The Mansfield autism statewide services travelling teacher service: An investigation of an innovative intervention model and its impact on the adjustment and wellbeing of children and young people with an autism spectrum disorder and their parents

Autism Spectrum Disorders (ASDs) are serious neurodevelopmental disorders that present in the first years of life and are characterized by impaired social interaction, communication skills and restricted, repetitive and stereotyped behaviour. Intellectual disability, medical conditions and mental health problems frequently co-occur, and while symptoms change over time, the majority of people with an ASD need individualised support throughout life. Parenting a child with an ASD contributes to a higher incidence of parental stress and mental health problems. As the aetiology of ASDs has not yet been determined in the majority of cases, there is no single or universally effective treatment for these complex conditions. Whilst a range interventions and treatment models have been developed, further systematic and controlled studies need to be conducted in order to evaluate immediate and long term outcomes. The Mansfield Autism Statewide Services (MASS) is a comprehensive programme for children and adults with an ASD and their families living in rural and remote regions of Victoria, Australia. MASS is an independent, not-for-profit organisation founded in 1968 by Dr. Joan Curtis. MASS currently offers a broad range of services for children and adults with an ASD and their families including two schools, respite and residential facilities, adult services and a travelling teacher service. MASS has similar elements to other comprehensive programmes including the provision of parent education, professional consultancy, continuity of care, transition support, and interventions that address communication, social skills and daily living skills (MASS, 2009). However, a key element that makes MASS different, and possibly unique, from other models is the Travelling Teacher Service (TTS). The TTS is staffed solely by specialist teachers who live in the family home for blocks of intervention. They provide child focussed intervention, parent education, information and support and professional consultation to the child’s school teachers and other relevant professionals in the family’s local rural community. This innovative service is based on a philosophical foundation of family centred practice (MASS, 2009). The TTS has not been described in enough detail to be replicated, nor has it been formally evaluated to date. Therefore the aim of this study was to use quantitative and qualitative research methodology to define the MASS TTS and investigate child and parent outcomes. The six objectives devised to achieve this aim were to using qualitative methodology, 1. systematically describe the MASS TTS model of intervention 2. investigate how the travelling teacher team, other service providers and parents who have been in receipt of the TTS for more than 2 years perceive the service and using quantitative methodology, were to: 3. investigate the perceptions of parents and TTs of the extent to which family-centred practices are being implemented 4. investigate whether the emotional and behavioural problems, autism symptoms and adaptive functioning of children with an ASD in receipt of MASS TTS improve compared with no TTS intervention at 6 months, and if any relative gains are sustained 12 months after programme commencement 5. investigate whether the mental health and perceived stress of the primary caregiver of a child with an ASD in receipt of MASS TTS improve compared with no TTS intervention at 6 months, and if any relative gains are sustained 12 months after programme commencement 6. investigate whether there are any longer term perceived benefits for parents who were in receipt of the TTS for more than two years, compared with no TTS intervention. Participants, diagnosed with an ASD, were identified from three MASS cohorts: a current TTS Treatment Group (n=30), a TTS Wait List Control Group (n=30), and a Long-term Group who had previously received the TTS (n=227). Data was also gathered from the founder of MASS, TTS staff (n=14), and service providers who have consulted with the MASS TTS (n=37). The study found that the TTS service delivery model could be described as an educational intervention aimed to promote the adjustment and wellbeing of children and young people (0-18 years) with an ASD and their family. The framework of the model comprises five contextual elements: ASDs specific, specialist teachers, home based, rural support, and individualised and flexible service delivery. These contextual elements are delivered within a service philosophy comprising three guiding principles: family centred practice, natural learning environments, and continuity of care. The intervention programme includes three core components: child focussed interventions, parent information, education and support, and professional consultation. The qualitative data showed that the experiences of parents who had accessed the TTS was mostly positive and was characterised by issues related to family centred practice, continuity of care, natural learning environments and the ‘uniqueness’ of the service. The TTS staff discussed their commitment and dedication and issues related to their work with children and families, consultancy to other services, their own professional support and development, and the policies and procedures of the organisation. Service providers who had involvement with the TTS primarily discussed their generally positive regard for the TTS, the consultation they received, their shared work with children with an ASD and their families, and the policies and procedures of the MASS TTS. Quantitative findings were that MASS TTS provides benefits for children with an ASD and their parents six months, and twelve months, after the initial TT visit, compared with a wait list control group. Significant improvements were found in child psychopathology and adaptive behaviour skills and a lessening of autism symptoms. Mothers had significantly improved mental health and decreased stress in response to the service, compared with a wait list control group. Findings also indicate that the MASS TTS intervention has positive effects on the overall daily rewards and worries of parents of young people with an ASD who were recipients of the service for more than two years. Parents of children currently in receipt of MASS TTS, and the TTs themselves, reported on their perceptions of the family centred practices provided by the TTs. Both groups agreed that the TTS generally provided respectful and supportive care, but were not as good at providing information. The TTS is an effective programme which builds collaborative partnerships between parents and professionals, assesses child and family needs and provides individualised interventions. It supports and empowers family members by offering ASDs specific information and education, with a focus on family centred practice, teaching in natural learning environments and providing positive, continuous support.