Implementation Pilot Elopement

Project Summary/Abstract Elopement is a prevalent and dangerous behavior for children with autism spectrum disorder (ASD).1, 2 Fortunately, treatments based in applied behavior analysis (ABA) can effectively reduce elopement.3-6 However, most parents of children who elope report receiving either no professional help or support that is likely not comprehensive or ongoing.7 Thus, there is a significant research-to-practice gap where children are not receiving the evidence-based strategies that exist for elopement. Community-based ABA services, provided by Board Certified Behavior Analysts (BCBAs), are ideal settings to address this gap as 40% of children with ASD receive ABA8 and the number of BCBAs has risen dramatically in recent years.9 Although BCBAs are trained in the behavioral knowledge underlying evidence-based strategies for elopement, they often do not receive hands-on training in assessing and treating elopement specifically (e.g., functional analyses)10 and may lack guidance for parent training,11 which is central to addressing elopement that occurs in home or community contexts. To help address the research-to-practice gap, our group developed a manualized parent-mediated Function Based Elopement Treatment (FBET) based on the past literature of ABA treatments for elopement. FBET impacts elopement through the mechanism of reinforcing and increasing appropriate behaviors that allow the child to access the functional reinforcer for elopement through more appropriate means.6 The intervention is time-limited, designed for non-specialized settings, and intended for use by BCBAs without specialized training. FBET demonstrated feasibility in a pilot randomized controlled trial (RCT ; N=24)6 and has positive results from a recently completed efficacy RCT (N=76; manuscript under review). To date, FBET has been delivered by BCBAs in a specialized, university-affiliated center with training and supervision fromexperts. There is a critical need to expand access by deploying FBET in community-based ABA clinics where the treatment can be more easily accessed. In partnership with 3 community ABA organizations, we propose a pilot, cluster randomized trial to evaluate the feasibility and preliminary effectiveness of FBET compared to treatment as usual (TAU) in these settings and evaluate inner and outer context factors related to implementation grounded in the EPIS (Exploration-Preparation-Implementation-Sustainability) model.12-14 Results will set the foundation for a R01 hybrid implementation-effectiveness RCT of FBET targeting the factors found to impact implementation in the current trial. Primary aims involve evaluating the feasibility of the pilot effectiveness RCT; evaluating preliminary effectiveness outcomes and analyzing the mechanism of action of FBET; and using mixed methods to evaluate factors associated with implementation in a community-based ABA setting. This line of research has strong potential to improve access to care for this dangerous behavior.