View in EDS HTML Full Text PDF Full Text

Early Intervention Provider-Reported NDBI Use and Relationships with Provider- to System-Level Implementation Determinants

Saved in:
Bibliographic Details
Title: Early Intervention Provider-Reported NDBI Use and Relationships with Provider- to System-Level Implementation Determinants
Language: English
Authors: Nicole Hendrix (ORCID 0000-0001-8272-9329), Emma Chatson, Hannah Davies, Brooke Demetri, Yijin Xiang, Millena Yohannes, Ainsley Buck, Shannon Harper, Jennifer Stapel-Wax, Katherine Pickard
Source: Journal of Autism and Developmental Disorders. 2025 55(1):103-113.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Early Intervention, Autism Spectrum Disorders, Naturalistic Observation, Behavior Modification, Health Personnel, Attitudes, Background, Intellectual Disciplines, Institutional Role, Social Support Groups
DOI: 10.1007/s10803-023-06203-3
ISSN: 0162-3257
1573-3432
Abstract: An expanding evidence base has advocated for delivery of naturalistic developmental behavioral interventions (NDBIs) within community systems, thus extending the reach of these practices to young autistic children. The current study examined provider-reported use of NBDIs within a Part C Early Intervention (EI) system and the extent to which provider background, attitudes, and perceived organizational support predicted NDBI use. Results from 100 EI providers representing multiple disciplines indicated reported use of NDBI strategies within their practice despite inconsistent reported competency with manualized NDBI programs. Although NDBI strategy use was not predicted by provider experiences or perceived organizational support, provider openness to new interventions predicted the reported use of NDBI strategies. Future directions include mixed methods data collection across and within EI systems to better understand NDBI use and ultimately facilitate NDBI implementation.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1460717
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwGJ0cspdkYqArWFSYZUFC3XAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDNqIaOgmtbftSTv3zAIBEICBm0B3NKbXN6eczkM0Nz5SZ_Hjcay5xGgUpEvWmSE1fw8I_4tWhhLTApUq8nGfpkes8szm6Jh0TPkq5vFpX-a_0H-uGGKuJRmcOP1HVe8c57Ui2VfQWu26vvn9zIqI96i4JMwjFEsxqb3WYVEFOaIZPcCvin7uLJ8wJwK-KC9anE2TldCiuqhVp91Q48ICtSQZ-c7Y6xuY4Fo4RORs
Text:
  Availability: 1
  Value: <anid>AN0182844517;aut01jan.25;2025Feb10.03:00;v2.2.500</anid> <title id="AN0182844517-1">Early Intervention Provider-Reported NDBI Use and Relationships with Provider- to System-Level Implementation Determinants </title> <p>An expanding evidence base has advocated for delivery of naturalistic developmental behavioral interventions (NDBIs) within community systems, thus extending the reach of these practices to young autistic children. The current study examined provider-reported use of NBDIs within a Part C Early Intervention (EI) system and the extent to which provider background, attitudes, and perceived organizational support predicted NDBI use. Results from 100 EI providers representing multiple disciplines indicated reported use of NDBI strategies within their practice despite inconsistent reported competency with manualized NDBI programs. Although NDBI strategy use was not predicted by provider experiences or perceived organizational support, provider openness to new interventions predicted the reported use of NDBI strategies. Future directions include mixed methods data collection across and within EI systems to better understand NDBI use and ultimately facilitate NDBI implementation.</p> <p>Keywords: Autism spectrum disorder; Naturalistic developmental behavioral interventions; Evidence-based practice; Implementation determinants; Medical and Health Sciences Public Health and Health Services</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0182844517-2">Introduction</hd> <p>Naturalistic developmental behavioral interventions (NDBIs) are an evidence-based approach that supports social communication development in young autistic children and children with an increased likelihood of being autistic (Crank et al., [<reflink idref="bib10" id="ref1">10</reflink>]; Schreibman et al., [<reflink idref="bib44" id="ref2">44</reflink>]; Tiede & Walton, [<reflink idref="bib53" id="ref3">53</reflink>]). When delivered in a parent-mediated format, NDBIs provide families with tools to foster social communication—with intended cascading effects on broader developmental outcomes (e.g., Gengoux et al., [<reflink idref="bib19" id="ref4">19</reflink>]; Koegel et al., [<reflink idref="bib26" id="ref5">26</reflink>]) —by using naturalistic teaching opportunities embedded within play and daily routines (Brian et al., [<reflink idref="bib7" id="ref6">7</reflink>]; Yoder et al., [<reflink idref="bib59" id="ref7">59</reflink>]). Despite positive outcomes observed for autistic toddlers (Sandbank et al., [<reflink idref="bib43" id="ref8">43</reflink>]; Tiede & Walton, [<reflink idref="bib53" id="ref9">53</reflink>]), NDBIs have not been widely disseminated within the communities in which toddlers live and learn, and community providers often report limited knowledge of these interventions (D'Agostino et al., [<reflink idref="bib11" id="ref10">11</reflink>]; Hampton & Sandbank, [<reflink idref="bib20" id="ref11">20</reflink>]; Pickard et al., [<reflink idref="bib36" id="ref12">36</reflink>]).</p> <p>To increase the accessibility of NDBIs, several research groups have begun exploring the feasibility of implementing these approaches within community settings (Vivanti et al., [<reflink idref="bib57" id="ref13">57</reflink>]). Much of this work has centered on NDBI delivery within Part C Early Intervention (EI) systems (Ibañez et al., [<reflink idref="bib23" id="ref14">23</reflink>]; Pickard et al., [<reflink idref="bib38" id="ref15">38</reflink>]; Reith et al., 2022; Rogers et al., [<reflink idref="bib41" id="ref16">41</reflink>]; Stahmer et al., [<reflink idref="bib49" id="ref17">49</reflink>]), a system federally mandated by the Individuals with Disabilities Education Act (IDEA, [<reflink idref="bib24" id="ref18">24</reflink>]) to provide therapeutic services to children under the age of 3 years with developmental delays in the United States. The use of NDBIs has been popularized within EI systems as NDBIs can be embedded within family routines and actively involve key family members as change agents in intervention (Adams & Tapia, [<reflink idref="bib5" id="ref19">5</reflink>]; Aranbarri et al., [<reflink idref="bib6" id="ref20">6</reflink>]). Further, EI systems serve families during a critical window of early development during which children maximally benefit from services, including children who may not carry a formal diagnosis of autism but have an increased likelihood of being autistic (Eisenhower et al., [<reflink idref="bib14" id="ref21">14</reflink>]).</p> <p>Research has focused on the delivery of both NDBI strategies and manualized NDBI programs within Part C EI systems. This work has demonstrated that EI providers can increase their fidelity to manualized NDBIs in response to formal training and ongoing consultation (Pickard et al., [<reflink idref="bib38" id="ref22">38</reflink>]; Rogers, [<reflink idref="bib41" id="ref23">41</reflink>]; Stahmer et al., [<reflink idref="bib49" id="ref24">49</reflink>]). Moreover, NDBI delivery within EI systems supports positive caregiver and child outcomes, including family empowerment and child social communication skills (Stahmer et al., [<reflink idref="bib49" id="ref25">49</reflink>]), and allows for manualized NDBIs to reach more families over time (Rieth et al., [<reflink idref="bib40" id="ref26">40</reflink>]). Yet implementation outcomes within EI systems are reduced compared to results from NDBI efficacy trials, indicating complexity when translating research-based interventions into clinical practice (Pickard et al., [<reflink idref="bib38" id="ref27">38</reflink>]; Rogers et al., [<reflink idref="bib41" id="ref28">41</reflink>]) and underscoring a need for more research to systematically identify and evaluate factors that influence the use of NDBIs within EI systems (e.g., Aranbarri et al., [<reflink idref="bib6" id="ref29">6</reflink>]). Implementation science frameworks describe a range of factors that are thought to impact the delivery of evidence-based practices across service settings. Though there are many distinct determinant frameworks (Nilsen, [<reflink idref="bib33" id="ref30">33</reflink>]), most frameworks specify that characteristics of frontline providers, leaders, organizations, and systems influence implementation outcomes (e.g., Aarons et al., [<reflink idref="bib4" id="ref31">4</reflink>]; Damschroder et al., [<reflink idref="bib12" id="ref32">12</reflink>]; Feldstein & Glasgow, [<reflink idref="bib15" id="ref33">15</reflink>]). These factors are important to consider within EI systems as they may drive NDBI adoption, implementation, and sustainment.</p> <p>EI provider attitudes and experiences likely play an important role in the delivery of autism evidence-based practices including NDBIs within EI systems. EI providers describe using empirically validated interventions as well as those with less established support (Pickard et al., [<reflink idref="bib36" id="ref34">36</reflink>]; Stahmer et al., [<reflink idref="bib48" id="ref35">48</reflink>]) and endorse needing additional training in evidence-based practices for autistic children (Aranbarri et al., [<reflink idref="bib6" id="ref36">6</reflink>]; Stahmer & Mandell, [<reflink idref="bib47" id="ref37">47</reflink>]). Although EI providers indicate higher openness to using new interventions than other community providers (Stahmer & Aarons, [<reflink idref="bib46" id="ref38">46</reflink>]), EI providers also describe that a lack of knowledge limits their ability to seek out training in evidence-based practices including NDBIs (Pickard et al., [<reflink idref="bib36" id="ref39">36</reflink>]). It is important to note that EI providers represent diverse disciplines (U.S. Department of Education, [<reflink idref="bib55" id="ref40">55</reflink>]), which may impact their adoption and use of intervention approaches. For example, research conducted with Canadian early intervention providers demonstrated that providers' clinical experiences and readiness for change impacted their fidelity to the Early Start Denver Model (Mirenda et al., [<reflink idref="bib32" id="ref41">32</reflink>]), and observation of U.S. providers suggests that their use of individual NDBI strategies may be influenced by their discipline (Lee et al., [<reflink idref="bib29" id="ref42">29</reflink>]).</p> <p>Provider attitudes also impact their intentions to use evidence-based family coaching practices, a central component of both NDBIs and family-centered care models inherent to EI systems (Lawson et al., [<reflink idref="bib28" id="ref43">28</reflink>]). Past work has revealed that EI providers have variable knowledge of family coaching models (Fleming et al., [<reflink idref="bib16" id="ref44">16</reflink>]) and only deliver these intervention approaches when providers view them favorably and when they believe that families will benefit from or engage in the intervention (Fleming et al., [<reflink idref="bib16" id="ref45">16</reflink>]; Tomczuk et al., [<reflink idref="bib54" id="ref46">54</reflink>]). Accordingly, provider attitudes and experiences impact the implementation of both manualized NDBIs and the delivery models in which NDBIs are implemented.</p> <p>Less attention has been devoted to organization- and system-level factors that impact the delivery of NDBIs in EI systems. States vary considerably in how they structure, finance, and determine qualification for EI services (Adams & Tapia, [<reflink idref="bib5" id="ref47">5</reflink>]; Noyes-Grosser et al., [<reflink idref="bib34" id="ref48">34</reflink>]; U.S. Department of Education, [<reflink idref="bib56" id="ref49">56</reflink>]), including autism-specific services (Williams et al., [<reflink idref="bib58" id="ref50">58</reflink>]). Organizational structures also vary considerably across EI systems and appear to drive providers' participation in autism and NDBI training initiatives. For example, providers within EI systems that rely upon an independent contracting structure note that a significant amount of unreimbursed time is a barrier to participating in NDBI training and ongoing consultation (Cidav et al., [<reflink idref="bib9" id="ref51">9</reflink>]; Pickard et al., [<reflink idref="bib36" id="ref52">36</reflink>]). In addition to costs associated with participating in training, EI administrators and providers describe system- and organization-level support as being needed to attend training alongside leadership capacity to champion and disseminate training initiatives and consistent communication around training priorities (Pickard et al., [<reflink idref="bib37" id="ref53">37</reflink>]). These emerging findings are consistent with implementation research conducted in other service systems including public schools, which has also demonstrated the importance of school- and district-level leadership support in the use of autism evidence-based practices (e.g., Melgarejo et al., [<reflink idref="bib31" id="ref54">31</reflink>]; Stadnick et al., [<reflink idref="bib45" id="ref55">45</reflink>]).</p> <p>Although research continues to highlight the importance of provider- to system-level factors in promoting the delivery of EBPs within EI systems, limited research has examined the role of these factors together and as they relate to the use of NDBIs specifically. The current study aims to address this gap by examining provider- and organization-level factors impacting EI provider reported use of NDBI strategies and programs within Georgia's EI system. The selection of both these factors was grounded in implementation frameworks (e.g., Aarons et al., [<reflink idref="bib4" id="ref56">4</reflink>]; Damschroder et al., [<reflink idref="bib12" id="ref57">12</reflink>]) with specific implementation determinants (e.g., provider attitudes and experience; leadership support) selected based on previous work conducted in EI systems (Aranbarri et al., [<reflink idref="bib6" id="ref58">6</reflink>]; Pickard et al., [<reflink idref="bib36" id="ref59">36</reflink>]).</p> <p>Specific aims are as follows: (<reflink idref="bib1" id="ref60">1</reflink>) summarize provider-reported training in and use of structured EI programs as well as use of broader NDBI strategies; and (<reflink idref="bib2" id="ref61">2</reflink>) examine the extent to which provider experiences and background, attitudes, and perceived organizational support predict reported use of NDBI strategies, particularly when dividing these strategies into developmental and behavioral subscales. We hypothesized that: (<reflink idref="bib1" id="ref62">1</reflink>) providers would report using broader NDBI strategies while reporting variable competence across structured EI programs; and (<reflink idref="bib2" id="ref63">2</reflink>) provider experiences, attitudes, and perceived organizational support would predict strategy use. Although provider-reported use of more developmental (e.g., engaging the child in play and social routines) and behavioral (e.g., pacing and frequency of direct teaching opportunities) NDBI strategies were correlated in another Part C provider sample (Pickard et al., [<reflink idref="bib36" id="ref64">36</reflink>]), we analyzed the relationships between developmental and behavioral strategies and implementation determinants separately to explore possible influence of provider discipline and thus varied experiences (e.g., Lee et al., [<reflink idref="bib29" id="ref65">29</reflink>]).</p> <hd id="AN0182844517-3">Methods</hd> <p></p> <hd id="AN0182844517-4">Procedure</hd> <p></p> <hd id="AN0182844517-5">Setting and System Participation</hd> <p>This study was conducted as part of an ongoing contract and partnership with Georgia's EI system. This system is housed within the Georgia Department of Public Health and is comprised of 18 public health districts which operate with relative autonomy in the delivery of EI services. Research procedures were approved by the Emory University Institutional Review Board and the Georgia Department of Public Health; all participants provided written consent prior to study participation. The research team worked in collaboration with state-level leadership to recruit participants.</p> <hd id="AN0182844517-6">Recruitment</hd> <p>The research team distributed surveys with the support of state-level leadership via EI listservs. Providers completed the 20- to 30-min survey electronically using the REDCap platform (Harris et al., [<reflink idref="bib21" id="ref66">21</reflink>]). One hundred and thirty-seven participants opened the survey, and one hundred participants (73.0%) participated in the study. Participants received $20 following survey completion.</p> <hd id="AN0182844517-7">Participants</hd> <p>Participants were 100 interdisciplinary EI providers who delivered services to children ages 12 to 36 months within the EI system. Ninety-seven percent of providers identified as female. Participating providers were an average of 47.20 years of age (<emph>SD</emph> = 12.55; range = 24–69), with an average of 9.40 years of experience working within EI systems (<emph>SD</emph> = 8.18; range = 0–35). Though 100 providers completed provider demographic information within the survey set, 72 providers completed the <emph>Organizational Readiness for Change</emph> and <emph>Evidence-Based Practice Attitudes Scale</emph> in addition to previous measures, and 67 providers completed all surveys in full. Providers with missing data did not differ demographically from providers who completed the full battery (<emph>p</emph>s > 0.05). Participants with missing data were excluded from associated analyses. See Table 1 for demographic information of the full sample.</p> <p>Table 1 Provider demographic characteristics</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>EI Providers</p><p>(<italic>n</italic> = 100)</p></th></tr></thead><tbody><tr><td align="left"><p>Gender</p></td><td align="left" /></tr><tr><td align="left"><p> Female</p></td><td align="left"><p>97.0%</p></td></tr><tr><td align="left"><p>Mean Age in Years (SD)</p></td><td align="left"><p>47.20 (12.55)</p></td></tr><tr><td align="left"><p>Mean Years of EI Experience (SD)</p></td><td align="left"><p>9.40 (8.18)</p></td></tr><tr><td align="left"><p>Race</p></td><td align="left" /></tr><tr><td align="left"><p> White/Caucasian</p></td><td align="left"><p>80.0%</p></td></tr><tr><td align="left"><p> Black/African American</p></td><td align="left"><p>18.0%</p></td></tr><tr><td align="left"><p> Asian/Pacific Islander</p></td><td align="left"><p>1.0%</p></td></tr><tr><td align="left"><p> Other</p></td><td align="left"><p>1.0%</p></td></tr><tr><td align="left"><p>Ethnicity</p></td><td align="left" /></tr><tr><td align="left"><p> Hispanic/Latinx</p></td><td align="left"><p>3.0%</p></td></tr><tr><td align="left"><p>Provider Language Use in Session</p></td><td align="left" /></tr><tr><td align="left"><p> Monolingual</p></td><td align="left"><p>92.0%</p></td></tr><tr><td align="left"><p> Bilingual</p></td><td align="left"><p>8.0%</p></td></tr><tr><td align="left"><p>Education</p></td><td align="left" /></tr><tr><td align="left"><p> High School Diploma, GED, or Associates</p></td><td align="left"><p>4.0%</p></td></tr><tr><td align="left"><p> Bachelors</p></td><td align="left"><p>16.0%</p></td></tr><tr><td align="left"><p> Masters</p></td><td align="left"><p>73.0%</p></td></tr><tr><td align="left"><p> Doctorate</p></td><td align="left"><p>7.0%</p></td></tr><tr><td align="left"><p>Independent Contractor</p></td><td align="left"><p>87.0%</p></td></tr><tr><td align="left"><p>Profession</p></td><td align="left" /></tr><tr><td align="left"><p> Special Instructor</p></td><td align="left"><p>41.0%</p></td></tr><tr><td align="left"><p> Speech Language Pathologist</p></td><td align="left"><p>28.0%</p></td></tr><tr><td align="left"><p> Occupational Therapist</p></td><td align="left"><p>5.0%</p></td></tr><tr><td align="left"><p> Physical Therapist</p></td><td align="left"><p>6.0%</p></td></tr><tr><td align="left"><p> Service Coordinator</p></td><td align="left"><p>9.0%</p></td></tr><tr><td align="left"><p> Social Worker</p></td><td align="left"><p>8.0%</p></td></tr><tr><td align="left"><p> Other (e.g., Board Certified Behavior Analyst)</p></td><td align="left"><p>3.0%</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0182844517-8">Measures</hd> <p>The measures selected for this study centered on factors impacting EI providers' reported use of NDBI strategies. Provider-level factors included provider demographic information and attitudes toward evidence-based practices. Organization-level factors included providers' perceptions of available support in the areas of clinical supervision, training, and staffing. Primary outcomes of interest included providers' experience with early intervention programs and reported use of NDBI strategies.</p> <hd id="AN0182844517-9">Provider Demographic Information</hd> <p>Participants reported on their gender, age, race, ethnicity, and educational attainment. They also provided information on professional discipline, years of experience working within the EI system overall and with autistic children, and caseload of children to whom they were providing direct services at the time of the study.</p> <hd id="AN0182844517-10">Evidence-Based Practice Attitudes Scale (EBPAS; Aarons, 2004)</hd> <p>This 15-item scale examines provider attitudes on adopting evidence-based practices. It contains <emph>Requirements, Appeal, Openness</emph>, and <emph>Divergence</emph> subscales. The <emph>Requirements</emph> subscale considers the degree to which the provider would use an evidence-based practice if it were required by their organization; the <emph>Appeal</emph> subscale examines to what extent a provider would use an evidence-based practice if they perceived it as intuitively appealing, able to be used correctly with training, or was being used by colleagues who were satisfied with it. The <emph>Openness</emph> subscale assesses the extent to which the provider has interest in trying new interventions, including those that are manualized. In contrast, the <emph>Divergence</emph> subscale examines the degree to which a provider views evidence-based practices as less important than experience or as lacking in practicality or utility.</p> <p>Providers rated items on a 5-point Likert scale (i.e., 0 = <emph>not at all</emph> through 5 = <emph>to a very great extent</emph>). The <emph>EBPAS</emph> demonstrates good internal consistency with alphas ranging from 0.77 to 0.79; subscale alphas range from 0.59 to 0.90 (Aarons, [<reflink idref="bib2" id="ref67">2</reflink>]). Convergent validity is evidenced through significant associations between the <emph>EBPAS</emph> and constructs like leadership (Aarons, [<reflink idref="bib1" id="ref68">1</reflink>], [<reflink idref="bib3" id="ref69">3</reflink>]). For the current study, internal consistency was in line with past work (Aarons, [<reflink idref="bib1" id="ref70">1</reflink>]). Cronbach's alphas for the <emph>Requirements</emph>, <emph>Appeal</emph>, and <emph>Openness</emph> subscales ranged from 0.83 to 0.88, and Cronbach's alpha for the <emph>Divergence</emph> subscale was 0.56.</p> <hd id="AN0182844517-11">Organizational Readiness for Change (TCU ORC-D4; Institute of Behavioral Research, 2009)</hd> <p>The <emph>ORC-D4</emph> is a 21-scale, 125-item measure that was developed to evaluate organizational climate through staff perceptions. There is evidence of concurrent validity between variations of the <emph>ORC</emph> and <emph>EBPAS</emph>, with <emph>ORC</emph> domains like the degree to which providers report their organizations would benefit from change and have adequate staffing and supervision being associated with providers describing evidence-based practices as more appealing (Saldana et al., [<reflink idref="bib42" id="ref71">42</reflink>]). This study used three <emph>ORC-D4</emph> scales within the Resources domain with items across scales within this domain designed to represent important resource categories. The <emph>Staffing</emph> scale included items on turnover, understaffing, and readiness of staff to perform their jobs. <emph>Training</emph> scale items centered on the support and availability of professional training within an organization in addition to the degree to which providers reported learning new skills when participating in these training opportunities. The <emph>Supervision</emph> scale included items on the availability, quality, and frequency of supervision opportunities as well as perceived competence of individuals providing supervision. To better align with study setting, the wording of scale items was adapted to focus on resource availability within the EI system. Providers rated these scale items using a 5-point Likert scale from 1 (<emph>strongly disagree</emph>) to 5 (<emph>strongly agree</emph>). Scale scores were calculated by averaging all scale items and multiplying by 10.</p> <hd id="AN0182844517-12">Early Intervention Program Competence</hd> <p>Using a measure employed in previous work on provider-reported practices within EI systems (Pickard et al., [<reflink idref="bib36" id="ref72">36</reflink>]), participants rated their perceived competence with a set of twelve manualized NDBIs (e.g., Early Achievements, Early Start Denver Model, Enhanced Milieu Training, JASPER, Pivotal Response Training, Project ImPACT, SCERTS, Social ABCs; Frost et al., [<reflink idref="bib18" id="ref73">18</reflink>]; Schreibman et al., [<reflink idref="bib44" id="ref74">44</reflink>]). Providers reported on their perceived competence with other commonly implemented comprehensive early intervention models that use primarily developmental (e.g., Hanen More than Words) or behavioral (e.g., Discrete Trial Training) teaching methods that have been considered in summary literature (Landa, [<reflink idref="bib27" id="ref75">27</reflink>]; Steinbrenner et al., [<reflink idref="bib50" id="ref76">50</reflink>]) as well. Participants rated their competence in each program using a 5-point Likert scale with one (<reflink idref="bib1" id="ref77">1</reflink>) indicating having no competence in the program and a five (<reflink idref="bib5" id="ref78">5</reflink>) indicating feeling very competent in delivering the program.</p> <hd id="AN0182844517-13">NDBI Strategy Use</hd> <p>Broad NDBI intervention techniques were previously identified through a process of NDBI treatment manual review, expert review and commentary, and designation of an observational tool (Frost et al., [<reflink idref="bib18" id="ref79">18</reflink>]). This tool was developed to function as a self-report measure, which has evidence of good reliability given an intraclass correlation between raters of 0.80 and is positively correlated (<emph>r</emph> = 0.60) with global fidelity scales for three social communication evidence-based practices (Frost et al., [<reflink idref="bib18" id="ref80">18</reflink>]). Replicating past work adapting this measure (Pickard et al., [<reflink idref="bib36" id="ref81">36</reflink>]), EI providers in this study reviewed descriptions of intervention strategies identified through this process (Table 2). They then indicated the percent they used each NDBI strategy within their last therapy session to ground reported behavior in the context of a specific past event and to encourage reporting of actual use as opposed to ideal or average use. For each strategy, providers also described their use of each strategy across the following 5-point response set: <emph>as needed</emph>; <emph>for positive reinforcement</emph>; <emph>used during breaks to help the child warm up</emph>; <emph>interspersed between other techniques</emph>; and <emph>integrated and used throughout the session</emph>. Average percentages were then calculated for behavioral (e.g., varying difficulty of the teaching target, supporting a correct response using prompts) and developmental (e.g., face-to-face with the child, imitating the child) subscales, which were guided by item loadings described in past work (Frost & Ingersoll, [<reflink idref="bib17" id="ref82">17</reflink>]). Items within subscales were presented randomly and not indicated to providers within the survey.</p> <p>Table 2 Provider-reported NDBI strategy use within a recent session</p> <p> <ephtml> <table frame="hsides" rules="groups"><tbody><tr><td align="left"><p>Face-to-face and on the child's level</p></td></tr><tr><td align="left"><p>Setting up the activity space</p></td></tr><tr><td align="left"><p>Imitating the child</p></td></tr><tr><td align="left"><p>Supporting turn-taking</p></td></tr><tr><td align="left"><p>Positive affect and animation</p></td></tr><tr><td align="left"><p>Engaging the child in play routines</p></td></tr><tr><td align="left"><p>Engaging the child in social routines</p></td></tr><tr><td align="left"><p>Managing challenging behavior</p></td></tr><tr><td align="left"><p>Modeling appropriate language</p></td></tr><tr><td align="left"><p>Modeling gestures and joint communication skills</p></td></tr><tr><td align="left"><p>Modeling new play acts</p></td></tr><tr><td align="left"><p>Responding to attempts to communicate</p></td></tr><tr><td align="left"><p>Using communicative temptations</p></td></tr><tr><td align="left"><p>Pace and frequency of direct teaching opportunities</p></td></tr><tr><td align="left"><p>Varying difficulty of teaching target</p></td></tr><tr><td align="left"><p>Using clear and appropriate teaching opportunities</p></td></tr><tr><td align="left"><p>Motivating and relevant teaching opportunities</p></td></tr><tr><td align="left"><p>Supporting a correct response using prompts</p></td></tr><tr><td align="left"><p>Contingent natural and social reinforcement</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0182844517-14">Statistical Analyses</hd> <p>We calculated descriptive statistics for demographic and study information using means and standard deviations (i.e., <emph>M</emph> and <emph>SD</emph>) for continuous data as well as frequencies and percentages for categorical data. We then evaluated hypothesized relationships between provider use of developmental and behavioral NDBI strategies using Pearson's correlation. Providers who identified as service coordinators (<emph>n</emph> = 9) were removed from these analyses given the coordinator role involving less provision of direct services and more caseload oversight. To assess factors associated with EI program competencies and NDBI strategy use, we employed bivariate linear regression to assess the association between these outcomes and provider- and system-level factors. Results were reported as means and standard deviations for categorical variables and linear slopes with 95% confidence intervals for continuous outcomes. We then performed multivariable linear regression to assess the association between NDBI strategy use and independent variables with <emph>p</emph>-values < 0.1 in previous bivariate analysis. All statistical analyses were conducted using R software (v4.2.0; R Foundation for Statistical Computing, [<reflink idref="bib39" id="ref83">39</reflink>]) with statistical significance evaluated at the 0.05 threshold.</p> <hd id="AN0182844517-15">Results</hd> <p></p> <hd id="AN0182844517-16">Early Intervention Program Competence and NDBI Strategy Use</hd> <p>We first examined provider perceived competencies in using manualized NDBI programs and other commonly used early intervention programs. Self-reported program competency was calculated by examining the average extent to which participating providers reported competency in these programs (Table 3). Mean competency ratings across the full sample ranged from 1.62 (<emph>SD</emph> = 1.16) for the Early Start Denver Model to 3.63 (<emph>SD</emph> = 1.14) for JASPER. Providers noted feeling very competent with delivering at least one manualized NDBI program (<emph>M</emph> = 3.89; <emph>SD</emph> = 1.03). Likewise, they reported feeling very competent when delivering at least one early intervention program not categorized as a manualized NDBI (<emph>M</emph> = 3.97; <emph>SD</emph> = 0.97).</p> <p>Table 3 Perceived competency in early intervention programs</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>N</p></th><th align="left"><p><italic>M (SD)</italic></p></th><th align="left"><p>Range</p></th></tr></thead><tbody><tr><td align="left"><p>Discrete Trial Training</p></td><td align="left"><p>90</p></td><td align="left"><p>2.01 (1.26)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Early Achievements<sup>a</sup></p></td><td align="left"><p>90</p></td><td align="left"><p>2.28 (1.38)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Early Start Denver Model (ESDM)<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>1.62 (1.16)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Enhanced Milieu Teaching (EMT)<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>1.53 (1.08)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Floortime/DIR Model</p></td><td align="left"><p>89</p></td><td align="left"><p>2.54 (1.33)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Hanen More than Words<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>1.63 (1.13)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Incidental Teaching<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>2.8 (1.45)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>JASPER<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>3.63 (1.14)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Preschool Autism Communication Therapy (PACT)<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>1.78 (1.24)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Pivotal Response Treatment (PRT)<sup>a</sup></p></td><td align="left"><p>88</p></td><td align="left"><p>1.8 (1.17)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>PLAY Project</p></td><td align="left"><p>88</p></td><td align="left"><p>1.77 (1.24)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Project ImPACT<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>1.89 (1.24)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Reciprocal Imitation Training (RIT)<sup>a</sup></p></td><td align="left"><p>88</p></td><td align="left"><p>2.07 (1.28)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>SCERTS/Early Social Interaction Project<sup>a</sup></p></td><td align="left"><p>86</p></td><td align="left"><p>1.8 (1.31)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Social ABCs<sup>a</sup></p></td><td align="left"><p>89</p></td><td align="left"><p>1.75 (1.14)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>TEACCH Program</p></td><td align="left"><p>89</p></td><td align="left"><p>1.85 (1.22)</p></td><td align="left"><p>1–5</p></td></tr><tr><td align="left"><p>Verbal Behavior</p></td><td align="left"><p>86</p></td><td align="left"><p>2.22 (1.25)</p></td><td align="left"><p>1–5</p></td></tr></tbody></table> </ephtml> </p> <p> <sups>a</sups>Denotes NDBI program</p> <p>On average, providers reported using developmental NDBI strategies across 57.5% of their most recent session. Similarly, they reported use of behavioral strategies across 57.8% of their last session. Use of developmental and behavioral NDBI strategies in providers' most recent session were strongly correlated (<emph>r</emph> = 0.84; <emph>p</emph> < 0.001). Strategies used frequently across sessions included using positive affect and animation (73.4% of session), modeling joint attention skills through exaggerated gesture use (70.3%), and responding to child communication attempts (74.2%). When describing the way in which they used these strategies within session, the majority of providers described integrating these four techniques with other strategies and using them throughout sessions (<emph>M</emph> = 71.1%; range: 67.1–75.0%). Strategies used less frequently included those related to managing challenging behavior (48.9%), expanding play acts (49.6%), and pacing direct teaching opportunities (47.6%). More variability was observed in how providers reported using these strategies. For example, 30.2% of providers reported using behavior management strategies only as needed, whereas 44.8% integrated this technique with other strategies. Across manualized NDBI programs, provider perceived competence did not predict reported use of NDBI strategies in session (<emph>p</emph>s > 0.05).</p> <hd id="AN0182844517-17">Provider- and Organization-Level Factors and Provider-Reported NDBI Use</hd> <p>We then investigated associations between provider- and organization-level factors and reported NDBI strategy use using Pearson's correlation and analyses of variance. Considering provider-level factors related to demographic data, correlations were not significant between years of experience working within EI systems and use of developmental (<emph>r</emph> = -0.15, <emph>p</emph> = 0.13) or behavioral NDBI strategies (<emph>r</emph> = -0.13, <emph>p</emph> = 0.17). Likewise, bivariate analyses indicated that reported NDBI strategy use did not differ by nearly all demographic variables (<emph>p</emph>s > 0.05; see Table 4), excluding provider race. When considering strategy use by race, White providers (<emph>M</emph> = 64.7%) endorsed using developmental NDBI strategies more often than Black or African American providers (<emph>M</emph> = 46.7%; <emph>p</emph> = 0.02). This pattern did not hold when comparing use of behavioral NDBI strategies (p > 0.05). No significant relationships were observed between NDBI use and perceived organizational supports related to staffing, training, and supervision (<emph>p</emph>s > 0.05). Considering attitudes toward evidence-based practices, only the <emph>EBPAS</emph> scale assessing provider openness to novel interventions was positively associated with the use of developmental and behavioral NDBI strategies (<emph>p</emph>s < 0.001).</p> <p>Table 4 Differences in reported NDBI strategy use by demographic variables</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Demographics</p></th><th align="left" rowspan="2"><p><italic>n</italic></p></th><th align="left" colspan="2"><p>Developmental NDBI</p></th><th align="left" colspan="2"><p>Behavioral NDBI</p></th></tr><tr><th align="left"><p><italic>M</italic> (<italic>SD</italic>)</p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p><italic>M</italic> (<italic>SD</italic>)</p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Gender</p></td><td align="left" /><td align="left" /><td align="left"><p>0.54</p></td><td align="left" /><td align="left"><p>0.45</p></td></tr><tr><td align="left"><p> Female</p></td><td align="left"><p>67</p></td><td align="left"><p>60.93 (24.17)</p></td><td align="left" /><td align="left"><p>61.76 (23.53)</p></td><td align="left" /></tr><tr><td align="left"><p> Male</p></td><td align="left"><p>2</p></td><td align="left"><p>71.67 (7.07)</p></td><td align="left" /><td align="left"><p>74.44 (14.14)</p></td><td align="left" /></tr><tr><td align="left"><p>Race</p></td><td align="left" /><td align="left" /><td align="left"><p>0.02*</p></td><td align="left" /><td align="left"><p>0.09</p></td></tr><tr><td align="left"><p> White/Caucasian</p></td><td align="left"><p>55</p></td><td align="left"><p>64.73 (20.56)</p></td><td align="left" /><td align="left"><p>64.52 (21.64)</p></td><td align="left" /></tr><tr><td align="left"><p> Black/African American</p></td><td align="left"><p>14</p></td><td align="left"><p>47.52 (31.25)</p></td><td align="left" /><td align="left"><p>52.70 (28)</p></td><td align="left" /></tr><tr><td align="left"><p>Ethnicity</p></td><td align="left" /><td align="left" /><td align="left"><p>0.29</p></td><td align="left" /><td align="left"><p>0.73</p></td></tr><tr><td align="left"><p> Hispanic/Latinx</p></td><td align="left"><p>2</p></td><td align="left"><p>79.17 (9.57)</p></td><td align="left" /><td align="left"><p>67.78 (17.28)</p></td><td align="left" /></tr><tr><td align="left"><p> Non-Hispanic/Latinx</p></td><td align="left"><p>67</p></td><td align="left"><p>60.70 (24.04)</p></td><td align="left" /><td align="left"><p>61.95 (23.58)</p></td><td align="left" /></tr><tr><td align="left"><p>Education</p></td><td align="left" /><td align="left" /><td align="left"><p>0.32</p></td><td align="left" /><td align="left"><p>0.51</p></td></tr><tr><td align="left"><p> High School Diploma/GED/Associates</p></td><td align="left"><p>3</p></td><td align="left"><p>42.78 (29.64)</p></td><td align="left" /><td align="left"><p>60.74 (13.89)</p></td><td align="left" /></tr><tr><td align="left"><p> Bachelors</p></td><td align="left"><p>7</p></td><td align="left"><p>51.90 (35.74)</p></td><td align="left" /><td align="left"><p>50.79 (35.04)</p></td><td align="left" /></tr><tr><td align="left"><p> Masters</p></td><td align="left"><p>53</p></td><td align="left"><p>63.84 (21.32)</p></td><td align="left" /><td align="left"><p>64.23 (21.93)</p></td><td align="left" /></tr><tr><td align="left"><p> Professional/Doctorate</p></td><td align="left"><p>6</p></td><td align="left"><p>58.33 (27.26)</p></td><td align="left" /><td align="left"><p>57.41 (24.58)</p></td><td align="left" /></tr><tr><td align="left"><p>Independent Contractor</p></td><td align="left" /><td align="left" /><td align="left"><p>0.90</p></td><td align="left" /><td align="left"><p>0.81</p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left"><p>59</p></td><td align="left"><p>61.39 (23.14)</p></td><td align="left" /><td align="left"><p>62.55 (23.32)</p></td><td align="left" /></tr><tr><td align="left"><p> No</p></td><td align="left"><p>10</p></td><td align="left"><p>60.33 (29.36)</p></td><td align="left" /><td align="left"><p>59.6 (24.59)</p></td><td align="left" /></tr><tr><td align="left"><p>Profession</p></td><td align="left" /><td align="left" /><td align="left"><p>0.87</p></td><td align="left" /><td align="left"><p>0.45</p></td></tr><tr><td align="left"><p> Special Instructor</p></td><td align="left"><p>30</p></td><td align="left"><p>60.68 (24.88)</p></td><td align="left" /><td align="left"><p>59.66 (23.52)</p></td><td align="left" /></tr><tr><td align="left"><p> Specialty Therapists</p></td><td align="left"><p>39</p></td><td align="left"><p>61.67 (23.43)</p></td><td align="left" /><td align="left"><p>64.02 (23.33)</p></td><td align="left" /></tr><tr><td align="left"><p>Caseload</p></td><td align="left" /><td align="left" /><td align="left"><p>0.85</p></td><td align="left" /><td align="left"><p>0.65</p></td></tr><tr><td align="left"><p> None</p></td><td align="left"><p>2</p></td><td align="left"><p>79.17 (12.96)</p></td><td align="left" /><td align="left"><p>69.44 (13.36)</p></td><td align="left" /></tr><tr><td align="left"><p> 1–3 clients</p></td><td align="left"><p>15</p></td><td align="left"><p>62.44 (21.77)</p></td><td align="left" /><td align="left"><p>59.41 (22.45)</p></td><td align="left" /></tr><tr><td align="left"><p> 4–10 clients</p></td><td align="left"><p>26</p></td><td align="left"><p>58.99 (27.22)</p></td><td align="left" /><td align="left"><p>58.11 (27.18)</p></td><td align="left" /></tr><tr><td align="left"><p> 11–15 clients</p></td><td align="left"><p>4</p></td><td align="left"><p>61.67 (35.36)</p></td><td align="left" /><td align="left"><p>62.42 (24.61)</p></td><td align="left" /></tr><tr><td align="left"><p> 15 + clients</p></td><td align="left"><p>22</p></td><td align="left"><p>61.36 (20.64)</p></td><td align="left" /><td align="left"><p>68.00 (19.67)</p></td><td align="left" /></tr><tr><td align="left"><p>Years of experience with autistic children</p></td><td align="left" /><td align="left" /><td align="left"><p>0.74</p></td><td align="left" /><td align="left"><p>0.37</p></td></tr><tr><td align="left"><p> 1–3 years</p></td><td align="left"><p>10</p></td><td align="left"><p>63.50 (15.9)</p></td><td align="left" /><td align="left"><p>67.33 (17.05)</p></td><td align="left" /></tr><tr><td align="left"><p> 4–10 years</p></td><td align="left"><p>17</p></td><td align="left"><p>57.76 (31.93)</p></td><td align="left" /><td align="left"><p>57.21 (28.04)</p></td><td align="left" /></tr><tr><td align="left"><p> 11–19 years</p></td><td align="left"><p>19</p></td><td align="left"><p>65.70 (25.67)</p></td><td align="left" /><td align="left"><p>68.35 (26.82)</p></td><td align="left" /></tr><tr><td align="left"><p> 20 + years</p></td><td align="left"><p>23</p></td><td align="left"><p>59.13 (18.63)</p></td><td align="left" /><td align="left"><p>58.34 (18.03)</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <p>*Indicates significance at 0.05 level</p> <p>When considering provider discipline, the sample was grouped into two categories: (<reflink idref="bib1" id="ref84">1</reflink>) specialty therapists including speech language pathologists, occupational therapists, physical therapists, nurses, behavior analysts, and social workers, and (<reflink idref="bib2" id="ref85">2</reflink>) special instructors, a group of providers with greater variability in educational level and training discipline. Providers' reported use of developmental NDBI strategies (<emph>p</emph> = 0.87) and behavioral NDBI strategies (<emph>p</emph> = 0.45) did not differ by whether providers were specialty therapists or special instructors.</p> <p>Finally, a regression model of best fit was used to determine to what degree predictor variables—provider race (subset of White and Black or African providers) and openness to novel interventions—significantly contributed to the variance in reported developmental and behavioral NDBI strategy use (Table 5). With race and openness to new interventions as the primary predictors, the model accounted for 37.1% of the variance in reported use of developmental NDBI strategies and 23.6% of the variance in behavioral NDBI strategy use.</p> <p>Table 5 Multivariable regression for provider-level factors in predicting NDBI strategy use</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Predictor</p></th><th align="left"><p>β (95% CI)</p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p>Adjusted <italic>R</italic><sup><italic>2</italic></sup></p></th></tr></thead><tbody><tr><td align="left"><p>Developmental NDBI</p></td><td align="left"><p>Race – White</p></td><td align="left"><p>24.49 (12.48, 36.50)</p></td><td align="left"><p>< 0.001</p></td><td align="left"><p>0.371</p></td></tr><tr><td align="left" /><td align="left"><p><italic>EBPAS</italic> Open</p></td><td align="left"><p>18.14 (11.59, 24.69)</p></td><td align="left"><p>< 0.001</p></td><td align="left" /></tr><tr><td align="left"><p>Behavioral NDBI</p></td><td align="left"><p>Race – White</p></td><td align="left"><p>16.09 (3.17, 29.00)</p></td><td align="left"><p>0.015</p></td><td align="left"><p>0.236</p></td></tr><tr><td align="left" /><td align="left"><p><italic>EBPAS</italic> Open</p></td><td align="left"><p>15.43 (8.38, 22.48)</p></td><td align="left"><p>< 0.001</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <hd id="AN0182844517-18">Discussion</hd> <p>The current study characterized providers' reported use of NBDI programs and strategies within a Part C EI system and examined the extent to which provider background, attitudes, and perceived organizational support predicted reported use of NDBI strategies. On average, providers reported feeling competent delivering at least one NDBI program and reported using a range of NDBI strategies within their most recent EI session, with behavioral and developmental strategy use highly correlated. When examining how provider- and organization-level factors impacted reported NDBI strategy use, neither providers' clinical experiences nor perceptions of organizational support predicted reported use of NDBI strategies. However, providers' openness to trying new interventions did uniquely predict the reported use of both developmental and behavioral strategies.</p> <p>Providers' perception of their NDBI program competency and strategy use within this EI system corroborated findings observed in other EI systems (Pickard et al., [<reflink idref="bib36" id="ref86">36</reflink>]). That is, despite inconsistent familiarity with manualized NDBI programs, findings suggest that EI providers often deliver broader NDBI strategies to autistic toddlers or toddlers with social communication delays. EI providers within this system also reported using developmental and behavioral strategies about equally. These findings are encouraging and reinforce the importance of building from foundational NDBI knowledge rather than specific NDBI approaches. However, it is important to weigh these results alongside research suggesting that EI providers have inconsistent fidelity to NDBIs and to family coaching strategies when observational measures are used (Pellecchia et al., [<reflink idref="bib35" id="ref87">35</reflink>]; Pickard et al., [<reflink idref="bib38" id="ref88">38</reflink>]; Rogers et al., [<reflink idref="bib41" id="ref89">41</reflink>]), and studies in other settings have noted discrepancies between provider-reported and observed use of evidence-based strategies (e.g., Hurlburt et al., [<reflink idref="bib22" id="ref90">22</reflink>]). In addition to a need for future research to intentionally examine whether there are differences in reported and observed strategy use in Part C provider samples, providers may hold perceptions about when both NDBI and family coaching strategies can and should be used (e.g., Straiton et al., [<reflink idref="bib52" id="ref91">52</reflink>]; Tomczuk et al., [<reflink idref="bib54" id="ref92">54</reflink>]), impacting the extent to which strategies reach families, particularly those who are historically marginalized. Ongoing work is thus needed to capitalize on existing NDBI knowledge in EI systems while responding to factors that may impact observable implementation.</p> <p>It is also important to note that the drivers of provider-reported NDBI use and the drivers of implementing NDBIs at fidelity are likely distinct. Providers' reported use of NDBIs may be more closely tied to their knowledge of these strategies, whereas the quality by which they implement them may be much more closely tied to their background and training experience, the amount of supervision and support they receive to implement strategies within EI systems, and the priorities of the system itself regarding the use of NDBIs or other best practices for autistic toddlers (Mirenda et al., [<reflink idref="bib32" id="ref93">32</reflink>]; Pickard et al., [<reflink idref="bib37" id="ref94">37</reflink>]). Further research is needed to understand the differences in providers' reported use and actual use of NDBIs, as well as the differences in factors that drive these implementation outcomes.</p> <p>In addition to characterizing reported NDBI use, the current study examined provider- and organization-level factors driving use of developmental and behavioral strategies. The fact that providers' EI and autism experience did not impact their reported use of NDBI strategies may suggest more widespread familiarity with these theoretical approaches to intervention. However, providers who were more open to trying new interventions were also more likely to report using developmental and behavioral strategies during their most recent EI session. The significant role of provider attitudes is consistent with research examining the role of provider attitudes in driving both intentions to use evidence-based practices (Lawson et al., [<reflink idref="bib28" id="ref95">28</reflink>]) and the actual use of evidence-based practices in EI systems and beyond (Aarons et al., [<reflink idref="bib2" id="ref96">2</reflink>]; Aranbarri et al., [<reflink idref="bib6" id="ref97">6</reflink>]). Findings may suggest the value of targeting attitudes towards trying new practices as an implementation strategy to support the uptake of NDBI strategies in this system. Of note, the current study used the <emph>EBPAS</emph>, which reflects general attitudes towards trying new practices rather than attitudes towards NDBIs specifically (Aaron, [<reflink idref="bib1" id="ref98">1</reflink>]). Future research is needed to examine whether NDBI-specific attitudes may better predict providers' use of these practices.</p> <p>The significant association between EI providers' race and their reported NDBI strategy use was unanticipated. Previous research examining providers' report of NDBI strategies and their actual implementation of NDBI programs has not found differences in delivery based on sociodemographic characteristics (Pellecchia et al., [<reflink idref="bib35" id="ref99">35</reflink>]; Stahmer et al., [<reflink idref="bib49" id="ref100">49</reflink>]). Our finding may reflect differences in provider experiences, disciplinary backgrounds, or attitudes towards trying novel manualized interventions. Yet reported NDBI strategy use only differed by 15% between White and Black or African American providers within their most recent therapy session. Thus, it is unclear whether the statistically significant role of provider race reflects meaningful differences by which NDBI strategies are delivered. Moreover, the sample of EI providers who identified as Black or African American in this study was quite small, and future research is needed to fully understand the impact of sociodemographic characteristics on both reported and actual NDBI use.</p> <p>It was similarly unexpected that perceived organizational support related to the use of evidence-based practices did not predict providers' reported use of NDBI strategies, particularly given the complexity of EI systems and emerging qualitative research suggesting the role of financial disincentives, leadership support, and consistent communication of EBP priorities in driving providers' participation in EBP training initiatives (Pickard et al., [<reflink idref="bib37" id="ref101">37</reflink>]). For example, to attend formal NDBI training efforts, providers often need to take time to attend intervention trainings, leading to fewer client interactions and reduced pay given the independent contracting system structure. Staffing, training, and supervision supports may not have had a clear impact in the current study as the Georgia EI system is structured such that most providers contract independently with the state rather than within agencies that contract with the state. This structure means that providers can operate with high autonomy in terms of caseload size and training experiences. As such, it is possible that the construct of "organizational" support plays less of a role in decentralized systems and systems in which there are more ambiguous structures by which providers are grouped and overseen. The present study also examined general provider perceptions of organizational support rather than objective description of these supports and the frequency with which providers access them. As evidence in other public health systems indicates that providers access organizational supports like supervision relatively infrequently (e.g., Dorsey et al., [<reflink idref="bib13" id="ref102">13</reflink>]), future work can provide greater description of the supports available, how these compare within and across EI systems, and how support relates to implementation outcomes.</p> <p>There are several future directions stemming from the study findings. First, this study was conducted with providers operating within one EI system. Although all states within the United States are mandated to deliver EI programming under Part C of IDEA, there is considerable variability in the structure, funding streams, and workforce comprised in these systems (Noyes-Grosser et al., [<reflink idref="bib34" id="ref103">34</reflink>]). Such substantial variations may impact system ability to deliver NDBIs. Future research is needed across states to examine how system-level factors, including funding streams, contracting structures, and intervention mandates, impact the delivery of NDBI programs and strategies by collecting data across individuals within the system. Use of mixed methods, or expanding upon quantitative findings with qualitative findings, may provide necessary context to interpret factors impacting NDBI use, in turn supporting development of implementation strategies that have a more sweeping impact on the use of NDBIs.</p> <p>Findings from this study contribute to possible discrepancy between high provider-reported use of NDBI strategies and research using observational measures to examine providers' actual and more variable fidelity to NDBI programs. However, it is not possible to make direct comparisons as most research has used observational measures to examine provider fidelity to specific manualized NDBI programs. Research is needed to directly examine the relationship between provider-report and observational measures of NDBI strategies, with qualitative follow-up to understand the reasons driving discrepancies. In conducting this future research, it will be important to explore other possible pragmatic measures of NDBI strategy use, such as using data collected through electronic medical records or claims data to approximate use (e.g., Straiton et al., [<reflink idref="bib51" id="ref104">51</reflink>]), as traditional observational methods like intensive fidelity scoring in the context of video review may not be practical in large systems (e.g., Brookman-Frazee et al., [<reflink idref="bib8" id="ref105">8</reflink>]).</p> <p>Key limitations in this study include a focus on provider-report measures of NDBI program and strategy use as opposed to observed use, a high rate of missing data, and data collection restricted to one state's EI system. Additionally, this study did not examine caregivers' perceptions of NDBIs or family coaching practices within the context of EI services. This is an important limitation as previous research suggests that provider and caregiver report of family-centered care and early intervention service quality differ significantly (e.g., McManus et al., [<reflink idref="bib30" id="ref106">30</reflink>]). It will be important to understand whether these differences also play out within autism-specific early intervention practices. Finally, this study would have benefited from qualitative data to expand upon survey-based results by understanding how and why providers use NDBI strategies and to understand their perceptions of the factors that drive their knowledge and implementation of these practice.</p> <p>The present study provides further evidence of the extent to which NDBI strategies are incorporated in routine practice within EI systems. The additional emphasis on examining factors associated with NDBI strategy use expands prior research in this area and is important knowledge that can guide implementation efforts aimed at increasing EI provider use of NDBI strategies. Although findings suggest that NDBI strategies are delivered by EI providers in the absence of formal implementation efforts or effectiveness trials, future research integrating observational data and caregiver perspectives is critical to better understand the service landscape.</p> <hd id="AN0182844517-19">Acknowledgements</hd> <p>We would like to acknowledge the contributions of providers within Georgia's Part C Early Intervention system, Babies Can't Wait. We also recognize the effort and support of Synita Griswell, the autism services coordinator within Babies Can't Wait, and other administrators within the system for supporting data collection.</p> <hd id="AN0182844517-20">Declarations</hd> <p></p> <hd id="AN0182844517-21">Conflict of interests</hd> <p>We have no known conflicts of interest to disclose.</p> <hd id="AN0182844517-22">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0182844517-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref60" type="bt">1</bibl> <bibtext> Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice attitude scale (EBPAS). Mental Health Services Research. 2004; 6: 61-74. 15224451. 10.1023/B:MHSR.0000024351.12294.65. 1564126</bibtext> </blist> <blist> <bibl id="bib2" idref="ref61" type="bt">2</bibl> <bibtext> Aarons GA. Measuring provider attitudes toward evidence-based practice: Consideration of organizational context and individual differences. Child and Adolescent Psychiatric Clinics. 2005; 14; 2: 255-271. 10.1016/j.chc.2004.04.008</bibtext> </blist> <blist> <bibl id="bib3" idref="ref69" type="bt">3</bibl> <bibtext> Aarons GA. Transformational and transactional leadership: Association with attitudes toward evidence-based practice. Psychiatric Services. 2006; 57; 8: 1162-1169. 16870968. 10.1176/ps.2006.57.8.1162</bibtext> </blist> <blist> <bibl id="bib4" idref="ref31" type="bt">4</bibl> <bibtext> Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research. 2011; 38: 4-23. 21197565. 10.1007/s10488-010-0327-7</bibtext> </blist> <blist> <bibl id="bib5" idref="ref19" type="bt">5</bibl> <bibtext> Adams RC, Tapia CD. Early intervention, IDEA part C services, and the medical home: Collaboration for best practice and best outcomes. Pediatrics. 2013; 132: e1073-e1088. 24082001. 10.1542/peds.2013-2305</bibtext> </blist> <blist> <bibl id="bib6" idref="ref20" type="bt">6</bibl> <bibtext> Aranbarri, A, Stahmer, A. C, Talbott, M. R, Miller, M. E, Drahota, A, Pellecchia, M, Griffith, E. M, Morgan, E. H, & Rogers, S. J. (2021). Examining U.S. public early intervention for toddlers with autism: Characterizing services and readiness for evidence-based practice implementation. Frontiers in Psychiatry, 12.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref6" type="bt">7</bibl> <bibtext> Brian J, Drmic I, Roncadin C, Dowds E, Shaver C, Smith IM, Zwaigenbaum L, Sacrey LR, Bryson SE. Effectiveness of a parent-mediated intervention for toddlers with autism spectrum disorder: Evidence from a large community implementation. Autism. 2022; 26; 7: 1882-1897. 35037520. 10.1177/13623613211068934</bibtext> </blist> <blist> <bibl id="bib8" idref="ref105" type="bt">8</bibl> <bibtext> Brookman-Frazee L, Stadnick NA, Lind T, Roesch S, Terrones L, Barnett ML, Regan J, Kennedy CA, Garland AF, Lau AS. Therapist-observer concordance in ratings of EBP strategy delivery: Challenges and targeted directions in pursuing pragmatic measurement in children's mental health services. Administration and Policy in Mental Health and Mental Health Services Research. 2021; 48: 155-170. 32507982. 10.1007/s10488-020-01054-x</bibtext> </blist> <blist> <bibl id="bib9" idref="ref51" type="bt">9</bibl> <bibtext> Cidav, Z, Mandell, D, Ingersoll, B, & Pellecchia, M. (2023). Programmatic costs of Project ImPACT for children with autism: A time-driven activity based costing study. Administration and Policy in Mental Health and Mental Health Services Research, 1–15.</bibtext> </blist> <blist> <bibtext> Crank JE, Sandbank M, Dunham K, Crowley S, Bottema-Beutel K, Feldman J, Woynaroski TG. Understanding the effects of naturalistic developmental behavioral interventions: A Project AIM meta‐analysis. Autism Research. 2021; 14; 4: 817-834. 33480474. 10.1002/aur.2471. 8862714</bibtext> </blist> <blist> <bibtext> D'Agostino SR, Dueñas AD, Bravo A, Tyson K, Straiton D, Salvatore GL, Pacia C, Pellecchia M. Toward deeper understanding and wide-scale implementation of naturalistic developmental behavioral interventions. Autism. 2023; 27; 1: 253-258. 36056601. 10.1177/13623613221121427</bibtext> </blist> <blist> <bibtext> Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science. 2009; 4; 1: 1-15. 10.1186/1748-5908-4-50</bibtext> </blist> <blist> <bibtext> Dorsey S, Kerns SE, Lucid L, Pullmann MD, Harrison JP, Berliner L, Thompson K, Deblinger E. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implementation Science. 2018; 13; 1: 1-12. 10.1186/s13012-017-0708-3</bibtext> </blist> <blist> <bibtext> Eisenhower A, Martinez Pedraza F, Sheldrick RC, Frenette E, Hoch N, Brunt S, Carter AS. Multi-stage screening in early intervention: A critical strategy for improving ASD identification and addressing disparities. Journal of Autism and Developmental Disorders. 2021; 51; 3: 868-883. 32144605. 10.1007/s10803-020-04429-z. 7483311</bibtext> </blist> <blist> <bibtext> Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. The Joint Commission Journal on Quality and Patient Safety. 2008; 34; 4: 228-243. 18468362. 10.1016/S1553-7250(08)34030-6</bibtext> </blist> <blist> <bibtext> Fleming JL, Sawyer LB, Campbell PH. Early intervention providers' perspectives about implementing participation-based practices. Topics in Early Childhood Special Education. 2011; 30; 4: 233-244. 10.1177/0271121410371986</bibtext> </blist> <blist> <bibtext> Frost, K. M, & Ingersoll, B. (2019). May 1–4). Utilization of developmental and behavioral intervention techniques in usual care: Initial validation of a self-report rating scale in a sample of applied behavior analysis providers. International Society for Autism Research 2019 Meeting, Montreal, Canada.</bibtext> </blist> <blist> <bibtext> Frost KM, Brian J, Gengoux GW, Hardan A, Rieth SR, Stahmer A, Ingersoll B. Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi. Autism. 2020; 24; 8: 2285-2297. 32731748. 10.1177/1362361320944011. 7541530</bibtext> </blist> <blist> <bibtext> Gengoux, G. W, McNerney, E, & Minjarez, M. B. (2020). Selecting meaningful skills for teaching in the natural environment. In Y. Bruinsma, M. B. Minjarez, L. Schreibman, & A. C. Stahmer (Eds.), Naturalistic developmental behavioral interventions for autism spectrum disorder. Brookes Publishing.</bibtext> </blist> <blist> <bibtext> Hampton LH, Sandbank MP. Keeping up with the evidence base: Survey of behavior professionals about naturalistic developmental behavioral interventions. Autism. 2022; 26; 4: 875-888. 34320872. 10.1177/13623613211035233</bibtext> </blist> <blist> <bibtext> Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics. 2009; 42; 2: 377-381. 18929686. 10.1016/j.jbi.2008.08.010</bibtext> </blist> <blist> <bibtext> Hurlburt MS, Garland AF, Nguyen K, Brookman-Frazee L. Child and family therapy process: Concordance of therapist and observational perspectives. Administration and Policy in Mental Health and Mental Health Services Research. 2010; 37: 230-244. 19902347. 10.1007/s10488-009-0251-x</bibtext> </blist> <blist> <bibtext> Ibañez LV, Scott S, Stone WL. The implementation of reciprocal imitation training in a part C early intervention setting: A stepped-wedge pragmatic trial. Autism Research. 2021; 14; 8: 1777-1788. 34080761. 10.1002/aur.2522</bibtext> </blist> <blist> <bibtext> Individuals With Disabilities Education Act [IDEA] (2004). 20 U S C § 1400.</bibtext> </blist> <blist> <bibtext> Institute of Behavioral Research. (2009). TCU Organizational Readiness for Change (ORC-D4). Texas Christian University, Institute of Behavioral Research.</bibtext> </blist> <blist> <bibtext> Koegel LK, Koegel RL, Carter CM. Pivotal responses and the natural language teaching paradigm. Seminars in Speech and Language. 1998; 19; 4: 355-372. 9857392. 10.1055/s-2008-1064054</bibtext> </blist> <blist> <bibtext> Landa RJ. Efficacy of early interventions for infants and young children with and at risk for autism spectrum disorders. International Review of Psychiatry. 2018; 30; 1: 25-39. 29537331. 10.1080/09540261.2018.1432574</bibtext> </blist> <blist> <bibtext> Lawson, G. M, Mandell, D. S, Tomczuk, L, Fishman, J, Marcus, S. C, & Pellecchia, M. (2022). Clinician intentions to use the components of parent coaching within community early intervention systems. Administration and Policy in Mental Health and Mental Health Services Research, 1–9.</bibtext> </blist> <blist> <bibtext> Lee J, Sone B, Rooney T, Roberts MY. The role of naturalistic developmental behavioral interventions in early intervention for autistic toddlers: An observational study. American Journal of Speech-Language Pathology. 2023; 32; 2: 439-451. 36630890. 10.1044/2022_AJSLP-22-00190. 10171846</bibtext> </blist> <blist> <bibtext> McManus BM, Murphy NJ, Richardson Z, Khetani MA, Schenkman M, Morrato EH. Family-centred care in early intervention: Examining caregiver perceptions of family‐centred care and early intervention service use intensity. Child: Care Health and Development. 2020; 46; 1: 1-8. 31782824. 10.1111/cch.12724</bibtext> </blist> <blist> <bibtext> Melgarejo M, Lind T, Stadnick NA, Helm JL, Locke J. Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity. American Psychologist. 2020; 75; 8: 1105-1115. 33252948. 10.1037/amp0000649</bibtext> </blist> <blist> <bibtext> Mirenda, P, Smith, V, Colozzo, P, Vismara, L. A, Ungar, W. J, & Kalynchuk, K. (2021). Training coaches in community agencies to support parents of children with suspected autism: Outcomes, facilitators, and barriers. Journal of Autism and Developmental Disorders, 1–18.</bibtext> </blist> <blist> <bibtext> Nilsen P. Making sense of implementation theories, models, and frameworks. Implementation Science. 2015; 10; 53: 1-13</bibtext> </blist> <blist> <bibtext> Noyes-Grosser DM, Elbaum B, Wu Y, Siegenthaler KM, Cavalari RS, Gillis JM, Romanczyk RG. Early intervention outcomes for toddlers with autism spectrum disorder and their families. Infants and Young Children. 2018; 31; 3: 177-199. 10.1097/IYC.0000000000000121</bibtext> </blist> <blist> <bibtext> Pellecchia, M, Mandell, D. S, Beidas, R. S, Dunst, C. J, Tomczuk, L, Newman, J, Ziegler, L, & Stahmer, A. C. (2022). Parent coaching in early intervention for autism spectrum disorder: A brief report. Journal of Early Intervention, 45(2), 185–197.</bibtext> </blist> <blist> <bibtext> Pickard, K, Mellman, H, Frost, K, Reaven, J, & Ingersoll, B. (2021). Balancing fidelity and flexibility: Usual care for young children with an increased likelihood of having autism spectrum disorder within an early intervention system. Journal of Autism and Developmental Disorders, 1–13.</bibtext> </blist> <blist> <bibtext> Pickard, K, Hendrix, N, & Greenfield, E. (2023a). Examining the infrastructure for the adoption of autism evidence-based practices in an Early Intervention system. International Society for Autism Research 2023 Meeting, Stockholm, Sweden.</bibtext> </blist> <blist> <bibtext> Pickard, K, Hendrix, N, Guerra, K, Brane, N, & Islam, N. (2023b). Examining provider decisions around the delivery and adaptation of a parent-mediated intervention within an Early Intervention system. Autism, 27(8), 2384–2396.</bibtext> </blist> <blist> <bibtext> R Foundation for Statistical Computing. (2022). R: A language and environment for statistical computing (version 4.2.0). Author.</bibtext> </blist> <blist> <bibtext> Rieth SR, Dickson KS, Ko J, Haine-Schlagel R, Gaines K, Brookman-Frazee L, Stahmer AC. Provider perspectives and reach of an evidence-based intervention in community services for toddlers. Autism. 2022; 26; 3: 628-639. 35301876. 10.1177/13623613211065535</bibtext> </blist> <blist> <bibtext> Rogers SJ, Stahmer A, Talbott M, Young G, Fuller E, Pellecchia M, Barber A, Griffith E. Feasibility of delivering parent-implemented NDBI interventions in low-resource regions: A pilot randomized controlled study. Journal of Neurodevelopmental Disorders. 2022; 14; 1: 1-14. 10.1186/s11689-021-09410-0</bibtext> </blist> <blist> <bibtext> Saldana L, Chapman JE, Henggeler SW, Rowland MD. The Organizational readiness for Change scale in adolescent programs: Criterion validity. Journal of Substance Abuse Treatment. 2007; 33; 2: 159-169. 17434703. 10.1016/j.jsat.2006.12.029. 2104560</bibtext> </blist> <blist> <bibtext> Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Dunham K, Feldman JI, Crank J, Albarran SA, Raj S, Mahbub P, Woynaroski TG. Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin. 2020; 146; 1: 1-29. 31763860. 10.1037/bul0000215</bibtext> </blist> <blist> <bibtext> Schreibman L, Dawson G, Stahmer AC, Landa R, Rogers SJ, McGee GG, Kasari C, Ingersoll B, Kaiser AP, Bruinsma Y, McNerney E, Wetherby A, Halladay A. Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders. 2015; 45; 8: 2411-2428. 25737021. 10.1007/s10803-015-2407-8. 4513196</bibtext> </blist> <blist> <bibtext> Stadnick NA, Meza RD, Suhrheinrich J, Aarons GA, Brookman-Frazee L, Lyon AR, Mandell DS, Locke J. Leadership profiles associated with the implementation of behavioral health evidence-based practices for autism spectrum disorder in schools. Autism. 2019; 23; 8: 1957-1968. 30915854. 10.1177/1362361319834398. 6764916</bibtext> </blist> <blist> <bibtext> Stahmer AC, Aarons GA. Attitudes toward adoption of evidence-based practices: A comparison of autism early intervention providers and children's mental health providers. Psychological Services. 2009; 6; 3: 223-234. 21796262. 10.1037/a0010738. 3143034</bibtext> </blist> <blist> <bibtext> Stahmer AC, Mandell DS. State infant/toddler program policies for eligibility and services provision for young children with autism. Administration and Policy in Mental Health and Mental Health Services Research. 2007; 34; 1: 29-37. 16758329. 10.1007/s10488-006-0060-4</bibtext> </blist> <blist> <bibtext> Stahmer AC, Collings NM, Palinkas LA. Early intervention practices for children with autism: Descriptions from community providers. Focus on Autism and Other Developmental Disabilities. 2005; 20; 2: 66-79. 16467905. 10.1177/10883576050200020301. 1350798</bibtext> </blist> <blist> <bibtext> Stahmer AC, Rieth SR, Dickson KS, Feder J, Burgeson M, Searcy K, Brookman-Frazee L. Project ImPACT for toddlers: Pilot outcomes of a community adaptation of an intervention for autism risk. Autism. 2020; 24; 3: 617-632. 31565955. 10.1177/1362361319878080</bibtext> </blist> <blist> <bibtext> Steinbrenner, J. R, Hume, K, Odom, S. L, Morin, K. L, Nowell, S. W, Tomaszewski, B, Szendrey, S, McIntyre, N. S, Yücesoy-Özkan, S, & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with autism. Frank Porter Graham Child Development Institute.</bibtext> </blist> <blist> <bibtext> Straiton D, Groom B, Ingersoll B. Parent training for youth with autism served in community settings: A mixed-methods investigation within a community mental health system. Journal of Autism and Developmental Disorders. 2021; 51: 1983-1994. 32876827. 10.1007/s10803-020-04679-x</bibtext> </blist> <blist> <bibtext> Straiton D, Frost K, Ingersoll B. Factors that influence clinical decisions about offering parent coaching for autistic youth served within the Medicaid system. Implementation Research and Practice. 2023; 4: 1-13. 10.1177/26334895231153631</bibtext> </blist> <blist> <bibtext> Tiede G, Walton KM. Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder. Autism. 2019; 23; 8: 2080-2095. 31018655. 10.1177/1362361319836371</bibtext> </blist> <blist> <bibtext> Tomczuk L, Stewart RE, Beidas RS, Mandell DS, Pellecchia M. Who gets coached? A qualitative inquiry into community clinicians' decisions to use caregiver coaching. Autism. 2022; 26; 3: 575-585. 34866429. 10.1177/13623613211059499</bibtext> </blist> <blist> <bibtext> U.S. Department of Education (2021). 43rd Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2021. Retrieved from: https://sites.ed.gov/idea/files/43rd-arc-for-idea.pdf.</bibtext> </blist> <blist> <bibtext> U.S. Department of Education (2022). Number of infants and toddlers ages birth through 2 and 3 and older, and percentage of population, receiving early intervention services under IDEA, Part C, by age and state (2020–2021 data table) Retrieved from https://data.ed.gov/dataset/idea-section-618-data-products-static-tables-part-c-child-count-and-settings-table-1/resources?resource=f28a5f96-d3b5-4fb7-af87-413e9be64e47.</bibtext> </blist> <blist> <bibtext> Vivanti G, Kasari C, Green J, Mandell D, Maye M, Hudry K. Implementing and evaluating early intervention for children with autism: Where are the gaps and what should we do?. Autism Research. 2018; 11; 1: 16-23. 29206358. 10.1002/aur.1900</bibtext> </blist> <blist> <bibtext> Williams ME, Harley EK, Quebles I, Poulsen MK. Policy and practice barriers to early identification of autism spectrum disorder in the California early intervention system. Journal of Autism and Developmental Disorders. 2021; 51; 10: 3423-3431. 33386551. 10.1007/s10803-020-04807-7</bibtext> </blist> <blist> <bibtext> Yoder PJ, Stone WL, Edmunds SR. Parent utilization of ImPACT intervention strategies is a mediator of proximal then distal social communication outcomes in younger siblings of children with ASD. Autism. 2021; 25; 1: 44-57. 32811160. 10.1177/1362361320946883</bibtext> </blist> </ref> <aug> <p>By Nicole Hendrix; Emma Chatson; Hannah Davies; Brooke Demetri; Yijin Xiang; Millena Yohannes; Ainsley Buck; Shannon Harper; Jennifer Stapel-Wax and Katherine Pickard</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib44" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib53" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib26" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib59" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib43" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib11" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib20" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib36" firstref="ref12"></nolink> <nolink nlid="nl11" bibid="bib57" firstref="ref13"></nolink> <nolink nlid="nl12" bibid="bib23" firstref="ref14"></nolink> <nolink nlid="nl13" bibid="bib38" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib41" firstref="ref16"></nolink> <nolink nlid="nl15" bibid="bib49" firstref="ref17"></nolink> <nolink nlid="nl16" bibid="bib24" firstref="ref18"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref21"></nolink> <nolink nlid="nl18" bibid="bib40" firstref="ref26"></nolink> <nolink nlid="nl19" bibid="bib33" firstref="ref30"></nolink> <nolink nlid="nl20" bibid="bib12" firstref="ref32"></nolink> <nolink nlid="nl21" bibid="bib15" firstref="ref33"></nolink> <nolink nlid="nl22" bibid="bib48" firstref="ref35"></nolink> <nolink nlid="nl23" bibid="bib47" firstref="ref37"></nolink> <nolink nlid="nl24" bibid="bib46" firstref="ref38"></nolink> <nolink nlid="nl25" bibid="bib55" firstref="ref40"></nolink> <nolink nlid="nl26" bibid="bib32" firstref="ref41"></nolink> <nolink nlid="nl27" bibid="bib29" firstref="ref42"></nolink> <nolink nlid="nl28" bibid="bib28" firstref="ref43"></nolink> <nolink nlid="nl29" bibid="bib16" firstref="ref44"></nolink> <nolink nlid="nl30" bibid="bib54" firstref="ref46"></nolink> <nolink nlid="nl31" bibid="bib34" firstref="ref48"></nolink> <nolink nlid="nl32" bibid="bib56" firstref="ref49"></nolink> <nolink nlid="nl33" bibid="bib58" firstref="ref50"></nolink> <nolink nlid="nl34" bibid="bib37" firstref="ref53"></nolink> <nolink nlid="nl35" bibid="bib31" firstref="ref54"></nolink> <nolink nlid="nl36" bibid="bib45" firstref="ref55"></nolink> <nolink nlid="nl37" bibid="bib21" firstref="ref66"></nolink> <nolink nlid="nl38" bibid="bib42" firstref="ref71"></nolink> <nolink nlid="nl39" bibid="bib18" firstref="ref73"></nolink> <nolink nlid="nl40" bibid="bib27" firstref="ref75"></nolink> <nolink nlid="nl41" bibid="bib50" firstref="ref76"></nolink> <nolink nlid="nl42" bibid="bib17" firstref="ref82"></nolink> <nolink nlid="nl43" bibid="bib39" firstref="ref83"></nolink> <nolink nlid="nl44" bibid="bib35" firstref="ref87"></nolink> <nolink nlid="nl45" bibid="bib22" firstref="ref90"></nolink> <nolink nlid="nl46" bibid="bib52" firstref="ref91"></nolink> <nolink nlid="nl47" bibid="bib13" firstref="ref102"></nolink> <nolink nlid="nl48" bibid="bib51" firstref="ref104"></nolink> <nolink nlid="nl49" bibid="bib30" firstref="ref106"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1460717
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Early Intervention Provider-Reported NDBI Use and Relationships with Provider- to System-Level Implementation Determinants
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Nicole+Hendrix%22">Nicole Hendrix</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-8272-9329">0000-0001-8272-9329</externalLink>)<br /><searchLink fieldCode="AR" term="%22Emma+Chatson%22">Emma Chatson</searchLink><br /><searchLink fieldCode="AR" term="%22Hannah+Davies%22">Hannah Davies</searchLink><br /><searchLink fieldCode="AR" term="%22Brooke+Demetri%22">Brooke Demetri</searchLink><br /><searchLink fieldCode="AR" term="%22Yijin+Xiang%22">Yijin Xiang</searchLink><br /><searchLink fieldCode="AR" term="%22Millena+Yohannes%22">Millena Yohannes</searchLink><br /><searchLink fieldCode="AR" term="%22Ainsley+Buck%22">Ainsley Buck</searchLink><br /><searchLink fieldCode="AR" term="%22Shannon+Harper%22">Shannon Harper</searchLink><br /><searchLink fieldCode="AR" term="%22Jennifer+Stapel-Wax%22">Jennifer Stapel-Wax</searchLink><br /><searchLink fieldCode="AR" term="%22Katherine+Pickard%22">Katherine Pickard</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(1):103-113.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Early+Intervention%22">Early Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Naturalistic+Observation%22">Naturalistic Observation</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Personnel%22">Health Personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Attitudes%22">Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Background%22">Background</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disciplines%22">Intellectual Disciplines</searchLink><br /><searchLink fieldCode="DE" term="%22Institutional+Role%22">Institutional Role</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Support+Groups%22">Social Support Groups</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-023-06203-3
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257<br />1573-3432
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: An expanding evidence base has advocated for delivery of naturalistic developmental behavioral interventions (NDBIs) within community systems, thus extending the reach of these practices to young autistic children. The current study examined provider-reported use of NBDIs within a Part C Early Intervention (EI) system and the extent to which provider background, attitudes, and perceived organizational support predicted NDBI use. Results from 100 EI providers representing multiple disciplines indicated reported use of NDBI strategies within their practice despite inconsistent reported competency with manualized NDBI programs. Although NDBI strategy use was not predicted by provider experiences or perceived organizational support, provider openness to new interventions predicted the reported use of NDBI strategies. Future directions include mixed methods data collection across and within EI systems to better understand NDBI use and ultimately facilitate NDBI implementation.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1460717
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1460717
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1007/s10803-023-06203-3
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 103
    Subjects:
      – SubjectFull: Early Intervention
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Naturalistic Observation
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Health Personnel
        Type: general
      – SubjectFull: Attitudes
        Type: general
      – SubjectFull: Background
        Type: general
      – SubjectFull: Intellectual Disciplines
        Type: general
      – SubjectFull: Institutional Role
        Type: general
      – SubjectFull: Social Support Groups
        Type: general
    Titles:
      – TitleFull: Early Intervention Provider-Reported NDBI Use and Relationships with Provider- to System-Level Implementation Determinants
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Nicole Hendrix
      – PersonEntity:
          Name:
            NameFull: Emma Chatson
      – PersonEntity:
          Name:
            NameFull: Hannah Davies
      – PersonEntity:
          Name:
            NameFull: Brooke Demetri
      – PersonEntity:
          Name:
            NameFull: Yijin Xiang
      – PersonEntity:
          Name:
            NameFull: Millena Yohannes
      – PersonEntity:
          Name:
            NameFull: Ainsley Buck
      – PersonEntity:
          Name:
            NameFull: Shannon Harper
      – PersonEntity:
          Name:
            NameFull: Jennifer Stapel-Wax
      – PersonEntity:
          Name:
            NameFull: Katherine Pickard
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0162-3257
            – Type: issn-electronic
              Value: 1573-3432
          Numbering:
            – Type: volume
              Value: 55
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Autism and Developmental Disorders
              Type: main
ResultId 1