Parent-Implemented Intervention In An Underserved Population

Background: Families of racial/ethnic minority, lower levels of education, and those who live in non-metropolitan areas experience greater limitations in accessing services for ASD (Mandell, et al., 2009; Thomas, Ellis, McLaurin, Daniels, & Morrissey, 2007).  Consequently, there has been a significant lack of intervention research focusing on families with limited resources.

Objectives: The purpose of the study is to expand, adapt, and evaluate a modified version of the Early Social Interaction (ESI) parent-implemented program by working with caregivers from a low-income, underserved population.  As recommended by the Interagency Autism Coordinating Committee Strategic Plan for ASD, the study 1) applies methods from an established treatment paradigm (ESI) to a diverse community setting, 2) collects information about the mode of delivery, intensity, and duration for interventions targeting families with limited resources, and 3) obtains first-hand insights and perspectives of family members and caregivers of children with ASD that will inform intervention research addressing the needs of diverse populations. 

Methods: This intervention utilizes a single-subject multiple baseline design in which caregivers are taught specific strategies to support their child’s social communication during everyday activities.  Baselines are defined by the systematic variation of targeted and non-targeted activities.   Eligible families include those with a child between 24 and 48 months whose caregivers have less than two years of higher education and whose family income does not exceed more than two times the federal poverty level.  All families are recruited from two geographic regions.  Participating families receive 3 months of weekly home-intervention sessions followed by an additional 3 months of community resource and follow-up support.  Child and family outcome are measured at pre-treatment, post-treatment, and follow-up.  Changes in caregiver behavior comprise the primary outcome measure while secondary outcome measures include child outcome (autism symptoms, social communication, developmental level, and adaptive behavior) and family outcome (caregiver measures of self-reported family functioning, resources, well-being, and treatment adherence, fidelity, and satisfaction.) 

Results: This project continues to enroll participants. To date, of the 15 families eligible to participate, 8 have completed the first evaluation and begun or completed the 3 month-intervention phase.  4 families are scheduled for the first evaluation, and 3 families discontinued their involvement after the first month of intervention due to time constraints.  We anticipate that 20 families will have completed the project by Summer 2011.  Preliminary analyses indicate that the modified ESI protocol is successful in enrolling and retaining families for participation. Caregivers’ behavioral supports have been shown to increase in targeted activities with some generalization to non-targeted activities by the end of the intervention.

Conclusions: This project is one of the first treatment outcome studies to deliberately recruit families from diverse socioeconomic backgrounds, a population that has been traditionally underrepresented in autism research.   Preliminary results suggest promise for the applicability of a modified caregiver-implemented early intervention benefiting families from low socioeconomic status.  Implications for the development of policy designed to eliminate barriers to autism services will be discussed.