Developing and Enhancing Adherence to a Telehealth ABA Parent Training Curriculum for Caregivers of Children with Autism

Abstract

The current COVID-19 pandemic poses unique challenges to the delivery of applied behavior analysis (ABA) services, and there has been a growing demand for evidence-based practices on how to develop a telehealth ABA service model. The current article provides a detailed technological guide on how to develop a telehealth ABA parent training curriculum. Our model also includes a series of brief acceptance and commitment training (ACT) protocols to enhance parental adherence. We provide the details for replicating our telehealth model and also demonstrate its effectiveness. To begin, a step-by-step guide on how to develop this curriculum is presented, as well as protocols used in a 60-day telehealth ABA parent training program. Afterward, we describe a randomized controlled trial design to examine the effectiveness of this protocol. Thirteen families from the southern Illinois region participated in the curriculum before the COVID-19 outbreak. Obtained data indicated training was effective to teach skills, and parents with supplemental ACT material made significantly more progress than those in the control group, t (11) = 2.36, p = .038. Halfway through the training, the outbreak of COVID-19 occurred, and parents in the ACT group were more likely to continue the program, whereas parents in the control group were significantly more likely to postpone their participation, χ 2 = 6.96, p = .008. Social validity measures indicated that parents rated the curriculum favorably. Limitations and suggestions for practitioners are discussed.

Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment

“…Integration of ACT procedures with BPT in ABA parent interventions (Corti et al, 2018 ; Pennefather et al, 2018 ; Yi & Dixon, 2021 ) and Stepping Stone Triple P (Brown et al, 2014 , 2015 ; Whittingham et al, 2014 , 2016 ) have produced significant improvements in children’s behaviors and parents’ well-being. Although limited, these studies show there are multiple advantages in supplementing traditional BPTs with ACT procedures.…”

“…Therefore, it stands to reason that clinicians could use ACT to assist parents in managing aversive private events and to ease the burden of parents implementing their children’s behavior treatment. Second, the directive style used in traditional BPTs may create resistance for parents to follow through with behavioral strategies (Corti et al, 2018 ; Raulston et al, 2019 ; Yi & Dixon, 2021 ). In fact, parents report that support from professionals and parent–professional collaboration, such as mutual trust, shared decision making, and affect–behavior integration, significantly improves intervention outcomes with parents (Raulston et al, 2019 ).…”

“…To date, only two published group studies have used online ACT-based interventions for parents with autistic children (Pennefather et al, 2018 ; Yi & Dixon, 2021 ). Results revealed that combining ABA and ACT produced significant reductions in the parent-reported level of child hyperactivity, increases in parent knowledge, parental adherence, and improvements in children’s prosocial behaviors.…”

“…Thus far, only one online RUBI study (Burrell et al, 2020 ) and four online ACT parent studies (Pennefather et al, 2018 ; Rayner et al, 2016 ; Sairanen et al, 2019 ; Yi & Dixon, 2021 ) have demonstrated significant improvements in children’s behaviors and parental well-being. In addition, research has indicated that combining BPT and ACT improved parent-reported child challenging behaviors, child functional performance, parent confidence, family functioning, and parental conflict and each maintained at 6-month follow-ups (Brown et al, 2014 , 2015 ; Whittingham et al, 2014 , 2016 ).…”

Psychosocial and Behavioural Effects of the COVID-19 Pandemic on Children with Autism and their Families: A Systematic Review and Initial Data from a Multinational Online Survey

“…Others argued for maintaining 1:1 treatment as far as possible, and in-person treatments when needed [56] or even keeping the physical setting where possible [57] while implementing adequate safety procedures [58] . Yi and Dixon [59] provide details on implementations of their telehealth model for ABA, and Nicolson et al [60] added the clients' perspectives to the decisionmaking process by providing a caregiver interview to assess demand for changes in frequency or setting.…”