4 - (SYM 115) Community Implementation of an Evidence-based Autism Intervention: Associations Between Therapist Engagement Strategy Use and Parent Participatory Engagement

Background: Parent-mediated mental health (MH) interventions require parent participatory engagement (PPE) in sessions. However, observational research in routine MH services shows that ethnic and language minority families have lower PPE compared to non-Hispanic White (NHW) and English-speaking families. Little is known about associations between therapist use of in-session parent engagement strategies (ES) and PPE. This study utilized data from a hybrid implementation-effectiveness trial of AIM HI, a skill-building intervention for autistic children receiving publicly funded MH services, to examine associations between therapist ES use and PPE behaviors (i.e., sharing perspective about child behavior, parenting experiences, between-session practice, and asking questions) and examine whether parent ethnic minority status and preferred language moderate these associations.

Method: Observational coding of AIM HI sessions (i.e., 1^st, 2^nd, or 3^rd session) was completed for 166 therapist/family dyads from 33 MH programs (child age: M = 9.6y, SD = 2.4y; parent ethnicity: 33% NHW, 54% Hispanic [47% Spanish preferred language], 11% Other Minority/Multicultural (OMM)) to examine therapists’ ES use and parent PPE behaviors. Multilevel regression analyses were used.

Results: Therapist ES use was positively associated with parents sharing about child behavior (β = 0.25, p</em> =0.02) and parenting experiences (β = 0.25, p</em> =0.01). Parent ethnicity moderated the relationship between therapist ES use and parents asking questions (NHW v. Hispanic, β = -0.77, p</em> =0.002; NHW v. OMM, β = -0.46, p</em> =0.04). Specifically, this relationship was positive for NHW participants compared to a negative relationship for Hispanic and OMM participants. Parent preferred language did not moderate the relationship between therapist ES use and PPE behaviors.  

Conclusion: This is the first study to examine the associations between therapist ES use and individual PPE behaviors in AIM HI, as well as how ethnicity and language might moderate these associations. The positive relationships between therapist ES use and sharing about child behaviors and parenting experiences are likely due to the structured nature of early AIM HI sessions, which involve integrating assessment information, psychoeducation, and behavior tracking. The finding that ethnicity moderates the relationship between ES use and parents asking questions highlights the need to tailor therapist ES use for ethnic minority families, though more work is needed to understand this finding.