Examining provider decisions around the delivery and adaptation of a parent-mediated intervention within an Early Intervention system.
Project ImPACT quality inches up with coaching in public Early Intervention, but staff will still tweak it—so build check-ins, not castles.
01Research in Context
What this study did
Ledbetter-Cho et al. (2023) watched Early Intervention staff teach Project ImPACT to parents of toddlers with autism. They tracked how closely each staff member followed the manual and what changes they made on the fly.
The team gave extra coaching calls and then scored videos of real sessions. They wanted to know if quality went up and what tweaks stayed in place.
What they found
Fidelity scores rose after coaching, but the range stayed wide. Some staff hit every step; others still missed key parts.
Almost every provider bent the program—shortening steps, swapping toys, or skipping jargon. These changes were common, not rare.
How this fits with other research
Rieth et al. (2022) asked 38 community providers the year before and heard, "We love this program; it’s easy." Katherine et al. now show that love does not equal perfect delivery—acceptability is high, yet fidelity varies.
Pickard et al. (2019) found that when parents helped re-design Project ImPACT for Medicaid, parents felt fewer barriers. The 2023 paper flips the lens: once the re-designed program reaches the public system, staff still adapt it session-by-session.
Hatton et al. (2005) painted a messy picture—community staff mixing many tricks with little training. Today’s data say even with one clear manual, tweaks still happen, but now they are tracked and coached instead of hidden.
Why it matters
If you supervise EI staff, expect drift and plan for it. Build quick fidelity checks into every supervision call and praise tiny gains. Let staff share their on-the-spot changes in team meetings; some may be smart shortcuts worth keeping. Share the 2023 data with funders to keep coaching dollars alive—brief calls do lift quality even if perfection stays elusive.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a five-minute fidelity spot-check to your next supervision call: pick one Project ImPACT step, watch a short clip, and give immediate feedback.
02At a glance
03Original abstract
Parent-mediated interventions are an evidence-based practice for autism in which providers support caregivers in learning and applying strategies that support their child's development. Research has begun to study whether parent-mediated interventions can be effectively delivered in Part C Early Intervention systems. This research has been promising; however, it has been difficult to determine how Early Intervention providers deliver and adapt parent-mediated interventions to meet the needs of the families they serve. Examining how parent-mediated interventions are delivered and adapted may help us understand whether parent-mediated interventions are a good fit in these systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by providers within an Early Intervention system. Results from 24 Early Intervention providers demonstrated that, on average, providers delivered Project ImPACT with higher quality during their time in training and consultation. However, there was also variability in how providers delivered Project ImPACT, with some delivering the program inconsistently, some increasing their quality throughout consultation, and others having consistently high-quality delivery. In addition, qualitative data demonstrated that a variety of events arose within Project ImPACT sessions that drove providers to adapt the program. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems.
Autism : the international journal of research and practice, 2023 · doi:10.1177/13623613231162149