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 up to 12 hours of training while control providers received six webinars on early development. Six months of intervention with children-families then followed, 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 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 in child developmental scores. Conclusions: Even though the experimental parent group averaged less than 30 minutes weekly with providers in the 6 months, both providers and parents demonstrated statistically significant gains 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, lack of significant differences in child group gains suggests that further work is needed on this model. Factors to consider include amount of contact with the provider, amount of practice children experience, 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, http://

Training Coaches in Community Agencies to Support Parents of Children with Suspected Autism: Outcomes, Facilitators, and Barriers

“…To address some of these concerns, NDBI researchers have examined the effectiveness of various streamlined approaches for training community-based providers via online instruction (e.g., Rogers et al, 2020;Rooks-Ellis et al, 2020;Vismara et al, 2009), in vivo instruction (e.g., Stahmer et al, 2020), or a combination of the two (e.g., Chang et al, 2016;Shire et al, 2017). Results have been mixed with regard to post-training fidelity.…”

Balancing Fidelity and Flexibility: Usual Care for Young Children With an Increased Likelihood of Having Autism Spectrum Disorder Within an Early Intervention System

“…With this in mind, there has been growing interest to embed early ASD interventions within the EI system (Stahmer et al 2017 ; Vivanti et al 2018 ). Recent research has suggested that, when NDBIs are moved into the EI system, they are perceived as feasible and acceptable by EI providers and may have positive outcomes for families of young children with ASD and social communication delays, even if delivered at somewhat low intensity (Stahmer et al 2017 ; Rogers et al 2020a ). This research has been foundational in building an understanding of how to translate NDBIs into systems naturally positioned to serve both children with a known diagnosis of ASD in addition to children with an increased likelihood of having ASD (Vivanti et al 2018 ).…”

A Randomized, Community-Based Feasibility Trial of Modified ESDM for Toddlers with Suspected Autism

“…Several of these studies found that coaching was effective in improving parent use of ESDM techniques and that child outcomes also improved in one or more domains (e.g., Vismara et al, 2009Vismara et al, , 2012Vismara et al, , 2013Waddington et al, 2021;Zhou et al, 2018). Other P-ESDM research found outcomes in favor of parent change but not child change (e.g., Rogers et al, 2019Rogers et al, , 2020Vismara et al, 2018). Finally, one P-ESDM study found no significant difference between coaching and control groups for either parent or child outcomes (Rogers et al, 2012a, b).…”

“…Another limitation of the current body of ESDM research has to do with the inclusion/exclusion criteria applied to parents. Many studies excluded children whose primary caregiver met one of the following criteria: (a) self-reported substance abuse and/or significant mental illness (e.g., Rogers et al, 2012aRogers et al, , b, 2019; (b) lived farther than a specified distance from the University clinic that housed the study (e.g., Rogers et al, 2014Rogers et al, , 2019; and/or (c) did not meet various criteria for spoken and/or written English language ability (e.g., Rogers et al, 2020;Vismara et al, 2018). While none of these criteria is unreasonable in the context of a research efficacy study, they become untenable when applied to publicly-funded community services where families rightfully expect equitable access regardless of their child's diagnosis, their own language/literacy skills, and their ability to participate with regularity.…”

“…In line with these efforts, Rogers et al (2020) conducted a randomized feasibility trial aimed at addressing the need for preemptive autism supports in low-resourced rural and urban communities. Early intervention providers in participating community agencies were randomized to receive streamlined training in either a modified version of ESDM (called Community ESDM, C-ESDM) or a comparison intervention.…”