Co-construction of a Positive Behavior Interventions and Supports Model in a Residential Care Setting for Autistic Adults: Exploring Implementation Barriers and Facilitators

Autistic adults who require significant support need an adapted living environment. In this study, we co-constructed, with the staff of a Canadian residential setting for autistic individuals, the PBIS-Residential setting for Autistic Adults (PBIS-RA) model, based on the five core components of the original system-wide PBIS model. We then sought to evaluate its implementation by identifying barriers, facilitators, and fidelity. Using a case analysis design, we collected data through field notes, PBIS-RA committee work, meeting minutes, staff interviews, and observations. We analyzed data using multiple modalities, such as coding interviews and analytical workshops, to understand the factors influencing organizational implementation of PBIS-RA, based on the Consolidated Framework for Implementation Research (CFIR). Our results identify the necessary adaptations for PBIS-RA to meet the unique needs of autistic adults in this residential setting. We highlight the specific elements that affected the implementation of the PBIS-RA, such as the expertise and motivation of key actors, the around-the-clock schedule, the high staff turnover, the complexity of the model, and the challenge of engaging all staff members. These findings contribute to a better understanding of adapting the PBIS model in a residential setting for autistic individuals and provide valuable insights to guide future implementation efforts.