4 - (SYM 22) The Use of Telehealth in Community-based Early Intervention: Insights into the Digital Divide, Parent Coaching Practices, and Parent Engagement

Families of autistic children report unmet service needs and difficulty reaching specialized providers. Telehealth (TH) shows promise in increasing access to autism services including parent coaching (PC). While studies support TH PC efficacy, growing literature describes a digital divide of unequal access for marginalized families. As TH increases in community service settings, like Part C Early Intervention (EI) for autistic toddlers, it is vital to examine how family sociodemographics impact TH access and how TH influences key service aspects that promote EI efficacy. This study examines 1) the influence of parent sociodemographic characteristics on TH use and 2) provider PC quality and parent engagement in TH vs. in-person (IP) sessions in EI. Parents (n=147) and providers (n=83) were recruited from an ongoing RCT examining a PC intervention for autism in Part C. Parents participated in weekly TH or IP EI sessions (chosen by parent-provider dyads) for 4 months with 1-3 sessions recorded per dyad (n=348, n_TH=61, n_IP=287). Parents reported sociodemographics (e.g., minoritized status, marital status, education, income, adults at home) at baseline. Observational coding assessed the quality of 4 provider PC strategies (i.e., collaboration, demonstration, in-vivo feedback, problem-solving). 3 measures assessed parent engagement: parent participation engagement (PPE) observational coding, cancellation frequency, and self-reported practice at home. Data collection is ongoing. Logistic regressions examined the effect of sociodemographics; only the number of adults at home predicted modality (b=1.05, p=.03). MLMs examined the impact of modality on PC and PPE given repeated/nested data. Greater quality collaboration was observed in TH (b=-.32, p=.007) with no other PC differences across modality. Higher PPE was observed in TH (b=-.36, p=.009). Modality did not predict average cancellations (b=-.18, p=.08) or practice (b=-.10, p=.61) in linear regressions. Findings suggest families with fewer adults at home may prefer TH sessions. TH may promote comparable quality of most PC strategies and greater collaboration than IP. Though attendance and between-session practice appear similar across modality, parents exhibit higher PPE during TH, which may naturally promote parent-led discussion by restricting direct child work. Despite limitations of non-randomized modality, findings suggest equal TH access for marginalized families and highlight key differences in PC and parent engagement across modalities in community EI.