Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


50th Annual Convention; Philadelphia, PA; 2024

Event Details

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Symposium #487
Diversity submission Caregiver-Mediated Naturalistic Developmental Behavioral Interventions for Young Autistic Children Receiving Community-Based Intervention: Implementation and Effectiveness
Monday, May 27, 2024
3:00 PM–3:50 PM
Convention Center, 100 Level, 103 B
Area: AUT/DDA; Domain: Service Delivery
Chair: Melanie Pellecchia (University of Pennsylvania)
CE Instructor: Melanie Pellecchia, Ph.D.

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.

Instruction Level: Intermediate
Keyword(s): Caregiver-mediated intervention, community-based intervention, NDBI
Target Audience:

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

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) Describe caregiver-mediated naturalistic developmental behavioral interventions; (2) Discuss the implementation of caregiver-mediated interventions for young children who receive publicly-funded early intervention services; (3) Describe methods to adapt caregiver-mediated interventions so that they are feasible for community-based implementation.
Diversity submission 

Implementing a Caregiver-Mediated Intervention for Autism Spectrum Disorder (ASD) in Early Intervention: Intervention Fidelity and Children’s Outcomes

MELANIE PELLECCHIA (University of Pennsylvania), Brooke Ingersoll (Michigan State University), David Mandell (University of Pennsylvania)

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.

Diversity submission Effects of a Naturalistic Developmental Behavioral Intervention on Social Communication Outcomes for Medicaid-Enrolled Autistic Children
DIONDRA STRAITON (Michigan State University), Jessie Greatorex (Michigan State University), Mariola Moeyaert (State University of New York Albany), Brooke Ingersoll (Michigan State University)
Abstract: Project ImPACT is an evidence-based parent-mediated naturalistic developmental behavioral intervention (NDBI). Little is known about the effectiveness of NDBIs for children served in under-resourced settings. The purpose of this study was to examine the effects of Project ImPACT on social communication challenges for Medicaid-enrolled autistic children. Seventeen families of Medicaid-enrolled autistic youth aged 2-6 received Project ImPACT via telehealth. Caregivers completed the Autism Impact Measure (Kanne et al., 2014) at 5 time points. We fit three, 2-level multilevel models to estimate the effect of time (weeks of Project ImPACT), child age (mean centered), and the interaction of time x age on Communication, Social Reciprocity, and Peer Interaction. Six caregivers completed interviews; data was analyzed using thematic analysis. Results indicate that scores for communication challenges decreased by 0.27 points each week, t(45.04) = -1.72, p = .09. Scores for peer interaction challenges decreased by 0.25 points each week, t(46.43) = -2.39, p = .02. Scores for social reciprocity challenges did not significantly change over time. All caregivers mentioned improvements in communication. Most caregivers mentioned improvements in social engagement (83%) and peer interaction (83%). Findings indicate that NDBIs can be effective in under-resourced settings.
Diversity submission 

The Impact of Adapting Naturalistic Development Behavioral Interventions (NDBI) in Community Settings: Relationship to Caregiver Engagement and Outcomes

KATHERINE PICKARD (Emory University School of Medicine; Marcus Autism Center), Nicole Hendrix (Emory University School of Medicine; Marcus Autism Center ), Nailah Islam (Marcus Autism Center), Millena Yohannes (Emory University School of Medicine; Marcus Autism Center )

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.




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