Organizational Factors Impacting Implementation of Evidence-based Practices for Autistic Youth: A Mixed Methods Evaluation of Virginia’s Community Mental Health System

Abstract Despite elevated rates of co-occurring mental health needs among autistic youth, availability of and access to mental and behavioral health evidence-based practices (EBPs) remain limited in U.S. community-based settings. Further, community-based service systems are complex, with client- and provider-level characteristics situated within broader system contexts that collectively influence adoption and implementation of EBPs. Thus, the current convergent mixed methods study aimed to evaluate agencies, or Community Service Boards (CSBs), in Virginia’s statewide Department of Behavioral Health and Developmental Services in terms of CSB leaders’ perspectives of: (1) their CSB’s organizational context, including leadership, structure, and climate around new practices, and (2) the process of adoption and implementation of EBPs for autistic youth at their CSB, including needs and barriers, processes for making adoption decisions, and leadership attitudes about EBPs. Surveys and interviews were conducted with 23 CSB leaders and data analyses and interpretation were guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. CSB leaders rated their organizations as ready for change and moderately supportive of EBPs, but reported barriers to adoption and implementation, including resource constraints, organizational silos, and misalignment between EBP characteristics and organizational context. Conversely, implementation was facilitated by funding, leadership support, collaboration, and EBP fit. These findings reinforce the importance of understanding local contexts to make place-based recommendations for equitable, sustainable implementation of EBPs for autistic youth in community settings. Future efforts to adopt, implement, and sustain EBPs within similar service settings should proactively address these factors. Intervention developers should proactively consider community mental health systems as end users to improve fit between EBPs and these systems’ organizational contexts.