FASTT Telehealth Behavioral Support Service for Caregivers of Children With Developmental Delay or Disability

The first three months of the project period will be used for planning and development, including cultural, content, and logistic adaptation and development of the evaluation procedures. During the next seven months, the adapted service will be implemented. The remaining two months of the project will be used for analysis of the evaluation data and creating the final report.

Implementation Plan. Integrating FASTT into the Undivided service platform will leverage the existing infrastructure and procedures of Undivided to link for families to FASTT Support Specialists. The Undivided infrastructure uses dedicated Care Navigators to assess family needs, provide assistance and encouragement in addressing those needs, and offer guidance and best practices to empower parents. The existing Undivided infrastructure uses a customized web-based and mobile app that provides messaging to the navigator support team for in-the-moment help and advice regarding service access and utilization, as well as a knowledgebase repository with expert-curated guides to support and navigation topics. Importantly, Undivided connects families to an online community of other caregivers of children with disabilities, effectively adding a peer support network for parents to share experiences, knowledge, and encouragement. The current Care Navigator team is focused on supporting families in accessing services, and stops short of making recommendations related to behavioral support.

Although family navigation services like Undivided have demonstrated efficacy in connecting families to services and reducing barriers to access, that function is dependent on the availability of services in the local community. Often, accessible services are not available to meet the needs of families due to insufficient capacity or the lack of flexible delivery methods. While availability of services has been an ongoing challenge for early intervention, it has been exacerbated by the advent of coronavirus disease 2019 (COVID-19) pandemic restrictions that reduced staffing and curtailed in-person support. These reductions have had significant negative effects on child behavior and caregiver stress and have disproportionately impacted families of color or those in low-resource circumstances. The FASTT service provides families with immediate expertise and support based on established principles of child development.

Undivided Care Navigators receiving support requests through the online app will identify family needs that fit within the FASTT scope of support. The FASTT scope focuses on three areas: 1) reducing child behavior problems, including sleep, feeding difficulties and picky eating, fearfulness, fussiness, tantrums, and defiant behavior; 2) addressing concerns about child development, including understanding what is typical vs. delayed development, having appropriate developmental expectations, knowing when to seek specialized support, and understanding how to promote healthy development through scaffolding; and 3) managing parenting stress, including maintaining work/life balance issues, regulating emotions, and reducing stress arising from concerns about attachment and parent/child relationship issues.

Caregivers requesting support in these areas will be provided with the FASTT line number which they can text to connect with a live Support Specialist. After a caregiver connects, they will be given the opportunity to continue the conversation by text or switch to a phone call at their preference. The Support Specialist begins with a set of discovery questions to understand the support topic, information about the strengths and challenges of the child, a history of the behavior, and what the caregiver has already tried to address the topic. Next, the Support Specialist suggests tips and advice drawn from established evidence-based practices (EBP) strategies and probes to determine the level of acceptance the caregiver has with the strategies. Motivational interviewing practices are used to support caregivers in selecting strategies that they feel they can implement. Recommendations are purposefully designed to be easily incorporated into caregivers' demanding schedules of tasks and activities. Conversations range from a few minutes to an hour or longer and can extend to days or weeks as caregivers may pause the conversation and return later when time is available. Strategies employ a strength-based approach that helps caregivers simultaneously facilitate skill development and diminish unwanted behaviors for their child. Parents can reach back out at any point for additional support or to share progress.