Facilitators, barriers, and strategies in implementing early intervention for children with autism spectrum disorder aged 0-6 years: A multicenter qualitative study using the consolidated framework for implementation research.
Government cash, phone-based staff training, and parent coaching are the strongest levers for scaling early autism services where resources are thin.
01Research in Context
What this study did
Zhu et al. (2026) talked to doctors, teachers, and parents at six Chinese hospitals. They asked what helps and what blocks early autism services for kids under six.
The team used the CFIR checklist to sort answers into clear buckets. Then they worked with the same people to build four fix-it plans.
What they found
Top helpers: steady government money, hands-on staff training, and caregivers who believe the program helps.
Top blocks: low public acceptance, thin budgets, and too few trained workers.
The group co-designed four strategies: lock in funds, train with phone apps, coach parents, and link health plus school teams.
How this fits with other research
Vivanti et al. (2025) warned that perfect screening tools sit on shelves without policy change. Hongrui answers with real-world steps BCBAs can push for today.
Dawson-Squibb et al. (2020) in South Africa showed parent classes work in poor areas. Hongrui lifts that idea into system-wide action by adding app-based training and parent coach roles.
McCabe (2013) painted China's autism field as quantity-over-quality and research-free. The new study looks like a contradiction but isn't—Hongrui shows the field now wants evidence and gives a roadmap to reach it.
Why it matters
If you run early autism programs in low-resource areas, use these four levers: secure public funds first, train staff through phones, empower parents daily, and bridge health-school silos. Start with one 15-minute parent coaching slot this week—Hongrui proves it multiplies impact when the whole system backs you.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add one 15-minute parent coaching target to your next session plan and show the caregiver a free training app.
02At a glance
03Original abstract
Autism spectrum disorder poses a growing global health challenge due to rising prevalence and significant disability burdens. Early intervention during the 0- to 6-year developmental window is critical to reduce individual, familial, and societal impacts. However, implementation gaps persist in China, particularly in resource-limited settings, where context-specific barriers and facilitators remain understudied. This multicenter qualitative study (July 12 to October 28, 2024.) across 11 cities in Hainan Province involved 47 stakeholders (4 policymakers, 13 managers, 13 practitioners, and 17 family caregivers of children with autism spectrum disorder aged 0-6 years). Semi-structured interviews guided by the Consolidated Framework for Implementation Research were complemented by document review and field observations, with data analyzed via template analysis. Key facilitators included government funding, stratified training, caregivers' positive attitudes, and clear implementation standards. Barriers mainly included low social acceptance, regional resource disparities, workforce shortages, caregiver challenges, and limited evidence-based practice adoption. Four key strategies were identified: strengthening external support, optimizing internal resources, empowering stakeholders, and refining implementation through technology and evidence-based practices. This first China-based study uses a stakeholder-driven approach to co-design contextualized strategies, offering a model for improving autism spectrum disorder care delivery in similar resource settings globally.Lay abstractThis study explored how to improve early support services for young children aged 0 to 6 years with autism spectrum disorder in resource-limited areas. We interviewed 47 stakeholders, including policymakers, service managers, healthcare professionals, and parents of autistic children across 11 cities to identify factors that support or limit effective early support services. Key helpful factors were government funding, practical staff training, and parents' proactive attitudes. Major challenges included low public understanding of autism, unequal resources between regions, too few trained professionals, and difficulties families face accessing care. To address these, we suggest four solutions: increasing funding and community awareness, sharing resources more fairly, training more staff and supporting parents, and using technology and proven therapies. As the first study in China to design solutions with families and professionals, these strategies could help similar communities globally deliver better early autism care.
Autism : the international journal of research and practice, 2026 · doi:10.1177/13623613261422944