Community Implementation of Social ABCs: Program Description, Feasibility, and Acceptability
Objectives: To describe a collaborative effort between the Social ABCs developers and community team to implement Social ABCs with confirmed or suspected ASD in a large community program. Information about the program, sample, training model, referral/service delivery model, feasibility, acceptability, and key factors related to implementation will be described. Effectiveness data will be described in a linked submission (Parent and Toddler Outcomes…).
Methods: Social ABCs is one of four NDBI models involved in a government-funded pilot demonstration initiative underway in Canada. Community implementation took place at Ron Joyce Children’s Health Centre in Hamilton, Ontario, where parents received 12 weeks of one-on-one coaching. Implementation included engagement with community stakeholders to understand local needs. Participants: a) Social ABCs developers ("expert team"): program developer (J.B.), psychologist, lead trainer, and additional trainers; b) Community team: 5 coaches, program coordinator, psychometrist, and psychologist; and c) Family participants: toddlers aged 12 to 30 months and one caregiver. Training/supervision: A positive and collaborative training approach included: a) week-long workshop (didactic, practice, video review); b) training phase (direct implementation, coaching supported by lead trainer); and c) ongoing training/supervision by lead trainer tapering over time (onsite/video review in individual/group format) and expert team (via Telemedicine). Evaluation: Caregivers completed a Caregiver Diary and satisfaction survey. Fidelity measures for caregivers and coaches were obtained, as well as child responsivity to parents’ prompts. Implementation facilitators were recorded during supervision sessions.
Results: Five front-line staff ("coaches") have been trained; mean time for fidelity of implementation and coaching was 119 days. Mean supervision hours during training was 4.8 hours/week per coach. To date, of the 215 toddlers referred, 159 have been enrolled (111 boys, 48 girls); age range: 15-34 months (M age = 25.4 months, SD = 4.16). Of 159 enrolled, 109 completed, 18 still completing, 23 waiting, and 9 dropped out. Caregivers reported child improvements, and child responsivity doubled from week 1 to 12 (from 33% to 66%). Caregivers reported increased adherence and competence, and 93% achieved the pre-established rate of 75% fidelity by weeks 8-12. Caregivers reported high satisfaction. Engagement of community stakeholders led to improvements in internal and external referral processes, including decreases in age at time of referral (from M = 30.8 to M = 22.7 months) and earlier referral for diagnostic assessment. Drivers of success included a careful and collaborative planning approach, shared decision-making, consideration of contextual issues, an opinion leader, institutional support, and a program coordinator with clinical training.
Conclusions: The Social ABCs intervention was successfully implemented in a large community program. Parent coaches achieved fidelity in a timely manner, caregiver- and child-level improvements were obtained, with positive feedback from coaches, caregivers and community partners. Findings highlight the feasibility and acceptability of the Social ABCs for implementation within a community service-delivery model.