Community-Partered Practice: Delivery of a Social Communication Intervention By Paraprofessionals with Toddlers with ASD

Background: Disparities in bridging the research to practice gap may be greatest in low resourced settings that support child development programs for disadvantaged and developmentally delayed children. The present project aimed to bring an evidence-based early intervention module into a community program in order to improve child social and communication outcomes. Within a community partnered participatory framework, we focused on supporting the delivery of the intervention by non-specialists within the existing structure of the child development program. A randomized controlled intervention trial was conducted in which paraprofessionals from the community were taught to deliver the intervention. Outcomes included paraprofessional implementation and maintenance of strategies as well as child social communication and language outcomes. 

Objectives: First, to explore the implementation of non-specialist delivery of a modular naturalistic developmental behavioural intervention- Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER: Kasari et al., 2008; 2014; 2015). Second, to examine if children receiving 30 minutes of JASPER intervention a day on top of center-based applied behaviour analytic (ABA) programming would show greater gains in joint attention gestures, language, play, and engagement over those receiving the ABA programming only. 

Methods: 147 children age 2-3 years (mean age=31.5 months) were randomized to immediate treatment (IT) or wait list control (WL) for 11 weeks plus 1 month follow up. 137 children had received an autism spectrum disorder (ASD) diagnosis while 10 received other diagnoses. Forty-nine paraprofessionals (teaching assistants), 12 group supervisors and two research coordinators also participated. All but one paraprofessional and four children were members of an ethnic minority group.

Intervention. Paraprofessionals were provided with two weeks of in-vivo training with the research team to learn the social communication intervention: JASPER. Significant effects on joint engagement, joint attention gestures, play skills, and language outcomes have been demonstrated in multiple JASPER RCTs conducted in laboratory and community settings by specialists or parents (Kasari et al, 2008; 2010; 2014; 2015). This is the first study of implementation by non-specialists with ASD toddlers in center-based care. JASPER was delivered 30 minutes a day for children in IT for 11 weeks, while children in WL continued with 30 minutes of music and movement social group time.

Measures. Ten minute paraprofessional-child interactions at entry, exit, and follow up were coded for children’s engagement and social communication and paraprofessionals’ JASPER implementation. Independent assessors also administered assessments of play, joint attention, and language.

Results:  Paraprofessionals in IT demonstrated significant gains in JASPER implementation scores over WL (f(1,91)= 239.94, p<.01) while children in IT made significant gains over WL in child-initiated joint engagement (f(1,70)= 46.13, p<.01), initiations of joint attention language (f(1,70)= 9.72, p<.01) and nonverbal skills (f(1,70)= 13.98, p<.01). Further gains in initiations of joint attention gestures transferred to independent assessments completed by assessors unfamiliar to the children (f(1,98)= 4.45, p=.038). All treatment gains were maintained at follow up.

Conclusions:  Paraprofessionals’ high strategy implementation scores, maintenance of strategies and positive child outcomes over control indicate that non-specialists can feasibly deliver and maintain previously determined evidence-based and specialized intervention for children with ASD.