Exploring and Developing Implementation Strategies to Support Parent Coaching

项目主任/首席调查员(最后、第一、中间)：Pellecchia，Melanie&Mandell，David Samuel 项目总结 本R21的目的是开发一套实施策略工具包，以增加早期干预(EI) 提供者对患有自闭症谱系障碍(ASD)或有自闭症谱系障碍(ASD)风险的幼儿家庭使用父母指导的情况。 近年来发展了许多循证的父母干预措施，并分享了干预措施。 旨在1)治疗ASD症状的TION组件，以及2)指导父母使用这些治疗方法。 虽然用于治疗儿童自闭症的干预成分受到了相当大的关注 关于它们在社区环境中的实施，用于指导父母的策略还没有。教练员 是治疗师改变父母行为的主动机制，但包括一组未被研究的 实施的目标。初步证据显示，基于社区的EI提供者花费了大部分时间 他们的时间直接与孩子一起工作，而不是指导父母，尽管EI领导人呼吁从 一种直接提供服务的模式，其中包括辅导父母。小规模研究表明，这种实施- 教育差距与提供者的低自我效能感、相互矛盾的教学态度和缺乏清晰度有关 对使用家长辅导的期望。组织和体制障碍也可能阻碍PAR的使用 通过影响临床医生对其使用的信念或设置障碍阻止临床医生采取行动进行ENT指导 他们的意图是指导父母。实施战略，解决与心理障碍相关的 而影响父母教练使用的组织变量最有可能是有效的。使用通信- 机构合作的参与性研究(CPPR)方法提供了一种新的方法来制定战略，以监督和 推广家长辅导的使用。费城EI系统的一项新举措，通过该倡议，EI提供商将 在Impact项目中接受培训，这是一种以证据为基础、父母为中介的自闭症儿童治疗方案，介绍 这是开发和试行这些实施战略的难得机会。通过这项研究，我们将测量 心理和组织结构通过直接影响EI提供者对父母指导的使用 观察、定量调查和定性访谈。然后，我们将与社区利益相关者合作 反复开发和测试实施策略，以增加EI提供者对家长指导的使用。我们 将依靠我们最近资助的敏捷中心赠款来支持使用创新的方法来迅速 制定并试行测试这些实施策略。这个项目的成功完成将产生一部小说， 易于使用的实施策略工具包，帮助EI提供者指导患有自闭症儿童的父母。这些 活动将为R01奠定基础，以评估该工具包在 后来的随机社区试验。 PHS 398/2590(06/09版)页面续格式页面

Program Director/Principal Investigator (Last, First, Middle): Pellecchia, Melanie & Mandell, David Samuel PROJECT SUMMARY The purpose of this R21 is to develop a toolkit of implementation strategies that increase early intervention (EI) providers' use of parent coaching for families of young children with or at risk for autism spectrum disorder (ASD). Many evidence-based parent-mediated interventions have been developed in recent years and share interven- tion components designed to 1) treat the symptoms of ASD, and 2) coach parents in the use of these treatments. While the intervention components used to treat children with ASD have received considerable attention with regard to their implementation in community settings, the strategies used to coach parents have not. Coaching is the active mechanism through which therapists change parent behavior, but comprises an understudied set of targets for implementation. Preliminary evidence shows that community-based EI providers spend most of their time working directly with the child, rather than coaching parents, despite calls from EI leaders to move from a model of direct service to one that incorporates coaching parents. Small studies suggest that this implementa- tion gap relates to providers' poor self-efficacy, conflicting pedagogical attitudes, and lack of clarity regarding expectations about using parent coaching. Organizational and systemic barriers also may inhibit the use of par- ent coaching by affecting clinicians' beliefs about its use or creating barriers that stop clinicians from acting on their intentions to coach parents. Implementation strategies that address barriers related to both psychological and organizational variables affecting the use of parent coaching are most likely to be effective. Using commu- nity-partnered participatory research (CPPR) methods offers a novel approach to developing strategies to sup- port the use of parent coaching. A new initiative in Philadelphia's EI system, through which EI providers will be trained in Project ImPACT, an evidence-based, parent-mediated treatment for young children with ASD, presents a rare opportunity to develop and pilot test these implementation strategies. Through this study, we will measure psychological and organizational constructs that influence EI providers' use of parent coaching through direct observations, quantitative surveys, and qualitative interviews. We then will partner with community stakeholders to iteratively develop and test implementation strategies to increase EI providers' use of parent coaching. We will rely on our recently funded ALACRITY center grant to support the use of innovative methods to rapidly develop and pilot test these implementation strategies. Successful completion of this project will result in a novel, easy-to-use toolkit of implementation strategies to help EI providers coach parents of children with ASD. These activities will lay the foundation for an R01 to evaluate the implementation and effectiveness of this toolkit in a later randomized community trial. PHS 398/2590 (Rev. 06/09) Page Continuation Format Page