Reaching Community Early Intervention Providers in Diverse Communities: Application of Remote Training Supports

Background. Rare disorders and distance from a University medical center can limit access to evidence based early interventions. In order to increase access, remote access with support from experts may be necessary. However, it is not currently known the extent to which remote training mirrors what can be obtained in person.

Methods. We examine data from three community partnered effectiveness-implementation hybrid trials. Studies 1 and 2 were conducted in a center based US early intervention program (Shire et al., 2018; Shire et al., 2019) and Study 3 was a provincial intervention deployment study delivering publicly funded health services in a Canadian Maritime province (Shire, et al in progress).

Intervention & Training. Across studies, children received approximately 3 months of a developmental social communication intervention- Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER: Kasari et al., 2006) from their local providers who were training to achieve implementation fidelity. All trainees received a 5 day intensive introduction to JASPER including discussion, live coached practice, and feedback delivered either by the research team (Study 1&2) or by local senior JASPER trainers who were trained by the same research team (Study 3). Then, due to the geographic distance of the research team and/or local supervisors from the trainees, this was followed by a combination of remote supports including video feedback, clinical supervision calls, and/or real time video conferenced supervision for the remainder of the study.

Participants. Studies 1 and 2 included a diverse sample of toddlers (n= 55/study) and teaching assistants (TAs; n=24/ study) randomized to immediate JASPER intervention. Study 3 included children age 2.0-6.0 years (n=33) paired with 20 community health providers (e.g., speech language pathologists, occupational therapists, psychologists). All children were eligible for community early intervention services based on diagnoses of autism and other rare sensory and genetic disorders (e.g., visual impairment, Down Syndrome).

Measures. Ten-minute interventionist-child interactions at treatment exit were coded for trainee’s JASPER implementation, a total score across 32 items each rated 0-5.

Results. After 3 months of support, all three trainee groups made significant gains over their entry implementation scores demonstrated an average of 80.9%, 72.0%, and 82.51% fidelity respectively. Study 3 allowed for the unique comparison of interventionists who received in person supervision and those who received remote supervision. On average, trainees receiving remote supervision scored 89.17% at exit while those receiving in person support on average achieved 80.29% at exit.

Conclusions. Together, these studies demonstrate that community interventionists of a variety of disciplines can learn to deliver JASPER with high quality through training and supervision methods using primarily remote support strategies. This substantial adaptation to the resource intensive in person supervision previously tested in JASPER clinical trials provides promising evidence for the broader deployment of the intervention model within public early intervention settings including those engaging rural and geographically remote communities.