Examining the potential reach and utilization of a self-directed telehealth parent-mediated intervention for

children with ASD in community settings

Brooke Ingersoll, Kate Shannon, Natalie Berger, & Bree Holtz
Michigan State University
Research supported by grant #R40MC277040100 from the Maternal and Child Health Bureau of the Health Resources & Services Administration, an Idea Development
Award #W81XWH-10-1-0586 from the Department of Defenses Autism Research Program, and a RAIND grant from Michigan State University

BACKGROUND Figure 4: Program Evaluation for

Initial lab-based trials of self-directed, telehealth-based parent- Open Trial (n=26)
mediated interventions (PMIs) for families of children with ASD
demonstrate: 4.6 4.9
Excellent program acceptability Figure 1: Percent of Families Offered
High levels of program engagement Open Trial Who Participated (Reach) 1.9
Improvements in parent and child behaviors Figure 2: Program Engagement by Group
Thus, these programs have potential as low-cost universal Treatment Website Usability Treatment
*
interventions 88.6 * 88 Acceptability (low=1, high=6) Barriers
TABLE 1: ImPACT ONLINE % Registered for
However, little is known about the potential reach of and parent
engagement with such programs outside of a lab setting Adapted from Project ImPACT (Ingersoll & Dvortcsak, 2010)
25.8 program
*
OT Group
(n=68)
(low=1, high=6) (low=1, high=5)
29.8 *
% Did not register 26.3
Self-Directed Interactive Modules 9.9 11.69 12
3.12 CT-SD Group
Narrated Slideshow Manual (n=17) Open-Ended Response Themes
OBJECTIVES 74.2 Number of Hours on Percent of Percent of
Logins Website Program Participants Program Benefits Program Limitations Recommendations
This study conducted an open trial of ImPACT Online, a self-directed, Completed Who Accessibility of the Need for therapist Teleconference support
telehealth-based PMI for children with ASD to examine: Completed program support from coach
1. The reach and representativeness of families who enrolled in the *p<.001 Program Ease of learning the Lack of online Increase online
No significant differences in child age, intervention community support community support
open trial (OT)
gender, or median household income for Acceptability of Time requirements Simplification of
2. The demographics of families who enrolled the OT compared to intervention strategies Stress in the home training components
families who enrolled in controlled trials (CT) families who participated and families Improvement in child Technology barriers Make available on
3. Metrics of program engagement for the OT and CT groups who did not, all ps>.05 Figure 3: Percent of Participants Who Completed social communication other platforms
skills
4. The relationship between program engagement and changes in (Representativeness) 100
Each Lesson by Group
Self-Check Quiz Video-Based Exercises

Percent of Participants
intervention knowledge
5. Program evaluation of ImPACT Online by OT participants 80
Table 2: Participant Demographics by 60 RESULTS AND DISCUSSION
OT Group (n=68)
Group 40 Only a quarter of parents referred to the Open Trial actually
Recruitment METHOD Open Controlled
CT-SD Group (n=17)
* accessed the website (see Figure 1). Parents who registered did
OT: 1) Flyer with web link to program provided during diagnostic Trial Trial p-value 20
feedback session in community clinics; 2) Web link on Statewide not differ demographically from those that did not. Research to
(n=112) (n=50) determine better strategies to increase the reach of the program
Autism Center website; or 3) Word of mouth and/or internet search 0
CT: 1) Study flyer with lab contact information provided by local Parent Characteristics will be important.
Homework Plan Reflection Questions 1 2 3 4 5 6 7 8 9 10 11 12
Z providers Lesson Parents who enrolled in the open trial were demographically
Gender
Enrollment and Assessment 85% 88% .59 similar to parents in the controlled trial, although the children
(% Female)
OT: Online consent and assessment in program. Received self- were slightly older and received slightly fewer hours of
directed (SD) program Marital status intervention (see Table 2). ASD families who participate in
CT: In person consent and assessment; Randomly assigned to self- (% Married)
80% 70% .17 Table 3: Relationship between Program controlled trials of telehealth are likely similar to the families who
directed (SD), therapist-assisted (TA) program will access the program in the community.
Education Engagement and Parent Post-Treatment
Participants (see Table 1) 58% 56% .63 Parents in the controlled trial were much more engaged in the
OT: 112 parents completed a survey of family demographics and
(% College Degree) Intervention Knowledge program than parents in the open trial (see Figures 2 & 3). Better
intervention knowledge at intake; 68 completed a 6-month follow- Employment methods are need to engage families who access self-directed
up survey 58% 65% .39 Change in Parent
Video Library Moderated Forum (% Employed full or part time) telehealth programs in the community.
CT: 50 parents from pilot and full-scale RCT; 17 parents in self- Knowledge
directed group (CT-SD) completed a 6-month follow-up. M = 36.7 M = 37.6 Program engagement was related to gains in parent intervention
Computer Fluency .14 Predictors t knowledge (see Table 3). Additional research is needed to
SD=3.5 SD=3.9
Procedure
determined whether increased knowledge gains lead to
Participants completed intake questionnaires, received access to Child Characteristics Pre-Treatment Knowledge .54 4.07** improvements in implementation and child outcomes.
ImPACT Online, and were sent a follow-up questionnaire after 6
months. Gender Treatment Group .13 -.77 Parents in the open trial evaluated the program positively and
One community clinic tracked referrals to the OT group to examine 83% 76% .29 reported few barriers to participation (see Figure 4). However,
(% Male)
reach of the program and representativeness of participants Percent of Program they also identified a number of additional supports that may
.41 2.43*
Participant demographics were compared for the OT (n=112) and Chronological Age M = 60.0 M = 43.0 Completed assist with program engagement.
<.001
CT groups (n=50). (Months) SD = 21.1 SD = 13.7
Program engagement was compared for the OT group (n=68) and The benefits of self-directed, telehealth programs extend beyond
Minority status *p<.05, **p<.001
the CT-SD group (n=17) who had access to the program for 6 38% 24% .07 controlled lab-based trials. However, their utility is likely to be
months. (% Minority) reduced when rolled out on a large scale. Research is needed on
Follow-up questionnaires were completed by 26 OT and 16 CT-SD M=6.9 M=10.7 program modifications and supports that can encourage program
participants Intervention hrs/wk .05 engagement for community families.
SD=9.2 SD=10.1