Telehealth Pilot Study of the Effects of a Naturalistic Developmental Behavioral Intervention on Child Social Communication Outcomes in a Community Mental Health System

Little is known about the effectiveness of caregiver-mediated naturalistic developmental behavioral interventions (NDBIs) implemented via telehealth for autistic children served in under-resourced settings. This mixed methods pilot study examined social communication outcomes for autistic children whose families received a caregiver-mediated NDBI in a community mental health setting. Twenty-one families of Medicaid-enrolled autistic children aged 2-6 received Project ImPACT (a caregiver-mediated NDBI) via telehealth. Caregivers completed the Autism Impact Measure at 5 timepoints. We fit three, 2-level multilevel models to estimate the effect of time (weeks of Project ImPACT), child age (mean-centered), and the interaction of time x age on the Autism Impact Measure domains of Communication, Social Reciprocity, and Peer Interaction. Six caregivers completed follow-up interviews, which were analyzed using the framework method. There were statistically significant decreases in caregiver-reported peer interaction challenges. Decreases in communication challenges approached statistical significance. Scores for social reciprocity challenges did not significantly change over time. Six qualitative themes centered around how the child- and family-centered aspects of the NDBI strategies led to improvements in the children's social communication outcomes and suggestions for improving Project ImPACT. Preliminary findings suggest that NDBIs may be feasible and potentially effective in under-resourced settings.