Iterative redesign of a caregiver-mediated intervention for use in educational settings.
Karen Bearss, Daina Tagavi, Aaron R Lyon and 1 others
PMID 34991353WHAT IT FOUND
School staff identified time constraints and lack of training as major barriers to using behavioral interventions.
The redesigned program addresses this by providing premade visual supports, adding autism training, and targeting paraeducators as the primary users.
Key findings
01Staff reported that creating individualized visual supports was a significant barrier due to lack of time, leading the developers to add a toolkit of premade, laminated visuals to the program.
02Paraeducators were identified as the most suitable end-users for the intervention because they spend the most time with autistic students but receive the least specialized training.
03The redesigned program removed physical prompting strategies in response to staff concerns about school policies and replaced compliance training with verbal 'when-then' prompts.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study did not test whether the redesigned intervention actually improves student behavior or outcomes; it only tested whether staff thought it was usable. Participants were recruited from only two US regions (West Coast and Midwest), so findings may not apply to other educational contexts. Data collection was disrupted by the pandemic, with some sessions moved to Zoom, which may have affected the depth of feedback. Autistic people and their families were not involved in the redesign process, despite the intervention targeting their children.
Declared interests
Dr. Bearss serves as a consultant for several companies (Attend Behavior, Genial Care, Behavioural Solutions) and receives royalties and speaker fees from others. The other authors declared no conflicts.
The easy way to misread this
Do not assume the redesigned program (RUBIES) is effective for reducing disruptive behavior. This study only tested whether school staff found the program usable and feasible to implement; it did not measure patient outcomes or compare the new program to existing practices.