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Pellecchia M, Mandell DS, Tomczuk L, Marcus SC, Stewart R, Stahmer AC, Beidas RS, Rieth SR, Lawson GM. A mixed-methods evaluation of organization and individual factors influencing provider intentions to use caregiver coaching in community-based early intervention. Implement Sci Commun 2024; 5:17. [PMID: 38414019 PMCID: PMC10900730 DOI: 10.1186/s43058-024-00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Most psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers' intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers' intentions to implement the components of caregiver coaching. METHODS We surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors. RESULTS The associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers' attitudes toward coaching caregivers and their perceptions of caregivers' expectations for service were particularly salient themes related to their use of caregiver coaching. CONCLUSION Results highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.
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Affiliation(s)
- Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA.
| | - David S Mandell
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Liza Tomczuk
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Steven C Marcus
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Rebecca Stewart
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Aubyn C Stahmer
- University of California, Davis, Mind Institute, Sacramento, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sarah R Rieth
- College of Education, San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Gwendolyn M Lawson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Pellecchia M, Mandell DS, Beidas RS, Dunst CJ, Tomczuk L, Newman J, Zeigler L, Stahmer AC. Parent Coaching in Early Intervention for Autism Spectrum Disorder: A Brief Report. J Early Interv 2023; 45:185-197. [PMID: 37655268 PMCID: PMC10469633 DOI: 10.1177/10538151221095860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers' use of parent coaching in an early intervention system. Twenty-five early intervention sessions were coded for fidelity to established caregiver coaching techniques. We found low use of coaching techniques overall, with significant variability in use of coaching across providers. When providers did coach caregivers, they used only a few coaching strategies (e.g., collaboration and in-vivo feedback). Results indicate that targeted training and implementation strategies focused on individual coaching components, instead of coaching more broadly, may be needed to improve the use of individual coaching strategies. A focus on strengthening the use of collaboration and in-vivo feedback may be key to improving coaching fidelity overall.
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Affiliation(s)
- Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania
| | - David S. Mandell
- Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania
| | - Rinad S. Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, & Medicine; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI); Center for Health Incentives and Behavioral Economics (CHIBE);Perelman School of Medicine, University of Pennsylvania
| | | | - Liza Tomczuk
- Center for Mental Health, Psychiatry Department, Perelman School of Medicine, University of Pennsylvania
| | - Jeannette Newman
- Philadelphia Infant and Toddler Early Intervention, Department of Behavioral Health and Intellectual DisAbility Services
| | - Lisa Zeigler
- Philadelphia Infant and Toddler Early Intervention, Department of Behavioral Health and Intellectual DisAbility Services
| | - Aubyn C. Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California Davis
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Lawson GM, Mandell DS, Tomczuk L, Fishman J, Marcus SC, Pellecchia M. Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems. Adm Policy Ment Health 2023; 50:357-365. [PMID: 36525093 PMCID: PMC10191901 DOI: 10.1007/s10488-022-01243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, 2716 South St, 8th Floor, Philadelphia, Pennsylvania, 19146, United States.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Liza Tomczuk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- Annenberg School, University of Pennsylvania, Pennsylvania, United States
| | - Steven C Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- School of Social Policy and Practice, University of Pennsylvania, Pennsylvania, United States
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
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Tomczuk L, Stewart RE, Beidas RS, Mandell DS, Pellecchia M. Who gets coached? A qualitative inquiry into community clinicians' decisions to use caregiver coaching. Autism 2021; 26:575-585. [PMID: 34866429 DOI: 10.1177/13623613211059499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Providers' beliefs about an intervention's fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers' decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality of and access to early intervention services in the community. We looked at differences in providers' use of caregiver coaching, an evidence-based practice, with families from minority or vulnerable backgrounds, and the possible reasons for those differences. We did this to figure out what factors affect providers' use of caregiver coaching. We interviewed 36 early intervention providers from early intervention agencies in two different parts of the United States. Providers pointed out things like what they thought about a family's circumstances that affected their beliefs about how well coaching fits with minority and vulnerable families. Our findings bring attention to these beliefs that likely make accessing evidence-based practices for minority and vulnerable families harder and lessen the quality of care for these families of young autistic children. These findings highlight the need to come up with and use strategies to improve both access to and the quality of evidence-based practices for young autistic children from minority and vulnerable groups.
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Schaller RD, Santangeli P, Tomczuk L, Frankel DS. Use of a novel bipolar sealer device in pocket infections: A case series. J Cardiovasc Electrophysiol 2019; 30:1727-1731. [DOI: 10.1111/jce.14026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Robert D. Schaller
- The Section of Cardiac Electrophysiology, Cardiovascular Division, Department of MedicineHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Pasquale Santangeli
- The Section of Cardiac Electrophysiology, Cardiovascular Division, Department of MedicineHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - Liza Tomczuk
- The Section of Cardiac Electrophysiology, Cardiovascular Division, Department of MedicineHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
| | - David S. Frankel
- The Section of Cardiac Electrophysiology, Cardiovascular Division, Department of MedicineHospital of the University of PennsylvaniaPhiladelphia Pennsylvania
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Nuske HJ, Finkel E, Hedley D, Parma V, Tomczuk L, Pellecchia M, Herrington J, Marcus SC, Mandell DS, Dissanayake C. Heart rate increase predicts challenging behavior episodes in preschoolers with autism. Stress 2019; 22:303-311. [PMID: 30822219 DOI: 10.1080/10253890.2019.1572744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Identifying triggers for challenging behavior is difficult in some children with autism because of their limited communication abilities. Physiological indicators of stress may provide important insights. This study examined whether heart rate (HR) predicts challenging behavior in children with autism. While wearing an electrocardiograph monitor, 41 children with autism aged 2- to 4-years participated in tasks designed to induce low-level stress (e.g. waiting for a snack). Coders identified 106 time periods during which challenging behaviors occurred and also coded 106 randomly selected time samples that did not include challenging behaviors. Thirteen (32%) participants exhibited challenging behaviors and were included in the study. Baseline-corrected HR was computed for each behavior/time sample. On average, children with autism showed a 22 ± 16% HR increase from baseline 58 ± 22 seconds before the onset of a challenging behavior episode. Peak HR change had moderate predictive utility (area under the curve = .72, p < .001). The increase in HR before challenging behaviors was similar for children of different characteristics (age, autism severity, expressive language ability, overall developmental ability). Results highlight the promise of using physiological stress to predict challenging behavior in preschoolers with autism; although, they need to be replicated in larger samples. Given recent advances in wearable biosensing, it may be useful to incorporate HR monitoring in autism intervention. Lay summary In children with autism, changes in heart rate (HR) may help us predict when challenging behavior is about to occur - but this hypothesis has not been well studied. In this study, HR increase moderately predicted challenging behavior in preschoolers with autism. Given recent advances in wearable sensors, it may be useful to incorporate HR monitoring in autism intervention.
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Affiliation(s)
- Heather J Nuske
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - Emma Finkel
- c Psychology Department, School of Arts and Sciences , University of Pennsylvania , Philadelphia , PA, USA
| | - Darren Hedley
- d School of Psychology and Public Health , Olga Tennison Autism Research Centre, La Trobe University , Melbourne , Australia
| | - Valentina Parma
- e Scuola Internazionale Superiore di Studi Avanzati , Trieste , Italy
| | - Liza Tomczuk
- f Neuroscience Program, Dickinson College , Carlisle , PA, USA
| | - Melanie Pellecchia
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - John Herrington
- b Center for Autism Research, Children's Hospital of Philadelphia , Philadelphia , PA, USA
| | - Steven C Marcus
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - David S Mandell
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - Cheryl Dissanayake
- d School of Psychology and Public Health , Olga Tennison Autism Research Centre, La Trobe University , Melbourne , Australia
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