Using Community Partnerships to Address the Fit of an Evidence-Based, Parent Mediated Intervention for ASD in a Medicaid System

Background:  Within the autism spectrum disorder (ASD) field, service access barriers and rates of attrition in ASD services are particularly relevant for parent-mediated interventions and may suggest a lack of fit when these services are implemented in underserved community settings. One strategy to improve the fit of parent-mediated interventions in these settings is to engage stakeholders around improving the delivery of these services.

Objectives: In a prior study, Roger’s Diffusion of Innovations theory was used to guide collaboration with parents from low SES backgrounds (i.e. below the federal poverty line) and providers working with these families in the Medicaid system around improving the delivery of an evidence-based, parent-mediated intervention, Project ImPACT. The goal of the present study was to determine the impact of these adaptations on parents’ and providers’ perception of program attributes specific to Roger’s theory (i.e compatibility, complexity, and relative advantage), as well as their intent to use the program.

Methods:  The target number of participants for this study is 100 parents of a child with ASD and 100 providers working with young children with ASD. Preliminary results are presented from 83 parents and 79 providers from a variety of socioeconomic backgrounds. Participants were randomized so that they either watched a 13-minute, video-based presentation of the original Project ImPACT program, or the same 13-minute, video-based presentation of the adapted Project ImPACT program. All presentations were standardized in format, length, and visual appeal. After watching the presentation, participants rated the following: 1) demographic information; 2) Project ImPACT attributes (i.e. compatibility, complexity, and relative advantage); 3) intent to use the program; and 4) either parent mental health or provider implementation climate.

Results: Two-way, between-subjects ANOVAs were run to examine the impact of program type (original vs. adapted), participant SES (i.e. above vs. below federal poverty line), and their interaction on perceptions of program attributes (i.e. compatibility, complexity, and relative advantage) and intent to use either program. Preliminary results are displayed in the supplemental table. Results show no main effect of program type or SES on parents’ ratings of program attributes or intent to use. However, there was a significant interaction between SES and program type such that low SES parents rated the adapted program more favorably and reported greater intent to use than the original program. These findings were somewhat similar for providers, with providers working with low SES families rating the adapted program as less complex and reporting greater intent to use the adapted program, however, these results were only marginally significant.

Conclusions: Results from the present study suggest that community partnerships may be beneficial in increasing the perceived fit of parent-mediated interventions within low SES settings, although these benefits may be setting-specific. Importantly, Roger’s Diffusion of Innovations theory may be a framework that can be used by researchers to guide adaptations aimed at improving the delivery of evidence-based, parent-mediated interventions without changing the core components of the intervention. Future directions include assessing the actual impact of these adaptations when implemented within the Medicaid system.