Family training, in which providers coach parents to use intervention strategies with their child, is considered evidence-based and best practice for families of children with Autism Spectrum Disorder (ASD). Parents generally value family training, but this service is underutilized in community-settings and many parents report it as an unmet need. Families receiving services through Medicaid have much to gain from family training, as it can increase the accessibility, intensity, and effectiveness of services in a system with limited resources. However, existing research with underserved populations reveals differences in perspectives on underutilization between families and providers and families in the Medicaid system are significantly underrepresented in this research, highlighting the need for a more thorough exploration of perspectives from parents in these communities.We partnered with eight agencies that provide Medicaid-funded Applied Behavior Analysis (ABA) services to develop this survey-based study and recruit 226 caregivers to participate. Participants were similar to the state-level Medicaid service population in terms of racial and ethnic background, suggesting a representative sample. Our first aim was to better understand caregivers’ current experiences with, satisfaction with, and attitudes toward evidence-based family training as part of their child’s ABA services. We found that caregiver’s experiences with evidence-based family training were limited, but attitudes toward that model were positive; this was unrelated to parent, child, or service characteristics. Satisfaction with ABA was positively correlated with experiences of family training and other aspects of caregiver involvement in treatment. Our second aim was to explore caregivers’ perspectives on engagement in family training using Staudt’s (2007) conceptual model of the engagement process, which outlines the influence of provider behaviors on caregiver’s engagement in treatment through family-level logistical, relational, and attitudinal factors. We conducted a multiple, parallel mediation analysis using Staudt’s (2007) model as a guide and found that relationships with providers and attitudes toward treatment played a strong role in caregivers’ readiness to participate in evidence-based family training, while logistical factors, such as stress and external demands, did not. Furthermore, the relationship between supportive provider behaviors and caregiver interest in engagement was fully mediated by relational and attitudinal factors. This suggests that parents’ experience of supportive provider behaviors, such as enabling participation and coordinating care, improved relationships and strengthened positive attitudes about treatment, which in turn increased their motivation to engage in family training. Interestingly, this was only true for caregivers who indicated that their provider engaged in some degree of supportive behavior. These results suggest that providers may benefit from spending more time building relationships with caregivers of the children they serve and supporting the development of positive attitudes towards evidence-based family training.
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