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

UNLABELLED: 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.