Preliminary Effectiveness of the Healthy Families Flourish Program for Families With a Child With Autism Spectrum Disorder

PURPOSE: The health of a family provides the ecological context in which a child can grow and develop. Family cohesion, communication, and adaptability can contribute to a family’s health. Families of children with autism spectrum disorder (ASD) may need occupational participation and health supports in order to support the individualized needs of family members. While traditional OT supports children with ASD, needed are family-level interventions (Kuhaneck & Watling, 2015). The purpose of this pilot study was to examine the preliminary effectiveness of the Healthy Families Flourish Program (HFFP), a 10-session occupation-based parent coaching telehealth intervention designed to improve family occupational participation and health (including family adaptability, balance, connection, and communication) for families with a child with ASD. This study was a pilot sample of a larger family health study involving families with a child with broader special healthcare needs. The research question was: What is the preliminary effectiveness of the HFFP in improving family occupational participation and health for families with a child with ASD?

DESIGN: To test this pilot intervention, researchers used a single-group pretest-posttest design. Researchers recruited participant families (n = 4) using convenience sampling via social media postings and emails to professional networks. For study inclusion, families had to speak English and have at least one child ages 2-17 with a diagnosis of ASD who lived in the home full time. The only exclusion criterion was if ASD was not the primary diagnosis of the child.

INTERVENTION: Participants completed the Healthy Families Flourish Program via Zoom with a licensed pediatric OT. The HFFP was developed by the researchers based on a model of family health (Smith et al., 2017) and parent-coaching principles (Rush & Shelden, 2020). Ten sessions were provided in a structured fashion with all families following the same sequence of activities. Sessions included a welcome, family health reflection discussion topic, parent coaching around specific goals, and wrap up.

METHOD: Researchers measured changes in family occupational participation using Goal Attainment Scaling (GAS) and in family health constructs of adaptation, balance, connection, and communication using the Family Adaptability and Cohesion Evaluation Scale-Fourth edition (FACES-IV). Researchers used descriptive statistics and nonparametric Wilcoxon signed-rank tests to examine changes in GAS and FACES-IV scores from pre to post intervention across all participants.

RESULTS: Family occupational participation significantly increased across all participants (p = 0.024) measured via GAS. Family health measured via the FACES-IV significantly increased in the areas of family connection (balanced cohesion p = 0.028), and family communication (p = 0.028). Family adaptation and balance slightly improved although not with statistical significance (balanced flexibility p = 0.068).

CONCLUSION: Findings suggest that a 10-week occupational therapy based coaching program provided via telehealth may be effective in improving family occupational participation and aspects of health for families with a child with ASD. A clinical trial with larger sample and control group is needed to confirm these preliminary findings.

IMPACT: This study is one of few to examine effectiveness of an OT intervention for family needs rather than exclusively the child for this population. Findings suggest practitioners can provide family-level services to augment traditional child-based services to improve family occupational participation and health among families with a child with ASD. Additionally, telehealth can provide service access for those who may have limited resources.

References

Kuhaneck, H. M., Madonna, S., Novak, A., & Pearson, E. (2015). Effectiveness of interventions for children with autism spectrum disorder and their parents: A systematic review of family outcomes. American Journal of Occupational Therapy, 69(5), 6905180040. https://doi.org/10.5014/ajot.2015.017855

Smith, S.L., DeGrace, B., Ciro, C., Bax, A., Hambrick, A., James, J., & Evans, A. (2017). Exploring families’ experiences of health: Contributions to a model of family health. Psychology, Health & Medicine, 22(10), 1239-1247. https://doi.org/10.1080/13548506.2017.1319069

Rush, D.D., & Shelden, M.L. (2020). The early childhood coaching handbook (2nd ed.). Brookes Publishing.