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This study will focus on examining the supports required to enable community Senior JASPER Trainers to support the training and development of junior interventionists throughout the province of Newfoundland and Labrador, Canada. The study will examine the training and supports delivered by Senior Trainers to help junior interventionists provide a targeted social communication intervention (JASPER: Joint Attention, Symbolic Play, Engagement, and Regulation) with children with autism spectrum disorder (ASD). Children's engagement, play, and social communication outcomes will be examined as well as the influence of junior interventionists' intervention implementation on children's outcomes. Further, the study will examine the supports required to help junior interventionists who demonstrate slower gains in implementation fidelity after the first three months of standard support. Interventionists who are slow to gain implementation fidelity will be randomized to either (a) enhanced feedback plus peer support or (b) enhanced feedback plus intensive refresher course.
The proposed study is an adaptive intervention trial that will focus on tailoring supports for new JASPER interventionists. Coaching and training supports will be provided by Local Senior JASPER Trainers will support the development of new interventionists. Based on the interventionist's individual response to the coaching/training supports, a change in support may be provided at a priori time points including end of month 1 (training case) if at least 70% fidelity is not reached, and at end of month 4 (midpoint of first child cohort), at least 90% fidelity is not reached.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| A. Above Fidelity Phase 1 and Above Fidelity Phase 2 | Active Comparator | Alternating coaching and streamed or video feedback each week through phase 1, moves to video feedback only for phase 2. |
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| B. Below Fidelity Phase 1 and Above Fidelity Phase 2 | Active Comparator | Receive weekly coaching in phase 1, move to video feedback only in phase 2 |
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| C. Above Fidelity Phase 1, Below in Phase 2- Add Refresher | Active Comparator | Alternating coaching and streamed or video feedback each week through phase 1. In phase 2, the interventionist is still working toward 90% fidelity and is randomly assigned (50/50) to one of two different types of support from the Senior Trainer. The interventionist will receive a one week intensive in person refresher and then continue with weekly coaching and video feedback from the Senior Trainer (Enhanced Feedback plus intensive refresher course) for the final 12 weeks. |
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| D. Above Fidelity Phase 1, Below in Phase 2- Add Peer | Active Comparator | Alternating coaching and streamed or video feedback each week through phase 1. In phase 2, the interventionist is still working toward 90% fidelity and is randomly assigned (50/50) to one of two different types of support from the Senior Trainer. The interventionist will receive weekly coaching and video feedback from the Senior Trainer plus a weekly session paired with a local interventionist at fidelity (Enhanced Feedback plus peer support). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Alternate Coaching and Video Feedback Phase 1 | Behavioral | Alternates each week between live/tele-health coaching (coaching) or Video review and call (feedback) |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in JASPER Strategy Implementation Fidelity | Quantitative ratings of the interventionists' quality and accurate use of JASPER intervention strategies. | Entry, 1 month, 4 months, and 7 month exit |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Children's Joint Engagement | Time the child spends jointly engaged in interactions with the interventionist | Entry for cohort two (month 2), half way (month 4), and exit (month 7) |
| Change in Children's Play Skills and Social Communication Skills |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Connie Kasari, PhD | University of California, Los Angeles | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Health and Community Services, Government of Newfoundland and Labrador | St. John's | Newfoundland and Labrador | A1B 3X9 | Canada |
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| ID | Term |
|---|---|
| D000067877 | Autism Spectrum Disorder |
| D003142 | Communication |
| ID | Term |
|---|---|
| D002659 | Child Development Disorders, Pervasive |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D017321 | Clinical Trials, Phase I as Topic |
| ID | Term |
|---|---|
| D002986 | Clinical Trials as Topic |
| D000068456 | Clinical Studies as Topic |
| D016020 | Epidemiologic Study Characteristics |
| D004812 | Epidemiologic Methods |
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JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) is a play based targeted social communication intervention. Sessions will be delivered one on one by an interventionist in training with a child age 2.0-8.11 years who has autism.
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| E. Below Fidelity Phase 1, Below in Phase 2- Add Refresher | Active Comparator | Receive weekly coaching in phase 1. In phase 2, the interventionist is still working toward 90% fidelity and is randomly assigned (50/50) to one of two different types of support from the Senior Trainer. The interventionist will receive a one week intensive in person refresher and then continue with weekly coaching and video feedback from the Senior Trainer (Enhanced Feedback plus intensive refresher course) for the final 12 weeks. |
|
| F. Below Fidelity Phase 1, Below in Phase 2- Add Peer | Active Comparator | Receive weekly coaching in phase 1. In phase 2, the interventionist is still working toward 90% fidelity and is randomly assigned (50/50) to one of two different types of support from the Senior Trainer. The interventionist will receive weekly coaching and video feedback from the Senior Trainer plus a weekly session paired with a local interventionist at fidelity (Enhanced Feedback plus peer support). |
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| Weekly Coaching in Phase 1 | Behavioral | Weekly coaching (live or telehealth) |
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| Weekly Coaching plus Intensive Refresher Course Phase 2 | Behavioral | Continue weekly coaching with senior trainer and add one week intensive refresher course |
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| Weekly Coaching plus Peer Coaching Phase 2 | Behavioral | Continue weekly coaching with senior trainer and add weekly peer coaching from another interventionist in the region who is at high fidelity |
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| Video Feedback Only Phase 2 | Behavioral | Receive video feedback and calls only |
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Rated during the child's interactions with the interventionist and during independent assessment, this includes the child's spontaneous play types by play level and child's spontaneous spoken and nonverbal communication skills to request and to share |
| Entry for cohort two (month 2), half way (month 4), and exit (month 7) |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |