27943
Fidelity with Flexibility: Implementing Evidence-Based Interventions to Enhance Child Outcomes through Telehealth Parent Training
In recent years, advances with telehealth technology have improved the opportunity for families of children diagnosed with Autism Spectrum Disorders (ASDs), living in areas with resource shortages, to collaborate with providers. As this distance consultation model becomes more prevalent, clinicians must adapt their service delivery repertoire to incorporate a fidelity with flexibility approach to training a parent acting in the role of practitioner. Best practices for children with ASD indicate that interventions must concurrently target decreasing challenging behavior which impair functioning and increasing the child’s adaptive and functional repertoire. When utilizing telehealth technology, it is essential that added emphasis be placed on developing interventions which embed family and cultural values into evidence-based treatment. This will lead to culturally-sensitive interventions which incorporate variables that are meaningful to the family’s values, and consequently improve child functioning within their cultural context.
Objectives:
The efficacy of telehealth-delivered, evidenced-based methodology on interfering and functional adaptive behaviors for children diagnosed with ASD using a parent training model was evaluated. Modifications made to the implementation of best-practice strategies to match the needs of families and educators in a manner that maintains the integrity of evidence-based services are also discussed.
Methods:
Telehealth consultation was delivered to parents of three school-aged children (ages 5, 10, and 15) with ASD to manage disruptive behavior and teach appropriate, functional skills in response to child-specific adaptive challenges. The families were located in Europe and Asia with participants living in England, Norway, and Sri Lanka. Regularly-occurring telehealth consultations provided the parents with training by a clinician via didactic instruction with role plays/review of video, development of protocols for parent practice and electronic sharing of data. Data were collected by the parents on interfering behaviors and replacement responses.
Results:
Participant 1's avoidant feeding behavior decreased from 100% of trials met with refusal when target foods were presented at baseline to 3% of trials met with refusal after intervention. Additionally, his repertoire of food consumed increased by 25 foods with intervention. For participant 2, the weekly average of episodes of aggressive behavior decreased by total of 77%, from 3 episodes per week at baseline to <1 episode per week after intervention. Participant 3, demonstrated a decrease in voiding accidents from 48 per week at baseline to 7 per week after intervention and increased the frequency of initiation requests from 0 per week at baseline to 34 per week following intervention.
Conclusions:
Parent training delivered through telehealth was an effective intervention in reducing interfering behaviors and increasing parent-identified adaptive responses. Additionally, as the child’s interfering behaviors decreased, their availability to access family and community-based activities increased. Following the reduction in interfering behavior, intervention for each participant was advanced to incorporate assessment of additional adaptive skills and develop instructional protocols that further promoted community participation and family functioning. By incorporating a family’s cultural variables into the development of a strong distance consultation framework, the needs and resources of families were meaningfully embedded into intervention strategies which promoted generalization of successful outcomes and prevented consultative failures.