Parent and professional perspectives on implementing the Pediatric Autism Communication Therapy: A mixed-methods analysis

This study examined factors of implementation in clinical practice across the world of the Pediatric Autism Communication Therapy, an evidence-based parent-mediated therapy. Data were gathered via a survey administered to professionals trained in Pediatric Autism Communication Therapy and parents with whom they worked. The study was a mixed-method design informed by the Consolidated Framework for Implementation Research. Over 70% of the practitioners recorded the intent to implement therapy after Pediatric Autism Communication Therapy training. Implementation was more likely if the practitioner saw mostly autistic children within their work (odds ratios approximate to 5), was easier with new referrals, and with peer support from colleagues and managers, allowing scheduling flexibility. The main barriers for practitioners were time (sessions > 1 h), suitable video equipment, low parental self-reflection abilities and family stress. Parents rated the feasibility of learning and using Pediatric Autism Communication Therapy in daily life highly (median = 5.4; interquartile range = 4.5, 6.8; range = 1-7) and delivered home-based practice a median of 4 days per week (daily practice recommended). The facilitators of implementation for parents included positive regard for the features of the Pediatric Autism Communication Therapy method (video reflection, parental empowerment, and play-based practice). The barriers for parents were mostly related to time availability. These results outline the importance of family and system-context factors necessary for successful parent-mediated therapy implementation. Factors influencing the implementation of parent-mediated intervention are insufficiently studied. This study examines for the first-time factors of implementation into clinical practice across the world of Pediatric Autism Communication Therapy, an internationally disseminated, evidence-based, parent-mediated therapy. From both the parents' and the professionals' perspectives, parents attitudes (e.g. self-reflection abilities and videotaping management) and life-circumstances (e.g. stressed families condition and time) were central factors. In this type of therapy, the target is a child's development; still, this improvement is dependent on the parent's behavior when interacting with their child. What's more, Pediatric Autism Communication Therapy method (video reflection, empowerment of parent, play-based) was enabler according to most of the parents. And more, most professionals report factors linked to the Implementation Process that is planning, execution, reflection and assessment in implementation of a new therapy. Indeed, the professionals underlined barriers related to the population seen in practice, flexibility of schedule, support from colleagues and manager. All these factors could be improved and addressed with a formal implementation plan including factors related to the parents of each country.