UC San Diego

While evidence-based interventions (EBIs) have improved outcomes for autistic children, challenges remain in implementing these EBIs in routine care. The TEAMS (Translating Evidence-based Interventions for Autism: A Multi-Level Implementation Strategy) Hybrid Type III trial tested the effectiveness of multi-level implementation strategies to facilitate EBI implementation in children’s mental health services and schools (Brookman-Frazee et al., 2025). Results of the TEAMS trial indicate that the organization-level implementation strategy (TEAMS Leadership Institute, TLI), but not the provider-level strategy (TEAMS Individual Provider Strategy, TIPS), was associated with higher observed EBI fidelity and improved child outcomes when paired with EBI provider training. TLI was linked to greater use of Implementation Support Strategies by leaders. Understanding the role of individual strategies that leaders employ has the potential to explain the impact of TLI on implementation and clinical outcomes.This study extracted data from 113 leaders from 65 mental health programs and school districts. Items were drawn from the leader-reported Implementation Support Strategies (ISS) measure, which was assessed at 6 months post-EBI training. Aim 1: multilevel modeling was utilized to identify individual strategies associated with (a) provider fidelity, (b) child outcomes, and (c) implementation climate. Aim 2: multilevel mediation was used to examine whether the individual strategies identified in Aim 1 mediated the effects of TLI on (a) provider fidelity and (b) child outcomes. Aim 3 utilized qualitative coding of interviews with TLI leaders, implementation plans, and coaching calls to characterize and explain leader use of individual support strategies.A subset of strategies were significantly negatively associated with observed EBI fidelity, but no strategies were significantly associated with child outcomes. Leaders who participated in TLI reported using these strategies to a greater extent compared to leaders who were not in TLI, but greater use of these strategies was associated with lower provider fidelity. Qualitative data expand on these findings by showing that leaders utilized strategies in real time to meet provider needs and respond to implementation challenges.Leaders employ multiple strategies to support providers in EBI implementation in response to perceived needs and challenges. Findings advance the understanding of core components of multi-component implementation interventions for autism. Future studies should utilize EPIS to tailor implementation support strategies across contexts and phases and examine leader–provider alignment to guide more strategic application.