Examining Fidelity of Implementation in a Naturalistic Developmental Behavioral Intervention in Community Settings: The Influence of Provider Characteristics

Background:  Research supports the critical need for early intervention to improve outcomes for young children at risk for autism spectrum disorder (ASD). Parent-mediated naturalistic developmental behavioral early interventions (NDBI) have demonstrated positive family outcomes and offer the potential for increased intervention intensity (Burrell & Borrego, 2012). However, there has been little dissemination of parent-mediated NDBI into community settings. Community providers with expertise in both implementation of NDBI strategies and parent coaching are needed to effectively deliver NDBIs. However, based on the multiple avenues through which children with ASD may receive services, community providers have a range of educational backgrounds and ASD specific experience. As communities struggle to effectively serve the growing number of toddlers at risk for ASD, more information is needed on provider characteristics that may influence the appropriate use of NDBIs in community settings.

Objectives:  This study provides a preliminary examination of provider characteristics as potential moderators of providers’ fidelity of implementation of an evidenced-based parent mediated NDBI for toddlers at risk for ASD (Project ImPACT for Toddlers or PI for T; Ingersoll & Dvortscak, 2010).

Methods:  Participants include 33 early intervention providers with varied training backgrounds, specializations and education levels working in a range of community-based settings. Participants received 12 weeks of training in PI for T from a leader within their agency who was trained by the research team. Video observations of providers utilizing intervention strategies with families were collected before, during, and after training. Observations were behaviorally scored for intervention fidelity of implementation (FI). Coders rated each intervention component on a 5-point scale (1=did not use; 5 = used throughout). FI scores were compared at baseline, post-training, and after three months of use. Provider characteristics (e.g. education, discipline, experience) and setting variables were examined as potential moderators of FI.

Results:  Preliminary results suggest that while many providers do not meet FI overall after training, they demonstrate improvement over time in some domains, including allowing the child to choose the activity, modeling developmentally appropriate communication and play, and expanding/adding complexity to the child’s responses. Preliminary analyses show no difference in FI based on education level. Providers’ years experience in early intervention demonstrate a relationship with appropriate use of prompting strategies, such that providers with moderate experience demonstrate highest fidelity. Additionally, providers with 20+ years of experience in either early intervention broadly or ASD specifically have lower FI scores in some domains. Further moderators, including intervention setting, will be analyzed to identify any additional impacts on fidelity.

Conclusions:

Identifying relationships between provider characteristics and FI of parent-mediated NDBIs can support improved dissemination of these evidence-based strategies in community settings. Providers who have been in the field longer may need individualized training on how to shift their current practice to best align with an evidence-based approach. Future research should continue to address the fit between community providers and the use of evidence based practices.