The Impact of Community-Implemented Esdm on Parents' Ratings of Parenting Reward and Providers' Sense of Competence

Background: Infants and toddlers at-risk for ASD frequently receive early intervention through federally regulated Part C services, which typically address family needs and general developmental and heath needs of children via transdisciplinary assessment and parent guidance, rather than disability-specific interventions. While research studies have demonstrated positive effects for parent-implemented ASD-specific interventions, none of these empirically supported approaches have been adapted and tested in existing community Part C service systems. A randomized controlled trial analyzing the efficacy of one such model, Community-Early Start Denver Model (C-ESDM), is currently underway to fill this gap. Here, we examine the effects of this model on the providers receiving training and on the families being served.

Objectives: To evaluate the effects of C-ESDM on 1) parents’ ratings of parenting reward and child developmental progress, and 2) community-based early intervention providers’ sense of competence.

Methods: Agencies and providers serving toddlers at-risk for ASD in low resource communities were recruited across 4 states: Alabama, California, Colorado, and Pennsylvania. Participating providers assisted with recruitment of families on their caseload. Agencies were randomly assigned to receive training in C-ESDM or a general developmental education program. The research team used telehealth to disseminate intervention materials to providers in both groups. Training consisted of: (1) provider webinars (general review of child development for the control group and training in C-ESDM strategies and autism for the experimental group); and (2) access to web-based materials for families (videos describing strategies to encourage general child development across domain areas for control group or a smartphone app, called Help is in Your Hands with multimodal materials to help parents implement key features of the C-ESDM at home). At intake and exit (6 months), providers completed a Sense of Competence Scale (PSOC) and parents completed Ratings of Parenting Reward (RPR) and Parent Rating of Child Progress (PRCP).

Results: To date, 32 providers (19 C-ESDM) and 33 parents (19 C-ESDM) have completed data for at least one time point (Provider: T1 n = 31; T2 n = 9; Parent: T1 n = 31; T2 n = 9). Preliminary findings suggest no differences between the randomization groups at baseline on any measure (PSOC, RPR, PRCP, all p’s >.4). There are no significant main effects of time for any measure (all p’s >.1), but non-significant differences between the groups over time in the expected direction (more positive improvements for C-ESDM group) are observed for the PSOC and PRCP measures. Time 2 data are expected to be available for all 32 providers and 33 families prior to the meeting.

Conclusions: These preliminary findings highlight the need to consider the effects on practitioners and parents when adapting laboratory-based empirically-validated interventions for use in existing early intervention service systems. Positive effects of an adapted intervention on providers and parents will support implementation and sustainment of evidence-based strategies in the community.