Background:

Autism is a neurodevelopmental disorder characterised by difficulties in social interaction and communication, repetitive and stereotyped interests and behaviours affecting almost 1% of the population worldwide (American Psychiatric Association, 2013). Interventions targeting social and communication skills can lead to better short and long-term outcomes, as well as an improved quality of life.

Parents play a crucial role in the education of their children and due to substantial cuts in service provision as well as the current pandemic outbreak and its impact on children’s education, the need to train parents using technology in innovative ways is more pressing than ever. Training and coaching practices have been suggested as essential for teaching adults new skills (Meadan et al., 2016). Telepractice is a promising service delivery approach, its main advantages including reduced money and time spent on travel as well as reduced intrusion into the family home (Chen & Liu, 2017). Digital delivery methods to engage parents in training have been increasingly used as an alternative to traditional face-to-face training and coaching. 

Children in rural areas are likely to be living in poorer conditions than children in urban areas (Cason, 2009) and be receiving interventions of less intensity (i.e. fewer sessions and of shorter duration) due to increased travel time and cost (Hallam et al., 2009). Cumbria is a large mountainous county in North West England with 54% of its residents living in rural areas (Cumbria.gov.uk, 2015). Professionals working with children with special educational needs and disabilities often have to travel long distances to meet parents and children putting additional stress to their workload. 

The Internet-Based Parent-Implemented Communication Strategies (i-PiCS) program is designed in the US to train and coach parents how to use evidence-based strategies to improve the social communication skills of their children with autism, from the comfort of their home (Meadan et al., 2016).  The i-PiCS program has the potential to be an effective tool in rural areas considerably reducing professionals' and parents' stress levels, enhancing parenting skills and family quality of life as well as children's social-communication skills. 

Outline and significance of the study:

This present study, funded by the BA/Leverhulme Small Research Grants scheme (SRG19\190421), aimed to replicate the original i-PiCS study conducted in the US (Meadan et al., 2016). It addresses the need for more replication studies in educational research to shape education policy and practice (Makel & Plucker, 2014). Moreover, the use of telepractice can result in great improvements to resource management and financial savings as a viable alternative or supplement face-to-face services. Given that the original study was conducted in the US, the present study represents an initial step into exploring the transferability of findings and effectiveness of i-PiCS in a European context. Such a feasibility study is of substantial importance given that in 2018, 29.1% of the EU population lived in rural areas (Eurostat, 2020). Further evidence is needed to demonstrate its application to the educational contexts of other European countries, which has the potential to influence policy.

Research design

A multiple-baseline design across strategies was implemented within four mother-child dyads in the rural county of Cumbria from February 2020 until February 2021. The present paper explores mothers’ views on the social validity of the goals, procedures and outcomes of i-PiCS, as well as its impact on families' quality of life, mothers' stress levels and parenting self-efficacy skills.

Research questions:

-       What are mothers’ views on the social validity of the goals, procedures and outcomes of i-PiCS?

-       What is the impact of i-PiCS on families' quality of life, mothers' stress levels, and parenting self-efficacy skills?

i-PiCS started at different time points for each evidence-based strategy (i.e. environmental arrangement, modeling, mand-modeling and time delay), and each family acted as their own control. The duration of the intervention lasted between 3,5 and 6 months for each family as the mothers’ speed of mastering each strategy (i.e. a precondition in order to move to the next strategy) as well as the availability of each family to commit to the intervention varied. Methods: This paper presents the mothers’ views on the intervention as captured via a combination of qualitative and quantitative data. Qualitative data from the interviews on mothers’ perceptions straight after the end of the intervention (post intervention) and 4-6 weeks later (follow-up) will be compared with and contrasted to quantitative data on families' quality of life, mothers' stress levels, parenting self-efficacy skills and the social validity of the i-PiCS (collected pre, post intervention and at follow up). Semi-structured interviews were used to explore mothers’ experience from i-PiCS as well as its impact on the family and the child’s communication. The social validity of the intervention was assessed by a Likert-type survey which asked the mothers to rate the usefulness of the different aspects of i-PiCS, the accessibility of the intervention, their satisfaction with the process and expected outcomes. The semi-structured interviews and the social validity survey were conducted post intervention and at follow up. The following three measures were collected to monitor the families' quality of life, mothers' stress levels and parenting self-efficacy skills pre and post-intervention: - the Family Quality of Life Scale (FQOLS) (Beach Center on Disability, 2012) - the Parenting Stress Index (PSI)- short form (Abidin, 2012) - the Tool to Measure Parenting Self-Efficacy (TOPSE) (Kendall & Bloomfield, 2005). All the above data collection tools were selected based on the original study (Meadan et al., 2016) and a follow-on piece of research (Daczewitz et al., 2020). For the development and the conduct of the study researchers from the University of Birmingham (UK) collaborated with researchers from the University of Illonois (US). The latter developed and have explored to a great extent the use of i-PiCS.

Preliminary findings: Preliminary findings from the analysis of the interviews with the four mothers revealed that all of them valued and could see benefits from the implementation of the i-PiCS program which were maintained at follow up. More precisely, the mothers reflected that their self-confidence in using the strategies increased through coaching and video-feedback. They also became more aware of their children’s initiatives for communication, as well as the value in investing time in practising the strategies. All four mothers reported that their children’s communication developed both in frequency and complexity. They perceived their children as more confident and persistent in, as well as skilled at communicating. Mothers valued and recognised the relevance of all parts of i-PiCS including the training videos, the live coaching sessions, and the reflection on past videos. The coaching on the mother-child live interaction and the relationship with the coaches were viewed as the most helpful elements of i-PiCS. The use of telepractice and having the flexibility to be coached in i-PiCS virtually were recognised as benefits of the intervention. The quantitative findings from the pre and post-intervention assessments (i.e. FQOLS, Beach Center on Disability, 2012, PSI, Abidin, 2012; TOPSE, Kendall & Bloomfield, 2005) as well as the post intervention and the follow up social validity survey will be compared and contrasted to the qualitative data resulting from the interviews. The results will be discussed in the light of the Covid-19 pandemic which was a variable the researchers had not considered at the planning of the study, but which ended up playing a crucial role in the life of the families involved in the study and the mothers’ training and coaching.

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