Adapting and Evidence-Based Practice for Children At-Risk for Autism for Diverse Early Intervention Service Systems

Specific interventions for young children with or at risk for autism spectrum disorders (ASD) demonstrate powerful effects in reducing intellectual impairment, improving social communication and language development, and improving social skills, when begun in the toddler period (e.g., Shonkoff & Phillips, 2000; Wallace & Rogers, 2010). However, technical aspects of research-based interventions, precision of implementation methods, and the inflexibility of many models have limited their utility in the Part C system for infants and toddlers. Characteristics of the Part C system in rural, low income, and culturally diverse areas also make it difficult to implement research-based interventions due to limitations on staff training, low number of service hours, or the Part C requirements for family centered care and interdisciplinary services. However, as the rates of ASD continue to increase and ASD pediatric screening efforts intensify, more infants and toddlers are entering the Part C system (e.g., Landa & Garrett-Mayer, 2006; Corsello, Akshoomoff, & Stahmer, 2012; Scull & Winkler, 2011). The proposed project seeks to improve developmental and functional outcomes of infants and toddlers at risk for ASD who are receiving early intervention services in Part C settings that serve lower income, highly diverse families. We will accomplish this by adapting the only practice shown to be efficacious in a randomized clinical trial (Dawson, et al., 2010) for toddlers at risk for ASD and their families, to make it feasible for Part C providers to use in diverse community early intervention programs. The current project proposes to use an innovative implementation science model to adapt the Early Start Denver Model (ESDM) to make it usable in existing Part C resources and practices of a wide range of Part C settings, in order to improve the outcomes of increasing numbers of toddlers at risk for ASD and their families. ESDM is uniquely appropriate for Part C usage because of its combination of developmental and behavioral strategies, defined and manualized developmental curriculum and teaching practices, existing fidelity of implementation method, interdisciplinary orientation, and family focus. Its teaching practices align well with Part C regulations and recent DEC recommendations (Division for Early Childhood, 2014). Adaptation of the ESDM will be conducted with community stakeholders using the Dynamic Adaptation Process model (Aarons et al., 2012) to increase the feasibility, uptake, ease of use, and sustainability of Community (C)-ESDM by community agencies and families. In addition, we will use a proven training approach developed through OSEP: the National Professional Development Center for ASD to train providers. The project will demonstrate its success in a small randomized controlled trial of Part C agencies that provide widely varying levels of staff support and intensity of services. We expect children receiving C-ESDM will demonstrate greater developmental gains in core areas affected by ASD than the comparison group. Families receiving C-ESDM will report greater uptake of intervention (e.g., use of strategies, attendance, understanding of development) and acceptability/usability than comparison families. Interventionists using C-ESDM will report more positive attitudes toward their intervention, greater confidence in their ability to provide needed services, and fidelity to the model. Stakeholders at all levels will indicate usability and feasibility of the adapted model.