A review of comprehensive treatment models revealed that there are parent mediated models and those with parent training components that have published research evidence of effectiveness for the model as a whole, or for key focused interventions that define the model (Odom, Boyd, Hall, & Hume, 2010). It is understandable that interventionists and families of individuals with ASD living around the globe would want to implement those models and strategies that are evidence-based. There is a lack of information about how to effectively implement and adapt effective practices when the cultural context differs from the one in which the model was developed. Through an analysis of four examples of the effective implementation of three different models in 3 countries (Turkey, Poland & Mexico) we can gain a better understanding of how to effectively adopt (work with families to overcome cultural barriers to implementing key strategies) and adapt (make changes in strategies so they can be used effectively in the cultural context) evidence-based parent mediated and parent training approaches.
Objectives:
This presentation will 1) describe examples of both adopting and adapting key features of evidence-based strategies when working with families in three countries (Turkey, Poland, and Mexico) and 2) summarize the similarities of strategies used to adopt and adapt practices across contexts.
Methods:
Information for this qualitative study was obtained through open-ended interviews with model developers of select comprehensive treatment models (Responsive Teaching, Princeton Child Development Institute, & Lovaas Institute) that include parent training. The models represent a clinic-based parent mediated approach, parent training accomplished in groups in a clinic and school, and individualized, home-based parent training. Implementers of these models in Turkey (Responsive Teaching & PCDI), Poland (PCDI) and Mexico (Lovaas) were interviewed, and asked to provide examples of how they worked with families to adopt these key features to the cultural context and how they adapted program features to fit the cultural contexts. Interview results were evaluated for similarities and differences in these examples across contexts.
Results:
Across contexts implementers were reluctant to adapt key model features due to concerns about jeopardizing the integrity of the program and, consequently, the effectiveness of the strategies for families and their children with ASD. Implementers of the strategies all provided examples of how they worked with families to facilitate the adoption of strategies that initially were not supported or uncomfortable for the families. They also all adapted those practices that were not seen as critical to the model or adapted features in a way that did not change the critical features of the strategy.
Conclusions:
Evidence-based strategies were successfully used and adopted in various cultural contexts in spite of initial concerns by model implementers and families about lack of cultural congruency. Implementers were very creative and highly skilled at problem-solving when challenges were presented. Examples of how strategies were adopted and adapted will inform those working in other countries that plan to use such evidence-based practices with families.
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