Implementation and Clinical Outcomes of the Autism Discussion Guide: A Resource for Supporting Part C EI Providers during Autism-Related Conversations with Families

Abstract

Early autism identification is widely recognized as a public health priority, yet many children experience delays in diagnosis and access to services. While the autism diagnostic pathway has received considerable attention, less focus has been placed on how providers communicate with families about possible autism, which is a crucial step in the process. Part C Early Intervention (EI) providers are well positioned to support early identification but often report uncertainty facilitating these conversations while maintaining a family-centered approach. This study evaluated the implementation and clinical outcomes of the Autism Discussion Guide (“Guide”), a structured resource designed to support EI providers in discussing autism with families. Participants included 124 EI providers across 16 U.S. states who were randomly assigned to either receiving only the Guide (“Guide-only” condition) or the Guide along with a workshop on Motivational Interviewing (“Guide + MI” condition). Data on provider-level (i.e., years of autism experience, professional background) and program-level characteristics (i.e., implementation climate, organizational climate, and autism climate), clinical outcomes (e.g., referral behaviors, provider self-efficacy in autism conversations), and implementation outcomes (i.e., adoption, feasibility, appropriateness, and acceptability) were gathered via self-report from providers before using the Guide and after using the Guide for approximately six months. Results revealed that 75.8% of providers across both conditions reported adopting the Guide into their practice. Neither provider nor program characteristics were significantly associated with adoption. Ratings of feasibility, acceptability, and appropriateness were high. Open-ended survey responses indicated that providers found the Guide helpful for starting conversations about autism, supporting understanding of caregiver perspective, and providing practical language that could be readily used in interactions with families. On the other hand, providers expressed interest in receiving additional training and opportunities for practice, noting that greater familiarity with the Guide would help them use it more effectively. Regression analyses indicated increased provider self-efficacy in autism-related conversations (b = 0.43, SE = 0.08, p < .001) and decreased use of a ‘wait-and-see’ approach (i.e., deferring these discussions while continuing to monitor the child’s development; b = -0.24, SE = 0.10, p = .02) from pre- to post-intervention. The Guide did not appear to improve timeliness of autism diagnostic referral (b = 0.39, SE = 0.36, p = .28). Providers in the two conditions demonstrated similar outcomes, suggesting that the MI workshop did not confer additional benefit beyond the Guide alone. Overall, these findings suggest that the Guide may be a practical tool to help EI providers approach autism-related conversations with greater confidence, while also supporting a family-centered approach. At the same time, the results highlight the influence of broader system factors on referral pathways, demonstrating that improving early autism identification likely requires attention to both provider communication and structural barriers within service systems (e.g., long waitlists, limited referral options).