Pellecchia Melanie, Beidas Rinad S, Mandell David S, Cannuscio Carolyn C, Dunst Carl J, Stahmer Aubyn C
1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA.
2Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
Pilot Feasibility Stud. 2020 Feb 13;6:22. doi: 10.1186/s40814-020-00568-3. eCollection 2020.
Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children's cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-mediated early interventions for ASD is clinician use of parent coaching and occurs when a clinician actively teaches the parent techniques to improve their child's functioning. Available evidence suggests that community-based EI clinicians rarely coach parents when working with families of these children, although specific barriers to coaching are unknown. This consistent finding points to the need to develop strategies to improve the use of parent coaching in community EI programs. The purpose of this community-partnered study is to iteratively develop and pilot test a toolkit of implementation strategies designed to increase EI clinicians' use of parent coaching.
This study has four related phases. Phase 1: examine how EI clinicians trained in Project ImPACT, an evidence-based parent-mediated intervention, coach parents of children with ASD. Phase 2: identify barriers and facilitators to clinician implementation of parent coaching by administering validated questionnaires to, and conducting semi-structured interviews with, clinicians, parents, and agency leaders. Phase 3: partner with a community advisory board to iteratively develop a toolkit of implementation strategies that addresses identified barriers and capitalizes on facilitators to improve clinician implementation of evidence-based parent coaching. Phase 4: pilot test the feasibility and effectiveness of the implementation strategy toolkit in improving EI clinicians' use of parent coaching with nine EI clinicians and parent-child dyads using a multiple-baseline-across-participants single-case design.
Completion of these activities will lead to an in-depth understanding of EI clinicians' implementation of parent coaching in usual practice following training in an evidence-based parent-mediated intervention, barriers to their implementation of parent coaching, a toolkit of implementation strategies developed through an iterative community-partnered process, and preliminary evidence regarding the potential for this toolkit to improve EI clinicians' implementation of parent coaching. These pilot data will offer important direction for a larger evaluation of strategies to improve the use of parent coaching for young children with ASD.
针对自闭症谱系障碍（ASD）儿童的家长介导早期干预（EI）可显著改善儿童的认知能力、社交功能、行为和适应技能，同时提高家长的自我效能感和治疗参与度。有效的家长介导早期干预ASD的共同要素是临床医生运用家长指导，即临床医生积极教授家长改善孩子功能的技巧。现有证据表明，社区EI临床医生在为这些孩子的家庭提供服务时很少对家长进行指导，尽管指导的具体障碍尚不清楚。这一一致的发现表明需要制定策略来提高社区EI项目中家长指导的运用。这项社区合作研究的目的是反复开发并试点测试一套实施策略工具包，以增加EI临床医生对家长指导的运用。
本研究有四个相关阶段。第一阶段：研究接受基于证据的家长介导干预项目“影响计划”培训的EI临床医生如何指导ASD儿童的家长。第二阶段：通过向临床医生、家长和机构领导发放经过验证的问卷并进行半结构化访谈，确定临床医生实施家长指导的障碍和促进因素。第三阶段：与社区咨询委员会合作，反复开发一套实施策略工具包，该工具包可解决已确定的障碍并利用促进因素，以改善临床医生对基于证据的家长指导的实施。第四阶段：采用多基线跨参与者单病例设计，对九名EI临床医生和亲子二元组进行试点测试，以检验实施策略工具包在提高EI临床医生对家长指导的运用方面的可行性和有效性。
完成这些活动将深入了解EI临床医生在接受基于证据的家长介导干预培训后的日常实践中对家长指导的实施情况、实施家长指导的障碍、通过反复的社区合作过程开发的实施策略工具包，以及该工具包在改善EI临床医生实施家长指导方面潜力的初步证据。这些试点数据将为更大规模评估改善ASD幼儿家长指导运用策略提供重要方向。
