Examining provider decisions around the delivery and adaptation of a parent-mediated intervention within an Early Intervention system

There is growing research aimed at translating parent-mediated interventions into Part C Early Intervention systems to examine the effectiveness and reach of these models. Although research to date suggests that Early Intervention providers deliver parent-mediated intervention near fidelity, current fidelity reporting practices make delivery difficult to discern. Understanding how parent-mediated interventions are delivered and adapted in a more nuanced manner, including fine-grained intervention delivery and adaptation processes, is important and may increase our understanding of how well these models are aligned within Early Intervention systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by Early Intervention providers and examined their intervention fidelity, the decisions they weighed when delivering Project ImPACT, and reported adaptations to Project ImPACT. Results from 24 providers demonstrated, on average, higher fidelity in response to consultative feedback but notable variability across providers. Preliminary qualitative data highlighted that many events arose within sessions that drove providers to augment their delivery of Project ImPACT. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems, and the impact of these decisions on fidelity metrics and service outcomes. Lay abstract Parent-mediated interventions are an evidence-based practice for autism in which providers support caregivers in learning and applying strategies that support their child’s development. Research has begun to study whether parent-mediated interventions can be effectively delivered in Part C Early Intervention systems. This research has been promising; however, it has been difficult to determine how Early Intervention providers deliver and adapt parent-mediated interventions to meet the needs of the families they serve. Examining how parent-mediated interventions are delivered and adapted may help us understand whether parent-mediated interventions are a good fit in these systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by providers within an Early Intervention system. Results from 24 Early Intervention providers demonstrated that, on average, providers delivered Project ImPACT with higher quality during their time in training and consultation. However, there was also variability in how providers delivered Project ImPACT, with some delivering the program inconsistently, some increasing their quality throughout consultation, and others having consistently high-quality delivery. In addition, qualitative data demonstrated that a variety of events arose within Project ImPACT sessions that drove providers to adapt the program. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems.