Developing a Framework for Engagement in Group Based Interventions: Interviews With Parents of Children With Autism

Background and Purpose: The CDC reports that 1 in 88 children are diagnosed with autism spectrum disorder (ASD) and characterizes the epidemic of ASD as an “urgent public health concern”. Research suggests a significant need for parent training and support for parents of children who live with ASD. While the positive effects of group-based parent interventions for this population have been documented, little is known about how the engagement of parents in these interventions may impact their effectiveness. More specifically, systematic evaluation of the factors that enhance or inhibit engagement with this particular population is limited. It is widely acknowledged that low client engagement is correlated with negative treatment outcomes, and it is therefore important to examine the engagement of this population. The objective of the current study was to develop a framework for parent engagement in a voluntary group-based parent intervention for parents of children with ASD.

Methods: This study presents a conceptual framework based on perspectives of parents of children with ASD who participated in a voluntary group-based parent intervention called Playing Fifth Base (PFB). Consistent with the exploratory and developmental aims of this study, a qualitative approach to data collection and analysis was implemented. Specifically, semi-structured phone interviews were conducted with 13 of 26 parents who participated in one of three PFB groups. Parents were asked to describe their experience in the group, their perception of the effectiveness of the group, and the factors that enhanced or detracted from their engagement in the intervention. All interviews were recorded and later transcribed. Authors participated in an analytic process that proceeded through three overlapping phases, including 1) open coding; 2) relating codes between authors, searching for causal relationships between codes, and grouping similar codes within broader conceptual categories; and 3) reviewing memos taken throughout data collection and analysis, sensitizing to existing research on treatment engagement, positing relationships between categories, and searching for confirming and disconfirming examples within the transcripts. This process yielded a conceptual framework in which five categories and their subcategories are causally related to each other.

Results: The qualitative, three-phase analysis yielded a tentative conceptual framework of the variables that contribute to engagement in voluntary group-based parent interventions for parents of children with ASD.  The authors propose that Intervention Characteristics (practitioner behaviors and program supports) contribute to Attitudinal Engagement by directly influencing parents' perceptions of the efficacy and relevance of the intervention. Intervention Characteristics also influence Relational Factors (group dynamics and therapeutic alliance), which in turn influence parents' Attitudinal Engagement in treatment. Attitudinal Engagement then contributes to Behavioral Engagement. Behavioral Engagement is also partly determined by the External Barriers and Daily Stresses that individual parents experience.

Implications: This study offers a conceptual framework of parent engagement that may help social workers and other professionals engage parents of children with ASD in voluntary group-based parent interventions.  Authors discuss the implications for social work research, practice, and policy.