Feasibility, Acceptability and Effect on Classroom Teaching of Delivering Early Intervention in an Inclusive Setting

Background: A small body of empirical research has focused on the outcomes achieved by young children with ASD in inclusive and specialized settings, providing mixed results. Little experimental research addresses whether early intervention for pre-schoolers with ASD is feasibly delivered in inclusive settings (vs. established autism-specific settings) and whether such delivery would be acceptable to families and staff and not detrimental to the quality of classroom teaching for all children.

Objectives: In the context of a pilot randomised controlled trial, whereby we assigned pre-schoolers with ASD to receive the Group-Early Start Denver Model (G-ESDM; Vivanti et al., 2017) within either mainstream inclusive classrooms or specialised autism-specific classrooms, we took a number of measures to evaluate classroom- and teacher-level outcomes. These served to inform the feasibility and acceptability of delivering G-ESDM in inclusive setting.

Methods: Twenty-nine pre-schoolers with ASD (aged 18-36 months) were randomly assigned to receive G-ESDM intervention across the 2015 and 2016 school calendar years in an Autism-Specific classroom or an inclusive classroom with mostly typically-developing children. Educators in both settings were supported to implement the G-ESDM through participation in a three day ESDM skills training workshop and ongoing coaching delivered in the classrooms by Senior ESDM therapists (certified for more than 5 years) and ESDM Trainers. Feasibility, acceptability and effect on classroom teaching quality was measured by examining the degree of fidelity to the ESDM achieved by key staff implementing the intervention within each setting, and by comparing blind-rated Sustained Shared Thinking and Emotional Well-Being (SSTEW; Siraj, Kingston, & Melhuish, 2015) scores across each setting, and against the current local benchmark within Australia.

Results: Average ratings for ESDM fidelity in the Specialized Setting exceeded 80% in both calendar years and, in the Inclusive setting, exceeded 72% in 2015 and 76% in 2016. Results from the SSTEW indicated that teaching quality in the classrooms was classified as ‘good’ overall, across both the Inclusive and Specialized settings. Subscales scores varied from ‘adequate’ to ‘excellent’ with no substantive differences between Settings on any indicator. The overall ratings were well above the benchmark reported across 54 local Australian early childcare centres.

Conclusions: Data from this pilot RCT highlighted that delivery of G-ESDM to children with ASD within inclusive early childhood education settings is, 1) feasible, acceptable and not detrimental to the quality of the general classroom teaching and learning environment, and 2) able to be successfully adopted by inclusive early childhood educators with ongoing support from Senior Certified therapists and ESDM trainers. Further research on this topic should include measures of 1) staff and management attitudes to inclusive education and to working with children with ASD, 2) staff buy-in to the particular model of early intervention adopted and to the training program provided, , and 3) staff well-being in the work place. These would advance knowledge on the feasibility and considerations for the effective implementation of early intervention training for staff working with children with autism in inclusive settings.