Community Implementation of Social ABCs: Program Description, Feasibility, and Acceptability

Poster Presentation
Thursday, May 2, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
I. Drmic1, J. A. Brian2, C. Roncadin1, C. Shaver3, E. M. Dowds4, A. Solish2, L. Conry5, M. Pase5, K. Paul5, N. Rugajs5, C. Calinescu5, L. Zwaigenbaum6 and S. E. Bryson7, (1)Autism Spectrum Disorder Service, McMaster Children's Hospital - Hamilton Health Sciences, Hamilton, ON, Canada, (2)Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada, (3)Hamilton Health Sciences, Hamilton, ON, Canada, (4)Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital-Autism Research Centre, Burlington, ON, Canada, (5)Ron Joyce Children's Health Centre, Hamilton, ON, Canada, (6)University of Alberta, Edmonton, AB, Canada, (7)Dalhousie University, Halifax, NS, Canada
Background: Naturalistic Developmental Behavioral Interventions (NDBIs) have been shown to be effective in toddlers with confirmed or suspected ASD in well-controlled research settings. The Social ABCs is an evidence-based caregiver-mediated NDBI involving in-home live-coaching for toddlers. Next steps involve implementation in community settings.

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.