Self-Directed Telehealth Parent-Mediated Intervention for Children With Autism Spectrum Disorder: Examination of the Potential Reach and Utilization in Community Settings

摘要

Background There is a significant need for strategies to increase access to evidence-based interventions for children with autism spectrum disorder (ASD).?One novel approach is to train parents to use evidence-based interventions for their child with ASD via telehealth.?Pilot work examining the efficacy of one such program, ImPACT Online, demonstrated a high rate of parent program engagement, low attrition, and associated gains in parent learning and child social communication. Objective The objective of this study was to conduct an open trial of ImPACT Online to better understand its dissemination potential. Methods We examined the reach and representativeness of families who registered (n=36) compared to families who were referred (n=139) to the open trial for one referral site. We then compared the demographics of all families who enrolled in the open trial (n=112) to families who enrolled in one of two controlled trials of the same program (n=50). We also examined metrics of program engagement for the open and controlled trials, the relationship between program engagement and changes in parents’ intervention knowledge, and program evaluation for the participants in the open trial. Results In total, 25.8% (36/139) of the parents who were given information about the program at their child’s diagnostic feedback session registered with the program. The parents who enrolled in the open (OT) and controlled trials (CT), respectively, were similar in gender (OT: 84.8% (95/112); CT: 88% (44/50), female), marital status (OT: 80.4% (90/112) ; CT: 69.6% (32/46), married), education (OT: 58.0% (65/112); CT: 54.0% (27/50), college degree or higher), and employment status (OT: 58.0% (65/112); CT: 65.3% (32/49), employed outside the home). The child participants were similar in terms of gender (OT: 83.0% (93/112); CT: 76.0% (38/50), male) and race and ethnicity (OT: 38.4% (43/112); CT: 24.0% (12/50), minority). However, the mean chronological age of the child participants in the open trial group was significantly higher (Mean=60.0 months) than in the controlled trial group (Mean=43.0 months), with t _(160)=5.22, P <.001. Parents in the open trial engaged with the program at a significantly lower rate than the controlled trial, F _(3,81)=21.14, P <.001. Program engagement was significantly associated with gains in parent intervention knowledge across both the groups, beta=.41, t =2.43, P =.02. Participants in the open access trial evaluated the program highly, but several barriers were noted. Conclusions These data suggest that additional strategies may need to be developed to support families in using telehealth-based parent-mediated intervention in community settings.