Barriers and facilitators to implementing prevent-teach-reinforce for young children in community-based early intervention services for autism

The present study examined barriers and facilitators to the implementation of evidence-based practices to manage challenging behavior under real-world conditions within community-based autism services. Parents, early intervention practitioners, and administrators at a public agency who participated in Prevent-Teach-Reinforce for Young Children (PTR-YC), an intervention based on positive behavior support principles, shared their perspectives on the factors that helped or hindered the implementation of the program. Barriers and facilitators were identified at the macrosystemic (community), services (organization and program), and case (parent, family, child, practitioner) levels. Of note, the governmental response and lockdown measures of the Covid-19 pandemic highlighted both challenges and opportunities for the planned large-scale deployment of the intervention. While the program itself includes built-in facilitating elements (e.g., peer support, flexibility, efficiency), results also underscored the importance of robust change management practices, administrative support, responsive clinical supervision, and organizational commitment to professional development. Parents and practitioners, the core members of the intervention team, bring to bear many positive personal qualities but benefit from support in adopting the new approach and its procedures. • Evidence-based practices are challenging to apply in autism public services. • Stakeholders identified barriers and facilitators to program implementation. • Organizations need change management practices and effective leadership. • Parents are invested and empowered, but may require support and flexibility. • Practitioners can draw from experience and adapt, but need support and realistic work demands.