Association for Behavior Analysis International

Caregiver-mediated naturalistic developmental behavior interventions (NDBI) are considered an evidence-based practice (EBP) for young autistic children (Sandbank et al., 2020). Caregiver-mediated NDBI result in improved child outcomes across a range of developmental domains, reduced challenging behavior, and improved parental self-efficacy, treatment engagement, and reductions in parental stress. In contrast to university-based studies of caregiver-mediated NDBI, outcomes for children receiving community-based services tend to be poor, especially in low-income communities. Poorer outcomes may be due in part to a lack of caregiver-mediated NDBI in these settings. This symposium will present findings from a series of research studies from publicly funded systems in 3 different states focused on evaluating the implementation and effectiveness of caregiver-mediated NDBI when implemented by community providers. Presentations will provide an overview of training methods, community-informed adaptations to manualized approaches, implementation outcomes, and effectiveness outcomes. Implications for improving the wide-scale implementation of caregiver-mediated NDBI in community-based intervention settings will be discussed.

Audience members should have experience implementing behavioral interventions to young children on the autism spectrum.

Caregiver-mediated early intervention (EI) can improve long-term outcomes for young autistic children. However, studies evaluating caregiver-mediated EI usually involve university-based clinicians working with a select group of families. Few studies examine whether these interventions can be implemented successfully in community-based agencies with culturally and economically diverse families. We partnered with an urban EI system to evaluate whether manualized training procedures are feasible and effective for community-based clinicians. We trained 12 clinicians in a caregiver-mediated intervention and evaluated intervention fidelity and children’s outcomes with 43 families across 6 months. Intervention fidelity was coded from video-recorded EI sessions. Despite training and consultation, fidelity was low. Mean fidelity was 57% (SD = 22%, Range: 11% - 91%), with only 15% of observations above the 80% fidelity benchmark. Higher fidelity was associated with greater gains in children’s social communication skills after 6 months of intervention. The results suggest the need for targeted implementation supports to augment traditional training and consultation models for providers working in community-based agencies, which will be critical for supporting large-scale rollouts in EI and reducing disparities in outcomes.

A growing number of research studies have trained providers to deliver naturalistic developmental behavioral interventions (NDBI). Although providers report being satisfied learning these programs, they also note attempts to adapt NDBIs to fit their delivery context. This study uses the Model for Adaptation Design and Impact (MADI) to characterize the adaptations made to an NDBI, Project ImPACT, and the impact of adaptation on caregiver outcomes. Participants were 48 providers and 45 caregiver-child dyads within Georgia’s Early Intervention (EI) system. Providers completed training in Project ImPACT and submitted video of their Project ImPACT sessions. A sub-sample 15 of providers and 17 caregivers completed surveys and interviews about Project ImPACT adaptation and engagement at the session-level. Results showed that provider fidelity to Project ImPACT was variable (see Figure 1) and that adaptations occurred in 47% of sessions, most often to integrate other therapeutic content. Across 81 sessions, caregivers’ participatory engagement was not associated with Project ImPACT coaching fidelity (r=0.06; p=0.71). Providers’ average coaching fidelity was also not associated with changes in caregiver empowerment (r=0.29; p=0.28). Findings highlight the need to align Project ImPACT with caregiver-initiated priorities. Adaptations were not related to provider fidelity or caregiver engagement which has implications for fidelity measurement.