Engagement in behavioral parent training (BPT), including enrollment, attrition, attendance, within-session engagement, and homework completion, has long been a critical issue in the literature. Several estimates of various aspects of engagement have been suggested in the literature, but a systematic review of the available literature has never been accomplished. This review examines engagement data across 262 studies of BPT. Recruitment attrition, program attrition, attendance, and within-session engagement are examined across studies, with particular emphasis on the impact that SES, study purpose (efficacy vs. effectiveness), treatment format (individual vs. group), and age of child may have on those rates. Results of this review suggest that the significant amount of attrition occurs prior to enrollment in BPT, with at least 25 % of those identified as appropriate for BPT not enrolling in such programs. An additional 26 % begin, but drop out before completing treatment. Still the combined dropout rate of at least 51 % leaves at best half of identified parents completing treatment. While SES status had a small effect on attrition, other variables were not found to meaningfully impact engagement. Information on within-session engagement (homework and ratings of participation) was not often reported in studies. Key issues in this literature (e.g., varying definitions of engagement, limited attention to reporting key aspects of engagement) are discussed, and recommendations are made to further improve this important area of research and clinical practice.

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Engagement in Behavioral Parent Training: Review of the Literature and Implications for Practice

Telehealth or online communication technologies may lessen the gap between intervention requirements for children with autism spectrum disorders (ASDs) and the available resources to provide these services. This study used a video conferencing and self-guided website to provide parent training in the homes of children with ASD. The first eight families to complete the 12-week online intervention and three-month follow up period served as pilot data. Parents’ intervention skills and engagement with the website, as well as children’s verbal language and joint attention skills were assessed. Preliminary research suggests telehealth may support parental learning and improve child behaviors for some families. This initial assessment of new technologies for making parent training resources available to families with ASD merits further, in-depth study.

Preliminary findings of a telehealth approach to parent training in autism.

http://everykid.on.ca/wp-content/uploads/2011/07/Sanders-Baker-Turner-AV-2012.pdf

A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems.

Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed internet-based instruction with remote coaching, was created to introduce parents of children with ASD to an imitation intervention. A single-subject multiple-baseline design study evaluated the effect of the program on changes in parent and child behavior. Parents improved in their use of the intervention techniques and their children demonstrated concurrent increases in spontaneous imitation skills. Parents also indicated that the intervention and telehealth service delivery model were acceptable, useable, and effective. Results suggest that this hybrid telehealth program has the potential to increase access to ASD services.

Increasing Access to an ASD Imitation Intervention Via a Telehealth Parent Training Program

Although there is consensus that parents should be involved in interventions designed for young children with autism spectrum disorder (ASD), parent participation alone does not ensure consistent, generalized gains in children's development. Barriers such as costly intervention, time-intensive sessions, and family life may prevent parents from using the intervention at home. Telehealth integrates communication technologies to provide health-related services at a distance. A 12 one-hour per week parent intervention program was tested using telehealth delivery with nine families with ASD. The goal was to examine its feasibility and acceptance for promoting child learning throughout families' daily play and caretaking interactions at home. Parents became skilled at using teachable moments to promote children's spontaneous language and imitation skills and were pleased with the support and ease of telehealth learning. Preliminary results suggest the potential of technology for helping parents understand and use early intervention practices more often in their daily interactions with children.

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Telehealth for expanding the reach of early autism training to parents.

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence-based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer- and web-based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self-determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence-based interventions.

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Christopher S Widdop

Papers

Computer-based intervention with coaching: an example using the Incredible Years program.