Purpose: We sought to understand the extent of the nationwide disruption to Part C Early Intervention services due to COVID-19 and the subsequent shift to telehealth, primarily through a focused examination of providers' perspectives on this disruption in a single state, which is Illinois. Method: To examine the impact of coronavirus disease (COVID-19) on Early Intervention service provision and implementation, 385 Early Intervention Illinois providers completed a web-based survey. Archival data were used to determine changes in number of Illinois Early Intervention referrals following the pandemic onset and to compare Illinois' telehealth and stay-at-home policies to those of other states. Results: The majority (85%) of Illinois Early Intervention providers reported a disruption in service provision during COVID-19. The number of sessions delivered and the number of children per caseload decreased significantly. Provider confidence also decreased significantly. Only 28% of providers reported high confidence with telehealth. Identified benefits of telehealth included increased accessibility and caregiver involvement, whereas limitations included perceived lack of caregiver buy-in. New Illinois Early Intervention referrals and cases were lower during COVID-19 than in the previous year. Prior to 2020, 33 states did not have a permanent reimbursement policy for providing telehealth Early Intervention services. For states with a suspension of in-person Early Intervention services due to COVID-19, time to approval for telehealth reimbursement varied (0–22 days). Conclusions: The shift to telehealth in Illinois resulted in decreases in service provision and provider confidence across disciplines. However, providers identified some benefits to telehealth. Telehealth may represent a means to increase Early Intervention accessibility following the pandemic. Supplemental Material: https://doi.org/10.23641/asha.19119539
Objective Research indicates that fathers’ criminal behavior can be problematic for children through multiple pathways, yet few studies have examined the effect of fathers’ kinship networks in this process. This study examines the association between fathers’ criminal behavior and involvement with their children and the extent to which a father’s relationships with individuals in his extended family network moderate this association. Method Hierarchical linear modeling was used to predict fathers’ involvement using data from a longitudinal intergenerational study of 335 children and 149 low-income, minority fathers. Measures included 8 father-involvement outcomes, a measure of fathers’ criminal behavior, and 2 moderator variables. Results High-quality relationships between fathers and their male relatives moderated the negative effect of criminal behavior on measures of fathers’ involvement. Criminal behavior was only associated with decreasing levels of father involvement when fathers had low-quality relationships with male relatives. Conclusions Strong and affirmative relationships—with male relatives specifically—may attenuate the adverse effects of antisocial and criminal behavior on fathers’ involvement in at-risk families. Implications for tailoring practice to improve relationships between fathers and male relatives and to enhance fathers’ prosocial involvement are noted.
Coaching parents to use language facilitation strategies improves long-term language outcomes for autistic children. To optimize parent-mediated interventions, more studies need to explore factors that influence parents’ learning. This study involved 119 autistic children (18–48 months) and their biological mothers enrolled in a single-site, factorial randomized clinical trial. Mothers were taught to use one of two types of language facilitation strategies (responsive or directive) during eight weekly, hour-long instructional sessions. We explored the impact of (a) type of language facilitation strategy, (b) maternal Broad Autism Phenotype (subclinical traits of autism spectrum disorder), and (c) preintervention strategy use on mothers’ outcomes measured immediately and 3 months after intervention sessions. At postintervention, mothers who learned responsive strategies demonstrated significantly greater use of taught strategies than mothers who learned directive strategies ( d = 0.90, 95% CI =[0.47, 1.32]). Mothers’ use of taught strategies did not differ by Broad Autism Phenotype status. However, a significant two-way interaction was found between preintervention strategy use and Broad Autism Phenotype status on taught strategy use ( F(1, 107) = 6.04, p = 0.016, Δ R2 = 0.053). Findings suggest that strategy type, maternal Broad Autism Phenotype status, and preintervention strategy use may be important factors to be considered to individualize parent-mediated interventions. Lay Abstract Parent-mediated interventions support parents’ use of language facilitation strategies to improve their autistic child’s communication and language development. To improve the effectiveness of parent-mediated interventions, it is important to individualize interventions. This article evaluates how different components of parent-mediated interventions and mothers’ learning styles influence the effectiveness of the intervention. In a randomized clinical trial, mothers were taught to use one of two types of language facilitation strategies: responsive and directive. Mothers’ learning styles were characterized by the Broad Autism Phenotype (BAP) and their natural tendency to use language facilitation strategies before intervention. Findings suggest that it was easier for all mothers (irrespective of learning style) to use responsive strategies compared to directive strategies. In addition, mothers with learning styles that were not consistent with the BAP were more likely to benefit from the intervention if they did not naturally use strategies before the intervention. In contrast, mothers with learning styles that were consistent with the BAP were more likely to benefit from the intervention if they did naturally use strategies before the intervention. Teaching mothers to use responsive strategies results in greater strategy use. Consideration of BAP and mothers’ natural use of language facilitation strategies may inform intervention individualization.
Child social communication outcomes of caregiver-mediated Naturalistic Developmental Behavioral Interventions (NDBIs) remain variable. To address variability of NDBI outcomes, the current study sought to isolate the effects of the instructional strategies of caregiver-mediated NDBIs (i.e., responsive and directive strategies). Participants included 119 autistic children (18-48 months) and their mothers. In this comparative efficacy trial, mothers were randomized to learn one of two sets of language facilitation strategies (responsive or directive). We explored the main effect of strategy type on proximal (joint engagement) and distal (language) outcomes and the extent to which proximal outcomes mediated the effect of strategy type on distal outcomes. Children in the responsive condition had a significantly greater frequency (d=0.13, 95% CI=[0.10, 0.16]) and mean length (d=.80, 95% CI=[0.40, 1.20]) of supported joint engagement states. Children in the directive condition had a significantly greater frequency of coordinated joint engagement states (d= 0.21, 95% CI=[ 0.25, 0.17]) and scores across multiple language assessments immediately after intervention and at follow-up. At follow-up the effect of strategy type on the frequency of spontaneous directed utterances was fully-mediated by coordinated joint engagement (indirect effect= 2.15, 95% CI=[ 3.785, 0.91]). The current study is an initial step in the identification of the active ingredients and mediators of early caregiver-mediated NDBIs for autistic toddlers.
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