Feasibility of delivering parent-implemented NDBI interventions in low-resource regions: a pilot randomized controlled study

Abstract

Background This implementation feasibility study was conducted to determine whether an evidence-based parent-implemented distance-learning intervention model for young children at high likelihood of having ASD could be implemented at fidelity by Part C community providers and by parents in low-resource communities. Methods The study used a community-academic partnership model to adapt an evidence-based intervention tested in the current pilot trial involving randomization by agency in four states and enrollment of 35 coaches and 34 parent-family dyads. After baseline data were gathered, providers in the experimental group received 12–15 h of training while control providers received six webinars on early development. Providers delivered 6 months of intervention with children-families, concluding with data collection. Regression analyses were used to model outcomes of the coach behaviors, the parent fidelity ratings, and child outcomes. Results A block design model-building approach was used to test the null model followed by the inclusion of group as a predictor, and finally the inclusion of the planned covariates. Model fit was examined using changes in R2 and F-statistic. As hypothesized, results demonstrated significant gains in (1) experimental provider fidelity of coaching implementation compared to the control group; and (2) experimental parent fidelity of implementation compared to the control group. There were no significant differences between groups on child developmental scores. Conclusions Even though the experimental parent group averaged less than 30 min of intervention weekly with providers in the 6 months, both providers and parents demonstrated statistically significant gains on the fidelity of implementation scores with moderate effect sizes compared to control groups. Since child changes in parent-mediated models are dependent upon the parents’ ability to deliver the intervention, and since parent delivery is dependent upon providers who are coaching the parents, these results demonstrated that two of these three links of the chain were positively affected by the experimental implementation model. However, a lack of significant differences in child group gains suggests that further work is needed on this model. Factors to consider include the amount of contact with the provider, the amount of practice children experience, the amount of contact both providers and parents spend on training materials, and motivational strategies for parents, among others. Trial registration Registry of Efficacy and Effectiveness Studies: #4360, registered 1xx, October, 2020 – Retrospectively registered, https://sreereg.icpsr.umich.edu/sreereg/

Remote Intensive Parent-Implemented Intervention for Young Children on the Autism Spectrum During Covid-19: The Experience of Parents and Therapists

“…The need for more accessible service provision was emphasized in de Nocker and Toolan's 2021 systematic review of telehealth intervention for autism 10 , where they suggest that in order to reach more families, and in particular underserved communities, we need to be open to more flexible telehealth solutions. 10,[29][30][31] Video-conferencing consultations have shown to reduce commute and waiting room time, and allow the professional to work in the natural context of the home, albeit virtually, instead of a clinic setting. 9,32 In the current study, both parents and therapists brought up the benefits of having frequent "in-home visits", describing how working on skills in the environment, where they typically take place, allowed them to better understand the strategies.…”

“…As de Nocker and Toolan's systematic review of telehealth autism services suggests, 9 increased accessibility, in particular for underserved communities, requires us to be open to flexible intervention solutions. 9,15,16,26,27 Importantly, delivering services via videoconference allows professionals to work in the natural context of the child's home, albeit virtually, instead of a clinic setting. 6,28 Our programs had always provided in-person home visits, however, due to commuting time, only at an average rate of once-a-month.…”

“…17 Researchers have begun to turn their attention to understanding how high-quality, evidenced-based practices, proven to work in clinical autism research settings, can be adapted to work in real-world community settings. [14][15][16]18 The COVID-19 stay-at-home home orders created a situation where families, from all walks of life, would have the chance to participate in telehealth autism intervention programs, allowing us to measure the feasibility of providing these services to caregivers from a wider demographic.…”

“…2,10,11 Less is known about how working parents, fathers, families with lower socioeconomic status or families from diverse cultural backgrounds experience these autism services. [15][16][17] This has meant that the majority of caregivers who could potentially benefit from PII services are not well represented in the literature. 11,17 Researchers have begun to look at how evidence-based practices, proven to work in clinical autism research settings, can be adapted to work in diverse community settings.…”

“…Research has, until recently, tended to study parent coaching with volunteers who were typically white, college-educated mothers, and not employed outside the home (Ellison et al, 2021; Ingersoll & Berger, 2015; Vismara et al, 2018). Less is known about how working parents, fathers, families with lower socioeconomic status or families from diverse cultural backgrounds experience these autism services (Mirenda et al, 2022; Rogers et al, 2022; Stahmer et al, 2019). This has meant that the majority of caregivers who could potentially benefit from PII services are not well represented in the literature (Ingersoll & Berger, 2015; Stahmer et al, 2019).…”