Parent and Toddler Outcomes from a Wide-Scale Community Implementation of the Social ABCs Parent-Mediated Intervention
Objectives: To evaluate the effectiveness of a parent-mediated intervention for toddlers with confirmed or suspected ASD in a large-scale community implementation.
Methods: Social ABCs parent-mediated intervention is one of four evidence-based models included in a government-funded pilot demonstration initiative currently underway in four regions of Ontario, Canada. The Social ABCs developers (“expert team”) trained 5 front-line staff (“coaches”) to deliver the Social ABCs parent coaching through the Ron Joyce Children’s Health Centre, the regional autism intervention service-provider in Hamilton Ontario (population ~750,000). Coaches attained fidelity of implementation and coaching, and 90 families have completed the 12-week coaching program to date (n > 120 anticipated by April 2019, for presentation at INSAR). To date, 159 toddlers have been enrolled (111 boys, 48 girls); age range: 15-34 months (M age = 25.4 months, SD = 4.16). Data were analyzed for those children who had completed week 12 (n = 90), including video-coded indices (parent implementation fidelity and child's rate of responding to parent-provided language opportunities; "responsivity") and standardized measures (Vineland Adaptive Behavior Scales (VABS) and Autism Diagnostic Observation Schedule-2; ADOS-2). Detailed information about the implementation process (i.e., training, referral/service delivery model, uptake, satisfaction, and acceptability, and other factors related to implementation are described in a linked submission: “Community Implementation of Social ABCs”). All parents received 12 weeks of one-on-one coaching, supported by the Social ABCs parent manual. Data were collected at baseline and weeks 1, 8, 12 (and 24 when available).
Results: Parents achieved implementation fidelity at a mean rate of 68% by week 4, and 80% by week 8, with significant gains compared to baseline (both p’s < .001); for the sub-set who have now completed their week 24 evaluation (n = 59), fidelity remained high (M = 73.76%). By week 8-12, 92.6% of families had achieved the pre-established target rate of 75% fidelity. Child Responsivity increased significantly from week 1 to week 12 (t = 13.32, p < .001). ADOS-2 scores pre-versus post-intervention revealed significant decreases in symptoms in the Social Affect domain (M = 14.3 vs. 11.8; t = 4.89, p < .001), but not the Restricted and Repetitive Behavior domain (p = .15). Standard scores for the VABS Communication domain (but no other domain) increased significantly from baseline (M = 71.0 to 73.4; t = 2.44, p = .02).
Conclusions: Findings demonstrate the successful implementation of the Social ABCs in a large, diverse community setting. Parents learned the techniques and toddlers made gains based on video-coded indices, direct assessment, and parent-reported function. These findings support the effectiveness of parent-mediated intervention for toddlers with confirmed or suspected ASD, and highlight both the scalability and portability of the Social ABCs for implementation within a community service-delivery model.
See more of: Interventions - Non-pharmacologic - Infant, Toddler, and Preschool