A Window into the Use of Post-diagnostic Services for Autism and Parents' Perspective on the Quality of Early Childhood Services Trajectory in a Canadian Province

The pathway for post-diagnostic services for autism tends to be complex, heterogeneous, and fraught with delays. This situation has repercussions for families' experience with care systems, the quality of early interventions, and family adjustment. To date, studies of parents' point of view on autism services have predominantly focused on the diagnostic phase of the services trajectory. The goal of the present study was to investigate the perspective of parents on autism early childhood services within a public healthcare and social services system in a Canadian province (Québec). Participants were 91 parents who completed a structured framework for the evaluation of the quality of services trajectories, the Evaluation of the services Trajectory in Autism by Parents (ETAP; Mello et al., in Research in Developmental Disabilities 133, 2023). Approximately three-quarters of families received interim services (e.g., punctual speech therapy interventions) for which they had overall neutral-to-positive appraisals but viewed as having comparably low validity and continuity. Although all children diagnosed with autism are entitled to receive early behavioral intervention (EBI) dispensed by the public health and social services system, approximately a quarter of families did not receive this service. Families who received EBI evaluated this service positively on all ETAP dimensions. The empathy (i.e., parent-provider relationships) dimension was rated highest for both interim and EBI services. Some systemic, family, and child-related factors were associated with the perceived quality of services for both interim and early childhood services. Our results emphasize the need for services for children and families as soon as possible, both during assessment and after diagnosis.

Competency drivers to support implementation of early intensive behavioral intervention in large-scale community-based services: Perspectives of caseworkers and organization representatives

Implementing evidence-based practices in "real-world" settings poses significant challenges. Organizations involved must address this issue by providing supportive infrastructures. Among the elements to consider are competency drivers, which refer to the selection, training, and supervision of caseworkers. The purpose of this study was to describe the perspectives of caseworkers and representatives on competency drivers that organizations put in place to support the implementation of early intensive behavioral intervention (EIBI) in large-scale community-based services. The sample consisted of 109 caseworkers and 23 organization representatives who completed questionnaires. Results demonstrated that respondents consider clinical support and training as key elements in EIBI implementation. However, despite recognizing these factors, respondents reported considerable variability in practices. It appears necessary to better define and plan the implementation of these competency drivers with a view to improving EIBI implementation.

Parent coaching intervention program based on the Early Start Denver Model for children with autism spectrum disorder: Feasibility and acceptability study

A parent coaching intervention program was launched in a Quebec community-based organization for autism spectrum disorder. This initiative was intended to support families following the child's diagnosis, as they awaited public early intensive behavioral intervention services. The parent-mediated intervention program, based on the Early Start Denver Model, included a 3 h parent group training, an initial assessment followed by the development of an individualized intervention plan, 8 weeks of live coaching, a final assessment to evaluate children's progress, and a feedback meeting with families. The present study used a mixed-method design to assess the feasibility and acceptability of the program. Ten families (ten mothers and three fathers) and four coaches participated in the present study. Parents and coaches perceived and achieved high levels of implementation overall (91 %) and there was a moderate improvement of parents' teaching skills. All participating families and coaches were satisfied or highly satisfied with the program and found it acceptable.

Le point de vue de parents d’enfants présentant un trouble du spectre de l’autisme en regard d’un programme public d’intervention comportementale

L’intervention comportementale intensive (ICI) est implantée depuis 2003 dans les services publics québécois destinés aux enfants de 2 à 5 ans ayant un trouble du spectre de l’autisme. Ce choix a été fait sur la base de l’avis d’experts et des données probantes à l’effet que l’ICI représente l’intervention la plus efficace pour les jeunes enfants ayant ce type de trouble. Bien que les effets de l’ICI soient largement documentés, la perception des familles quant aux services d’ICI reçus demeure peu étudiée. À partir d’entretiens effectués auprès de 52 familles, le point de vue des parents concernant les services d’ICI a été abordé selon trois dimensions : l’appréciation générale, les effets perçus sur l’enfant et la famille ainsi que le niveau de satisfaction. Les données ont été recueillies à partir de questions ouvertes, d’un questionnaire structuré et de l’Échelle de satisfaction des services (CSQ-8). Les parents participants rapportent que l’équipe d’intervention, les modalités d’intervention ainsi que le contenu de l’intervention des services ICI sont les principaux points forts des services évalués. Des améliorations pourraient néanmoins être apportées à certaines modalités de dispensation des services, ainsi qu’à l’accessibilité, aux mouvements de personnel et à l’implication des parents. Tous les parents, sauf un, rapportent des effets positifs chez l’enfant, notamment sur les plans de la communication, du fonctionnement cognitif et des aspects sociaux. Les services ont aussi des effets sur le bien-être des parents, leurs habiletés parentales et la vie quotidienne familiale. Plus de 95 % des répondants se sont déclarés satisfaits ou très satisfaits des modalités du programme ICI. Le niveau général de satisfaction est également très élevé.