Who Engages and Who Misses Out? Evaluating the Reach and Implementation of the More Than Words® Program in a Canadian Context.

While caregiver-mediated programs have been studied in research settings, little is known about their delivery and accessibility in real-world practice, including which populations they reach and their levels of engagement. This project evaluated the reach and implementation of one such program, More Than Words® (MTW), delivered virtually, as part of a large-scale government initiative for families in Ontario, Canada during the COVID-19 pandemic. Data from 2284 families with a young autistic child who registered for MTW were analyzed using the RE-AIM Framework to assess two domains: (a) reach, by examining demographic characteristics such as child age, social communication stage, and geographic location; and (b) implementation, by analyzing completion rates and attendance patterns. While the MTW program reached many families with autistic children of varying ages and social communication skills, participation from families living outside large population centres was lower than expected based on census data. Most families (71%) completed the program, but only 39% attended all of the program sessions, suggesting challenges to sustained participation. Further research is needed to understand barriers to engagement and how service delivery models can be adapted to better meet the diverse needs of families participating in the real world.