Making goals visible: A feasibility study of co-designed visual goal sheets to support parent implementation in early autism intervention

Abstract

Background Translating individualized intervention goals into everyday family routines can be challenging. This mixed-methods feasibility study examined the use/adoption and parent-reported acceptability/social validity of visual goal sheets embedded within routine Early Start Denver Model (ESDM) care. Methods Ten families in a French university-hospital ESDM program used visual goal sheets for up to 36 weeks across two naturally occurring cohorts. The clinical team developed the initial visual-support framework, which was refined through parent feedback. Use/adoption was summarized using each family’s final available assessment. Acceptability/social validity was assessed with a project-specific questionnaire comprising 13 four-point items, with weekly scores averaged within families. Home-practice frequency was reported separately as contextual information. Open-ended comments underwent descriptive content analysis. Results Eight families completed 36 weeks and two ended participation after 12 weeks. At their final available assessment, all ten families reported using the visual goal sheets at least weekly: five daily, four several times per week, and one approximately weekly. The mean participant-level acceptability/social-validity score was 3.6/4 (SD = 0.3). Qualitative findings described perceived improvements in clarity and recall, easier prioritization, integration into everyday routines, communication across caregivers and settings, reassurance and support, and contextual barriers. Conclusions Participating families reported regular use and positive acceptability/social-validity ratings of visual goal sheets embedded within routine ESDM care. The small uncontrolled sample and reliance on parent-reported data limit interpretation. Future studies should distinguish the contributions of visual representation, simplified language, clinician guidance, and parent-informed refinement while incorporating objective indicators of use and more diverse service and cultural contexts.