Implementation pilot elopement

Emory University received a $713,195 Project Grant from the National Institute of Mental Health under the Mental Health Research Grants program (CFDA 93.242) for an Implementation Pilot Elopement project, awarded August 1, 2025, with completion scheduled for July 31, 2028. The project addresses a significant research-to-practice gap in evidence-based treatment for elopement—a dangerous behavior prevalent among children with autism spectrum disorder (ASD). Emory developed a manualized parent-mediated Function-Based Elopement Treatment (FBET) intervention grounded in applied behavior analysis (ABA) principles. FBET is designed to be time-limited, implementable in non-specialized settings, and suitable for delivery by board-certified behavior analysts (BCBAs) without specialized training. The intervention reduces elopement by reinforcing and increasing appropriate alternative behaviors that allow children to access functional reinforcers through appropriate means rather than through elopement.

The grant supports the implementation pilot phase of FBET, transitioning the intervention from university-affiliated specialized settings with expert training and supervision to community-based ABA service providers. This scale-up effort addresses the critical gap where most parents of children with ASD who elope report receiving inadequate or no professional support, despite established evidence-based treatments. Marcus Autism Center, Inc., a nonprofit autism treatment center, serves as the sub-awardee providing clinical research services, including subject recruitment, diagnostic assessments, clinician training, and clinical coordination to support the project's implementation and evaluation activities across Georgia.

Abstract

Elopement is a prevalent and dangerous behavior for children with autism spectrum disorder (ASD).1, 2 fortunately, treatments based in applied behavior analysis (ABA) can effectively reduce elopement.3-6 however, most parents of children who elope report receiving either no professional help or support that is likely not comprehensive or ongoing.7 thus, there is a significant research-to-practice GAP where children are not receiving the evidence-based strategies that exist for elopement. Community-based ABA services, provided by board certified behavior analysts (bcbas), are ideal settings to address this GAP as 40% of children with ASD receive ABA8 and the number of bcbas has risen dramatically in recent years.9 although bcbas are trained in the behavioral knowledge underlying evidence-based strategies for elopement, they often do not receive hands-on training in assessing and treating elopement specifically (e.g., functional analyses)10 and may lack guidance for parent training,11 which is central to addressing elopement that occurs in home or community contexts. To help address the research-to-practice GAP, our group developed a manualized parent-mediated function based elopement treatment (fbet) based on the past literature of ABA treatments for elopement. Fbet impacts elopement through the mechanism of reinforcing and increasing appropriate behaviors that allow the child to access the functional reinforcer for elopement through more appropriate means.6 the intervention is time-limited, designed for non-specialized settings, and intended for use by bcbas without specialized training. Fbet demonstrated feasibility in a pilot randomized controlled trial (RCT ; n=24)6 and has positive results from a recently completed efficacy RCT (n=76; manuscript under review). To date, fbet has been delivered by bcbas in a specialized, university-affiliated center with training and supervision fromexperts. There is a critical need to expand access by deploying fbet in community-based ABA clinics where the treatment can be more easily accessed. In partnership with 3 community ABA organizations, we propose a pilot, cluster randomized trial to evaluate the feasibility and preliminary effectiveness of fbet compared to treatment as usual (TAU) in these settings and evaluate inner and outer context factors related to implementation grounded in the epis (exploration-preparation-implementation-sustainability) model.12-14 results will set the foundation for a R01 hybrid implementation-effectiveness RCT of fbet targeting the factors found to impact implementation in the current trial. Primary aims involve evaluating the feasibility of the pilot effectiveness RCT; evaluating preliminary effectiveness outcomes and analyzing the mechanism of action of fbet; and using mixed methods to evaluate factors associated with implementation in a community-based ABA setting. This line of research has strong potential to improve access to care for this dangerous behavior.