This study aims to determine the feasibility and acceptability of delivering ACHIEVE—a home‑based, parent‑coached OT/SLT intervention—in everyday UK practice and to describe recruitment/retention, data completeness, working alliance, delivery logistics, and exploratory changes in parent‑reported functional, behavioural, communication and stress outcomes. Single‑arm, non‑randomised feasibility study aligned with CONSORT pilot/feasibility guidance. Thirty‑six families of adolescents (11–19 years) with moderate–severe learning disabilities (many also autistic) were recruited via three special schools. Individually tailored OT/SLT sessions focussed on parent‑nominated goals in self‑care/daily living, communication, and behaviour. Hybrid delivery (home visits + secure video); feasibility and acceptability were primary outcomes; exploratory secondary outcomes included DBC, HSQ, APSI, COPM, and GAS. Recruitment via schools was via a convenience sample (36 families). Attendance was high (159/190 sessions; 83.7%) with 99 home and 59 video sessions. Endpoint data were obtained for 22 families. Parents reported strong alliance (WAI median 89.5, IQR 73.0–91.0). Exploratory signals suggested improvement: DBC T‑score − 3.90 (p = 0.004; n = 19); HSQ mean severity − 0.71 (p = 0.018; n = 19); APSI total − 6.80 (p = 0.046; n = 20). COPM median change + 3.0 (performance) and + 4.0 (satisfaction) (both p < 0.001; n = 17). GAS modelling suggested dose effects: ~ 7 sessions linked to ~ 80% probability of achieving expected goals, and ~ 10 to exceeding them (n = 31).Conclusion: ACHIEVE was feasible and acceptable in UK practice with high engagement and manageable data collection. Dose–response signals and alliance strength support a minimum session count and continued coaching emphasis. Findings inform outcome selection, dose, and schedules for a definitive trial; clinical changes remain exploratory.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Adolescents with learning disabilities (often with co-occurring autism) and their families struggle to access practical home‑based support; robust evidence is limited. • Family‑centred, parent‑coached allied‑health interventions are promising but under‑studied for adolescents and in home/hybrid formats. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> What is New: • ACHIEVE—a home‑based Occupational therapy/Speech & Language Therapy, parent‑nominated goal programme—proved feasible and acceptable with strong therapeutic alliance for families of adolescents with learning disabilities with or without autism. • Exploratory improvements and a dose signal (~7–10 sessions) guide scheduling and outcomes for a future comparative trial. </entry> </row> </tbody> </tgroup> </Table>

A nonrandomised feasibility evaluation of a home‑based intervention for parents of adolescents with learning disabilities, with or without autism

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2026年7月17日

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Michael Absoud,
Carla Rush,
Lisa Mackey,
Amy Waters,
Gordon Forbes,
Karen Pratt,
Ashley Liew,
Katy Strudwick,
Vicky Slonims

摘要

This study aims to determine the feasibility and acceptability of delivering ACHIEVE—a home‑based, parent‑coached OT/SLT intervention—in everyday UK practice and to describe recruitment/retention, data completeness, working alliance, delivery logistics, and exploratory changes in parent‑reported functional, behavioural, communication and stress outcomes. Single‑arm, non‑randomised feasibility study aligned with CONSORT pilot/feasibility guidance. Thirty‑six families of adolescents (11–19 years) with moderate–severe learning disabilities (many also autistic) were recruited via three special schools. Individually tailored OT/SLT sessions focussed on parent‑nominated goals in self‑care/daily living, communication, and behaviour. Hybrid delivery (home visits + secure video); feasibility and acceptability were primary outcomes; exploratory secondary outcomes included DBC, HSQ, APSI, COPM, and GAS. Recruitment via schools was via a convenience sample (36 families). Attendance was high (159/190 sessions; 83.7%) with 99 home and 59 video sessions. Endpoint data were obtained for 22 families. Parents reported strong alliance (WAI median 89.5, IQR 73.0–91.0). Exploratory signals suggested improvement: DBC T‑score − 3.90 (p = 0.004; n = 19); HSQ mean severity − 0.71 (p = 0.018; n = 19); APSI total − 6.80 (p = 0.046; n = 20). COPM median change + 3.0 (performance) and + 4.0 (satisfaction) (both p < 0.001; n = 17). GAS modelling suggested dose effects: ~ 7 sessions linked to ~ 80% probability of achieving expected goals, and ~ 10 to exceeding them (n = 31).

Conclusion: ACHIEVE was feasible and acceptable in UK practice with high engagement and manageable data collection. Dose–response signals and alliance strength support a minimum session count and continued coaching emphasis. Findings inform outcome selection, dose, and schedules for a definitive trial; clinical changes remain exploratory.

What is Known:

• Adolescents with learning disabilities (often with co-occurring autism) and their families struggle to access practical home‑based support; robust evidence is limited.

• Family‑centred, parent‑coached allied‑health interventions are promising but under‑studied for adolescents and in home/hybrid formats.

What is New:

• ACHIEVE—a home‑based Occupational therapy/Speech & Language Therapy, parent‑nominated goal programme—proved feasible and acceptable with strong therapeutic alliance for families of adolescents with learning disabilities with or without autism.

• Exploratory improvements and a dose signal (~7–10 sessions) guide scheduling and outcomes for a future comparative trial.