Training Caregivers in PRT: Lessons Learned in Private Practice

Background: Training parents in evidence-based behavioral intervention techniques can amplify the effect of direct behavioral therapy and improve the developmental trajectory of children with autism spectrum disorder (ASD; Coolican, Smith, & Bryson, 2010; Green et al., 2010; Kasari, Gulsrud, Wong, Kwon, & Locke, 2010; Schreibman et al., 2015). Additionally, parent implemented interventions are associated with reduced costs (Koegel, Bimbela, & Schreibman, 1996; Symon, 2001). Community studies of parent training programs revealed that parents were capable of implementing evidence-based treatments with fidelity and were able to train other caregivers and providers in acquired techniques, thus multiplying the effects of parent training exponentially (Symon, 2005). 

Objectives: (1) To identify logistical hurdles encountered in private practice and community settings, (2) To present strategies used at a small, fee-for-service private practice to overcome these hurdles, and (3) To provide recommendations for efficient training of caregivers who possess multiple learning styles, strengths and challenges.

Methods: A review of the caseload at a small, fee-for-service private practice over the past 9 years was conducted to identify characteristics associated with the following outcomes: (1) Clinical outcome; (2) Efficiency of acquisition of treatment procedures with fidelity, and (3) High coordination of care with school and other agencies and providers.

Results: (1) Clinical outcome: When parent training was mandated prior to assignment of an in-home therapist, some parents opted not to work with the practice, but those who did were highly engaged, satisfied, and experienced positive child and family outcomes; (2) Efficient acquisition of treatment procedures occurred when sessions occurred in the home setting; however, the ability to acquire general parenting skills occurred most efficiently in multi-family group settings; (3) Brief, concise treatment plans that included baseline and outcome data, with specific recommendations for how components of PRT could be implemented in additional settings resulted in higher levels of coordinated care. Video examples were very effective at convincing agencies and schools to align their practices with those occurring at home. Parents with multiple children with ASD and/or limited finances required significant support when working with their school district to receive appropriate services.  

Conclusions: Although logistical hurdles exist, such as parent compliance and arranging coordinated care with schools, brief parent training in PRT within a private practice setting is feasible for many families and results in positive child and family outcomes. Varying skills (i.e., PRT implementation vs. general parenting skills) may be learned more efficiently in specific settings, and family characteristics may impact the relative ease of coordinating care. This review supports the notion that PRT is a cost-effective intervention that can be adopted widely in community settings, including private practice.