A Mixed Methods Approach to Understanding Community Providers’ Implementation of an Evidence-Based, Parent-Mediated Intervention

Background: Despite best practice recommendations for parent involvement in intervention for young children with ASD, parent-mediated interventions (PMIs) are highly under-utilized in community settings. A better understanding of factors that influence providers’ implementation of PMIs is important for the development of successful training models. Research in other fields suggests a number of factors that influence implementation of evidence-based practices for young children, including provider self-efficacy, attitudes, and perceived barriers.

Objectives: The aim of the current study is to better understand factors that influence community providers’ implementation of Project ImPACT, an evidence based PMI, using a mixed methods approach.

Methods: Ninety-two providers completed a follow-up 6 to 24 months after attending multi-day Project ImPACT workshops (response rate=24%). Providers reported whether or not they implemented Project ImPACT and rated their self-efficacy in using the program as a PMI. They completed questionnaires about attitudes towards and perceived barriers in their use of Project ImPACT. Finally, providers responded to open-ended questions about how they implemented the program, any modifications they had made, and characteristics of families for whom it was most and least helpful.

Results: Forty-four providers (48%) reported that they had implemented Project ImPACT as a PMI (group=5, individual=26, both=13). Of the 48 providers who did not implement Project ImPACT as a PMI, 31 reported implementing in other ways (direct intervention=17, used some components=8, telehealth=1). Implementers did not differ from non-implementers on demographic characteristics other than profession (χ²=15.40, p=.017); SLPs were more likely to implement the intervention (p<.05), while social workers were less likely (p<.05).

Point-biserial correlations examined the relationship between implementation and provider self-efficacy, attitudes, and perceived barriers. Self-efficacy (r=.396, p<.001) and positive attitudes towards Project ImPACT (r=.271, p=.013) were positively correlated with implementation; perceived barriers (r=-.329, p=.004) were negatively correlated with implementation. Correlations also examined the relationship between individual barriers and implementation. Of the 18 potential barriers, 7 were significantly associated with program implementation (see Table 1).

An analysis of open-ended responses suggested that providers who implemented the program made a number of modifications, including alterations to intervention content (n=7), length of the program (n=24), and session format (n=4). Providers also reported making changes to core components, including collaborative goal setting (n=5) and homework (n=8). Two providers indicated they did not provide coaching. Providers thought the intervention was most helpful for parents with who were motivated (n=19), had adequate time to devote to the program (n=14), and have children with low attention and engagement (n=8); they indicated it was least helpful for parents with limited time (n=15), high stress (n=11), and other children (n=8).

Conclusions: Self-efficacy, barriers to program use, and provider perceptions of Project ImPACT were all significantly related to implementation as expected. There were also family characteristics, such as time, motivation, and stress, which influenced the successful use of the program. We can modify the development of EBPs and alter trainings to best support providers going forward by creating more intensive trainings, planning for common barriers to program use, and improving strategies for engaging and supporting parents.