This document summarizes a proposed research study that aims to evaluate the in-home mediator model of autism intervention. Specifically, the study will conduct in-depth interviews with 10-15 parents who recently completed an autism intervention program to understand their experiences as mediators and identify any factors that influenced the effectiveness of the intervention. Insights from the interviews will be used to inform improvements to the services provided and guide future research comparing the mediator model to in-clinic treatment models. The interviews will be structured around five factors identified in previous research as influencing interventions: the home environment, training received, skills developed, perceptions/emotions, and areas for service improvement.

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Behaviour Consultation
Evaluating the In-Home Mediator Model
Author: Jessica Barnett

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Behaviour Consultation: Evaluating the In-Home
Mediator Model
Introduction
The foundation of interventions for Autism Spectrum Disorders (ASD) is based heavily in both
behaviourism and functionalism (Cuvo & Vallelunga, 2007; Oono, Honey & McConachie, 2013;
Vismara & Rogers, 2010; Pottie & Ingram, 2008). Target behaviours (or unwanted behaviours)
are assessed, not only from their antecedents, and immediate consequences, but also how
those behaviours affect and are affected by the people and the world around them. The
Mediator Model of autism intervention takes advantage of both behaviouristic and functional
treatments by training a parent or guardian in Applied Behaviour Analysis (ABA) or Intensive
Behavioural Intervention (IBI) based approaches, thus allowing them to become the mediator
between the Behaviour Consultant and the child. In this way, children get intensive therapy that
can be generalized across far more settings than would be possible in-clinic. The Mediator
Model also has the advantage of creating a stronger, more reciprocal relationship between the
parent and child, which leads to increased harmony within the home (Oono, Honey &
McConachie, 2013; Ozonoff & Cathcart, 1998)
It is important however, to consider that in home, school or mediator based interventions are
only successful when the integrity of the Behaviour Intervention Plan (BIP) drawn up by the
Behaviour Consultant is intact (Cook, Meyer, Wright, Kraemer, Wallace, Dart, Collins & Restore,
2010; Vismara & Rogers, 2010). This means that ABA or IBI techniques must be applied
consistently with each target behaviour. The same behaviour must be reinforced with the same
consequences immediately, time and again. Without consistency, learning can erode and the
child can become confused, or learn to curb behaviours only around certain people
Unfortunately, this is where the Mediator Model can become problematic. Often, mediators are
still learning how to apply their new skills as they are dealing with their child’s day-to-day needs
and target behaviours. This may leave mediators feeling overwhelmed, underprepared, and
stressed out, putting them at risk for psychological problems (most commonly depression),
which may in turn have detrimental effects on the child’s learning (Baron & Kenny, 1986; Gold,
1993; Koegel, Schreibman, Loos, Dirlich-Wilheim, Dunlap, Robbins & Plienis, 1992; Pottie &
Ingram, 2008). This kind of “stress proliferation” is described by Benson and Karlof (2008) who
report that an initial stressor can create secondary stressors in other areas of the individual’s
life. Families dealing with the high stakes job of learning how to become a mediator may feel
overwhelmed when also having to deal with work, school, and family tensions, leading to
mistakes during intervention that can further exacerbate family discord.
One major source of stress for mediators are feelings of low self-efficacy (Kuhn & Carter, 2006),
in which the mediator doubts their ability to successfully participate and make a difference in
their child’s intervention. If parents do not feel competent as mediators, they will not have the
confidence to directly and efficiently address target behaviours. These small failures, when
added up, could possibly jeopardize the consistency with which the BIP is implemented, slowing
and even reversing any progress in the child’s intervention.

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Fortunately, several researchers (Benson & Karlof, 2008; Hastings, 2003; Pottie & Ingram,
2008) have found that social support systems, both formal and informal, reduce the effects of
stress and negative emotions. Furthermore, Pottie and Ingram (2008) found that mediators who
engaged in both pleasurable distractions (recreation and social interaction) and problem-
focused coping methods (addressing target behaviours, practicing skills), showed increased
positive mood and better ability to manage stress than those who used problem focused coping
alone.
It would seem that current literature outlines the need to understand more about the needs of
families during intervention from their own perspective. It may be that families accessing
Behaviour Intervention Services may need increased access to social support systems such as
family and personal therapies, community outreach, support groups access to recreation during
intervention. Furthermore, it seems necessary to see how parents/mediators feel during
intervention. Do they feel confident in their abilities? do they feel overwhelmed or stressed? and
what effect is this having on the child’s intervention? If self-efficacy is a major problem, perhaps
the mediator-model would be more effective if clients were first treated in clinic while parents are
being trained in intervention techniques. This way, the target behaviours could be fully treated
by a clinician before the child is returned to a fully trained mediator. This could reduce the strain
on the mediator and the number of mistakes they make during intervention, thereby increasing
the consistency of reinforcement of the child’s learning.
Surprisingly, little research has been conducted concerning the efficacy of the mediator-model
versus in-clinic treatment. Most studies compare the efficacy of the mediator-model against
other out-patient, or school based programs, and methodologies are inherently aversive to
quantitative, controlled, and generalizable techniques (Hastings, 2003; Sheinkopf & Siegel,
1998; Ozonoff & Cathcart, 1998). As research into ASD interventions relies heavily on case
work, where participants cannot necessarily be randomly assigned and controlled, it seems
necessary to first delve deeper into the mediator-model and establish a set of influential factors
that affect the success of a BIP.
These factors can later be used to compare the efficacy of the mediator and in-clinic models
and establish any criteria that may need to change in the clients environment before the child is
released into mediator care . Furthermore, having an established set of influential factors will
give us the ability to equally distribute clients between groups based on specific criteria, which
will allow for more empirically based research.
For this reason, the current study has been constructed to, not only evaluate the services
provided by the GCA, but also establish what factors may influence the efficacy of the mediator-
model. These factors will be established from the direct experiences of mediators and the
behaviour consultants working with them. Results should lend themselves to deeper insight into
how the GCA can amend it’s services to better support clients, as well as inform possible future
research into the efficacy of the mediator vs in-clinic models.
Research Opportunity and Objectives
This study is designed to evaluate the mediator-model intervention system currently offered
through Behaviour Intervention Services at the GCA. By establishing an evidence based
Discussion Guide, the researchers hope to create a dialogue with previous clients who have
recently cleared their BIP. In talking with clients, we hope to discover:

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• Gaps in the services provided during a BIP
• Any factors clients found counter-productive to the BIP that the behaviour consultants were
unaware of
• Weaknesses in the Mediator-Model, specifically those associated with mediator self-
efficacy
The Transactional System Model
The construction of the Discussion Guide will be heavily based on the Transactional Systems
Model of Autism Services (TSM) (Cuvo & Vallelunga, 2007), a functional approach to ASD in
which human development is believed to progress through simultaneous transactions between
the child and environment, thereby causing both to change reciprocally over time. There are
several “environmental levels” in the TSM, including family members and peers, the services
and organizations involved in the individuals life, the immediate community and finally the larger
society and its culture, with the individual existing at the centre of all levels (Cuvo & Vallelunga,
2007).
With the above literature and the help of several Behaviour Consultants employed at the GCA,
five factors were included in the Discussion Guide as the most influential levels affecting
intervention. The Discussion Guide was structured to elicit answers about how participants
perceived their lives at each of these levels during intervention.
The Five Factors of the Discussion Guide
The Environment
While the TSM classifies all levels as part of the environment surrounding an individual, for the
purposes of this study “The Environment” refers to the immediate living environment of the
individual, including family, education, service providers, the content and structure of the home
(ex. socio-economic status, structural limitations to disabilities), and any other factors within the
home or living space that mediators find influential to the child and the BIP.
The Training
The training that mediators get would be a direct example of services accessed. It is obvious
that the quality of the training mediators receive would heavily influence their ability to carry out
the BIP. This study will evaluate what mediators thought about the delivery, timing and difficulty
of the training they received and if they felt there were any gaps in their education.
The Skills
The “skills” section in the Discussion Guide will help evaluate both service and family levels of
the child’s environment. In this study, “Skills” refers to how well mediators felt they had learned
and applied their new skills. As we have already seen in the above literature, the mediators
self-efficacy could have detrimental effects on how well they carry out a BIP, initiating a
reciprocal degradation of relation between the mediator and the child.
Perception and Emotions

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In addition to self-efficacy, the perceptions and emotions of mediators and family members (as
well as the child) also have detrimental effects on the BIP. In this study, The Discussion Guide
will address emotions and coping of family members and the services they accessed (or could
not access) and will evaluate both the services and family levels of the child’s environment.
Service Improvement
While each of these 5 factors will help inform on the mediator model, they will also be used to
help improve the services provided at the GCA. There will be questions in each section of the
Discussion Guide that address how well the GCA dressed the needs of the client, and if there
were any other means by which the GCA could help.
The Million Dollar Question
At the very end of the interview, participants will be asked the “If you had a million dollars and
the possibilities were infinite, what would you wish for?”. This question is designed to elicit
answers from participants that are not inhibited by what is considered a reasonable demand.
Many parents with children on the autistic spectrum are well aware of the cost of services, and
the limitations associated with providing them (ex. human resources and time limitations). It is
believed that this question may provide insight into some of the largest influences on
interventions that mediators believe cannot be addressed.
By finding out what mediators found most influential in their environments, we can also
understand how well Behaviour Intervention Services at the GCA are addressing clients’ needs,
and what additional services could be provided in support of client’s needs.
The GCA would be considered part of the service/organizational level of the client’s environment
and is a prime example of the reciprocal relationship between the different levels in a
transactional model. From children and their mediators, were can inform organizations on
services that operate on the mediator-model and thereby add research to the larger society. It
is intended that these insights will directly affect the lives of the children and their mediators.
Method
In-Depth Interviews
Following informed consent, a researcher will be interviewing participants using a structured
Discussion Guide based on evidence gathered from previous literature and suggestions from
the experience of several Behaviour Consultants employed at the GCA.
These interviews will take approximately an hour to an hour and a half and will be conducted
either in person or over the phone. The interviews will be audio recorded with the consent of
participants to ensure accurate transcripts can be made. The researcher will also be taking
notes during the interview to record personal experience of the participants’ reactions, body
language and responses.
The Discussion Guide will contain questions that evaluate the home environment, training
program, parental skills, parental perception and emotions, and areas of service improvement
as supported by the Transactional Systems model of Autism Services. Please see Appendix B
for the Discussion Guide.

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It is important to note that participants will be made to feel as comfortable as possible with the
researchers and interview process. An element of trust will have to be established, and
participants should feel confident that their responses will have no adverse affects. This is
necessary to ensure that responses from participants are natural, fluid, and most of all,
proliferate.
Furthermore, the researcher will have to ensure that the line of questioning does not influence
responses to be biased in any way. The Discussion Guide will contain as few leading questions
as possible (except for probes when necessary). Participants will be provided with a general
outline of interview topics and should, in no way, have access to the Discussion Guide used by
the researcher.
Data will be analyzed using both Nvivo and SPSS for windows. Nvivo will be used to import and
analyze transcripts for emerging themes in participant reports. SPSS will be used to run cross
tabs and frequencies on demographics and how they may interact with the themes discovered
through Nvivo.
Sample Frame
Sample Size: 10-15 participants
Specifications: English Speaking, cleared BIP within the last 4 months
It was considered that interviewing families presently enrolled in Behaviour Intervention
Services may have a negative impact on clients’ perceptions of GCA services due to the nature
of the questions involved in the interview. The interview is meant to target possible gaps in the
services the GCA provides, as such, many of the questions could lead participants to believe
that they are not getting the quality of services they deserve. Although participants will be told
that the study is being conducted to improve Behaviour Intervention Services, the results will not
be available before participants’ interventions have ended, and therefore, will not directly benefit
the participants involved in the study.
Consideration was also given to the degrading effects of memory over time. Participants who
had cleared Behaviour Intervention Services several months or a year ago may not have an
accurate memory of events and emotions that occurred during the intervention. They may also
have been subjected to biasing factors (such as increased knowledge, and access to other
services) that influenced their memory of events.
Due to time limitations of researchers involved, and the speculative nature of the study (little
research into mediator perceptions of the mediator model), it was also decided that the sample
size be conducive to a pilot study. This way, insightful, qualitative information can be gained
from the experiences of mediators while allowing for time restrictions. Methodologies can then
be refined for future, more quantitative investigations into the efficacy of the mediator-model.
Demographics
SES, Services Accessed, IQ or BC evaluations for baseline to do cross tabs on demographics.
Family structure. behaviour consultant, time in training, time since diagnosis, postal code
Timeline and Resources
Devices

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The researcher will require a recording device to record audio from the interviews, and a
computer to take notes and analyze data. Data will need to be analyzed using Nvivo and SPSS
programs for Windows.
Human Resources
At least one researcher will be necessary to interview participants, however, a second
researcher would allow one person to take notes while the other conducts the interview. This
way, interviews will run more smoothly, without interruptions or pauses for note taking. This
should reduce the amount of time necessary for interviews as well as make the participants feel
more comfortable (as if having a conversation, rather than being interrogated).
Participants will also have to be contacted ahead of time by a reputable member of the GCA.
This will help establish a rapport for the researcher/interviewer, allowing participants to feel
more comfortable with the process and the person interviewing them
Timeline
The entire project should take about 2 months, allowing for varied schedules of the participants
involved.
Project Timeline
Task Days/Weeks to
Complete
Start Date End Date
Contact and Recruit
Participants
3 Days January 12, 2015 January 14, 2015
Conduct Interviews 2-3 Weeks January 15, 2015 February 4, 2015
Transcribe Interview
and Notes
2 Weeks
(5hours/hr of interview)
February 5, 2015 February 19, 2015
NVivo Analysis 1 Week February 20, 2015 February 27, 2015
SPSS Analysis 3 Days March 2, 2015 March 4, 2015
Interpretation and
Rough Report
1 Week March 5, 2015 March 11, 2015
Flashpage 2 Days March 12, 2015 March 13, 2015
Final Draft Report 3 Days March 16, 2015 March 18, 2015
Powerpoint
Presentation
3 Days March 19, 2015 March 23, 2015

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References
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social
psychological research: Conceptual, strategic, and statistical considerations. Journal of
Personality and Social Psychology, 51, 1173–1182.
Benson, P. R., & Karlof, K. L. (2009). Anger, stress proliferation, and depressed mood among
parents of children with ASD: A longitudinal replication. Journal of autism and
developmental disorders, 39(2), 350-362.
Cook, C. R., Mayer, G. R., Wright, D. B., Kraemer, B., Wallace, M. D., Dart, E., ... & Restori, A.
(2010). Exploring the link among behavior intervention plans, treatment integrity, and
student outcomes under natural educational conditions. The Journal of Special Education.
Cuvo, A. J., & Vallelunga, L. R. (2007). A transactional systems model of autism services. The
Behavior Analyst, 30(2), 161.
Gold, N. (1993). Depression and social adjustment in siblings of boys with autism. Journal of
Autism and Developmental Disorders, 23, 147–163.
Hastings, R. P. (2003). Behavioral adjustment of siblings of children with autism engaged in
applied behavior analysis early intervention programs: The moderating role of social
support. Journal of autism and developmental disorders, 33(2), 141-150.
Koegel, R. L., Schreibman, L., Loos, L. M., Dirlich-Wilheim, H., Dunlap, G., Robbins, F. R., &
Plienis, A. J. (1992). Consistent stress profiles in mothers of children with autism. Journal
of Autism and Developmental Disorders, 22, 205–216.
Kuhn, J. C., & Carter, A. S. (2006). Maternal self-efficacy and associated parenting cognitions
among mothers of children with autism. American Journal of Orthopsychiatry.
Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent‐mediated early intervention for
young children with autism spectrum disorders (ASD). Evidence‐Based Child Health: A
Cochrane Review Journal, 8(6), 2380-2479.
Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young
children with autism. Journal of autism and developmental disorders, 28(1), 25-32.
Pottie, C. G., & Ingram, K. M. (2008). Daily stress, coping, and well-being in parents of children
with autism: a multilevel modeling approach. Journal of Family Psychology, 22(6), 855.
Sheinkopf, S. J., & Siegel, B. (1998). Home-based behavioral treatment of young children with
autism. Journal of autism and developmental disorders, 28(1), 15-23.
Vismara, L.A., & Rogers, S.J., (2010). Behavioral treatments in autism spectrum disorder: What
do we know? The Annual Review of Clinical Psychology, 447-468. doi: 10.1146/
annurev.clinpsy.121208.131151

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Appendices
Appendix A: Consent Form/ Information Letter
INFORMATION LETTER / CONSENT FORM
In-Depth Interview (IDI) for Geneva Centre for Autism
Purpose of the Study:
The Geneva Centre for Autism (GCA) is constantly looking to improve the services it provides. By helping
us understand your experience with Behaviour Intervention Services, we hope to see where our strengths
were and if there were any other services that could have been provided to better support you during
intervention.
Study Design:
In-depth interviews (IDI) conducted either in person or over the phone. The IDI will take approximately 1
hour. In order to keep the interview below 1.5 hours, we ask that participants schedule the interview at a
time and place where distractions will be minimal.
You and the researcher will agree on a set date, time and location to discuss the how you felt about the
Behaviour Intervention Services at the GCA. Topics will include the quality of the training you received,
any obstacles you encountered at home, work or school, how you felt during intervention, and if you had
any needs you felt weren’t being met.
With your permission, we will audio record the interview so that our records about your experience are
accurate. The only people with access to this information will be the research team.
Potential Harms, Risks or Discomforts:
There are minimal risks involved in this study. Participants may experience discomfort resulting from
being asked about personal experiences and opinions.
Anonymity and Confidentiality:
Complete anonymity and confidentiality will be upheld during the reporting of the results to ensure that
your reports cannot be connected to your name.
To be sure no person can be identified when we report our findings, your name will not be used, nor will
any other personal information. Your name will be be changed on all records to ensure your complete
comfort.
All of the information obtained will be kept confidential and in a locked filing cabinet or password
protected computer. Your information will only be accessible to the research team directly involved with
this study and will be destroyed at the end of this project.
Potential Benefits:
Your experiences and opinions will help us identify any gaps in the services we provide. You will help us
improve Behaviour Intervention Services to better support families during intervention.
You will also be helping contribute to present research on different approaches to interventions in autism.

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The research will not benefit you directly.
Participation:
Your participation in this study is completely voluntary and you can decide to stop at any time, even after
signing the consent form. If you decide to stop, there will be no consequences and your data will be
removed and destroyed unless you say we can use it.
You can still be in the study if you decide there are some questions you would prefer not to answer.
Questions About the Study:
If you have more questions or need more information about the study, please contact:
Jessica Barnett
Phone: 519-619-4581
Email: jessica.l.barnett@hotmail.com
or
Angela Kaushal
Phone: 416-322-7877 ext. 314
Email: akaushal@autism.net
This study has approval by THIS RESEARCH ETHICS BOARD and has received ethical clearance. If
you have concerns or questions about your rights as a participant, or about the way the study was
conducted, please contact:
Tracey McMullen
Phone:
Email: traceymcmullen@autism.net
Consent
I have read the information in this letter and had the opportunity to ask questions about my involvement
and receive additional details.
I understand that, by signing this form, I agree to participate in this study and may withdraw from the
study at any time.
I have been given a copy of this form and agree to participate in the study.
Name of participant(s):__________________________________________________________
Signature of participant(s):_______________________________________________________
Date:_______________________

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Appendix B: Discussion Guide
BC Project: Discussion Guide Skeleton
Evaluate the environment (Note: These headings are for analysis, do not read allowed)
The first few questions I have for you are about how you felt about your
“environment” during the intervention. The “environment” can mean your home,
work, school, accessed services, or anything else that you experience in day to
day life. In this interview, we are interested in looking at how the “environment”
affected your’s and your child’s ability to successfully complete the BIP.
(be sure to make notes on what you observe about the environment)
- Looking back, what would you say were your biggest problems/obstacles at home or
at school before training?
• Distractions? Timing? Family tensions? Lack of resources?
- How did the GCA help you overcome these obstacles, and do you feel it was
enough?
- Is there anything you would have changed in your environment before the transition?
- How long were the behaviours an issue before contacting the GCA? How long until
you started the intervention?
- How much knowledge and experience would you say you had about ASD before
contacting the GCA?
Evaluate the Training
At the beginning of the intervention, you learned new skills to become the
mediator during your child’s intervention. We would like to know how you felt
about what and how you learned.
- How difficult would you say it was to learn to be the mediator? Did you find the
information understandable and easy to apply?
- Can you remember how much time you spent learning your new skills as mediator
(either with the Behaviour Consultant or online)? Do you feel you had enough time to
learn before applying your skills with your child?

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- What methods did you use to learn? (consultant, classes, online)
- Was the method of learning convenient? (location, hours available etc)
- Do you feel that your “training” was lacking in any area that made it difficult for you to
be successful?
- What would you say were your biggest challenges as a mediator?
Evaluate Perception of Skills
- How confident did you feel with your new skills when you finished training?
- How well do you feel you did as mediator during intervention?
- Did you ever doubt your ability to successfully apply your skills? If so, why? and how
did/could the GCA have helped?
Evaluate Emotions
Interventions can be very stressful for everyone involved and sometimes
emotional support systems are needed to be successful. We would like to know
what you can remember about how you and your family felt emotionally during
the intervention.
- How did you feel emotionally (what questions, worries, personal issues):
• Before the intervention
• Directly after “training”
• During the intervention
• After discharge?
- How do you feel the GCA helped you with through this?
- Do you feel that family or personal therapy sessions would have helped you cope?
General Services
Finally, we would like to finish this interview with three important questions:
- What were your expectations of Behaviour Intervention Services before the
intervention and did it meet your expectations?

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- Do you feel that the services provided by the GCA made a difference? Did it make
enough of a difference?
Million Dollar Question
- If you had a million dollars and the possibilities were infinite, what would you wish for?