Examining the Active Ingredients of Consultation: Effects of Discrete Consultation Components on Implementation Outcomes for an Autism Intervention in a Community Mental Health System

Purpose We examined the extent to which group consultation training activities (i.e., case support, skill rehearsal via role play, and performance feedback using videotapes) were associated with improvements in clinician fidelity (i.e., manual adherence and competence) and case penetration (i.e., proportion of eligible clients receiving the intervention) for a caregiver coaching intervention for autism (Project ImPACT) in a community mental health system. Methods We observed twenty clinicians across six agencies, scoring clinician fidelity from videotapes of 154 telehealth sessions with 21 families of Medicaid-enrolled autistic children. We utilized two-level multilevel models to examine (a) the effect of discrete consultation components on manual adherence and five caregiver coaching domains, and (b) the effect of group consultation on case penetration. Results None of the consultation components were associated with changes in manual adherence. Competency scores for reflective coaching skills in the Performance Feedback phase were 0.32 points higher than those in the Baseline phase, t (62.12) = 2.65, p = .01. No other consultation components were associated with changes in competency. Case penetration did not significantly change during the Baseline phase, but significantly increased in the Consultation phase, t (275.29) = 3.45, p < .001. Conclusion To improve clinician fidelity in under-resourced settings, performance feedback should be emphasized in consultation. Clinical Trial Registration This trial was registered at ClinicalTrials.gov (ID: NCT04654117).