Provider Feedback on the Integration of Parent Engagement Strategies into an Evidence-Based Parent Coaching Intervention for Toddlers at-Risk for ASD

Background: State-of-the-art evidence-based treatments for children with autism spectrum disorder (ASD) include parent coaching interventions (e.g., Schreibman et al., 2015) that require active parent participation. One implementation challenge with parent coaching interventions is community providers’ level of training and comfort working directly with parents (Bailey et al., 1992). Little is known about how providers perceive training specific to parent engagement, in particular as part of an intervention for children with ASD.

Objectives: To use mixed-methods to characterize both agency trainer and therapist perspectives on parent engagement strategies integrated into a parent coaching intervention, Project ImPACT for Toddlers (PI^T; Stahmer et al., 2016), within a community-based train-the-trainer pilot study. The engagement strategies, referred to as Alliance, Collaboration, and Empowerment (ACEs), were adapted from a toolkit designed for child mental health services (Haine-Schlagel et al., 2016).

Methods: Fifteen community agencies serving toddlers with ASD each identified an agency leader to learn PI^T and become an agency trainer (n=14), who subsequently trained interventionists (n=24) within their agencies. Trainers were 21% Hispanic/Latinx; interventionists were 29% Hispanic/Latinx. 29% of trainers and 33% of interventionists had a special education credential. Training was delivered over 12 weeks and included two sessions focused on ACEs. After an additional three months utilizing PI^T independently, trainers and interventionists received an intervention feedback survey (1=strongly disagree to 5=strongly agree) and were invited to participate in an interview. The survey and interview guide questions specifically about ACEs are the focus of this study. Quantitative data were analyzed using SPSS; qualitative data were coded using an iterative grounded theory approach (Glaser & Strauss, 1967).

Results: The four ACEs survey items were combined into one attitudes score (Cronbach’s alpha=.82; higher scores more positive). Overall, attitudes were positive (M=4.06; SD=.66). Demographic and background characteristics of trainers and interventionists were examined as predictors of ACEs attitudes. Provider age and ethnicity were not associated with attitudes. Experience working with children with ASD had a modest positive association (r=.34) and caseload had a modest negative association (r=-.39), but neither were statistically significant. ACEs attitudes did not vary for trainers versus interventionists, but providers with a general background (child development, early intervention) had significantly more positive ACEs attitudes (p=.041) compared to providers with a specialist background (SLP, PT, OT). Interview results indicated both trainers and interventionists agreed on the usefulness of the ACEs, their appropriateness for providers, and reported some sustainment in current practice. Trainers indicated high acceptability of ACEs and appropriateness for parents, and suggested placement of ACEs information earlier in training.

Conclusions: Results indicate that across service roles, providers consider training on parent engagement strategies to be useful and generalizable. Providers in supervisory positions had more positive attitudes about engagement strategies in their interviews but not in the survey data. Survey results preliminarily suggest that background (generalist versus specialist) may play a role in readiness to receive training on parent engagement strategies. Future research should examine whether provider use of parent engagement strategies improve both parent engagement and child outcomes.