Project Impact Implementation Fidelity: Researcher, Clinician, and Parent Measures Relative to Child Outcomes

Background:

Documented intervention gains resulting from the Project ImPACT intervention model (Ingersoll & Dvortcsak, 2009) include increased spontaneous language (Ingersoll & Wainer, 2013), decreased social impairments (Ingersoll & Wainer, 2011; Stadnick et al., 2015) and increased social engagement (Pierucci, 2013). Further, parents demonstrate adherence to Project ImPACT strategies (Ingersoll & Wainer, 2011, 2013; Pierucci, 2013; & Stadnick, et al., 2015), and report improved parenting efficacy, a critical component to child and parent outcomes (Karst et al., 2012).  Little is known about the contributions of implementation fidelity to intervention outcomes (Stahmer et al., 2015), although systematic measurement of treatment fidelity is essential when interpreting intervention efficacy (Zwaigenbaum et al., 2015).

Objectives:

To measure fidelity of Project ImPACT at three levels: researcher, clinician, and parent.

To measure child and parent outcomes and implementation fidelity across two dosage groups: one versus two hours per week of Project ImPACT intervention.  

Methods:

Six children with ASD (mean age = 32 months) participated. Group 1 received Project ImPACT for 2 hours per week, for twelve consecutive weeks, group-based parent coaching, an individualized session with a clinician and more dense individual parent coaching. Group 2 received intervention 1 hour per week, group-based parent coaching, an individualized session with a clinician, and less personalized parent coaching. Social engagement, language, and play were assessed using the Social Communication Checklist (SCC; Ingersoll & Dvortcsak, 2009). The Parental Sense of Competency Scale (PSOC) measured parent satisfaction (anxiety, motivation, frustration) and efficacy (competence, problem solving, and capability).  Finally, developmental and vocabulary measures were administered. All measures were completed pre-and post-intervention. Fidelity was measured at three levels: group sessions, parent implementation, and clinician implementation.

Results:

An 80% average was considered implementing the strategy with fidelity (Ingersoll & Wainer, 2013). The primary researcher achieved an average of 95% fidelity across both groups. Clinician implementation fidelity during individual sessions averaged 60.7 % and 52.3% in Groups 1 and 2, respectively. Parent implementation fidelity averaged 72% and 54% in Groups 1 and 2, respectively. Fidelity was elevated for both clinicians and parents in the higher dose group. Higher parent fidelity was related to better child outcomes. A Mann-Whitney U test revealed no clinically significant differences in social engagement, (U= 5.50 p=1.0), language (U= 4.00, p=1.0), or social imitation (U=3.50, p=1.0) domains across dosage groups, though all children demonstrated gains. Interestingly, parents with higher fidelity scores reported lower sense of efficacy on the PSOC. Parent sense of satisfaction increased across all parents, though no group differences were found for efficacy or satisfaction. Potential influences of demographic variables will be discussed. Visual analysis of outcomes will be presented.

 Conclusions:

Intervention fidelity may be a more accurate predictor of intervention outcomes than dose, at least within this modest comparison. Fidelity outcomes are higher when material is more structured (Stahmer et al., 2015), such as in instructional group settings, and with more experienced clinicians. These findings contribute to growing literature supporting the efficacy of Project ImPACT intervention for young children with ASD and their parents.