True adaptations vs. recommendations reflecting existing components of FN
autism-specific, autism
An unexpected finding was that nine of the 38 recommendations reflected existing components of the intervention. For example, navigators suggested adding more training on behavior change strategies, such as MI, and local service systems. This recommendation reflects the first core component of FN: “Intensive initial training to navigators on MI, navigation, problem-solving approaches, and ASD diagnostic and treatment services” [While the remaining 29 recommendations represented true adaptations that participants believe may improve the intervention, future research should consider whether such changes would be consistent or inconsistent with intervention fidelity, and the potential for adaptations to add to or detract from the effectiveness of the intervention. For example, if FN were adapted to focus on care transition points, such as the initiation of EI services or the transition to school services, as suggested by parents, this would change the goal of the intervention and potentially alter what would be considered a successful outcome. If the navigator was able to get a family through the diagnostic process and enrolled in autism-specific services through EI programs, this was seen as a success in the larger RCT. However, interviews with parents a few years after study completion brought up an important point about sustained access to services. Multiple parents mentioned difficulties about transitioning from EI services to services throughout school-age. Given that EI often ends at 3 years and kindergarten usually begins at 5 years, parents of children with ASD must advocate for the child to receive services in this critical window. Thus, although these interviews identified challenges post-implementation that might have been resolved had they been identified sooner, they also uncovered additional challenges that parents faced related to the primary outcome (early identification of autism and early intervention services). Future research could thoughtfully consider multiple additional measures of success with time, or the possibility to extend autism FN to a lifespan model.