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Background <p>The increased prevalence of autism spectrum disorder creates a sense of urgency to improve outcomes for this population in publicly funded education systems, the primary setting in which autistic children receive behavioral health services in the United States. Important barriers to progress include a lack of feasible clinical interventions that address autistic children’s externalizing behaviors in schools and major challenges sustaining fidelity to newly implemented programs over time. This trial addresses these gaps by (1) testing the clinical effectiveness of the Research Units on Behavioral Interventions in Educational Settings (RUBIES) program relative to educator psychoeducation on externalizing behaviors of autistic children in public elementary schools, and (2) testing the effects of adding a leadership-focused organizational implementation strategy, Helping Educational Leaders Mobilize Evidence (HELM), to educator coaching in RUBIES on RUBIES sustainment.</p> Methods <p>In a cluster-randomized, hybrid type 2 effectiveness-implementation trial, schools will be randomized to one of 3 arms: 1) educator coaching in RUBIES and school participation in HELM; 2) educator coaching in RUBIES only; or 3) a control condition incorporating an active clinical comparator, educator psychoeducation. We will enroll 42 schools and 126 educators yoked to 126 elementary-aged autistic children. Depending on arm, educators will complete study instruments up to six times: 1) Spring semester prior to the year of school and student enrollment (implementation baseline; arms 1–2); 2) Fall semester Year 1 (clinical baseline; arms 1–3); 3) 16&#xa0;weeks (arms 1–3); 4) 24&#xa0;weeks (arms 1–3); 5) 52&#xa0;weeks (arms 1–2); and 6) 76&#xa0;weeks (arms 1–2). The primary clinical outcome compares arms 1 &amp; 2 vs. 3 on change in autistic children’s externalizing behavior from clinical baseline to 24&#xa0;weeks. The primary implementation outcome compares arms 1 vs. 2 on RUBIES sustainment, operationalized as educators’ average RUBIES fidelity at 52 and 76&#xa0;weeks.</p> Discussion <p>Generating evidence for the clinical effectiveness of RUBIES addresses a significant gap in educator-delivered interventions to minimize highly prevalent externalizing behaviors among autistic children in public schools. Simultaneously, testing the effectiveness of HELM on sustainment of RUBIES will inform future efforts to successfully implement and sustain new innovations for autistic youth in public schools.</p> Name of the registry <p>Clinical Trials.</p> Trial registration <p>NCT07276750.</p> <p><b>Date of registration</b></p> <p>12/10/25.</p> <p><b>URL of trial registry record</b></p> <p><a href="https://clinicaltrials.gov/study/NCT07276750?cond=Autism&amp;intr=RUBIES&amp;rank=1">https://clinicaltrials.gov/study/NCT07276750?cond=Autism&amp;intr=RUBIES&amp;rank=1</a>.</p>

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Study protocol for coaching and leadership in autism support settings: a cluster randomized controlled hybrid type 2 effectiveness-implementation trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月28日

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  • Jill Locke,
  • Nathaniel J. Williams,
  • Aksheya Sridhar,
  • Wendy Shih,
  • Christine Espeland,
  • Daina Tagavi,
  • Karen Bearss

摘要

Background

The increased prevalence of autism spectrum disorder creates a sense of urgency to improve outcomes for this population in publicly funded education systems, the primary setting in which autistic children receive behavioral health services in the United States. Important barriers to progress include a lack of feasible clinical interventions that address autistic children’s externalizing behaviors in schools and major challenges sustaining fidelity to newly implemented programs over time. This trial addresses these gaps by (1) testing the clinical effectiveness of the Research Units on Behavioral Interventions in Educational Settings (RUBIES) program relative to educator psychoeducation on externalizing behaviors of autistic children in public elementary schools, and (2) testing the effects of adding a leadership-focused organizational implementation strategy, Helping Educational Leaders Mobilize Evidence (HELM), to educator coaching in RUBIES on RUBIES sustainment.

Methods

In a cluster-randomized, hybrid type 2 effectiveness-implementation trial, schools will be randomized to one of 3 arms: 1) educator coaching in RUBIES and school participation in HELM; 2) educator coaching in RUBIES only; or 3) a control condition incorporating an active clinical comparator, educator psychoeducation. We will enroll 42 schools and 126 educators yoked to 126 elementary-aged autistic children. Depending on arm, educators will complete study instruments up to six times: 1) Spring semester prior to the year of school and student enrollment (implementation baseline; arms 1–2); 2) Fall semester Year 1 (clinical baseline; arms 1–3); 3) 16 weeks (arms 1–3); 4) 24 weeks (arms 1–3); 5) 52 weeks (arms 1–2); and 6) 76 weeks (arms 1–2). The primary clinical outcome compares arms 1 & 2 vs. 3 on change in autistic children’s externalizing behavior from clinical baseline to 24 weeks. The primary implementation outcome compares arms 1 vs. 2 on RUBIES sustainment, operationalized as educators’ average RUBIES fidelity at 52 and 76 weeks.

Discussion

Generating evidence for the clinical effectiveness of RUBIES addresses a significant gap in educator-delivered interventions to minimize highly prevalent externalizing behaviors among autistic children in public schools. Simultaneously, testing the effectiveness of HELM on sustainment of RUBIES will inform future efforts to successfully implement and sustain new innovations for autistic youth in public schools.

Name of the registry

Clinical Trials.

Trial registration

NCT07276750.

Date of registration

12/10/25.

URL of trial registry record

https://clinicaltrials.gov/study/NCT07276750?cond=Autism&intr=RUBIES&rank=1.