Strategies to Engage Underrepresented Parents in Child Intervention Services: A Review of Effectiveness and Use

Background: Parent involvement is considered to be a key ingredient in successful interventions for children with autism spectrum disorders (Benson, et al., 2008). Effectively engaging parents in their child’s treatment contributes to improvements in the child’s symptoms, parent-child interactions, and family functioning (Dowell & Ogles, 2010; Haine-Schlagel & Walsh, 2015). Engaging parents from traditionally underrepresented families is particularly important, as children and families from ethnic minority backgrounds are less likely to engage in services (Dickson, et al., 2017), and retention in parent training programs is lower among parents from ethnic minority and low income households (Chacko et al., 2016; Kazdin & Whitley, 2003). Little is known about which strategies are most effective in engaging underrepresented families, many of whom are at high risk for poor treatment outcomes. Information about how strategies are routinely combined to support parent engagement is still emerging (Michie, Fixsen, Grinshaw & Eccles, 2009), but could provide valuable insight into how engagement strategies can be delivered in combination to enhance parent engagement.

Objectives: To estimate the impact of parent engagement strategies in improving engagement among underrepresented (i.e., minority race or ethnicity and/or low income) families of children with ASD and related social, emotional, or behavioral disorders, and to describe the combinations in which these strategies are commonly used together.

Methods: A systematic literature review of parent engagement strategies with underrepresented families of children with ASD and related disorders was conducted. The PracticeWise Engagement Coding System was used to identify which strategies had the strongest empirical support for engaging underrepresented families receiving psychosocial services for their children. Linear regression was used to estimate the impact of each strategy on parent engagement, using attrition as a proxy for non-engagement. Social network analyses were used to identify the frequency of strategy use and how strategies were combined to engage underrepresented families.

Results: Thirty-five studies met inclusion criteria for the review. Less parent attrition was predicted by interventions that were based in the community or home (vs. in a clinic), less therapist monitoring/positive reinforcement from therapists, and more pairing of parents with peers for guidance and support. Social network analyses found that more effective strategies were more frequently implemented alone and less effective strategies were commonly combined with each other.

Conclusions: Findings point to the need for more community-based intervention trials for children with ASD that explicitly report on measures of parent engagement, development of implementation measures to better characterize the quality of engagement strategies, and the need to better understand how income and education level may interact with the use of engagement strategies and outcomes. Multiple aspects of parent engagement (e.g., participation, attendance, retention) should be examined as potential mediators and moderators of treatment outcome. As parent-mediated intervention techniques become more common, there is an urgent need to explicitly measure and discuss the contributions of combining parent engagement strategies and practices.