Background Intervention during the first years of life for children with autism spectrum disorder (ASD) may have the strongest impact on brain development, behavior and long-term functioning. Yet, barriers such as a shortage of trained professionals contribute to significant delays in service. The goal of this proof-of-concept study was to explore strategies that support timely and equitable deployment of ASD-specific interventions. Methods We conducted a 15-week, randomized control trial (RCT) comparing a stepped-care model (i.e. parents first used an interactive website, and then received parent coaching if warranted) of Online Reciprocal Imitation Training (RIT; a naturalistic developmental behavioral intervention) versus a waitlist control condition (WLC). To be eligible, children had to be between 18 to 60 months, meet the cutoff for ASD on the Autism Diagnostic Observation Schedule-2 Edition and demonstrate significant social imitation deficits. Primary outcome measures included child imitation skills (Unstructured Imitation Assessment (UIA)), parental self-efficacy (Early Intervention Parenting Self-Efficacy Scale (EIPSES)), and parent fidelity (RIT Parent Fidelity Form (RIT-PFF)) to the intervention. Secondary outcome measures included child social communication (Social Communication Checklist (SCC)) and family quality of life (Beach Center Family Quality of Life Scale (FQOL)). Results Twenty participants were randomized in a 1:1 fashion, after participant drop out, eight were in the WLC and seven were in Online RIT. Among the primary outcomes, there were significant group differences and improvements in parent fidelity (p= .000), self-efficacy (p=.029), and ratings of child social communication (p=.048) in Online RIT relative to wait-list controls. There was no significant difference of improvement in imitation ability (p=.05) or family quality of life (p=.220)Limitations There are several limitations with this study, including the small sample size, lack of enactment data, and a lack of website engagement data. The WLC design limits the strength of the conclusions that can be drawn.Conclusions Overall, the novel use of stepped-care telehealth shows strong acceptability and holds promise as an innovative delivery model.Trial Registration Trial Registration: ClinicalTrials.gov, NCT04467073. Registered 10 July 2020- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04467073