A mixed methods exploration of community providers' perceived barriers and facilitators to the use of parent training with Medicaid-enrolled clients with autism
A mixed methods exploration of community providers' perceived barriers and facilitators to the use of parent training with Medicaid-enrolled clients with autism
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DOI：
10.1177/1362361321989911
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发表时间：
2021-02-08
期刊：
影响因子：
5.2
通讯作者：
Ingersoll, Brooke
中科院分区：
文献类型：
--
作者：
Straiton, Diondra;Groom, Barb;Ingersoll, Brooke
这种混合方法分析考察了提供者对参加医疗补助客户的家长培训的障碍和促进因素的看法。使用分层线性回归模型对提供者调查数据进行分析，并使用主题分析来分析对提供者的后续访谈。定性主题是从访谈记录中归纳出来的，没有先入为主的假设。在家庭、提供者和组织层面确定了障碍和促进因素。家庭层面的障碍是唯一预测家长培训广泛性的唯一障碍（beta = -0.27，p = 0.007），这是家长培训频率和质量的综合衡量标准。没有协调员能够唯一预测广泛性，但提供者技能和专业培训经验对广泛性的预测微乎其微（ps < 0.06）。关于家长培训障碍的五个主题如下：后勤障碍、有限的家庭参与/兴趣、有限的机构支持/规范、有限的专业培训以及家庭压力源/家庭结构。关于促进者的四个主题如下：后勤促进者、机构支持/规范、高家庭参与/兴趣和专业培训。提出了在资源匮乏的社区环境中增加家长培训的使用的建议。 摘要：研究人员利用在线调查的定量数据和对应用行为分析提供者的后续访谈的定性数据，研究了向参加医疗补助的患有自闭症谱系障碍的青少年提供家长培训的障碍和促进因素。在家庭、提供者和组织层面确定了障碍和促进因素。家庭层面的障碍与家长培训使用频率较低和使用质量较差显着相关。提出了两项建议，以增加资源匮乏社区环境中家长培训的使用：(1) 向提供者提供有关家长培训最佳实践的专业培训机会；(2) 增加机构对家长培训的支持，特别是在减少后勤障碍方面。
This mixed methods analysis examined provider perspectives on barriers and facilitators to parent training use with Medicaid-enrolled clients. Provider survey data were analyzed using hierarchical linear regression models and thematic analysis was used to analyze follow-up interviews with providers. Qualitative themes were developed inductively from interview transcripts without preconceived hypotheses. Barriers and facilitators were identified at the family-, provider-, and organization-level. Family-level barriers were the only barriers to uniquely predict parent training extensiveness (beta = -0.27, p = 0.007), which is a composite measure of parent training frequency and quality. No facilitators uniquely predicted extensiveness, but provider skills and professional training experiences marginally predicted extensiveness (ps < 0.06). Five themes regarding barriers to parent training emerged as follows: logistical barriers, limited family engagement/interest, limited agency support/norms, limited professional training, and family stressors/family structures. Four themes about facilitators emerged as follows: logistical facilitators, agency support/norms, high family engagement/interest, and professional training. Recommendations are provided to increase the use of parent training in low-resourced community settings.Lay abstractUsing quantitative data from an online survey and qualitative data from follow-up interviews with applied behavior analysis providers, researchers examined barriers and facilitators to providing parent training to Medicaid-enrolled youth with autism spectrum disorder. Barriers and facilitators were identified at the family-, provider-, and organization-levels. Family-level barriers were significantly related to less frequent parent training use and poorer quality of use. Two recommendations are provided to increase the use of parent training in low-resourced community settings: (1) provide professional training opportunities to providers about best practices in parent training and (2) increase agency support for parent training, particularly in reducing logistical barriers.