Community Interventionists' Perspectives Toward Using Parent Coaching

Background: University-based randomized trials demonstrate that parent-mediated early intervention for children with autism spectrum disorder (ASD) results in improved child outcomes across a range of developmental domains, as well as improved parental self-efficacy and treatment engagement (Green et al., 2010; Kasari et al., 2014; Rogers et al., 2012; Wetherby & Woods, 2006). The manner through which interventionists coach parents is a critical component of all parent-mediated interventions. Effective parent coaching requires the therapist to actively teach the parent techniques to improve their child’s development. However, preliminary evidence shows that community therapists infrequently implement parent coaching strategies (Aranbarri, Miller, Stahmer, & Rogers, 2017; Salisbury, Woods, & Copeland, 2009); especially in under-resourced settings. An in-depth understanding of the barriers and facilitators to using parent coaching in community-based treatment settings is a necessary first step towards improving the implementation of this approach in the community.

Objectives: The objective of this community-partnered study is to learn directly from community interventionists working with families of young children with ASD about their experiences with, and perspectives toward, using parent coaching during usual practice. We identified barriers and facilitators to using parent coaching within community-based early intervention (EI), the primary service setting for young children with ASD, in order to inform the development of an implementation strategy toolkit designed to improve the use of parent coaching in EI.

Methods: Semi-structured interviews were conducted with 15 interventionists employed within a publicly-funded EI system, which encourages the use of family-based interventions such as parent coaching. Interview questions asked about the interventionists’ experiences using a specific set of evidence-based parent coaching strategies, barriers and facilitators to using each strategy, as well as attitudes, self-efficacy, and intentions to implement parent coaching. All interviews were audio recorded and professionally transcribed for analyses. Transcripts were analyzed in an iterative process based upon an integrated approach that incorporates both inductive and deductive features, which provides a rigorous and systematic approach to analyzing qualitative data.

Results: Analyses are ongoing. Preliminary results provide important insights into community-based interventionists’ perspectives toward the acceptability and appropriateness of parent coaching. Common themes are consistent with constructs described in the Consolidated Framework for Implementation Research (CFIR: Damschroder et al., 2009) and include barriers related to the outer setting (parental expectations for a direct service model; busy, chaotic, and challenging home environment) and inner setting (inconsistencies in treatment approach across interventionists), as well as facilitators related to the outer setting (parental buy-in; flexible approach to implementing strategies within home settings), and individual characteristics (interventionist self-confidence). Distinct barriers and facilitators for different coaching strategies were described by interventionists.

Conclusions: This study is one of the first to provide first-hand perspectives regarding community interventionists’ use of parent coaching. The findings highlight the unique challenges to implementing parent coaching within publicly-funded service systems and point to the need to develop strategies to support the widespread implementation of parent coaching within these systems.