Challenges for Translating Early Intervention Evidence into Practice in ASD Community Settings

Background: Translating evidence-based diagnostic and intervention practices for Autism Spectrum Disorders (ASD) into community settings is especially challenging in low-resource settings, even those situated in high-income countries. Successful translation will depend on funding streams that dictate service-delivery, and the knowledge, skills and attitudes of service providers. The focus of this study was on the potential to translate ASD early interventions found effective in research settings to a community setting.

Objectives: Our aim was to explore the ASD service delivery context within a regional town (population 107,000). We further sought to evaluate the potential use of telehealth to upskill clinicians in evidence-based intervention delivery, and consider its potential uses in supporting service provision for families located at least 2 hours by private or public transport from the nearest metropolitan centre.

Methods:  Restricting the study to one regional town, we obtained data on all ASD services in a geographic area, whose residents ranked high on a disadvantage scale (983, SEIFA). Mixed methods included structured interviews with a senior representative of each service, and surveys of clinicians and families about service access and provision, and attitudes towards telehealth. Five organisations participated, providing 15 services to children aged 0-6 years. Fifteen clinicians and 19 families completed surveys. Eight clinicians (Early Childhood Advisors, Occupational Therapists, Speech-Language Pathologists) from one service participated in semi-structured interviews.

Results:  Service models: Most services were funded through autism support packages (with caps per child); two were fully fee-paying. Two provided a diagnostic service only and among the others, assessments for goal setting either were not provided, or only if requested by families for a fee. Most provided multi-disciplinary supports, but clinicians tended to work as individuals providing centre-based and in-home direct intervention, and consultation services. Referral pathways to diagnostic services varied, but often began with a GP. One diagnostic service used telehealth. Diagnosis and Interventions: The mean age of ASD diagnosis was reported by both clinicians and families as 3 years. Interventions were described in broad terms only (e.g., behavioural, family-centred), without evidence of structured or evidence-based programmatic approaches. Most families received an hour a week of intervention per fortnight; many received less. Attitudes to Telehealth: Both clinicians and families were open to telehealth, but largely for consultative services. Interviewed clinicians were interested in learning new skills and finding out about new strategies, and some wanted to learn about recent research. They saw telehealth as a possible way to link with expertise, but few saw value in its use in delivering their services.  

Conclusions: Most families in this regional town received services that were far removed from best practice regarding early diagnosis, frequency and intensity of intervention, and evidence-based strategies. This situation is likely to reflect that found elsewhere in this and in other developed countries. Shifting service provision towards evidence-based practices requires fundamental changes to funding mechanisms, and expert support to service providers. Knowledge gained from efforts to translate best-practice into low-resource settings in high-income countries offers the potential to inform translation into settings in low-income countries.