|Title:||Adapting an Evidence-Based Practice for Children At-Risk for Autism for Diverse Early Intervention Service Systems|
|Principal Investigator:||Rogers, Sally||Awardee:||University of California, Davis|
|Program:||Early Intervention and Early Learning in Special Education [Program Details]|
|Award Period:||3 years (7/1/2015-8/31/2018)||Award Amount:||$1,498,581|
|Goal:||Development and Innovation||Award Number:||R324A150211|
Co-Principal Investigator: Aubyn Stahmer
Purpose: The goal of this project is to improve developmental outcomes and school readiness of infants and toddlers at risk for autism spectrum disorders (ASD) and their families by adapting an existing empirically supported practice—the Early Start Denver Model (ESDM)—for use in Part C of the Individuals with Disabilities Education Act (IDEA) intervention systems in low-income, ethnically diverse community settings. The Program for Infants and Toddlers with Disabilities, commonly known as Part C, is a federal grant program to assist states in the provision of early intervention services to these children (birth to age 3). As rates of ASD continue to increase, more infants and toddlers with ASD are entering the Part C system. Improved access to effective care will reduce long-term costs and service intensity for these children at risk for ASD in later years and improve child outcomes over time.
Project Activities: This project's activities will be conducted in four phases. In the exploration phase, the researchers will obtain a comprehensive understanding of community needs and barriers to serving children with ASD in early intervention. In the following phase, the team will work collaboratively with Part C administrators, providers, and families to adapt the ESDM for use in Part C services. Next, the revised model, Community Adapted Early Start Denver Model (C-ESDM), will be implemented in diverse Part C agencies using individualized implementation plans. Finally, the pilot study will examine the C-ESDM on implementation and the promise of efficacy for child and family outcomes.
Products: The products of this project will include a manual that contains the modified and adapted assessment instrument and implementation procedures for the C-ESDM; a training package for Part C providers and families that will increase the effectiveness of intervention services for infants and toddlers at risk for ASD; and peer-reviewed publications and presentations.
Setting: Qualitative data collection and collaboration in adapting the ESDM for diverse, low-resource communities will take place in care settings—including agencies, centers, and homes—in six different states: Alabama, California, Colorado, Montana, New Mexico, and Pennsylvania. The pilot study will take place in low-resource, low-income, highly culturally diverse parts of Alabama, California, and Colorado.
Sample: Part C administrators, providers, and the families they serve will participate in the first phases of the project to adapt and field test the intervention. In Phase 1, study participants include (a) 5 state Part C coordinators; (b) 10 local Part C agency administrators; (c) 20 early intervention providers; and, (d) 20 parents or caregivers of children at risk for ASD who have participated in Part C services. In Phase 2, participants include 5 early intervention experts, 10 providers, and 5 administrators from participating states. In the final two phases, implementation and pilot study, three to four providers per agency will participate, with two to three children ages 12–30 months and their families per provider. Overall, approximately 25 providers and 50 children will comprise the final pilot sample.
Intervention: The intervention to be developed is the Community Adapted Early Start Denver Model (C-ESDM). Although the ESDM has demonstrated efficacy, adaptations are needed to make it more applicable for Part C community providers. Based on the National Professional Development Center for Autism Spectrum Disorder model, C-ESDM will include implementation teams and coaching for local agencies. The intervention will provide a comprehensive, individualized intervention to enhance the development of young children with ASD through supports for families to incorporate needed learning experiences into everyday routines.
Research Design and Methods: In Phase 1, surveys and structured interviews will be used to obtain an understanding of needed adaptations to ESDM from Part C coordinators, administrators, providers, and families. An iterative process will be used to adapt the intervention and training materials in Phases 1 and 2. Phase 3 involves implementation and further adaptations based on the results from prior phases. Fidelity will be assessed and then fidelity measures finalized in this phase. Phase 4 involves pilot testing using a cluster randomized trial to compare the treatment group (C- ESDM) to the control group (Part C services as usual). The intervention and control groups will be matched for treatment intensity, and random assignment to the treatment or control group will occur within levels of treatment intensity.
Control Condition: The control group will receive services as usual in Part C programs.
Key Measures: Outcome measures focus on family functioning, child communication, and social and cognitive development. These measures include the following: Autism Program Environment Rating Scale-Infant Toddler; Bayley Scales of Infant Development-2nd Edition; MacArthur-Bates Child Development Inventory; Vineland Adaptive Behavior Scale; Pervasive Developmental Disorders Behavior Inventory; Infant Toddler Checklist; and Parenting Sense of Competence Scale. Additional measures will collect evidence of usability, feasibility, and family and provider satisfaction (via structured interviews and in-depth surveys) as well as fidelity of implementation (via observation data and implementation surveys).
Data Analytic Strategy: Phases 1 and 2 survey and interview data will be analyzed using mixed methods and a rapid assessment approach to inform adaptations and implementation in Phase 3. In Phase 4, the pilot study, a univariate three-level longitudinal mixed-effect (LME) growth curve analyses will be conducted to assess the outcome measures and to compare feasibility and the promise of efficacy of the C-ESDM to the control condition.