Consultation and Collaboration to Support Meaningful and Socially Valid Outcomes for Autistic People: Introduction to the Special Issue Part 2

ABSTRACT

This introduction outlines Part 2 of the Special Issue centered on consultation and collaboration to support meaningful and socially valid outcomes for autistic people. In Part 2, four quantitative studies focused on strategies to promote generalization and sustainability of consultant and consultee skills are presented. Part 2 concludes with a commentary from autistic adults on future directions and considerations for consultative practices to facilitate meaningful and socially valid outcomes for autistic people.

Contemporary views of autism are comprised of substantially differing perspectives, ranging from a conceptualization of autism as a disability to emphasizing strengths of the unique skills and characteristics of autism (Hume et al., 2021; Urbanowicz et al., 2019). Irrespective of these perspectives, it is well documented that autistic¹ individuals often experience difficulties throughout the lifespan (Mendelson et al., 2016; Picci & Scherf, 2015), thus highlighting a need for supports to improve the quality of life of autistic individuals. In Part 1 of the Special Issue, conceptual frameworks and considerations for consultation practices supporting autistic individuals are presented with qualitative studies centering the experiences and perspectives of autistic people. In Part 2, demonstrations of supports to promote generalization and sustainability of consultant and consultee skills are offered through the presentation of quantitative studies. Part 2 concludes with a commentary from autistic adults on future directions and considerations for consultative practices to support meaningful and socially valid outcomes for autistic people.

There are several well-established mechanisms to support autistic students to enhance overall quality of life. Evidence-based practices (EBPs) can be defined as “practices and programs shown by high-quality research to have meaningful effects on student outcomes” (Cook & Odom, 2013, p. 136). For example, multiple EBPs are demonstrated to improve academic, adaptive and/or self-help, interfering behavior, cognitive, communication, joint attention, mental health, motor, play, self-determination, school readiness, social, and vocational outcomes for autistic students (Hume et al., 2021). Attending to the research in supporting autistic students is especially important as professionals and other invested parties have a long history of employing unsubstantiated interventions, with potentially detrimental effects (Morin et al., 2021; Travers et al., 2016; Worley et al., 2014).

Educational settings are often the locale in which autistic students gain access to intervention services (Kang-Yi et al., 2016; Locke et al., 2019). However, there has been a recent focus on concerns with EBPs for autistic students within educational contexts, particularly related to fidelity of implementation, or the degree with which EBPs are used as intended (Locke et al., 2015; Pellecchia et al., 2015). Teachers report that, although they agree EBPs for autistic students are important, they often feel unprepared to deliver effective instruction (Knight et al., 2019; Van Der Steen et al., 2020). School-based consultation, through the vehicle of collaborative relationships with general and special education teachers and caregivers, offers a mechanism to enhance the quality of EBPs for autistic students. In Part 2 of this Special Issue, several important practices consultants may consider employing when collaborating with consultees supporting youth on the autism spectrum are overviewed.

Of note, with increased prevalence rates of autistic students generally, the number of autistic students within general education settings has also increased (U.S. Department of Education, National Center for Education Statistics, 2019). The increase aligns with legal mandates enacted by the Individuals with Disabilities Education Improvement Act (2004) stating that students are served in the least restricted environment and have access to the general education curriculum (IDEIA, 2004). Further, teachers must employ intervention practices that are evidence-based with empirical demonstration of their efficacy (Sam et al., 2021). Accordingly, the need to support both special education and general education teachers through consultation is evident.

Special education teachers are an essential partner with whom consultants frequently collaborate. Within Part 2 of this Special Issue, Helbig et al. (2023) provide an example of a school-based consultant supporting a special education teacher to implement an evidence-based social skills intervention in her class comprised of autistic students and students with other developmental disabilities. Results demonstrated that students increased their accuracy of targeted social skills within the training context (i.e., using the targeted social skills with their special education teacher) as well as a majority of students had increased skill accuracy with novel persons. Further, the special education teacher’s treatment fidelity remained at high levels during intervention sessions.

One implication from Helbig et al. (2023) is that when supporting consultees to implement evidence-based social skills interventions, consultants should consider highlighting the importance of generalization, or the transfer of skills across contexts. Consultees are uniquely positioned to promote the generalization of skills for autistic students by not only teaching the use of the skills but by being embedded within the student’s naturalistic environment (e.g., classroom). Consultees, including special education teachers but also general education teachers, can continue to support students when opportunities arise to use the targeted social skills outside of the social skills lesson through prompting and provision of reinforcement when skill demonstration is observed. During the consultation process, consultants may consider providing psychoeducation on generalization, which may in turn can empower consultees in their unique role by emphasizing the importance and reach they have to promote socially meaningful outcomes for autistic students.

Another consideration for consultants when engaging in the consultative process is the importance of establishing rapport with consultees. For example, Helbig et al. (2023) discussed specific procedures they employed to develop rapport with the consultee (special education teacher). This was especially important in this specific context, as the consultant was assigned by the district administration to work with the special education teacher; it was not voluntary, unlike traditional definitions of consultation (e.g., Bergan, 1977). As a way to develop rapport, instead of immediately initiating procedures related to the social skills intervention, the consultant assisted the teacher with day-to-day activities (e.g., direct instruction in a one-on-one format with students, cleaning up after snack or art activities, transition between activities, and recess supervision) for 3 days prior to discussing anything related to the social skills intervention. In addition to supporting the teacher, entering the consultation process in this way benefitted the consultant in that she was able to learn the daily routine and environmental context of the classroom. Although this took additional time, the establishment of rapport may have contributed to the consultative process and in turn, the high levels of treatment fidelity observed in the study. This is consistent with previous research suggesting the importance of establishing relationships as a meaningful part of the consultation process (Newman et al., 2017). Consultants should consider various strategies to ensure rapport development with consultees as part of the consultation process.

Azad et al. (2024), also in Part 2 of this Special Issue, offer another perspective related to rapport development, with a focus on the importance of communication to enhance the consultative relationship between parents and teachers supporting autistic students. The authors investigated teachers and parents’ experiences with Partners in Schools plus School Talk, a consultation model adapted from Conjoint Behavioral Consultation (Sheridan & Kratochwill, 2007) aimed at improving evidence-based practices for autistic youth with an added parent-teacher communication training. Results suggest that both parents and teachers perceived the model to be feasible to implement, however parents found it to be more usable than teachers. When collaborating with both parents and teachers, consultants may consider facilitating a meeting that focuses on communication prior to the start of intervention training, which according to Azad et al. may enhance the connection between home and school environments, and in turn offer a continuity of experiences for autistic youth.

Sustaining evidence-based practices

A research to practice gap in implementation of EBPs to support people with autism is well documented in the literature (Boyd et al., 2022; McNeill, 2019; Odom et al., 2020; Parsons et al., 2013). Research often focuses on practices that support the best outcomes and may include resources and training that are not available within current school systems. In Part 2 of this Special Issue, Albright et al. (2024) directly address this concern through a partnership with an urban school district to provide ongoing consultation and support to teachers of Autistic students. The school district partnership with researchers began as part of a randomized controlled trial (RCT) to evaluate evidence-based teaching strategies of students with autism. Following the RCT, the partnership with the school district remains ongoing, including assessing formative training and consultation needs. To determine short-term needs of the school district, the researchers meet weekly with the district autism support coordinators. Additionally, long-term needs of the district are evaluated through summary reports that include implementation outcomes.

Through this collaboration, the researchers and school district developed procedures for supporting teachers new to the school district and veteran teachers who have already participated in training and consultation. Teachers new to the school district received (a) professional development in EBPs to support autistic students; and (b) 12 consultation sessions during their first-year teaching in the district, and six during their second year. For veteran teachers whose treatment fidelity had declined following their initial consultation, Technical Assistance and Targeted Training (TATT), an intensive short-term consultation approach, was provided. By including the school administrators directly some barriers could be addressed immediately. For example, if a teacher required additional training, the administrator would be aware immediately and could schedule coverage for the teacher’s class so they could complete the training. Each veteran teacher’s consultation was targeted to the specific skills or strategies no longer demonstrated by the teacher.

Training consultants to implement and sustain evidence-based practices

One way to ensure that EBPs are successfully translated into school settings is to ensure that novice consultants choose and support appropriate interventions for autistic learners and their teams. Ogle et al. (2024) investigated the role of a newly developed tool, the Intervention Plan Quality Scale (IPQS), for its ability to reliably measure the degree to which community-based practitioners who served as consultant trainees were able to develop and support high-quality intervention plans for learners with autism as part of the Individualized Education Plan (IEP) development process. Via the IPQS, the authors identified specific skills (e.g., ensuring that teaching plans are specific and sufficiently detailed) in which consultant trainees required improvement following the first consultation meeting.

To advance school consultation training, a better understanding of how specific training experiences connect to consultation outcomes is needed (Newman et al., in press). By focusing specifically on training and coaching one element of the consultation process (i.e., intervention plan development), Ogle et al. (2024) findings provide a starting point to disentangle the complex relationships between consultation quality, implementation fidelity, and client outcomes. They observed that when the intervention plan was developed with higher quality at the first consultation session, higher teacher adherence to the intervention was observed at the last session. Neither intervention plan quality or consultant adherence to intervention plans impacted client outcomes.

Additionally, there are unanswered questions in consultation training research about the way in which intervention expertise and consultation expertise develop vis a vis one another. There is yet no agreed upon timepoint at which novice practitioners should begin to apply their intervention expertise through consultation work (Newman et al., in press). Albright et al. (2024) highlight two important concepts that are relevant to consultation training in support of autistic learners. First, consultants must have a thorough understanding of the autism evidence-base. In this case, the practices taught and supported by Albright and colleagues were derived from the National Clearinghouse on Autism Evidence and Practice (NCAEP) and also informed by the National Standards Project findings of the National Autism Center. Importantly, the authors integrated their understanding of each EBP with their knowledge of school-based service delivery. As a result, each intervention and practice being supported was conceptualized in terms of its influence on other practices (i.e., foundational practices were taught first) and its relation to service delivery (i.e., practices influencing classroom structure versus intensive interventions).

The integration of expertise in autism with a deep understanding of school systems highlights a second key element of consulting to support meaningful outcomes for autistic students. Consultants need to have familiarity with schools as organizations that operate under a variety of influences, ranging from federal and state mandates to local norms and cultures. Thus, it is important to ensure opportunities for consultant trainees who will indirectly support students with autism to gain knowledge and skills in school-level and child-level issues that may affect outcomes.

Both Ogle et al. (2024) and Albright et al. (2024) highlight the importance of intervention expertise in consultation, at least insofar as relates to support of autistic learners. Given the extent to which consultant trainees with existing experience struggled to develop plans that fully address the processes through which autistic learners best develop, maintain, and generalize new skills, one implication of this work is the extent of familiarity needed with autistic students’ and their teams’ needs, when providing autism-specific consultation. Many of the intervention steps that were missed or under-implemented in Ogle et al. (2024) were those related to common challenges for autistic learners: attention, response time, and prompting. Consultants who are going to support learners with autism and their teams may need training in the unique cognitive and behavioral needs of autistic learners that should be considered when developing intervention plans.

Finally, as previous work in this two-part Special Issue demonstrated, consultants are best prepared to ensure socially valid outcomes when they incorporate an appreciation for neurodiversity within the consultation process (Hamsho et al., 2023). Thus, we also need to ensure that future consultants are trained to understand neurodiversity and the complex nature of skill acquisition and development among autistic learners. To apply such skills, consultants also need to be cognizant of the importance of soliciting input from autistic students on their experiences, and knowledgeable about effective ways to obtain feedback. The entirety of this two-part Special Issue provides examples that can be drawn upon and applied to consultation training to begin to develop those skills, including the process of choosing functionally relevant goals, as highlighted by Dart et al. (2023). With additional research into the development of tools for obtaining this information and the process of training consultants to use such tools, the provision of school-based consultation as a valued and meaningful school-based intervention service can be advanced.

Inclusion of autistic people in the consultation process

As we continue to discuss and evaluate consultation, and other supports, services, and research that impacts autistic people, it is important that people on the autism spectrum are included in those conversations, not only in the role as clients. Participatory models of autism research can align the aims, procedures, and interpretation of results with the perspectives and needs of autistic people, and may be more likely to have a positive impact on people’s lives and limit perpetuating ableist ideas (Bottema-Beutel et al., 2021, 2023; Fletcher-Watson et al., 2019). Through examining research partnerships between neurotypical researchers and researchers on the autism spectrum, specific recommendations for these partnerships have been developed (Nicolaidis et al., 2019), which can also apply to provision of services, such as consultation. Recommendations include (1) determining partnership goals and identifying an approach to the partnership that aligns with goals; (2) defining roles and responsibilities of each team member and ensuring the people who are needed on the team are included on the team; (3) developing processes for clear and effective communication and ensuring power-sharing across team members; (4) focusing on building and maintaining trust between partners; (5) presenting findings collaboratively; (6) ensuring community representation on the research team, and not only including academics who identify as autistic; and, (6) providing compensation fairly to all team members for their roles (Nicolaidis et al., 2019).

The commentary for this two-part Special Issue on Consultation, Collaboration, and Autism is written by two Autistic adults (Giese & Harris, 2024). In Andrea Giese’s commentary, she provides a personal account of being autistic and the ways in which others perceive her autism when it does not align with their previous ideas of autism. In his commentary, Jason Harris offers ideas for how we can reimagine consultation related to services and supports for autistic people to include more autistic voices and perspective throughout the consultation process and in educational settings more broadly.

While it is important that we highlight the perspectives of autistic people related to our work in supporting people on the autism spectrum through consultation, we also recognize that a commentary does not equate full inclusion of the autistic perspective throughout this Special Issue. As our field and practices continue to evolve, we need to prioritize inclusion of people with autism in more research and practice, to ensure that our work aligns with the goals and needs of this population, rather than what others want for them or think that the population wants and needs. Our hope is that the next Special Issue in this journal on collaboration and consultation to support autistic people will include the voices and perspective of autistic people throughout the issue and in many different roles, including as researchers, educators, and consultants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Kate A. Helbig

Kate A. Helbig, Ph.D., BCBA-D, NCSP, is an Assistant Professor in the School Psychology Program at the University of Utah. She is a licensed psychologist, board certified behavior analyst, and nationally certified school psychologist. Dr. Helbig’s research interests broadly include behavioral interventions within educational contexts with an emphasis on social skills teaching for individuals with neurodevelopmental disorders.

Lori B. Vincent

Lori B. Vincent, Ph.D., BCBA-D is an Assistant Professor in the School Psychology Graduate Programs at the University of Cincinnati. She is a Licensed Psychologist, Board Certified Behavior Analysis-Doctoral, and a Certified Ohio Behavior Analyst. Lori has worked with children and adolescents with neurodevelopmental disabilities and their families for over 15 years in home, school, hospital, and clinical settings. Dr. Vincent’s primary research interests include behavioral supports implemented in natural setting to increase the inclusions and improve the quality of life of people with intellectual and developmental disabilities.

Elizabeth L.W. McKenney

Elizabeth L. W. McKenney, PhD, NCSP is a Professor of Psychology at Southern Illinois University Edwardsville, where she is the director of the Clinical Child and School Psychology graduate program. Her research interests include school-based consultation as a form of implementation support for educators delivering evidence-based interventions, particularly for students on the autism spectrum and students from historically under-served and marginalized backgrounds, and the appropriate, ethical practice of school psychology in pursuit of social justice in schools.