Parent Training for Medicaid-Enrolled Families of Children with ASD

Background: Parent training, in which providers teach parents to address their child’s maladaptive behavior or skill development, is considered best practice in the treatment of autism spectrum disorder (ASD). However, it is underutilized in community settings, particularly for traditionally underserved families of children with ASD.

Objectives: Little is known about the use of parent training with families from lower-resourced backgrounds. The present study utilized Medicaid claims data and a survey of applied behavior analysis (ABA) providers to describe the parent training service use landscape for children receiving ABA services through the Michigan Medicaid Autism Benefit.

Methods: Six months of Medicaid claims for 879 youth receiving the Autism Benefit in a 12-county region were examined to determine the number of encounters of ABA parent training received per child. Child characteristics (age, gender, race, and ethnicity) were examined as potential predictors of number of parent training encounters. ABA providers who service Medicaid-enrolled children with ASD (n = 97) were asked to provide a written description of parent training, and then asked to report how frequently they provide parent training for an average client per month and the content of their parent training sessions. Content analysis was used to code provider descriptions of parent training.

Results: Youth received an average of 1.5 parent training sessions (range 0-19 encounters), which was less than 2% of the total number of ABA encounters that they received. Only 1.6% of children received at least 8 encounters (consistent with lower intensity evidence-based models), and 44.9% received no encounters. Gender and racial minority status were not associated with number of parent training encounters, but Hispanic/Latino ethnic status and age were; thus, these two predictors were entered into a multiple regression model. The model was significant (R² = .01, F (2,876) = 4.49, p = .012), with Hispanic/Latino status predicting fewer parent training encounters (β = -.069, p = .043) and younger age predicting more (β = .077, p = .023).

The majority of providers reported delivering 1-2 encounters of parent training per month (74.2%). Providers reported that the content of their parent training sessions primarily included principles of ABA (90.8%), communication skills (87.8%), self-care skills (85.7%), and play skills (70.4%). When defining parent training, most providers described it as an opportunity to discuss the child’s progress with caregivers or to provide psychoeducation. Providers infrequently mentioned the use of evidence-based strategies like modeling an intervention strategy or providing time for caregiver practice with feedback.

Conclusions: Parent training is infrequently provided to this population, with younger children receiving significantly more sessions. Hispanic/Latino individuals received significantly less parent training sessions, possibly due to language and cultural barriers. Providers reported a substantially higher rate of parent training than what was reflected in the claims data, with session content targeting a range of relevant skills. Yet providers appear to be largely unaware of evidence-based parent training components and use critical components infrequently; thus, additional pre-service and in-service training is needed to increase community use.