Using Community Partnerships to Better Understand the Barriers to Using an Evidence-Based, Parent Mediated Intervention for ASD in a Medicaid System

Background: Within the autism spectrum disorder (ASD) field, service use disparities have been noted to impede under-resourced, ethnic minority families’ ability to access high quality services for their child with ASD. Service access barriers and rates of attrition in ASD services are particularly relevant for parent-mediated interventions, and may suggest a lack of fit between evidence-based, parent-mediated interventions as they are presently being implemented in underserved community settings. However, no research to date has explicitly examined this fit. 

Objectives: The present study used Roger’s Diffusion of Innovations theory to guide the understanding of the variables that might influence parent and provider use of an evidence-based, parent-mediated program (Project ImPACT) in a Medicaid system. The longterm goals are to use this understanding to enhance the fit of Project ImPACT for Medicaid systems. 

Methods: Community-based partnerships were formed with 3 Medicaid systems to better understand the perceived compatibility, complexity, and relative advantage of using Project ImPACT within a Medicaid eligible population. As part of the community partnerships, 3 focus groups were conducted with 16 Medicaid eligible parents, and 3 focus groups were conducted with 16 ASD providers operating within a Medicaid system (i.e. see Tables 1 and 2). Groups were designed to elicit participants’ perceptions of Project ImPACT and feedback on adaptations that would enhance the fit of the Project ImPACT program within the Medicaid system.   

Results: Across all groups, parents’ and providers’ reported general interest in using the Project ImPACT program. However barriers and suggestions consistently emerged regarding the need to: 1) reduce the complexity of all written materials; 2) include more visuals and metaphors in teaching; 3) ensure a strong alliance between the therapist and parent; 4) involve the extended family; and 5) have specific strategies to help families practice the intervention within their chaotic environments and within their pre-existing resources.  

Conclusions: Results from the present study suggest that Project ImPACT is generally viewed as an important intervention by Medicaid parents and providers. However, parents and providers specify a number of perceived barriers centering on Project ImPACT’s compatibility, acceptability and relative advantage that would likely impede its use within this setting. Future directions are thoroughly discussed regarding next steps in designing and testing an adapted Project ImPACT program geared for the Medicaid system.