Iterative Redesign of a Behavioral Skills Training Program for Use in Educational Settings

Study Overview
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Brief Summary
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This study proposes to redesign the RUBI Parent Training program, a low-intensity intervention for youth with autism spectrum disorder and disruptive behavior, for use by school personnel in the classroom. Using a mixed-methods approach, 40 school staff members from 20 elementary schools will be recruited to inform current classroom behavior management practices and RUBI redesign needs.

Detailed Description
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Approximately 50% of children with autism spectrum disorder (ASD) exhibit disruptive behaviors such as tantrums, aggression, and noncompliance that significantly impact social, adaptive, and academic functioning. The RUBI program is an evidence-based parent-mediated intervention that improves disruptive behavior in children with ASD. Considering schools serve as the primary intervention setting for children with ASD, and teachers and school staff often struggle to address challenging behavior, there is an opportunity to meaningfully improve care by adapting RUBI for delivery in schools. To address these needs, the Discover, Design/Build, Test (DDBT) framework,which leverages user-centered design and implementation science, will be used to engage 40 end users from 20 elementary schools to inform current classroom behavior management practices and redesign needs for the RUBI curriculum to ensure that the modified curriculum (RUBI in Educational Settings; RUBIES) is useful and useable for school personnel who work with children with ASD. Specific aims include: Aim 1: Identify the contextual constraints and end users (teachers, school psychologists, behavior technicians, classroom aides) relevant to the management of disruptive behavior in the classroom. Through in-class behavioral observations and interviews, Aim 1 will allow us to understand the values and priorities of the school context and end users directly involved with children with ASD (e.g. resources, work flow, policies). Aim 2: Identify targets for RUBI redesign. Using in-depth intervention demonstration of RUBI paired with behavioral rehearsal, prospective think-aloud, and structured assessment methods, Aim 2 will allow us to determine which RUBI components should be retained, eliminated, or modified to address the needs of the context and end-users identified in Aim 1. Aim 3: Iteratively adapt RUBI content and procedures based on identified targets for redesign and continual user testing to improve the hypothesized mechanisms of redesign (usability) and perceptual implementation outcomes (feasibility, acceptability, and appropriateness). Aim 3 will allow us to determine the extent to which redesigned RUBI, or RUBIES, improves usability and implementation outcomes.

Official Title
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Iterative Redesign of a Behavioral Skills Training Program for Use in Educational Settings

Conditions
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Autism Spectrum Disorder, Disruptive Behavior

Intervention / Treatment
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* Behavioral: RUBI
* Behavioral: RUBIES


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elementary school (kindergarten through 5th grade) personnel (i.e. general and special education teachers, school psychologist, paraprofessionals) Works with at least one student with ASD for part of the day Exclusion Criteria: -School personnel who do not have contact with youth with ASD during the work day
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Classroom Observation<br>The investigators will use day-long observational and interview procedures with eight staff from four schools. The classroom observation will focus on documenting episodes of classroom disruptive behavior, including antecedents and consequences to the behaviors. The interview will involve discussing with staff decision-making processes and current needs around classroom behavioral management. | |
| RUBI Redesign<br>Two separate demonstration studies comprising 6 staff members each will focus on informing adaptation or pruning needs related to RUBI content and structure to ensure the redesigned curriculum (RUBIES) is contextually appropriate for schools. | Behavioral: RUBI<br>* Parent-mediated behavioral program targeting disruptive behavior utilizing principle of applied behavior analysis<br>|
| RUBIES Collaborative Design<br>Eight staff from 4 schools will attend one of four 2-hour in-person feedback sessions to support collaborative feedback around RUBI redesign, including feasibility and appropriateness and methods supporting implementation. | Behavioral: RUBIES<br>* School-staff mediated behavioral program targeting disruptive behavior utilizing principle of applied behavior analysis<br>|
| RUBIES Redesign<br>Two separate demonstration studies comprising 6 staff members each will focus on informing final RUBIES adaptation or pruning needs. | Behavioral: RUBIES<br>* School-staff mediated behavioral program targeting disruptive behavior utilizing principle of applied behavior analysis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability of Intervention Measure (AIM): 5-point scale | The 4-item AIM assesses participants' acceptability of RUBI(ES). Raters score items on a 5-point scale ranging from (1) Completely Disagree to (5) Completely Agree. Internal consistency (α = .89) and test-retest reliability were good (α = .83). | Completed by participants during the 4-hour RUBI Redesign meeting (Aim 1) | 
| Acceptability of Intervention Measure (AIM): 5-point scale | The 4-item AIM assesses participants' acceptability of RUBI(ES). Raters score items on a 5-point scale ranging from (1) Completely Disagree to (5) Completely Agree. Internal consistency (α = .89) and test-retest reliability were good (α = .83). | Completed by participants during the 4-hour RUBIES Redesign meeting (Aim 3) | 
| Intervention Appropriateness Measure (IAM): 5-point scale | The 4-item IAM assesses the appropriateness of RUBI(ES). Raters score each item on a 5-point scale ranging from (1) Completely Disagree to (5) Completely Agree. Internal consistency (α = .87) and test-retest reliability were good (α = .87). | Completed by participants during the 4-hour RUBI Redesign meeting (Aim 1) | 
| Intervention Appropriateness Measure (IAM): 5-point scale | The 4-item IAM assesses the appropriateness of RUBI(ES). Raters score each item on a 5-point scale ranging from (1) Completely Disagree to (5) Completely Agree. Internal consistency (α = .87) and test-retest reliability were good (α = .87). | Completed by participants during the 4-hour RUBIES Redesign meeting (Aim 3) | 
| Feasibility of Intervention Measure (FIM): 5-point scale | The 4-item FIM assesses the feasibility of RUBI(ES). Raters score each item on a 5-point scale ranging from (1) Completely Disagree to (5) Completely Agree. Internal consistency (α = .89) and test-retest reliability were good (α = .88). | Completed by participants during the 4-hour RUBI Redesign meeting (Aim 1) | 
| Feasibility of Intervention Measure (FIM): 5-point scale | The 4-item FIM assesses the feasibility of RUBI(ES). Raters score each item on a 5-point scale ranging from (1) Completely Disagree to (5) Completely Agree. Internal consistency (α = .89) and test-retest reliability were good (α = .88). | Completed by participants during the 4-hour RUBIES Redesign meeting (Aim 3) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intervention Usability Scale (IUS) | The 10-item IUS is adapted from the System Usability Scale and assesses intervention usability on a 5-point scale ranging from (1) Strongly Disagree to (5) Strongly Agree. A score ≥70 on the IUS demonstrates good or better usability. | Completed by participants during the 4-hour RUBI Redesign meeting (Aim 1) | 
| Intervention Usability Scale (IUS) | The 10-item IUS is adapted from the System Usability Scale and assesses intervention usability on a 5-point scale ranging from (1) Strongly Disagree to (5) Strongly Agree. A score ≥70 on the IUS demonstrates good or better usability. | Completed by participants during the 4-hour RUBIES Redesign meeting (Aim 3) |