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As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommen...
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Background
Self-directed web-based parent-mediated intervention programs may help counter some barriers associated with access to evidence-based practices.
Methods
The current study is a systematic review of 14 studies that included parent-mediated intervention programs for children with Autism Spectrum Disorder (ASD), reported on child outcomes,...
Citations
... Further, because parents can implement intervention even when the provider is not present (Rocha et al., 2007), children may receive a greater intervention dosage relative to cliniciandelivered treatment. Moreover, parent coaching may be especially helpful for families of low-income backgrounds, who often receive fewer hours of early intervention services than higher income families (Aranbarri et al., 2021). ...
Background:
Parent coaching is an evidence-based practice for young autistic children, but it is underutilized in lower-resourced community settings like the Medicaid system (Straiton et al., 2021b). Clinicians often struggle to implement parent coaching with low-income and marginalized families (Tomczuk et al., 2022), but little is known about which factors influence clinician decision making processes about providing parent coaching to this population.
Methods:
This qualitative analysis used the framework method and thematic analysis. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (Aarons et al., 2011) to identify factors in the clinical decision-making process that community providers use when offering parent coaching to families of Medicaid-enrolled autistic children. Interviews with 13 providers and a focus group with 13 providers were analyzed.
Results:
The following themes emerged: 1) Policies drive provider task priorities and affect competing demands; 2) Providers are more likely to use parent coaching when agency leaders monitor parent coaching benchmarks, though this is rarely done; 3) Logistical factors like scheduling and treatment location affect perceived feasibility of using parent coaching; 4) Previous experience or coursework in parent coaching and/or family systems supports the quality of parent coaching implementation; 5) Provider perceptions of "parent readiness" are initially indicated by overt expressions of parent interest.
Conclusions:
In the absence of outer-context and inner-context policies, providers have more decision-making power to offer parent coaching based on their own judgements and preferences, which may result in fewer families being offered parent coaching and increased bias related to which families are offered this service. State-, agency-, and clinician-level recommendations are provided for increasing equitable provision of this evidence-based practice for autism.
... Research studies for young children with communication difficulties often report activity-based outcomes (Kwok et al., 2022) which target the child's overall communication skills, raising the possibility that NDBIs do not adequately address family-centered goals. Furthermore, autistic children often experience difficulties in many domains of development and functioning (e.g., sleep, emotional and sensory regulation; (Aranbarri et al., 2021), and EI providers may need to help families gain access to information to best support children in these domains. A greater understanding of the skills, behaviors, and developmental domains discussed by caregivers and EI SLPs will elucidate the role of NDBIs in addressing the wide range of needs EI providers must address with their autistic clients and their families, and may facilitate the use of more clinically-relevant outcome measures to be used in future studies. ...
... Furthermore, caregivers report difficulties supporting their child's development and functioning in many non-communication related domains. For example, in a recent study of caregiver and provider needs in EI, over 80% of caregivers of autistic children reported concerns about their child's sleep, behavior, and sensory patterns (Aranbarri et al., 2021). Therefore, it is likely that SLPs in the current sample discussed such domains in order to best build caregiver capacities to support their child's needs. ...
Purpose
Naturalistic developmental behavioral interventions (NDBIs) have demonstrated initial promise in facilitating social communication development for autistic toddlers, but their highly structured protocols may be a barrier toward their use by early intervention (EI) providers who must individualize intervention according to family-centered principles. This study aimed to characterize the extent to which EI speech-language pathologists (SLPs) use NDBI strategies, and the range of skills and behaviors addressed during their EI sessions, to contextualize the role of NDBIs within the scope of needs of families with autistic children in EI.
Method
This observational study included 25 families with an autistic toddler and their EI SLP. One home-based session was recorded for each family, and an observational measure was used to describe SLPs' NDBI strategy use. Qualitative content analyses were also used to characterize the strategies SLPs recommended to families, and the child skills and behaviors they discussed.
Results
SLPs did not implement NDBI strategies with high quality, but they implemented developmental NDBI strategies with significantly higher quality than behavioral NDBI strategies. SLPs discussed many strategies and skills across disciplines within the session.
Conclusions
SLPs may require further training to implement NDBI strategies, but given the breadth and depth of skills addressed during sessions, researchers should investigate and report on the impact of NDBIs on a wider range of communication skills and developmental domains. This will facilitate clinical decision making and make these interventions better aligned with family-centered EI principles.
Supplemental Material
https://doi.org/10.23641/asha.21834480
Lay abstract:
Early Intervention systems provide therapeutic services to families of young children birth to 3 years with developmental delays and are considered a natural access point to services for young children and their families. Research studies in the autism field have been interested in training providers to deliver evidence-based practices in Early Intervention systems to increase access to services for young children with an increased likelihood of being autistic. However, research has often overlooked that Early Intervention systems prioritize family-centered care, an approach to working with families that honors and respects their values and choices and that provides supports to strengthen family functioning. This commentary points out that family-centered care deserves greater attention in research being done in Early Intervention systems. We describe how family-centered care may shape how interventions are delivered, and discuss directions for future research to evaluate the impact of family-centered care alongside intervention delivery.
Purpose
Family-centered practice (FCP) is a core component of early intervention (EI) associated with improved child and family outcomes, but little is known about community-based speech-language pathologists' (SLPs') inclusion of families in EI. Many caregivers of autistic children experience caregiving-related stress, making these intervention principles especially critical to the provision of optimal services. This study aimed to characterize EI SLPs' use of FCP coaching strategies and the quality of caregiver–SLP relationships.
Method
Participants included 25 families with an autistic toddler and their EI SLP. One intervention session for each SLP–family dyad was recorded and coded for the SLP's use of FCP coaching strategies. Caregivers and SLPs completed surveys about their working alliance, caregiver perceptions of family-centered care, and SLPs' approach to FCP.
Results
SLPs primarily use child-directed strategies without caregiver involvement. When involving caregivers, SLPs infrequently use coaching strategies that are important for caregiver learning and collaboration (e.g., joint planning and guided practice with feedback). However, caregivers perceived their child's services to be highly family-centered, and caregivers and SLPs rated their working alliance to be of high quality.
Conclusions
The presence of strong caregiver–SLP working alliances alongside infrequent usage of effective coaching strategies indicates that SLPs may engage caregivers in ways that are perceived to be highly collaborative but are not optimal for caregiver involvement in all aspects of their child's services (goal setting and implementation of intervention). Consideration of family preferences and SLP beliefs about FCP will inform ways to disseminate FCPs needed to optimize families' capacities to support their child's development.
Supplemental Material
https://doi.org/10.23641/asha.20113550
