A mixed methods exploration of community providers’ perceived barriers and facilitators to the use of parent training with Medicaid-enrolled clients with autism

Abstract

This mixed methods analysis examined provider perspectives on barriers and facilitators to parent training use with Medicaid-enrolled clients. Provider survey data were analyzed using hierarchical linear regression models and thematic analysis was used to analyze follow-up interviews with providers. Qualitative themes were developed inductively from interview transcripts without preconceived hypotheses. Barriers and facilitators were identified at the family-, provider-, and organization-level. Family-level barriers were the only barriers to uniquely predict parent training extensiveness (β = −0.27, p = 0.007), which is a composite measure of parent training frequency and quality. No facilitators uniquely predicted extensiveness, but provider skills and professional training experiences marginally predicted extensiveness (ps < 0.06). Five themes regarding barriers to parent training emerged as follows: logistical barriers, limited family engagement/interest, limited agency support/norms, limited professional training, and family stressors/family structures. Four themes about facilitators emerged as follows: logistical facilitators, agency support/norms, high family engagement/interest, and professional training. Recommendations are provided to increase the use of parent training in low-resourced community settings.

Lay abstract

Using quantitative data from an online survey and qualitative data from follow-up interviews with applied behavior analysis providers, researchers examined barriers and facilitators to providing parent training to Medicaid-enrolled youth with autism spectrum disorder. Barriers and facilitators were identified at the family-, provider-, and organization-levels. Family-level barriers were significantly related to less frequent parent training use and poorer quality of use. Two recommendations are provided to increase the use of parent training in low-resourced community settings: (1) provide professional training opportunities to providers about best practices in parent training and (2) increase agency support for parent training, particularly in reducing logistical barriers.