A multi-constituent qualitative examination of facilitators and barriers to caregiver coaching for autistic children in publicly funded early intervention

Abstract

Caregiver coaching is an evidence-based practice for autistic children that is poorly implemented in community-based early intervention. Previous studies have identified factors that influence implementation of caregiver coaching in early intervention; however, multi-informant (e.g., caregiver, provider, leadership) qualitative research is lacking. As such, the purpose of this study was to simultaneously examine the perspectives of caregivers and early intervention providers and agency leaders for triangulation of perceived barriers and facilitators to caregiver coaching in community-based early intervention. Interviews with 36 providers, 6 agency leaders, and 20 caregivers of autistic children were conducted. We used qualitative thematic analysis to identify barriers and facilitators, which we then mapped onto the Consolidated Framework for Implementation Research post hoc. Several themes emerged, including at the outer setting level (i.e., COVID-19 pandemic), inner setting level (i.e., caregiver views toward telehealth), individual characteristic level (i.e., caregiver attitudes toward coaching, caregivers concerns preventing progress, caregiver expectations regarding services, caregiver stress), and implementation process level (i.e., caregiver and provider collaboration, caregiver and provider relationship, caregivers coordinating services, caregiver involvement, provider flexibility). We offer suggestions for implementation strategies that will increase adoption of caregiver coaching in early intervention for autistic children and their families. Lay Abstract Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers’ attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.