Compass for Hope: Evaluating the Effectiveness of a Parent Training and Support Program for Children with ASD As a Telehealth Tool
The impact of disruptive behaviors in ASD extends to parents and caregivers. Caregivers of children with ASD report higher stress compared to parents of neurotypical children and parents of children from other disability groups (Hayes & Watson, 2013).Research has demonstrated effectiveness of parent focused interventions through rigorous evaluation over the past 30 years (Zisser & Eyberg, 2010). Unfortunately for most families in rural areas, access to interventions that address disruptive behaviors is limited and physical access to services can be a barrier for many families (Bearss et al., 2013; Hodgetts, Zwaigenbaum, & Nicholas, 2015). One solution for access is the use of telehealth technologies to deliver specialized services in real time over a geographical distance (Dudding, 2009; Turner, 2003). COMPASS for Hope (C-HOPE) is an 8-week parent intervention program that was tested via telehealth (TH) and face-to-face (FF) delivery and is adaptable to rural settings. Developed from an existing framework called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble & Dalrymple, 2002), C-HOPE showed preliminary effectiveness. when comparing pre- and post-ratings of parent stress, parent efficacy, and problem child behaviors with a wait-list control (Rodgers, Ables, Ruble, Kuravackel & Reese, 2015).
The purpose of this study was to establish the efficacy of C-HOPE with families of children with ASD (ages 3 to 12) and its effectiveness as a tele-health tool to support families of children with ASD in underserved communities. Adaptive child behavior (Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999), parent self-efficacy (Being a Parent Scale (BPS; Johnston & Mash, 1989), and parenting stress (Parental Stress Index - Third Edition (PSI; Abidin, 1995) were evaluated using a pretest-posttest partially nested design and outcomes were evaluated based on type of delivery format (telehealth vs. face to face).
Participants were assigned to one of three conditions: waitlist control (WLC; n = 10), C-HOPE delivered via TH (n = 10), and C-HOPE delivered FF (n= 13). FF was delivered over 4 cohorts and TH was delivered over 3 cohorts.
Due to the partially nested design and small number of cluster (therapy groups) a multilevel modeling approach for handling partial nesting could not generate stable results; therefore, single-level analyses were conducted correcting for the non-independence using the Type = Complex option in Mplus to get unbiased estimates of the inferential statistics. Analyses of pretest-posttest differences showed significant improvement in all three outcomes (see Table 1).
Planned comparison analyses of differences on outcomes using pretest scores as a covariate (see Table 2) showed those in the TH condition had significantly lower adjusted child behavior posttest (ECBI) scores than those in the WLC condition (d = 0.99). The combined treatment modality (TH+FF) had significantly better child behavior outcomes (ECBI) than the WLC. condition. Small to moderate effect sizes were obtained on parent efficacy (BPS) and parent stress (PSI).
C-Hope shows promise as a parent intervention that targets child behavior, parent skill and stress. Moreover, preliminary data suggest that C-Hope can be delivered effectively using telehealth technology.