Running head: PEER-MEDIATED INTERVENTIONS 1

Exploring Feasibility and Fit: Peer-Mediated Interventions for High School Students with

Autism Spectrum Disorders

Erik W. Carter, Vanderbilt University

Jessica R. Dykstra Steinbrenner, University of North Carolina at Chapel Hill

Laura J. Hall, San Diego State University

Authors’ Note: The research reported here was supported in part by the Institute of Education
Sciences, U.S. Department of Education through Grant R324C120006 awarded to University of
North Carolina—Chapel Hill. The opinions expressed represent those of the authors and do not
represent those of the Institute or the U.S. Department of Education.

Correspondence regarding this article should be addressed to Erik Carter, Department of Special
Education, Vanderbilt University, Nashville, TN 37203; e-mail: [email protected]

Carter, E. W., Dykstra Steinbrenner, J. R., & Hall, L. J. (2019). Exploring feasibility and fit:
Peer-mediated interventions for high school students with autism spectrum disorders.
School Psychology Review, 48(2), 157-169. doi.org/10.17105/SPR-2017-0112.V48-2
PEER-MEDIATED INTERVENTIONS 2

Abstract

Although peer-mediated interventions can provide effective pathways for enhancing the social

outcomes of students with autism spectrum disorders (ASD), their application within secondary

schools has been fairly limited. In this exploratory study, we examined the implementation of

peer support arrangements and peer networks for 102 adolescents with ASD attending 15 public

high schools. Our focus was on the characteristics of students selected to receive these two

interventions, the fidelity with which each was implemented, and the views of participating

educators on the social validity of both. Educators involved a wide range of students with ASD

in these interventions, delivered each with varied levels of fidelity, and considered both

approaches to be acceptable and feasible. We highlight some of the complexities associated with

delivering these social-focused interventions in high school settings and offer recommendations

for future research and practice.

Keywords: inclusion, social relationships, high school, peer-mediated interventions

PEER-MEDIATED INTERVENTIONS 3

Exploring Feasibility and Fit: Peer-Mediated Interventions for High School Students with

Autism Spectrum Disorders

Enhancing the social lives of students with autism spectrum disorders (ASD) has been a

longstanding focus of both research and practice (Gaylord-Ross, Haring, Breen, & Pitts-Conway,

1984; Watkins et al., 2015). The importance of this investment becomes especially apparent

when considering the power of peer relationships in the lives of adolescents. Through their

interactions with others within and beyond the classroom, students can learn an array of critical

skills (e.g., social, communication, academic, self-determination, and other life skills), access

practical and emotional supports, develop an understanding of themselves and their world, and

experience a sense of companionship and belonging that enhances their well-being (Powers et

al., 2015). Accessing these interactions and relationships can be challenging for many

adolescents with ASD, especially during high school (Carter, Common, et al., 2014). A

combination of factors—such as the social-related challenges of students, the attitudes and

expectations of peers, the support models used by school staff, and the paucity of inclusive

practices within secondary schools—can coalesce to limit the opportunities students have to

develop satisfying peer relationships (Carter, in press; Carter, Bottema-Beutel, & Brock, 2014).

Peer-mediated interventions are advocated as effective approaches for fostering social

connections by introducing ongoing, supported opportunities for students with and without ASD

to spend time together within or beyond the classroom (Huber & Carter, in press; Wong et al.,

2014). A variety of peer-mediated interventions have been developed (e.g., peer tutoring, peer

partner programs, cooperative learning) and two are the focus of this study—peer support

arrangements and peer networks. Peer support arrangements involve one or more peers in

providing ongoing and individualized support to a classmate with ASD within inclusive general

education classrooms (Carter, Cushing, & Kennedy, 2009). These peers receive guidance and
PEER-MEDIATED INTERVENTIONS 4

feedback from school staff (e.g., special educators, general educators, paraprofessionals) on how

best to support their classmate socially and academically across class activities (e.g., small-group

projects, whole-group discussions, lectures, non-instructional activities). As students gain

experience and confidence working with one another as classmates, the involvement of school

staff is gradually faded to a background role. Peer networks involve establishing a cohesive

social group of 3-6 peers around a student with ASD that meets formally and informally outside

of the classroom and throughout the semester (Carter et al., 2013; Haring & Breen, 1992). The

network formally meets regularly (e.g., weekly, biweekly)—during lunch, as part of an

extracurricular club, or during some other non-instructional time—to participate in an enjoyable

activity and interact socially. The group is launched and facilitated by school staff (e.g., general

educator, school counselor, special educator) who shift to a background role as the network

solidifies over time. Students also arrange time to connect informally before or after school,

during breaks between classes, or as part of other school-sponsored activities. Both interventions

are designed to introduce sustained and supported opportunities for students with ASD to meet,

work alongside, and develop new relationships with peers at their school.

Applications of these two intervention approaches to high school students with ASD have

been somewhat limited to date. Prior studies have either employed single-case designs with

application to small numbers of participants with ASD (2-4 students; Carter et al., 2017; Gardner

et al., 2014; Hochman, Carter, Bottema-Beutel, Harvey, & Gustafson, 2015; Huber, Carter,

Shaw, & Stankiewicz, in press; Sreckovic, Hume, & Able, 2017) or group designs involving

mixed samples of students with severe disabilities who sometimes had ASD (6-51 students;

Asmus et al., 2016, 2017; Carter et al., 2016). Little is known about the considerations and

complexities that arise when introducing these interventions into high school contexts and across

a broad range of students who have ASD.

PEER-MEDIATED INTERVENTIONS 5

Additional research is needed in at least three areas. First, it is important to understand

the range of students who might benefit from peer support arrangements and peer networks.

Although adolescents with ASD share a common educational label, they comprise a

heterogeneous group of students reflecting a diversity of strengths, needs, and educational

pathways (Carter, Brock, & Trainer, 2014; Volkmer, Reichow, & McPartland, 2014). As

educators consider the goals and guidelines of these two interventions against what they know

about the individualized needs of the students they serve, much can be learned from observing

which interventions they allocate to which students. Second, it is important to understand how

local educators actually implement these interventions with their students. Educational efficacy

studies often involve research teams extensively in the design and delivery of interventions,

raising questions about what it would look like for local teachers to carry out these interventions

under ordinary conditions in their own schools. Peer support arrangements and peer networks

include multiple components that can be applied flexibly based on the needs of participating

students (Huber & Carter, in press). Examining the ways in which educators implement these

two peer-mediated interventions apart from extensive external support could provide new

insights into how practical and adaptable these approaches are within high school contexts.

Third, it is important to understand how these educators view the acceptability, feasibility, and fit

of these interventions for high school students with ASD. A key contributor to the research-to-

practice gap may relate to the social validity of interventions advocated in the literature (Carter

& Pesko, 2008; Snell, 2003). As reflected in a recent review by Callahan et al. (in press),

relatively few intervention studies include strong indicators of social validation. Asking

educators about their experiences implementing these two interventions could shed light on the

extent to which they work well within high school settings.

The purpose of this study was to examine the implementation and acceptability of two
PEER-MEDIATED INTERVENTIONS 6

peer-mediated interventions—peer support arrangements and peer networks—for a large sample

of high school students with autism spectrum disorder. Our research questions were: What are

the characteristics of students with ASD who educators selected to participate in these two peer-

mediated interventions? To what extent were the interventions implemented with fidelity by

school staff? How do these educators assess the social validity of these intervention approaches

within the high school context? To answer these questions, we drew upon data collected during

the first cohort of a multi-site randomized evaluation of a comprehensive intervention package

carried out by the Center on Secondary Education for Students with Autism Spectrum Disorders

(CSESA). We draw upon these findings to highlight some of the considerations and complexities

associated with delivering these social-focused interventions in high school settings. We

emphasize that our goal in the present paper was not to examine intervention efficacy. This

question will best be addressed at the conclusion of the multi-year randomized trial.

Method

Participants

Participants were 150 students with ASD randomly assigned to participate in the

intervention group during the first year of the CSESA evaluation project. The majority was male

(84.7%) and White (72.0%); their average age was 15.8 (SD = 1.3). Among all participants, 102

students received one or more peer-mediated interventions (i.e., peer support arrangements, peer

networks, both); the remaining 48 received other aspects of the CSESA intervention package

without these peer-mediated components. Table 1 displays participant characteristics and

diagnostic information by the types of interventions received.

To participate in the overarching project, students must have (a) received special

education services under the Individuals with Disabilities Education Act, (b) had an

Individualized Education Plan (IEP), (c) had a primary or secondary label of autism on their IEP,
PEER-MEDIATED INTERVENTIONS 7

and (d) been at least two years away from graduation (i.e., no seniors). After we obtained

Institutional Review Board (IRB) and district approvals, school staff sent home study invitations

and permission forms for all students meeting these inclusion criteria at a participating school. If

12 or fewer packets were returned by the project deadline, then all students were enrolled in the

study. If more than 12 consent packets were returned by the project deadline, we randomly

selected students stratified by diploma type (i.e., standard diploma, modified diploma).

Schools

The multi-year study involved 60 high schools in three states. After recruiting school

districts, we worked with district staff to identify high schools with (a) at least 8 students

meeting inclusion criteria, and (b) a willingness to participate, as evidenced by at least three

school staff (including an administrator) signing a study memorandum of understanding. Once

high schools were recruited, we blocked schools by district (or similar districts if the numbers

were uneven) and randomly assigned each block to receive the CSESA package (intervention

group) or to carry out their services-as-usual (comparison group). High schools participated for

two years and entered the study in two staggered cohorts. The present study focuses on students

with ASD at intervention high schools (n = 15) from year one only.

All 15 schools were public high schools serving a wide range of students with ASD.

These schools ranged in size from 900 to 3,079 students (M = 1,849 students). Six were in urban

areas (cities), seven were in suburban areas, and two were in rural areas. The proportion of white,

non-Hispanic students ranged from 12% to 93% (M = 57.9%). The mean proportion of students

receiving free and reduced-priced meals was 34.6% (range, 7.0% to 75.0%). The two peer-

mediated interventions took place in a wide range of classrooms and other schools settings.

Intervention Model and Implementation

The CSESA model is a comprehensive intervention package designed for public high
PEER-MEDIATED INTERVENTIONS 8

schools serving students with ASD (Odom, Duda, Kucharczyk, Cox, & Stable, 2014). At each

school, the model involves a five-step process addressing professional development, assessment,

planning, intervention, and evaluation. Students with ASD attending the school are provided a

combination of up to eleven research-based interventions (i.e., alternative achievement literacy

instruction; Collaborative Strategic Reading-High School; Social Competence Intervention-High

School; peer support arrangements; peer networks; Personal Responsibility, Independence and

Self-Management; student involvement in the IEP; work-based learning; Transitioning Together;

community/school resource mapping; transition planning) spanning four domains: academics,

independence and behavior, peer and social competence, or transition and family. The

combination and sequencing of these interventions is individually determined for each student by

those school staff who comprise a newly formed Autism Team at every school. Each school also

has access to at least one project coach who provides training and support to team members on

the implementation of the overall model and its individual interventions. The CSESA model

incorporates implementation science principles and so individual interventions are rolled out

over the course of the two-year study based on input from the Autism Team, individual student

needs, and logistical considerations (e.g., student schedules, staff availability). Although

participating students could receive any combination of interventions, we anticipated every

student would receive at least one intervention in each of the four domains. Peer support

arrangements and peer networks represented two of the three interventions comprising the social

competence domain.

Peer support arrangements. Peer support arrangements involved inviting 1-2

classmates without disabilities (called “peer partners”) to support a participating student with

ASD in one general education class. Peer partners sat in close proximity to the focus student and

provided social (e.g., initiating conversations, modeling appropriate social skills, making
PEER-MEDIATED INTERVENTIONS 9

introductions to other classmates, conversing about school and other activities) and/or academic

(e.g., encouraging contributions to class and group discussion, highlighting key concepts, sharing

materials, providing feedback) support in the spirit of a classmate, rather than a tutor. The

students were supported by a member of the school staff (e.g., special educator, general educator,

paraprofessional) who adopted a facilitation role within the classroom—providing any initial

training, assistance, feedback, and encouragement the students needed as they worked together.

A written peer support plan was typically developed for the classroom, which outlined basic

ideas for the participation of the focus student, their peer partners, and the facilitator during each

segment of a typical class period (e.g., beginning of class, lecture, small-group work,

independent seatwork, end of class). After selecting and inviting peer partners, the facilitator

often reviewed the written plan with students (with or without the focus student present) during

an initial orientation meeting. Although students need not have worked together constantly

throughout each class period, the expectation was that the peer support arrangement would last

throughout the semester. These procedures were adapted from prior studies evaluating these

interventions in middle and high school classrooms (see Carter et al., 2016; Carter, Moss,

Hoffman, Chung, & Sisco, 2011). Peer support arrangements were implemented within a wide a

range of classes, including both core academic (e.g., English, math, science, social studies) and

elective (e.g., art, computer software, culinary arts, gym) classes.

Peer networks. Peer networks involved the creation of small, social groups comprised of

1-2 students with ASD and 3-5 peer partners. The students met together once per week outside of

instructional time to participate in conversation and a shared activity (e.g., playing games,

creating posters for school activities, drawing, watching or discussing anime videos). A

secondary goal was to encourage informal connections among students outside of the formal

meetings. The group was supported by a member of the school staff (e.g., school counselor, club
PEER-MEDIATED INTERVENTIONS 10

leader, special educator) who served as a facilitator during at least some of each regular meeting

(e.g., checking on students’ connections throughout the week, encouraging interactions during a

shared activity, providing reminders about upcoming meetings). After selecting and inviting peer

partners, the facilitator held an orientation meeting with all network members to discuss goals

and expectations. Some schools opted to hold separate peer trainings as well. During meetings,

peer partners modeled social skills and finding common interests to support the focal students

socially. The facilitator employed strategies to encourage social interaction (e.g., highlight

strengths, interpreting behaviors, redirecting conversations) and gradually faded direct

involvement as the group coalesced. These procedures were adapted from our pilot studies and

prior evaluations of these interventions in high schools (see Asmus et al., 2017; Gardner et al.,

2014; Hochman et al., 2015). Although peer networks could meet anywhere, they most often

took place outside of the cafeteria during lunch periods (e.g., empty classrooms, media centers)

or were embedded within existing school clubs (e.g., Best Buddies® programs, anime club).

Training and coaching. A project coach provided training on both peer-mediated

approaches to those school staff implementing the interventions, as well as to the entire school

faculty at some interested high schools. Each coach used a standardized set of presentation

slides, implementation manuals, and other key resources (e.g., sample peer support plans) to

ensure consistency in content across sites. Although each training was designed to be

approximately 45 min in length, they varied widely from 30 to 90 min in practice. The actual

delivery of these trainings varied in format (e.g., with individuals, small groups, the whole

school), timing (e.g., beginning of the year, in the midst of a semester when facilitators were

identified), and frequency based on the preferences of school administrators, the availability of

school staff, and the numbers of students chosen to receive each intervention.

The project coaches also provided some support to educators who facilitated the peer
PEER-MEDIATED INTERVENTIONS 11

support arrangements and peer networks. These coaches were present in intervention schools

approximately one day each week throughout the school year. However, this coaching addressed

all aspects of the CSESA intervention model (i.e., a 5-step process involving up to 11

interventions). As a result, additional coaching was scheduled only as needed for peer-mediated

intervention facilitators. Coaching typically involved direct observation and follow-up

discussion, but could also include modeling or other action (e.g., supporting the creation of peer

support plans) as requested by school staff.

Measures and Data Collection

Numerous measures were collected as part of the overarching evaluation study. The

present study focuses on data addressing student characteristics, implementation fidelity, and

social validity.

Student characteristics. Information about the characteristics of students was gathered

through demographic forms collected from families, student information forms collected from

school staff, standardized assessments completed directly with students by research staff, and

standardized assessments completed by teachers and parents.

Leiter International Performance Scales-Third Edition (Leiter-3). The Leiter-3 (Roid,

Miller, Pomplun, & Koch, 2013) is a non-verbal intelligence test designed specifically for

individuals ages 3 to 75 who may have difficulty with verbal directions. Four of the eleven

subtests (i.e., figure ground, form completion, classifications/analogies, sequential order) are

used to provide a brief non-verbal IQ assessment, which results in IQ scores with a mean of 100

and standard deviation of 15. The reliability on the four core subtests range from 0.67 to 0.95 for

high school age individuals (Roid et al., 2013). The Leiter was administered with participating

students at their school by project staff toward the beginning of the project; all research staff

were trained to reliability.

PEER-MEDIATED INTERVENTIONS 12

Social Communication Questionnaire-Lifetime (SCQ-L). The SCQ-L (Rutter, Bailey, &

Lord, 2003) is a 40-item questionnaire designed as a quick parent assessment of autism

symptoms by measuring communication skills and social functioning. Each item is scored

dichotomously (i.e., no or yes). Raw scores of 15 or greater suggest an individual would meet

criteria for autism spectrum disorder. The SCQ has demonstrated concurrent validity with the

Autism Diagnostic Interview-Revised, with correlations between the two measures ranging from

0.73 to 0.92 (Rutter et al.). A parent or caregiver completed the SCQ-L at the start of the study.

Social Responsiveness Scale-Second Edition (SRS-2). The SRS-2 (Constantino &

Gruber, 2012) is a 65-item questionnaire used to assess autism symptomatology across five

areas: social awareness, social cognition, social communication, social motivation, and repetitive

behaviors and restrictive interests. Each item is scored using a 4-point, Likert-type scale ranging

from 1 = not true to 4 = almost always true. The SRS-2 provides a T-score and cut off scores for

mild (T = 60 to 65), moderate (T = 66 to 75), and severe (T = 76 and over) autism

symptomatology. The test-retest reliability ranges from 0.77 to 0.85 (Constantino & Gruber).

Scores also are derived for five treatment subscales: Social Awareness; Social Cognition; Social

Communication; Social Motivation; and Restricted Interests and Repetitive Behavior. A familiar

teacher completed the SRS-2 at the start of the study.

Vineland Adaptive Behavior Scales-Second Edition (VABS-2). The VABS-2 (Sparrow,

Cicchetti, & Balla, 2005) is a 223-item scale assessing adaptive functioning across a variety of

domains. It has a test-retest reliability of 0.86 and an internal consistency of 0.98 (Sparrow et al.,

2005). The Vineland Adaptive Behavior Composite (ABC) and each of the domains have a mean

of 100 and a standard deviation of 15. A teacher familiar with the target student completed 184

items across three domains (i.e., communication, socialization, daily living skills) using the

Teacher Rating Form at the beginning of the study.

PEER-MEDIATED INTERVENTIONS 13

Implementation fidelity. Fidelity of implementation measures for both peer-mediated

interventions were created in collaboration with the intervention developers and were aligned

with other project fidelity measures to provide a uniform structure (i.e., dosage, preparation and

structure, process, strategies and content, general strategies, evaluation and progress monitoring)

across the multiple CSESA intervention components. Each measure contained items reflecting

key elements of the specific intervention, along with indicators and descriptions of each element.

Up to four response options were available for each element (see Tables 2 and 3). We used a

sampling approach to gauge fidelity across schools and sites, in which the measure was

completed three times during the first semester of implementation and one time during any

subsequent semester of implementation at each school; this captured a subset of implementers

and students. These measures were scheduled and collected by project coaches. For the present

study, fidelity data was available for 51.5% of students involved in a peer support arrangement

and 57.4% of students involved in a peer network.

Social validity. Social validity measures for both peer-mediated interventions were

adapted with permission from the widely used Usage Rating Profile-Intervention (URP-I,

Chafouleas, Briesch, Neugebauer, & Riley-Tillman, 2011). Each of the 22 items are evaluated

using a 6-point, Likert-type scale ranging from 1 = strongly disagree to 6 = strongly agree (see

Table 4). Items on both measures are organized within three sub-domains: coaching, training,

and support; feasibility and acceptability; and usefulness and effectiveness. The measures were

completed by educators involved in intervention implementation at the end of the semester. All

measures were collected anonymously and linked to school and intervention, but not to

individual students. For peer support arrangements, 41.2% were completed by general educators,

26.5% by special educators, 26.5% by paraprofessionals, and 5.9% by speech/language

pathologists. For peer networks, 41.7% were completed by special educators, 19.4% by general
PEER-MEDIATED INTERVENTIONS 14

educators, 13.9% by speech/language pathologists, 8.3% by paraprofessionals, and 16.7% by

other school staff (e.g., school counselor, school psychologist, district autism specialist).

Data Analysis

To address Research Question 1, we used descriptive statistics to characterize the sample

of students who received at least one peer-mediated intervention. We then used analyses of

variance (ANOVAs) to compare ratings across the four groups of students based on the

interventions they were provided—peer support arrangement only, peer network only, both peer-

mediated interventions, no peer-mediated interventions. We planned follow-up Tukey HSD

comparisons when significant differences were evident. To address Research Question 2, we

used descriptive statistics to summarize each dimension of intervention fidelity separately for

peer support arrangements and peer networks. As a post hoc comparison, we examined whether

variations in selected fidelity items were associated with diploma type, which provides an

indicator of disability severity. To address Research Question 3, we used descriptive statistics to

summarize individual item ratings. We used independent samples t tests to compare ratings

across peer support arrangements and peer networks.

Results

What are the Characteristics of Students Participating in Peer-mediated Interventions?

Students receiving at least one or both of the peer-mediated interventions varied widely

in their diploma pathways and characteristics (see Table 1), suggesting educators considered the

interventions to be applicable across a diverse group of students. Half of students (50.0%) were

working toward a standard diploma; the remainder were pursuing an alternative diploma. Across

these students, nonverbal IQ scores ranged from 30 to 123 (SD = 26.5), suggesting students with

severe cognitive impairments as well as those without an intellectual disability could participate.

Likewise, large variations in autism-related symptomology were evident. Specifically, SCQ-L

PEER-MEDIATED INTERVENTIONS 15

scores ranged from 4 to 37 (SD = 7.9) and SRS-2 total scores ranged from 43 to 110 (SD = 12.4).

Overall adaptive behavior scores (i.e., VABS-2) ranged from 35 to 119 (SD = 14.8).

Some student characteristics varied based on the interventions they were provided.

Almost two thirds (65.9%) of students pursuing a standard diploma participated in a peer support

arrangement only, 48.6% participated in a peer network only, and 25.9% participated in both

interventions. The students receiving the standard diploma comprised over three quarters

(77.1%) of the students who did not receive a peer-mediated intervention. Likewise, some

differences in nonverbal IQ scores were apparent. An ANOVA identified significant differences

across groups, F(3, 138) = 2.71, p = .047. Post hoc analyses indicated higher IQ scores for

students who received no peer-mediated interventions versus students who received both peer-

mediated interventions (p = .026); no other comparisons were significant. However, no

differences were found between groups on the Social Communication Questionnaire-Lifetime (p

= .170), SRS-2 total score (p = .840), or VABS-2 adaptive behavior composite scores (p = .267).

What Did Intervention Fidelity Look Like When Implemented by Secondary Educators?

For the majority of students for whom fidelity was sampled, peer support interventions

were implemented at least three times in the prior two weeks, for at least 60 min each time, and

over a period of at least eight weeks (see Table 2). Although every intervention involved an adult

facilitator (e.g., paraprofessional, special educator) and at least one peer partner, other aspects of

the intervention reflected more variations in implementation. For example, a sizable percentage

of interventions did not include a written support plan (43.9%) or involve an initial orientation

session (35.0%). The absence of a written support plan was more common for students pursuing

a regular diploma (48.3%) than students pursuing an alternate diploma (33.3%). Likewise, the

omission of an orientation occurred for the same students (48.3%) who were pursuing a regular

diploma, but for fewer (16.7%) students pursuing an alternative diploma. Although some peer-
PEER-MEDIATED INTERVENTIONS 16

and adult-delivered support strategies were almost always observed, the combination of

strategies used by each of these participants varied. Peer-delivered support strategies were

observed more often for students pursuing a standard diploma, while adult facilitation strategies

were observed more often for students pursuing an alternative diploma. Finally, while

reinforcement was consistent, prompting and feedback/data collection was fairly inconsistent. No

differences in pattern were apparent based on diploma pathway.

For the majority of students, peer networks were implemented at least twice in the past

two weeks, for more than 20 min each time, and over a period of at least eight weeks (see Table

3). These interventions almost always involved an adult facilitator (e.g., special educators,

general educators, counselors) and at least two peer partners who were present for some to all of

the network meetings. Although formal orientation meetings were held for most students, they

were not held for 44.4% of students pursuing a regular diploma and 28.6% of students pursuing

an alternative diploma. Regular meetings in which students participated in shared activities were

quite consistent. Lower fidelity ratings for meetings regarding peer networks were most often

due to a lack of planning for upcoming meetings and explicit discussion of identified social

goals. Although both reinforcement and prompting regularly occurred, the extent to which adults

used at least one social facilitation strategy or faded their support to students/peer partners was

less consistent and more common for students/peer partners pursuing an alternative diploma. The

provision of feedback to student/peer partners and collection of data were highly variable for

peer supports and peer networks.

How Do These Educators Assess the Social Validity of these Intervention Approaches?

Across all three subdomains of the Usage Rating Profile-Intervention, educator ratings

supported the social validity of both intervention approaches (see Table 4). In the area of

Training, Support, and Coaching, more than three quarters of respondents agreed or strongly
PEER-MEDIATED INTERVENTIONS 17

agreed that they understood the intervention procedures, had the skills needed for

implementation, and considered the intervention directions to be clear. Views regarding the

extent to which implementation support would be needed from co-workers, parents, or

administrators was more mixed. Significant differences were found for just one item (“The

ongoing support (e.g., coaching) provided for this intervention was useful.”), t(69) = 2.48, p =

.016, with higher ratings provided for peer networks.

In the area of Feasibility and Acceptability, most items were rated very highly. More than

90% of respondents agreed or strongly agreed that they liked the intervention procedures, felt the

time requirements were reasonable, considered the intervention to be acceptable for students

with ASD, and it was not disruptive. Somewhat lower percentages of respondents agreed that the

intervention could be implemented exactly as described or that the time required for record

keeping was reasonable. Significant differences were found for just one item (“This intervention

would not be disruptive to other students.”), t(67) = 2.73, p = .008, with higher ratings provided

for peer networks.

In the area of Usefulness and Effectiveness, ratings were also high. More than 90% of

respondents agreed or strongly agreed they were motivated to continue using the intervention,

that it was a good way to support the social needs of students with ASD, that it promoted social

and/or academic engagement, that it helped address existing IEP goals, and that it was beneficial

for these students. Smaller percentages of respondents felt the intervention would save time spent

on classroom management or help them collaborate with other school staff. No significant

differences were found in ratings across interventions.

Discussion

The social dimensions of high school have long been highlighted for the importance to

adolescents. We examined the student characteristics, fidelity of implementation, and social

PEER-MEDIATED INTERVENTIONS 18

validity associated with the delivery of peer support arrangements and peer networks across 15

high schools. The size and diversity of our sample, as well as the exploration of these three data

sources, provide new insights into the application of these intervention approaches within high

school settings. Our findings extend the literature in several ways.

First, peer-mediated interventions were implemented with a wide spectrum of students

reflecting diverse characteristics and educational pathways. Although peer-mediated approaches

have been advocated as promising interventions for addressing the social needs of adolescents

with ASD (Cole, 2015; Watkins et al., 2015), actual examples of such a broad application have

been limited in the literature. When considered alongside both implementation and social

validity findings, reflection on the characteristics of the 102 students who received a peer support

arrangement and/or peer network suggests these peer-mediated interventions do indeed have

broad applicability. Participants included high school students with extensive support needs to

students with above average abilities, as reflected in measures of nonverbal IQ, social

impairment, adaptive behavior, and autism symptomology. Although additional experimental

studies are needed to advance the field’s understanding of which interventions are best suited for

which students, our descriptive findings lend support for consideration of these interventions as

approaches for addressing the social dimensions of the lives of students with ASD.

In the CSESA study, local school staff made decisions about which students received

which interventions from a menu of available options. Such an approach aligns with typical

practice in which educators make informed judgments about how best to meet the needs of their

students. Although we did not ask educators why they selected certain intervention combinations

over others, the patterns of student participation provide some insight into possible

considerations. For example, peer-mediated interventions tended to be provided for students who

had lower nonverbal IQs and were less likely to be pursuing a regular diploma. Students
PEER-MEDIATED INTERVENTIONS 19

pursuing an alternative diploma may have been perceived by educators as more in need of

supplementary support, may have had schedules that allowed more flexibility to focus on social

domains, and may have been participating in an already established school club or activity

focused on social interaction with peers. Over three quarters of the students who did not receive

peer-mediated interventions were pursuing a regular diploma. It may be that these students spent

less time in general education classrooms where academic interventions are often prioritized, or

that students pursuing a standard diploma were more reticent to participate in peer-mediated

interventions. Future work is needed to better understand the factors educators consider when

making social-focused intervention decisions (e.g., Knight, Huber, Kuntz, Carter, & Juárez, in

press), as well as to delineate which of those factors are appropriate to consider. For example,

Huber and Carter (2016) detailed a range of assessment approaches educators might use when

determining which peer-mediated approach to adopt and how to tailor the intervention to meet

the needs of individual students.

Second, peer support arrangement and peer networks appear to have been applied

adequately—albeit flexibly—with these students. In other words, fidelity data indicate the peer-

mediated interventions were implemented often, over time, and with most features observed.

One promising facet of this finding is that it indicates typical educators can deliver these

interventions in authentic settings without extensive external support from researchers. Indeed,

the field has long lamented the advocacy of research-based interventions that are too difficult to

implement within ordinary schools (Carter & Pesko, 2008; Malouf & Schiller, 1995; Snell,

2003). Yet some variations in implementation by these educators were clearly apparent. Without

additional observational and outcome data, it is difficult to discern whether the variations in

fidelity we reported are expected, desirable, or concerning. For example, it makes sense that the

need for and delivery of specific support strategies by facilitators or peers would be shaped by
PEER-MEDIATED INTERVENTIONS 20

the context of the class, the activities students are working on together, and the experiences they

have accrued over their time together. Moreover, facilitators sometimes involved additional (for

peer support arrangements) or fewer (for peer networks) peer partners than suggested,

implemented peer support arrangements class-wide to meet the needs of multiple students, or ran

multiple peer networks concurrently. Such variations in fidelity have been similarly documented

in other studies focused on high school students with severe disabilities and may reflect the sort

of individualization so important to serving students with ASD (e.g., Asmus et al., 2017; Carter

et al., 2016). The absence of a written peer support plan and the omission of initial orientation

sessions for either intervention, however, could negatively influence the quality of the

intervention. In looking more closely at student characteristics, we found that these intervention

elements were omitted more often for students pursuing a regular diploma—students who likely

had less extensive support needs. Perhaps educators felt the nature of these students’ needs did

not necessitate a formal plan or an explicit time of training for peer partners (e.g., Carter et al.,

2017). Another possibility is that students pursuing a regular diploma had more discomfort with

being singled out, and that educators omitted peer support plans or trainings to respect the

feelings and opinions of their students. Future efforts to scale-up these interventions school- or

district-wide should strive to delineate the extent to which particular intervention elements are

considered critical or flexible for widespread implementation.

Third, both interventions were strongly affirmed by high school staff who were actively

involved in their implementation. A large majority of educators—typically more than 90%—

considered the two interventions to be feasible, acceptable, useful, and effective for delivery

within their high school and with students with ASD. This particular portrait of social validity

aligns well with other high school studies examining either of these intervention approaches

(e.g., Asmus et al., 2017; Carter et al., 2016; Sreckovic et al., 2017), bolstering claims that peer-
PEER-MEDIATED INTERVENTIONS 21

mediated interventions align especially well with secondary school settings (Carter, in press;

Huber & Carter, in press). The somewhat lower ratings related to the amount of record keeping

for peer support arrangements—as well as lower fidelity on gathering data—was an issue we

noticed anecdotally across other areas of the project. This may not be a familiar aspect of

facilitating a peer-mediated social group and collecting data requires skills by the educator who

values obtaining this information. At the same time, our study is the first to directly compare

social validity ratings of these two interventions when carried out within the same set of high

schools. We found few significant differences in educators’ views of these two interventions. As

part of future efforts to further enhance these peer-mediated interventions, it may be helpful for

researchers to look more closely at the perspectives of those few educators who did not affirm

particular aspects of the interventions to understand what refinements might need to be in place

to address their concerns.

Limitations and Future Research

Additional research is needed to address several limitations of this exploratory study.

First, we considered only a limited range of student characteristics in our analyses. Although we

examined measures often omitted in other studies of peer-mediated interventions (e.g., autism

symptomology, adaptive behavior, nonverbal IQ), we were not able to explore other factors that

may influence decisions about which intervention to implement with a particular student. For

example, a combination of student-level (e.g., student’s IEP and transition goals, prior

intervention experiences, challenging behaviors, social and academic skills), support-level (e.g.,

available staffing, educator’s attitudes and confidence), and school-level factors (e.g., service

delivery models, school climate) are likely to shape intervention decisions. Future studies should

consider additional factors, as well as interview staff about their decision-making process.

Second, we used a sampling approach when assessing fidelity of intervention, which provides
PEER-MEDIATED INTERVENTIONS 22

only a snapshot of implementation at a particular point in time. Although this was consistent with

approaches used in other studies (e.g., Carter et al., 2016; Huber et al., in press), the fidelity of

peer-mediated interventions likely fluctuates throughout the semester. Future studies might

analyze more closely the day-to-day variations in intervention delivery (e.g., the ways in which

supports are delivered by peer partners and adults; the use and fading of prompting,

reinforcement, and feedback) and the factors that shape implementation. Third, our social

validity measures were completed only by adults and we are missing the perspectives of

participating students with ASD and their peers. Adolescents are likely to hold diverse views

about the acceptability of these interventions (Bottema-Beutel, Mullins, Harvey, Gustafson, &

Carter, 2016). Future studies should seek their perspectives on these interventions, as well as

solicit their recommendations for enhancing the design and delivery within their schools.

This study addressed the implementation of peer-mediated interventions for high school

students with ASD in classrooms and other school settings. Our findings indicate both peer

support arrangements and peer networks can be implemented across a diverse range of

adolescents in ways that are considered to be feasible and acceptable. For educators working in

secondary schools, peer-mediated interventions present a promising approach for enhancing the

social participation of students for whom strong connections to peers can be elusive.
PEER-MEDIATED INTERVENTIONS 23

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PEER-MEDIATED INTERVENTIONS 28

Table 1
Characteristics of Students with ASD by Types of Peer-Mediated Intervention They Received

Peer support Peer Both Neither

Variables arrangements networks interventions intervention

Agea 15.9 (1.4) 16.0 (1.1) 15.9 (1.3) 15.7 (1.4)

Sexb
Female 4 (9.8) 7 (20.6) 5 (18.5) 7 (14.6)
Male 37 (90.2) 27 (79.4) 22 (81.5) 41 (85.4)

Raceb
African American/Black 3 (7.3) 2 (5.9) 2 (7.4) 1 (2.1)
Asian American 2 (4.9) 1 (2.9) 0 (0.0) 0 (0.0)
American Indian/Alaskan Native 1 (2.4) 1 (2.9) 0 (0.0) 0 (0.0)
White 25 (61.0) 25 (73.5) 20 (74.1) 38 (79.2)
Multiple 5 (12.2) 1 (2.9) 2 (7.4) 3 (6.3)
Other 1 (2.4) 0 (0.0) 1 (3.7) 1 (2.1)
Not reported 4 (9.8) 4 (11.8) 2 (7.4) 5 (10.4)
Ethnicity
Hispanic 4 (9.8) 5 (14.7) 3 (11.1) 7 14.6)

Annual family incomeb

<20K 4 (9.8) 0 (0.0) 1 (3.7) 7 (14.6)
20-39K 4 (9.8) 6 (17.6) 3 (11.1) 5 (10.4)
40-59K 3 (7.3) 5 (14.7) 2 (7.4) 4 (8.3)
60-79K 9 (22.0) 1 (2.9) 2 (7.4) 7 (14.6)
80-99K 2 (4.9) 1 (2.9) 2 (7.4) 3 (6.3)
99K< 13 (31.7) 15 (44.1) 12 (55.6) 17 (35.4)
Not reported 6 (14.6) 6 (17.6) 5 (18.5) 5 (10.4)

Diploma pathwayb
Standard 27 (65.9) 17 (50.0) 7 (25.9) 37 (77.1)
Other 14 (34.1) 17 (50.0) 20 (74.1) 11 (22.9)

Leiter Nonverbal IQa 83.6 (27.6) 84.5 (24.2) 73.3 (26.9) 99.1 (22.8)

Social Communication Questionnaire-Lifetimea 20.3 (8.1) 22.0 (7.5) 21.9 (8.2) 17.9 (9.2)

Social Responsiveness Scale (SRS-2)a

Total T-score 71.0 (12.1) 69.9 (12.0) 72.4 (13.7) 72.1 (12.5)
Social Awareness T-score 64.8 (13.6) 62.9 (10.7) 68.4 (13.8) 67.8 (10.3)
Social Cognition T-score 68.2 (12.3) 68.1 (9.9) 70.9 (11.8) 69.7 (11.4)
Social Communication T-score 70.2 (10.5) 66.5 (11.8) 71.0 (13.0) 70.3 (10.9)
Social Motivation T-score 68.2 (12.5) 66.0 (10.4) 66.3 (13.3) 66.8 (12.8)
Restrict Interests/Repetitive Behaviors 71.2 (15.5) 71.7 (16.2) 74.0 (18.7) 75.7 (17.1)

Vineland Adaptive Behavior Scales-2a

Communication SS 77.2 (16.2) 78.4 (19.3) 72.0 (13.9) 80.4 (15.4)
Daily Living SS 79.6 (16.1) 81.6 (19.0) 75.9 (16.1) 82.4 (16.3)
Socialization SS 72.2 (12.6) 73.2 (14.1) 70.0 (9.5) 72.5 (11.8)
Adaptive Behavior Composite 74.3 (14.8) 77.6 (16.6) 70.3 (11.6) 76.3 (14.6)

a
Mean (standard deviation). SS= standard scores. bFrequency (percentage).
Running head: PEER-MEDIATED SUPORTS 29

Table 2
Fidelity of Implementation for Peer Support Arrangements

% rating
Dimension of Fidelity 0 1-2 times 3-6 times 6+ times
Frequency 0.0 17.1 34.1 48.8
How often in the past two weeks has this student received this intervention/support?
0 min <30 min 30-60 min > 60 min
Amount 0.0 4.9 24.4 70.7
On average, how long were each of the sessions over the past 2 weeks?
0 weeks <4 weeks 4-7 weeks 8+ weeks
Duration 0 9.8 36.6 53.7
For how long has this student receive this intervention/support?
Not observed Low Mid High
Participants 0.0 0.0 - 100.0
One adult facilitator, at least one peer partner without ASD
Peer support plan 43.9 - - 56.1
Developed written peer support plan
Orientation 35.0 - - 65.0
Facilitator, peer partners, and student (if appropriate) participated in initial orientation
meeting
Peer support strategies 2.4 4.9 36.6 56.1
In close proximity to student for the majority of class period; provides academic support as
needed (e.g., redirected, helped with materials, asked question); provides social support
(e.g., initiated conversation, introduced to another peer)
Adult facilitation strategies 2.4 22.0 39.0 36.6
Observes student and peer partners as they worked together; uses at least one social and/or
academic facilitation strategy with students/partners during each class; provides
constructive feedback to student/peer partners during each meeting
Reinforcement 0 9.8 - 90.2
Demonstrates positive rapport with student; provides and directs reinforcement to student
Prompting 7.3 29.3 - 63.4
Provides prompts if needed; provides appropriate wait time (facilitator only)
Feedback and data 5.0 32.5 45.0 17.5
Checks in with peer supports (and student if appropriate); provides constructive feedback to
student/peer partners; gathers some form of data
Note. Not observed = no features observed; low = less than half (but at least 1 feature) observed; mid = half or more features were observed; high = all
features were observed. - = rating not possible. ASD = autism spectrum disorder.
PEER-MEDIATED SUPPORTS 30

Table 3
Fidelity of Implementation for Peer Networks

% rating
Dimension of Fidelity 0 times 1 time 2+ times
Frequency 0.0 17.9 82.1
How often in the past two weeks has this student received this intervention/support?
0 min 1-10 min 11-20 min > 20 min
Amount 1.8 0.0 3.5 94.7
On average, how long were each of the sessions over the past 2 weeks?
0 weeks <4 weeks 4-7 weeks 8+ weeks
Duration 0 5.4 14.3 80.4
For how long has this student receive this intervention/support?
Not observed Low Mid High
Participants 1.8 16.1 - 82.1
Network has one adult facilitator; network has at least two peer partners without ASD
Meetings 3.6 21.4 - 75.0
Focus student and at least 2 peer partners present for majority of the meeting; facilitator
present for at least 25% of meeting
Orientation 38.6 - - 61.4
Facilitator, peer partners and student participate in initial orientation meeting
Meetings 0.0 20.0 21.8 58.2
Engage in a shared activity (student & peers); discuss dates and activities of upcoming
meetings; addresses social-related goal(s)
Adult facilitation strategies 10.7 35.7 - 53.6
Uses at least one social facilitation strategy with student/partners; fades involvement as
appropriate
Reinforcement 0.0 16.1 - 83.9
Demonstrates positive rapport with student; provides and directs reinforcement to student
Prompting 7.3 18.2 - 74.5
Provides prompts if needed; provides appropriate wait time (facilitator only)
Feedback and data 18.2 40.0 21.8 20.0
Tracks social contacts; provides constructive feedback to student/peer partners; gathers
data on social-related goal
Note. Not observed = no features observed; low = less than half (but at least 1 feature) observed; mid = half or more features were observed; high = all
features were observed. - = rating not possible. ASD = autism spectrum disorder.
Running head: PEER-MEDIATED SUPORTS 31

Table 4
Social Validity Ratings for Peer Support Arrangements and Peer Networks

Peer support Peer

arrangements networks
Agree/ Agree/
Strongly Strongly
Items agree (%) M (SD) agree (%) M (SD)
Training, Coaching, and Support
The training provided for this intervention was useful. 88.2 5.4 (0.7) 94.6 5.6 (0.6)
The ongoing support (e.g., coaching) provided for this 76.5 5.0 (1.1) 94.6 5.5 (0.6)
intervention was useful.
I understand the procedures of this intervention. 88.2 5.2 (0.7) 97.3 5.5 (0.6)
I have the skills needed to implement this intervention. 94.1 5.4 (0.7) 97.3 5.6 (0.5)
The directions for using this intervention are clear to 85.3 5.2 (1.0) 97.3 5.5 (0.6)
me.
Implementation of this intervention would require 70.6 4.7 (1.4) 75.7 5.0 (1.2)
support from my coworkers.
Parental collaboration is required in order to use this 60.6 4.4 (1.3) 37.8 4.0 (1.4)
intervention.
I would need support from my administrator to 47.1 4.3 (1.4) 54.1 4.3 (1.4)
implement this intervention.
Feasibility and Acceptability
The amount of time required to use this intervention is 76.5 5.1 (0.9) 89.2 5.3 (0.8)
reasonable.
I would implement this intervention with a good deal 94.1 5.6 (0.6) 94.6 5.6 (0.6)
of enthusiasm.
The intervention could be implemented exactly as 82.4 5.1 (1.0) 78.4 5.2 (0.9)
described.
The amount of time required for record keeping with 65.6 4.8 (1.1) 83.3 5.2 (0.9)
this intervention is reasonable.
This is an acceptable intervention strategy for the 93.9 5.5 (0.7) 97.2 5.6 (0.6)
needs of students with ASD.
This intervention would not be disruptive to other 93.9 5.2 (0.7) 97.2 5.6 (0.5)
students.
I liked the procedures used in this intervention. 90.9 5.4 (0.7) 94.4 5.5 (0.6)
Usefulness and Effectiveness
This intervention is a good way to support the social 93.9 5.5 (0.7) 97.2 5.7 (0.5)
needs of students with ASD.
This intervention promoted academic and/or social 90.6 5.4 (1.0) 100.0 5.7 (0.5)
engagement.
Use of this intervention would save time spent on 80.6 5.2 (0.9) 65.7 4.9 (0.8)
classroom management.
This intervention helped to address the student’s 93.3 5.4 (0.7) 86.1 5.2 (0.8)
existing IEP goals.
This intervention helped me to collaborate with other 75.0 5.0 (0.9) 83.3 5.2 (0.7)
staff.
I am motivated to continue using this intervention. 90.9 5.5 (0.8) 100.0 5.7 (0.5)
Overall, the intervention is beneficial for students with 90.9 5.5 (0.8) 100.0 5.7 (0.5)
ASD.
Note. Percentages are based on the number of individuals completing each item. 1 = strongly disagree, 2 =
disagree, 3 = slightly disagree, 4 = slightly agree, 5 = agree, 6 = strongly agree.