A Compass for Hope: A Parent Training and Support Program for Children with ASD and Problem Behavior

Background: Parents of children with ASD are at greater risk for stress and depression than parents of children with other developmental disorders (Montes & Haltherman, 2007). Some explanations come from child and environmental factors, such as severity of child problem behavior (Hayes & Watson, 2013) and the effectiveness of interventions (Baker et al., 2005). Unfortunately, there are limited evidence-based programs available to clinicians in outpatient settings that target parent stress, parent self-efficacy, and child problem behavior. One exception is Stepping Stones Triple P, for which a meta-analysis has shown significant effect sizes for reducing child problem behavior, as well as for parenting satisfaction and efficacy (Tellegen & Sanders, 2013). We aim to develop a new manualized program that can allow for adaptation and customization appropriate for caregivers with limited socioeconomic resources. Building on the ecological-systems framework described by Ruble and Dalrymple (2002) called the Collaborative Model for Promoting Competence and Success (COMPASS), we are currently developing and testing an 8-week parenting intervention program called COMPASS for Hope (C-Hope) using an iterative approach. Additionally, to facilitate access to services from underserved portions of Eastern Kentucky, we will evaluate outcomes from the C-Hope program delivered to parents using videoconferencing technology.

Objectives: The purpose of this study is threefold: (a) to test and adapt the C-Hope program, using an iterative process that includes evaluating each of the sessions and making modifications based on qualitative and quantitative outcomes, including feedback from families, child problem behavior, parent self-efficacy, and parenting stress using a pre-post design; (b) to formally evaluate the efficacy of the modified C-Hope program by randomly assigning families to the intervention or waitlist control condition, and  measuring outcomes; and (c) to compare the outcomes based on type of delivery format (videoconferencing vs face-to-face).

Methods:  After adaptation of C-Hope, a waitlist control design will be used to compare outcomes. Table 1 describes demographic information of the pilot participants. For the waitlist control condition, two groups (n = 10) are concurrently underway, and two additional groups (n = 13) will begin in January 2015 and end in March 2015 (providing more data for analysis for IMFAR 2015). The program is manualized and includes four, 1-hr, individual sessions and four, 2-hr, group sessions. Outcome measures include the Eyberg Child Behavior Inventory, measuring child problem behavior, as well as the Being a Parent Scale and the Parenting Stress Index, measuring parent self-efficacy and stress.

Results:  Visual analysis of preliminary data shows that after the pilot group, parents who participated reported increased self-efficacy and decreased distress, dysfunction, and overall stress. Additionally, children were reported to have decreased externalizing behaviors. Child internalizing behaviors increased slightly, and parental report of having a difficult child remained the same. Mean scores for the pre- and post-measures are shown in Table 2. Additionally, pilot parents reported high satisfaction with the program.

Conclusions:  We anticipate that overall findings will show that C-Hope improves outcomes of parents and caregivers of children with ASD.