyRedesign RUBI to ensure the modified intervention meets the needs of end users and is usable and relevant within elementary schools that promote ease of access to care.

Impact

The culmination of this project will be an end user vetted RUBIES curriculum in preparation for a large-scale implementation trial in public elementary schools. This addresses the critical need for accessible behavioral interventions in schools where children with ASD spend most of their time, potentially reducing the barriers families face in accessing specialty mental health services while providing teachers and school staff with evidence-based tools to address challenging behaviors in the classroom setting.

Project Publications

Iterative Redesign of a Caregiver Mediated Intervention for Use in Educational Settings

Autism 26(3); 2022 · PubMed · Publisher

Authors

Karen Bearss, Daina Tagavi, Aaron R Lyon, Jill Locke

Abstract

Teachers endorse disruptive behavior as a considerable concern for autistic students, which is compounded by the lack of adequate resources for behavioral intervention planning in the classroom. The RUBI program is an evidence-based, low-intensity manualized intervention, initially developed for parents of autistic children ages 3–14 and co-occurring disruptive behavior. Utilizing the Discover, Design/Build, Test (DDBT) framework, which combines user-centered design and implementation science, RUBI intervention content was collaboratively and iteratively redesigned with elementary school stakeholders (40 school staff from 28 schools) to ensure the feasibility, acceptability, and appropriateness of the redesigned intervention, RUBI in Educational Settings (RUBIES). Iterative quantitative and qualitative methods were conducted with stakeholders to identify targets for RUBI redesign. Conventional content analysis was used to code qualitative data and identify usability issues. Recommendations were provided for modifications to RUBI sessions to address the needs of the school context and end-users to develop RUBIES. Feasibility scores improved following the redesign. The use of the DDBT framework to redesign the RUBI intervention may promote greater usefulness and usability in school contexts.