(PS4-77) The Relation Between Demographic Factors and Part C Provider-reported Augmenting and Reducing Intervention Adaptations

Adaptations to evidence-based interventions are inherent when used in community settings. However, there is a limited understanding of how and why providers make practice-based adaptations, particularly for historically underserved families. The objective of this study was to examine differences in Early Intervention (EI) provider self-reported adaptations to Caregiver-Implemented Reciprocal Imitation Teaching (CI-RIT) based on demographic factors (racial ethnic minoritized identity (REM), household income, and caregiver educational attainment).

EI providers in Part C systems across 4-states implemented CI-RIT, an evidence-based intervention for social communication, as part of an effectiveness-implementation trial. Providers (n= 35) rated the extent to which they adapted CI-RIT within 3 months of implementation with specific families (n= 64) using a 5-point Likert scale (Table 1). Adaptations were measured at both content and coaching-levels and categorized based on a simplification of FRAME (Wiltsey-Sirman et al., 2019), the Adaptation of Evidence-based Practices Scale (Lau et al., 2017), distinguishing between reducing (shortening, removing, reordering) and augmenting (lengthening, adding, and modifying) adaptations. Providers also selected from a list of factors that influenced their decision to modify the intervention (caregiver, child, family, cultural, and provider characteristics).

The regression analysis revealed a significant negative relationship between household income and reducing adaptations at the coaching level. Providers did in more reducing coaching adaptations for families whose self-reported household income was in the lower brackets [R²= 0.95, F(1, 44) = 4.61, p = 0.037]. Clinicians did not differentially adapt CI-RIT based on caregivers’ REM identity or educational attainment. For adaptation rationale, providers were more likely to indicate caregiver characteristics as an influencing factor in adapting CI-RIT for REM families in comparison to non-Hispanic, white families, χ² (1, N = 62) = 6.45, p = .012.

Providers reported differentially adapting coaching techniques when working with families whose household income is in lower brackets. Specifically, they are more likely to omit or skip coaching activities within their RIT sessions. While providers did not differentially adapt for REM identity, they indicated that adaptations were driven by caregiver characteristics when working with REM families. Future research should examine whether these increased modifications lead to improved outcomes (e.g., engagement, intervention fidelity, social communication skills), as it can inform strategies that address disparities in access to early interventions for underserved groups.   

 

Table 1 Caregiver Demographics