Examining the Potential Reach and Engagement with a Self-Directed Telehealth Parent-Mediated Intervention for Children with ASD in Community Settings

Background: Initial lab-based trials of self-directed, telehealth parent-mediated interventions (SDT-PMIs) for families of children with ASD demonstrate high levels of program acceptability, program engagement, and improvements in parent and child behaviors, indicating their potential as a low-cost universal intervention.  However, little is known about the potential reach of and parent engagement with such programs outside of a lab setting. 

Objectives:  This study conducted a field trial of ImPACT Online, a SDT-PMI for families of children with ASD to: 1) Examine the potential reach of the program; 2) Compare the demographics of families who enrolled in a field trial (FT) to families who enrolled in lab-based trial (LT) of ImPACT Online; 3) Compare metrics of program engagement for FT and LT families; and 4) Examine the relationship between program engagement and changes in parents’ intervention knowledge.

Methods: FT families were recruited by:  1) a flyer with a link to the program website which was provided to families during the feedback session at several community autism diagnostic clinics; 2) a link to the program website which appeared on a Statewide autism center website; or 3) word of mouth and/or internet search.  Parents enrolled through the program website, and did not have direct contact with research staff.  One diagnostic clinic tracked referrals to obtain an estimate of reach.  Sixty-two parents completed a survey of family demographics and intervention knowledge at intake and 21 (34%) completed a 6-month follow-up survey.  Program engagement (% of program components completed) was recorded by the website.   Data were compared to families who participated in a lab-based trial of ImPACT Online (n=27).

Results:   18.71% of parents referred to the program by the diagnostic center enrolled in the program; these children did not differ significantly in age or gender from the referral sample.  Parent demographics did not significantly differ between FT and LT groups; the majority of participants in both groups were female (FT: 87%; LT: 96%), married (FT: 81%; LT: 82%), with a college degree or higher (FT: 57%; LT: 56%), were employed outside the home (FT: 58%; LT: 62%), and felt fluent with computer/internet technology (FT: 35.95, SD=3.71; LT: M=35.57, SD=4.25), all ps>.05.  FT child participants were slightly older (FT: 52.0 months; LT: 43.26 months, t(84.04)=2.24, p<.05) and marginally more likely to be male (FT: 87%; LT: 70%; X² (n=89)=3.57, p=.059) and a minority (FT:44%; LT: 22%; X²(n=89)=3.67, p=.056) than LT children.  FT parents had significantly lower program engagement (M=20.51%, SD=28.80) than LT parents (M=81.31%, SD=30.46), t(72)=6.84, p<.001.  Program engagement was a significant predictor of post-treatment intervention knowledge, controlling for pre-treatment knowledge and group, β=.41, t=3.37, p=.002.

Conclusions: Families who enrolled in the field trial of ImPACT Online were demographically similar to families who enrolled in the lab-based study.  However, parent engagement was much lower, and the reach was limited.  Given the relationship between program engagement and gains in intervention knowledge, strategies for increasing engagement with SDT-PMIs in real-world settings are a priority.