Caregiver Self-Regulation as a Key Factor in the Implementation Potential of Caregiver-Mediated Interventions.

Caregiver self-regulation may be a critical component of caregivers' effective delivery of caregiver-mediated interventions (CMIs). CMIs are a highly evidence-based group of interventions that target a broad range of challenges, including social communication, emotion regulation, and externalizing behaviors, for autistic and neurotypical children. CMIs teach caregivers to be "coaches" to help their children learn and practice skills in daily life. However, being a good "coach" likely requires caregivers to optimally self-regulate their emotions, thoughts, and behaviors when working with their children in moments that are often emotionally heightened. Caregiver self-regulation is a set of skills that promote parenting autonomy and confidence: self-sufficiency, self-efficacy, self-management, personal agency, and problem solving. This conceptual paper will briefly discuss the literature on the role of caregiver self-regulation in CMIs and argue that future implementation research on CMIs should measure caregiver self-regulation because, in line with recent expansion of the theory of planned behavior, caregiver self-regulation may predict more effective implementation of CMIs. We also argue, in line with CFIR 2.0, that supporting caregiver self-regulation could ultimately improve the implementation of CMIs with regard to each implementation outcome in the Implementation Outcomes Framework. For example, enhancing caregiver self-regulation may improve CMI appropriateness (by increasing alignment with each caregiver's values and culture), adoption (by increasing engagement to finish the full CMI protocol), and even CMI sustainability (by increasing caregivers' ability to problem-solve and generalize to new child challenges independently, freeing up provider time to work with new caregivers and allowing the agency to provide the CMI for a reduced relative cost). Should future research demonstrate that caregiver self-regulation is an implementation determinant, future implementation strategies may need to include support for caregiver self-regulation, because it may explain or enhance the implementation of CMIs across early intervention and community mental health systems.