1 - (SYM 115) Recommendations from Clinicians and Agency Leaders to Optimize Consultation for a Parent Coaching Intervention for Autistic Children Served in the Medicaid System

Background: Consultation is a common implementation strategy utilized in implementation efforts for behavioral health; however, little is known about how to optimize consultation, particularly in under-resourced and publicly funded settings. This thematic analysis will yield feedback on discrete consultation training activities (i.e., feedback on videotaped sessions, role plays, case support discussions) and recommendations for improving consultation about parent coaching interventions delivered in the Medicaid system.

Methods: Two coders will utilize thematic analysis and the framework method to investigate feedback and recommendations about consultation from community clinicians (N = 11) and agency leaders (N = 7) who were interviewed about a group consultation model to improve fidelity to Project ImPACT (an evidence-based parent coaching intervention to support social communication in young autistic children) in the Medicaid system via telehealth.

Results: Data analysis is ongoing. Preliminary analyses suggest that community collaborators: 1) appreciate the opportunity to discuss emergent clinical issues in consultation as they utilize the intervention with clients for the first time; 2) feel apprehension about participating in active consultation strategies (e.g., role plays), but describe these strategies as helpful in improving manual adherence and coaching competency; 3) describe case support discussions (e.g., problem-solving implementation challenges) as useful, though they can be somewhat repetitive; and 4) provide recommendations for: optimizing individual training activities (e.g., shorten case support sessions), determining the order of training activities (e.g., complete role plays first), adding additional training activities (e.g., incorporate exemplar videos and videos at low fidelity), and supporting additional training objectives (e.g., training about addressing disruptive behavior).

Conclusions: Consultation models rarely incorporate feedback and recommendations from community collaborators, who are local experts in their implementation context. Preliminary results from this analysis yield several changes that can be implemented to optimize consultation. These recommendations will be used in future consultation efforts focused on parent coaching interventions for autistic children served in under-resourced settings. This will ultimately improve clinician fidelity and client/family outcomes for low-income autistic children.