Table 2.

Incorporating diffusion of innovation research into Smith et al.’s (2007) recommendations for future autism intervention research

Phase	Goals and activities	Refinements from dissemination and implementation research
1. Formulation and systematic application of a new intervention using single-case or between-group designs	Conduct initial efficacy studies to refine techniques and document clinical significance of effects	Involve parents, practitioners, and administrators in the research from the early stages: Build on prior community-academic relationships Conduct a community analysis to identify key opinion leaders and other potential community partners Use change agents as “boundary spanners” who cultivate relationships with the community Target research towards issues that are most salient to public interest and actual practice, as identified by these community partners
2. Manualization and protocol development via pilot studies, surveys and focus groups	Manualize efficacious intervention Put togetxher a manual for comparison group Develop treatment fidelity measures Test feasibility of implementing manuals across sites Assess acceptability of interventions to clinicians and families Examine sustainability of interventions in community settings Estimate sample size	Continue to elicit guidance from the treatment developers, administrators, community practitioners, and families to encourage: Faithfulness to the core principles guiding the treatment protocol; and Goodness of fit with the clinical setting, practitioners, and clients Make successive modifications to protocol as problems of fit are identified Build formal mechanisms for evaluating sustainability and planning for sustainability of protocol in community settings, including: Continuing to partner with administrators, practitioners, and families to assess long-term feasibility of protocol Assessing potential long-term costs and other potential treatment demands Building data collection mechanisms into protocol that can be used in community to monitor fidelity of implementation, child outcomes, and stakeholder satisfaction
3. Efficacy studies using randomized clinical trials	Evaluate efficacy of intervention in large-scale trial Demonstrate consistent effects across sites, as a step towards disseminating the intervention Conduct hierarchical analyses of mediators and moderators	Recruit a diverse sample representative of all children with ASD Report exclusions, participation rates, dropouts, and representativeness on key characteristics Include outcome measures relevant to the system in which the intervention ultimately will be implemented, and assess both positive (anticipated) and negative (unintended) outcomes Include proxy measures of adoption, such as expressed interest of community practitioners in participating or providing feedback on protocol Consider the representativeness of the intervention agents by: Describing the participation rate and characteristics of those delivering the intervention, and how these agents compare with those who will eventually implement it in the community Including a variety of intervention agents with respect to background/experience, and report on potential differences in implementation and outcomes associated with these differences Collect data on likely treatment demands, such as time, staffing, parent involvement required, and total cost of implementation Continue to evaluate and plan for sustainability of protocol, as described above
4. Community effectiveness studies using between-group designs	Assess whether competent clinicians in community can implement treatment	Implement two-stage community-based effectiveness trials: Series of group-design partial effectiveness studies testing the newly adapted treatment protocol in the context representative community care. Explore, in stepwise fashion, the extent to which the protocol works with referred youths, in clinical care settings, when used by representative practitioners, and when compared to usual care Full effectiveness group-design clinical trials in community setting: Include all referred clients with ASD in community settings with community practitioners Report exclusions, participation rates, dropouts, and representativeness Include organization-wide economic outcomes, along with child outcomes Assess willingness of stakeholders from multiple settings to adopt/adapt program Continue having administrators, practitioners, and parents assess fit Report on representativeness of settings, participation rates, and reasons for declining Assess practitioners’ ability to implement intervention components in routine practice Systematically program for institutionalization of the program elements after formal study assistance is terminated by strengthening organizational capacity Utilize formal data collection mechanisms and comprehensive follow-up to monitor fidelity of implementation, child outcomes, and stakeholder satisfaction, and provide ongoing consultation as needed Plan for self-regulation and stabilization by providing training and program materials, and incrementally facilitating independent use
5. Sustainability studies focused on the relation between the treatment program and the practice contexts in which it is employed	Not addressed	Assess protocol’s sustainability, with treatment fidelity and youth outcomes, over time, after the research support is withdrawn