2 - (SYM 22) Characterizing Intervention Delivery and Outcomes Within Community Settings Serving Underrepresented Autistic Toddlers and Their Families

Background: The science of intervention adaptation is rapidly expanding, yet there has been limited research evaluating how context affects the delivery and associated outcomes of autism early interventions. The current study sought to address this gap by closely characterizing the delivery of an autism evidence-based practice (EBP), Project ImPACT, within an Early Intervention (EI) system serving underrepresented children and families.

Methods: Twenty-one EI providers and 24 caregivers of children with social communication delays participated. Following training in Project ImPACT, EI providers submitted videos of each of their Project ImPACT sessions. Sessions were scored for Project ImPACT coaching fidelity, Project ImPACT adaptation, and the presence and quantity of supplemental therapeutic content. After each session, EI providers completed a brief survey about how they delivered Project ImPACT and adaptations they made. Caregivers also completed a survey after each session of their participatory engagement and therapeutic alliance.

Results: Mixed methods data from 100 sessions demonstrated that EI providers’ coaching fidelity was variable and driven by the integration of other content areas within the confines of relatively short therapy sessions. EI providers adapted Project ImPACT in approximately half of their sessions and spent about 17% of their recorded session time covering other therapeutic content. Spending a greater percentage of session time integrating other content areas was significantly associated with dropping core Project ImPACT coaching activities and having lower Project ImPACT fidelity within that same session. Augmenting adaptations were associated with caregiver ratings of therapeutic alliance at the session level. Providers’ coaching fidelity predicted caregiver fidelity to certain Project ImPACT strategies.

Conclusion: The current study highlights the critical role of context in shaping providers’ Project ImPACT coaching fidelity. Fidelity outcomes in this study were consistent with other EI implementation trials and raise questions about normative delivery within community settings. Findings also highlight the need for holistic fidelity tools and training models that support the delivery of core intervention functions in relationship to child-, family-, and system-level factors.