Autism Resource Base attached to a mainstream secondary school?
Although the sensory intelligence approach is considered suitable for adults and young people with autism (personal communication with Lombard), Lombard (2007;2015) does not specify the nuances involved in applying the programme to an autistic adolescent population nor in implementing it in an ARB attached to a mainstream secondary school. The conjectured CMO for the programme was formulated by combining the programme theory provided in Table 22 with the core components indicated in Table 23. It is presented in Table 43.
168 Table 43
Conjectured CMO:
CONTEXT • The Sensory Intelligence programme, incorporating the 10 core components', when provided to participants over the age of 12 years enables them to:
MECHANISMS • achieve conscious awareness of their sensory preferences, through the use of the Sensory Matrix,
• resulting in increased understanding of their behaviour and that of others,
• this understanding and the implementation of strategies provided, such as 'sensory snacks', 'sensory diets' and sensory ergonomics, enable them to consciously influence their sensory modulation.
OUTCOME • Consciously influencing sensory modulation can enhance health and well-being.
The empirical data generated from the case study provides feedback on nuances and some of the challenges experienced implementing this programme in a ‘real-life’ context. This, in conjunction with the interrogation of the literature, allows consideration of a revised or ‘re-conjectured CMO’ to suggest ways forward for more successful
implementation in the future. Such re-conjectured CMOs are also designed to be tested by subsequent empirical data as part of the ‘fine-tuning’ process.
Weiss (1997) indicated that it is important to distinguish between implementation theory and programme theory mechanisms. The former is concerned with structural or systemic issues, whilst the latter focuses on participants’ responses to the programme itself. With respect to the latter, Weiss suggests that ‘The mechanism of change is not the
program service per se but the response that the activities generate’. (p.46). This study is concerned with both implementation theory and programme theory mechanisms and their implications for the successful implementation of the Sensory Intelligence approach in a specific context. It is considered prudent to consider both aspects separately for ease of explanation, however.
In terms of implementation theory considerable ‘real-life’ challenges were apparent which appear to have significantly influenced the ability of this study to fully establish potential benefits of the Sensory Intelligence programme. This is not considered unusual as similar difficulties were alluded to by researchers such as Blackwell et al. (2014) and Drmic, Aljunied, & Reaven (2017). Researchers, such as Wood et al. (2015), Macdonald et
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al. (2017), Kasari & Smith (2013) and Fixson et al. (2013) have also commented on restrictions working within schools challenging implementation of evidence-based interventions. Odam et al. (2014) also warns about a ‘perfect storm of complexity’ due to the complicated logistic nature of secondary schools.
In the case of the current study these challenges contributed towards deviations to the intended study which are highlighted in appendix 19. The researcher was able to ensure that all key tenets of the programme were shared with the children and that extensive resources were provided for future reference, nevertheless.
‘Essential elements’ (White et al., 2010) likely to be pertinent in the ‘Sensory Intelligence’ intervention, such as the following, were lacking as a result of limited parental and staff involvement, neverthless:
• Parent and family involvement and the opportunity to practice new skills at home.
• Regular practice- learning and repeated practice of new skills in contexts that approximate as closely as possible, the situations and environments in which the adolescent needs to use the skills.
• Modelling new skills.
As children with autism may have difficulty generalising behaviours taught in one setting or with one person (Lovannone et al., 2003) a collaborative partnership with the family had been considered an intrinsic aspect of the intervention to promote generalisation between home-school. There was slight evidence of generalisation for Peter, with regards to homework, which was encouraging.
Lack of time for staff involvement also reduced:
• Access to ‘insider knowledge’ of the children to help incorporate the child’s own interests into activities and to set realistic goals.
• Facilitation of the delivery of the programme in an engaging, fun and autism- friendly manner.
• The sustainability of the intervention after the researcher left (Kasar & Smith, 2013).
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In order to minimise difficulties, the empirical literature (for example, Fixsen et al., 2010; 2013) emphasises the importance of investing in implementation capacity (Fixsen et al., 2013), namely extensive pre-intervention planning.
Detailed pre-intervention planning is considered a very time-consuming but necessary exercise, as opposed to “letting it happen” or “helping it happen” which characterises many of the past and current approaches. Odam et al. (2014) adds that an enabling context needs to be ‘created and nurtured’. The researcher now appreciates that the pre-intervention planning for the current study, was not sufficient for reliable
production of intended outcomes in practice (Fixsen, 2013).
Fixsen et al. (2010; 2013) suggests four implementation stages, each having different functions. Stage one is exploration in which time is spent determining need and capacity, which includes identifying whether staff had the interest, time, and expertise required and engaging with senior management. Lieber et al. (2009) found that staff ‘buy in’ was a key indicator that differentiated quality of implementation. The researcher wrote to the Head-teacher of the school who passed the letter onto the Head of Unit. All
subsequent planning was conducted between the researcher and Head of Unit which meant that no senior managers were involved. This was clearly a mistake, and although the Head- teacher was leaving the school at the end of that term, it would have been prudent to establish a communication link and facilitate an interest in the programme.
Stage two is installation in which communication protocols are established and school personnel participate in any necessary training and planning. Communication protocols were not sufficiently established in the run up to the commencement of the study as the new Head of Unit was busy getting settled into his new management role. As
meetings were postponed or cancelled, most communication also took place by email, which added to delay.
The original agreement was for a member of staff to co-present each session with the researcher. This would have formed a significant part of the staff training, in an apprenticeship role, provided there was also time available for session planning and
formative assessment, at the end of each session. Due to staff sickness and the children not being ‘group ready’, and therefore requiring 1:1 or small group sessions, no staff were available to jointly present sessions and therefore there was no staff training element. Without staff awareness of the programme theory, they were not easily able to reinforce
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the key tenets of the programme with the children. In addition, the building had not benefitted from an environmental audit prior to the commencement of the intervention nor during the study, which added to the sensory challenges faced by the children during the sessions which included the presence of bright displays on the walls, the telephone
remaining in one of the classrooms and another classroom being used as the main entrance to the building.
Stage three is initial implementation where it is considered vital to develop an implementation action plan with timelines, respective roles and responsibilities and a clear strategy for using data for decision-making, including the modification of strategy if necessary. Liaison by email was insufficiently detailed to provide a clear implementation action plan; respective roles and responsibilities were changed, from what had been previously agreed, due to unavailability of staff and this had implications for ongoing formative assessment protocols. Summative assessment was also limited as a result of a change of ARB policy half-way through the term regarding the collection of behaviour logs and Autism Education Trust progression framework data, neither of which were subsequently available to the researcher at the end of the study.
According to Fixson et al. (2013), only after stages one to three of the
implementation stages have been completed should the final stage of full implementation be considered appropriate. The consequences of insufficient pre-intervention planning suggest that it would have been prudent to have set aside a whole academic year for pre- planning purposes and to delay the start of the programme start until the following
September. The researcher did not have this time-scale available, however, due to the time- limited nature of a Top Up Doctorate. The considerable process issues resulted in a reconfigured CMO, which is presented below:
A refined programme theory, targeting implementation theory, is presented as re- conjectured CMO 1 in Table 44.
172 Table 44
Re-conjectured CMO 1:
CONTEXT • Children over the age of 12 years, attending an ARB attached to a mainstream secondary school are capable of fully benefiting from the Sensory Intelligence programme provided the following mechanisms are put in place:
MECHANISMS • Liaison with the Senior Management Team to access funding to release staff for training purposes, to provide non-contact time and possibly some administrative support, during the intervention.
• An environmental audit of the building is conducted and there is access to additional accommodation as required.
• Staff training on sensory profiles, environmental adaptations and self-regulation is provided prior to the start of the intervention.
• All necessary resources and suitable
accommodation are made available at the start of the study.
• Time and opportunity are available to facilitate trust and relationships with all participants involved.
• Respective roles and responsibilities are clearly understood, which includes mainstream staff and family involvement.
• Opportunities are afforded to practice new skills at home, in the ARB and in mainstream classes.
OUTCOMES • An enabling context is ‘created and nurtured’ to facilitate the children’s ability to:
• achieve conscious awareness of their sensory
preferences, through the use of the Sensory Matrix, • increase understanding of their behaviour and that of
others,
• implement strategies provided such as 'sensory snacks', 'sensory diets' and sensory ergonomics to enable them to consciously influence their sensory modulation.
The testing of reconfigured CMO 1 would enable the researcher to explore the hypothesis that pre-implementation planning is vital for the development of an ‘enabling context’ to fully evaluate the Sensory Intelligence programme in the ARB and to ascertain outcomes more easily.
Whilst failure to give due regard to pre-implementation planning undermined the development of an enabling context, data generated from the case study through
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observation and interviews with the children, parents and ARB staff, and subjected to thematic analysis, is available to partially test the conjectured programme theory. Taken as a whole, the analyses of themes provide the opportunity for more specific consideration of mechanism thinking which plays a key role in the evaluation of the programme theory. Whilst there are naturally numerous mechanisms and outcomes in play, the researcher has pragmatically chosen to highlight only the most robust tentative mechanisms and
outcomes, at this point, as the purpose of the study is to ascertain whether the programme is worthy of more systematic research with this population.
Dalkin et al. (2015) warn that attempts to distinguish which aspects within an implementation process contribute mechanistically and which contribute contextually is a key realist researcher’s quandary. Their suggested way forward, adopted by this researcher, is to consider both reasoning and resources to be mechanisms.
When the resources associated with the Sensory Intelligence programme (book, lessons, reference file, exercise equipment etc.) are introduced into the context of the ARB, there is an interaction between them which influence the reasoning of the participants towards the programme. Any alterations in their behaviour are then considered to be outcomes. The main themes revolved around the importance of relationships (‘I’m
listening’), previous knowledge and understanding of sensory processing (‘Where does the expertise lie?’), respective responsibility (‘Whose job is it anyway?’) and suggested ways forward (‘A ‘can do’ approach to ‘real-life’ challenges’) though systemic issues are the focus of re-conjectured CMO-1.
174 Table 45
Re-conjectured CMO 2
CONTEXT • Children over the age of 12 years, attending an ARB attached to a mainstream secondary school are provided with the sensory intelligence programme. The parents and teachers are provided with the associated reference materials. MECHANISMS • The children are engaged when information is
presented by activities which are fun and accessible to them (requiring autism-friendly approaches).
• Children share sensory experiences with trusted adults and problem-solve together.
• Provided they have access to the materials, parents' prior knowledge and experience of sensory issues enable them to incorporate aspects of the programme into their interactions with their children and other members of their family.
• When staff have time to access and discuss the materials, they consider respective responsibilities and what aspects of the programme are manageable in their working environment.
OUTCOMES • The children become more aware and understanding of their own and others' sensory preferences.
• The children feel empowered to manage their own
sensory needs more easily using some of the strategies provided.
• The children become more tolerant of others. • Some parents have increased understanding of
their own and family's sensory needs.
• Parents suggest the need for school staff to receive training to meet the sensory needs of their children more easily.
• Parents share considerable knowledge and
expertise which could assist staff in meeting the needs of the children more easily.
• Staff consider the benefits of using sensory profiling in their work and raising the awareness of mainstream staff.
A reconfigured C-M-O is not designed to confirm any hypothesis, but rather to afford new ways of thinking to open fresh avenues for further empirical enquiry (Emmel et al., 2018). The re-configured C-M-O 2 is designed to contribute to what realists’ call ‘the theory of the middle range’ (Pawson, 2018). These are bundles of hypotheses that can be
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tested empirically. They are referred to as ‘middle range’ because they are abstract enough from one instance, such as the ARB in the current study, to test in other situations.
The tentative evidence of awareness-raising, understanding and empowerment, supporting the sensory intelligence programme theory, despite real-life challenges reducing intended exposure to the programme suggests that the material is both robust and relatively easily accessible to adults and children with autism over the age of 12 years. This indicates that the programme may have the potential of being provided as a short, low-cost
intervention package.
The links between the research findings and the existing literature will now be discussed within the context of the remaining secondary research questions.
5.2.2 What are the potential benefits and limitations of the ‘Sensory