Increasing Access to an Evidence-Based ASD Intervention Via a Telehealth Parent Training Program

Background: Systematic research focused on developing and improving strategies for the dissemination and implementation of evidence-based ASD services is essential. One nascent, yet promising, area of research has explored the use of telehealth programs to train parents of children with ASD in evidence-based intervention techniques. There are numerous benefits associated with the use of telehealth programs, including providing a cost-effective means for information to be accessed from anywhere at any time. The benefits of telehealth technology, together with the interest in such programs across health-related fields, and rapid increases in access to computer and internet technology for consumers, suggest that telehealth applications may serve as a promising alternative service-delivery model to increase the reach of, and access to, evidence-based ASD interventions, including ASD parent training programs. 

Objectives: A hybrid telehealth program, combining self-directed internet-based instruction with remote coaching, was created to introduce parents of children with ASD to an evidence-based imitation intervention, Reciprocal imitation training (RIT). The first goal of the current study was to assess the degree to which parents could learn about and effectively implement RIT after engaging in the self-directed and coaching portions of the telehealth program. The second goal of the current study was to evaluate the impact of parent participation on child behavior, specifically spontaneous imitation skills. A final goal of the study was to assess the acceptability of this hybrid telehealth service delivery model to parents.

Methods:   A single-subject multiple-baseline design study evaluated the effect of the program on changes in parent knowledge and behavior, and changes in child behavior, across 5 parent-child dyads. Participants engaged in a randomly assigned number of predetermined baseline sessions. Next, participants completed the self-directed portion of the program and then received three 30-minute remote coaching sessions from a parent trainer. One- and three-month follow up probes were also collected to examine maintenance of treatment effects. Changes in participant behavior were assessed throughout the four phases of the study (baseline, self-directed portion, remote coaching portion, and follow-up). Data examining the hybrid telehealth program’s strengths and suggestions for improvement were collected.

Results: Program participation was associated with significant increases in parent knowledge about RIT and naturalistic intervention, and all parents demonstrated meaningful improvements in their abilities to correctly implement the intervention strategies in response to the program. Four out of the five children demonstrated clear increases in spontaneous imitation associated with parent participation in the hybrid telehealth program. Parents indicated that the intervention and hybrid telehealth service delivery model were acceptable, useable, and effective.

Conclusions:   This study provides initial evidence for the effectiveness of a hybrid telehealth program in teaching parents evidence-based intervention strategies to improve spontaneous imitation in their young children with ASD. Results suggest that such hybrid telehealth programs may serve a role in significantly increasing access to evidence-based interventions for those on lengthy waitlists or living in areas with limited services.