Category: Autism Spectrum and Developmental Disorders
Despite their important role in intervention services, parent-mediated interventions for ASD are reported to be an unmet health need in community settings, with parents from lower-socioeconomic status (SES) settings reporting greater need for this type of service. In order to meet this need, research has more recently attempted to translate existing evidence-based, parent-mediated interventions into low-SES, Medicaid settings. These studies have been met with relatively high levels of parent attrition despite the suggested need for the service. The difficulty translating parent-mediated interventions for ASD into low-SES settings may reflect an inadequate fit between these interventions and the needs of parents and providers within these settings. The present study used Roger’s Diffusion of Innovations theory to understand, adapt and pilot an evidence-based, parent-mediated program (Project ImPACT; Ingersoll & Dvortcsak, 2010) for use in a Medicaid system. Results are presented from both: 1) our community partnership that centered on adapting the Project ImPACT for use within the Medicaid system; and 2) a small-scale, pilot of the program in a Medicaid system to understand the feasibility and acceptability of the adapted program. As part of the community partnerships, 3 focus groups were conducted with 16 Medicaid eligible parents, and 3 focus groups were conducted with 16 ASD Medicaid providers. Groups were designed to elicit participants’ perceptions of Project ImPACT attributes specific to Roger’s theory and feedback on adaptations that would enhance the fit of Project ImPACT within the Medicaid system. Across all groups, parents’ and providers’ reported interest in using Project ImPACT. However barriers and suggestions consistently emerged regarding the need to: 1) reduce the complexity of written materials; 2) include more visuals and metaphors in teaching; 3) ensure a strong alliance between the therapist and parent; 4) involve the extended family; and 5) have strategies to help parents practice the intervention within their chaotic environments and within their pre-existing resources. These results and continued collaboration with our community partners and the intervention developers were used to propose an adapted Project ImPACT program. After doing so, the adapted program was piloted on 4 families of a child with ASD within a community-based Medicaid agency. Preliminary results suggest relatively high rates of program attendance and engagement (M=83.33% attendance), parent learning of the intervention strategies, and high ratings of parent satisfaction and perceptions of the program’s compatibility, complexity and relative advantage. Qualitative feedback from the group will be used to continually refine the program with future goals to pilot it on a larger scale while also collecting outcomes to facilitate implementation.
Clinical Psychology Doctoral Student
Michigan State University
East Lansing, Michigan