Understanding Stakeholder Perspectives Towards Parent Training for ASD in the Michigan Medicaid Autism Benefit

Lab members involved: Diondra Straiton, Karís Casagrande, & Brooke Ingersoll, in partnership with Barb Groom and the Mid-State Health Network.

Additional community partners include Bay Arenac Behavioral Health, CEI-CMH, DWMHA, Lifeways CMH, Genesee Health Systems, Newaygo CMH, Oakland CMH, and Saginaw CMH.

This project was funded in part by Blue Cross Blue Shield of Michigan Foundation Student Award 002701.SAP (Straiton) and an Organization for Autism Research Graduate Research Grant (Casagrande).

This large project evaluated billing data, provider perspectives, and caregiver perspectives on family training during Medicaid-funded Applied Behavior Analysis (ABA) services in Michigan. The goal of this project was to better understand the current landscape of family training in Michigan, the supports and challenges providers experience when providing family training services, and the experiences and motivations for families eligible for these services.

Billing data: We found that nearly half of Medicaid-enrolled children had not received a parent training session over the course of 6 months, and only 2.7% received parent training sessions at a frequency that is consistent with evidence-based models. Another study found that Medicaid-enrolled youth with ASD from rural areas received approximately 11 hours less of applied behavior analysis (ABA) than children from non-rural areas. Younger children also received more hours of ABA.

Provider Perspectives: While providers reported using family training with almost all of their families, their description of services was not in line with evidence-based models that emphasize active learning through coaching and feedback. Instead, providers described family training as psychoeducation, progress monitoring, and check-ins. Additionally while organizational and provider level barriers like limited agency support and training affected their use of family training strategies, providers’ perceptions of family-level barriers were the most important predictors of providers’ self-reported quality of parent training. 

Caregiver Perspectives: Families felt that they faced few barriers in participating in evidence-based family training. Interviews found that most caregivers valued the coaching and feedback components of family training, but shared that current ABA family support services, which were primarily progress monitoring, were not worth the burden of participation. However, caregivers were willing to prioritize involvement in PMI specifically despite the burden.

Although the 2018 Michigan Autism State Plan emphasizes providing parents with quality family training, our study found that many families did not receive family training and for those that did, the services were not in line with evidence-based parent training practices. Provider perspectives within this system found high perceived family-level barriers to engagement limited their use of family training. However, parents themselves reported relatively few barriers and high motivation to participate. The difference in perspective between parents and providers within this system may be related to caregivers’ limited perceived value in current family training services, rather than a lack of motivation to participate overall.

Relevant citations:

  • Straiton, D., Groom, B., & Ingersoll, B. (in revision). A mixed methods exploration of community providers’ perceived barriers and facilitators to the use of parent training with Medicaid-enrolled clients with autism. 
  • Straiton, D., Groom, B., and Ingersoll, B. (in revision). Parent training for youth with autism served in community settings: A mixed-methods investigation within a community mental health system.
  • Straiton, D., Groom, B., Kashy, D., & Ingersoll, B. (in prep). Applied behavior analysis disparities for Medicaid-enrolled individuals with ASD: A multilevel analysis.