RUBI Goes to Town: Community Implementation of an Evidence-Based Parent Training Protocol for Disruptive Behavior in Autism

Background: Up to half of autistic children experience disruptive behaviors (DBs) that hinder daily functioning and caregiver well-being. Early intensive intervention can effectively address these challenges. This study examines the feasibility and acceptability of implementing the RUBI parent training protocol, an evidence-based intervention for reducing DBs, in diverse community settings across Israel. Objectives: This study aimed to assess the challenges and facilitators of implementing RUBI in community settings and evaluate its impact on DBs. Methods: A convergent mixed-methods approach was used, integrating quantitative and qualitative data. A total of 53 families across six sites received the RUBI protocol, delivered over 12 weekly sessions. The Aberrant Behavior Checklist (ABC) assessed DB changes pre- and post-intervention, complemented by qualitative interviews and site-specific observations. Results: RUBI was well received by parents and clinicians, with sustained implementation at sites with strong managerial involvement. Barriers included clinician time constraints, variability in cultural and professional backgrounds, and usability issues with the RUBI companion website. Reductions in DBs were observed across all sites: 27% of children showed significant improvement on the ABC Irritability subscale, 35% on Hyperactivity, and 38% on the ABC Total scale. Conclusions: RUBI effectively reduced DBs in community settings. Key recommendations for implementation include ensuring protected clinician time, developing materials for non-applied behavioral analysis (ABA) therapists, and culturally adapting parent-facing materials.