Who Gets Coached? A Qualitative Inquiry into Community Clinicians' Decisions to Use Caregiver Coaching

Clinicians' beliefs about an intervention's fit with an individual family influence whether they use it with that family. The factors that influence clinicians' decisions to implement evidence-based practices for young autistic children have yet to be evaluated systematically. These factors may partially account for the significant disparities in quality of and access to early intervention. We examined disparities in clinicians' reported use of caregiver coaching, an evidence-based practice, with families from minoritized or structurally marginalized groups, and the perceived reasons for those disparities, to assess the factors that influence clinicians' use of caregiver coaching. We conducted semi-structured interviews with 36 early intervention clinicians from publicly funded early intervention agencies in two distinct geographic regions in the United States. Clinicians identified social and structural factors, including perceived family characteristics and stigma, that influenced their beliefs about the fit of coaching with families from minoritized or structurally marginalized groups. These findings point to the presence of beliefs that likely exacerbate disparities in access to evidence-based practices and reduce the quality of care for minoritized families of young autistic children. These findings highlight the need to develop and deploy equity-focused implementation strategies to improve both access to and quality of evidence-based practices for young autistic children from minoritized groups. [For the corresponding grantee submission, see ED618068.]