Identifying and Addressing the Missing Links Between Research, Policy, and Practice in Autism Research: Lessons From Early Autism Screening and Intervention Research.
Solid autism interventions stay unused because policy and payment rules lag behind the evidence.
01Research in Context
What this study did
The authors looked at why proven autism tools stay on the shelf. They used the EPIS model to map policy gaps. EPIS stands for Exploration, Preparation, Implementation, Sustainment.
They focused on early screening and NDBIs. NDBIs are naturalistic developmental behavioral interventions. These are play-based ABA methods backed by strong data.
What they found
Big P policies block the path. Medicaid won't pay for some screens. State rules leave out NDBI codes. Little p policies also hurt. Clinic forms skip parent choice. Staff train on old manuals.
The result: kids wait. Families drive hours. Therapists burn out. Evidence sits unused.
How this fits with other research
Wetherby et al. (2018) showed parents can coach toddlers online and win fast gains. Giacomo et al. say those gains won't spread until payers and policies line up. The studies talk past each other at first glance, but both are true: efficacy is ready, scale-up is stuck.
Elsabbagh et al. (2014) called for community workshops to close the research-use gap. The new paper keeps that spirit but adds hard policy levers. It updates the 2000 warning from W et al. that autism services need system fixes, not just more studies.
Balabanovska et al. (2025) details parent stress and manager buy-in as inner barriers. Giacomo et al. place those same barriers inside the EPIS map, showing why even perfect fidelity fails if outer policy stays hostile.
Why it matters
You can run flawless sessions, but if the code isn't billable, the kid still loses access. Use this paper to argue for change. Ask your agency to add NDBI descriptors to intake forms. Join state Medicaid comment periods. Push for reimbursement codes. Clinical skill is only half the battle; policy fluency is the new core competency.
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02At a glance
03Original abstract
The evidence base on autism diagnosis and intervention has grown exponentially in the past two decades, but there continue to be gaps in the path connecting research, policy, and practice. For example, although standardized autism screening tools have been shown to be helpful for identifying early signs of autism and facilitating early diagnosis, many pediatricians in the United States do not use them as recommended. Similarly, despite the sound evidence supporting Naturalistic Developmental Behavioral Interventions, they are seldom used in early intervention practice. This commentary examines the nature of these gaps using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, with a focus on the role of "big P" policies, which include legislation and agency regulations, and "little p" policies, which include guidelines set by professional organizations. Efforts to bridge the gap between research and practice through policy offer the potential for improving the lives of those on the autism spectrum through early detection and intervention programs and beyond.
Autism research : official journal of the International Society for Autism Research, 2025 · doi:10.1002/aur.70055