SPED 5490 Week 10 Lecture

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Teaching parents of young children with autism & final thoughts on EBP:

Teaching parents of young children with autism & final thoughts on EBP Heather Enos, Ed.S , BCBA University of Colorado at Denver SPED 5490

Agenda :

Agenda Teaching Parents What is the evidence? Discuss EBP >>> Implementation

Parent Training Philosophy:

Parent Training Philosophy Parents ’ childrearing knowledge and specific skills can directly enhance their child’s development Provide systematic instruction in strategies to help parents accomplish specific goals or outcomes for their child Parent training is a primary intervention strategy

Main Focuses of Parent Training:

Main Focuses of Parent Training Enhance parents ’ skills in engaging their child in play and social interaction Teach parents strategies to help their child acquire developmental skills Help parents manage child ’ s behavior during ongoing daily routines

Benefits of Parent Training (Shearer & Shearer, 1977):

Benefits of Parent Training (Shearer & Shearer, 1977) Learning occurs in the child ’ s natural environment Increased generalization and maintenance of skills Wider range of behavior can be addressed Parents can address new behaviors when they occur Individualization of instructional goals for child and parent Increased hours of intervention More opportunities for full family participation in intervention

Special Needs in Autism:

Special Needs in Autism Intensive needs 25 hours per week (NRC, 2001) Difficulty with generalization High stress levels for parents High rate of behavior problems

Research on Autism (e.g., Koegel et al., 1982):

Research on Autism (e.g., Koegel et al., 1982) Parents can learn intervention strategies Better generalization and maintenance of skills Increases parents ’ leisure and recreation time Decreases parents ’ stress levels Cost-effective

NRC Recommendations for the Education of Children with Autism:

NRC Recommendations for the Education of Children with Autism Across primarily preschool programs, there is a very strong consensus that the following features are critical: …Inclusion of a family component, including parent training (p. 219) . National Research Council. (2001). Educating children with autism. Committee on Educational interventions for children with autism. Division of Behavioral and Social Sciences and Education. D.C. National Academy Press.

Barriers to Implementation:

Barriers to Implementation Format of parent education models incompatible with classroom-based program Lack of user-friendly parent education materials Insufficient teacher preparation in parent education strategies

Teaching Parents :

Teaching Parents Rationale: NRC- intervention should begin ASD is suspected AAP recommends 25 hours per week for children under 5

Teaching Parents :

Teaching Parents Rationale: Caregiver responsivity has positive effects on child language Delaney & Kaiser, 2001 Dunst et al., 2007 Hancock et al., 2002

Teaching Parents :

Teaching Parents Rationale: Parent as intervention agents Increased opportunities for generalization Continuity over time Cost effectiveness

What do we know? :

What do we know? Limited research on HOW to teach parents

Does one hour per week work? :

Does one hour per week work? Vismara , Columbi , & Rogers, 2009 Early Start Denver Model Embed into routines Parents acquired strategies by 5th or 6th hour Children demonstrated sustained change and growth

Does teaching within routines work? :

Does teaching within routines work? Wetherby & Woods, 2006 Early Social Interaction Project Increase opportunities to practice meaningful, functional goals within predictable routines ] Quasi experimental design Results promising

Does teaching within routines work? :

Does teaching within routines work? Kashinath , Woods, & Goldstein, 2006 Arrange environment Use natural reinforcers Use time delay Contingent imitation Modeling Cuing Embedded into routines & generalization routines Results: parents increased use of strategies, child increased communication, parent rated satisfaction high

Does including parents in ECSE work? :

Does including parents in ECSE work? Ingersoll & Dvortcsak, 2006 Targets: Following your child ’ s lead Modeling and expanding Environmental arrangement Prompting and Sr + / -

Does including parents in ECSE work? :

Does including parents in ECSE work? Ingersoll & Dvortcsak, 2006 Coaching Techniques: Building rapport Reviewing information Modeling techniques Feedback Building independence

Does including parents in ECSE work? :

Does including parents in ECSE work? Ingersoll & Dvortcsak, 2006 Results: Attrition Positive social validity / parent satisfaction Coaching was in school Parents indicated home visiting would have been useful

So, what do we know?:

So, what do we know? observe the care provider - child interactions within the routine identify and describe strategies care providers already use successfully to enhance their feeling of competence

So, what do we know?:

So, what do we know? share the signals and skills the child currently uses within the routine to provide developmental information problem-solve potential opportunities for training to be embedded within the routine without interfering with the routine;

So, what do we know?:

So, what do we know? discuss and demonstrate potential strategies as choices for the care provider to use observe and synthesize the sequence and strategies used by the care provider to support implementation.

So, what do we know?:

So, what do we know? provide opportunities for the child to initiate use indirect questions or comments to maintain interaction continue the exchange for multiple turns pause expectantly to provide time for the child to respond or initiate use naturally occurring consequences (juice becomes the reinforcer, not good talking)

Parent Skill Training::

Parent Skill Training: A Family-Centered Component of Early Intervention Presentation done by Phil Stain and University of Colorado Denver PELE Center Staff.

Background and History:

Background and History Originally developed as a component of the LEAP Preschool Model, 1981. Developed with materials and ideas used in the Regional Intervention Program (RIP) a statewide service delivery model for parents of young children with severe behavioral problems. All elements of the Parent Skill Training curriculum have been empirically validated over time Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Intervention in Part C:

Intervention in Part C Family Focus vs. Child Focus Home-based vs. Clinic-based Functional Goals vs. Discrete Skills Parents as Decision Makers vs. Parents as Consumers Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Characteristics of Intervention (Bjorck-Akesson & Granlund, 1997):

Characteristics of Intervention (Bjorck-Akesson & Granlund, 1997) Characteristics of Intervention Child-centered learning Family-centered adaptation Basis for Intervention Developmental level Actual behaviors Social factors Environmental factors Agents of Intervention Professionals Specialists Family, Social Network, Environment Goal of Intervention Next or Highest Developmental Level Generalization, Independence, Maintenance Type of Intervention Learning new more complex skills Adaptation of, Building on, Existing skills

LEAP Family Services - Guiding Beliefs:

LEAP Family Services - Guiding Beliefs Support and services should be responsive to the needs of the family Family-focused versus child-focused Support families as decision-makers and encourage parent-professional partnerships Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

LEAP Family Services - Guiding Beliefs:

LEAP Family Services - Guiding Beliefs Intervention strategies should support family values and beliefs Intervention efforts should build on family strengths and resources and provide families with opportunities to learn new skills Both formal and informal supports should be utilized to address family concerns and priorities Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Overview of Parent Training:

Overview of Parent Training Family involvement is essential Ongoing parent training, parents as intervention agents, consistency is crucial Identification of specific goals & objectives Use of Behavioral Strategies Functional Analysis of Problem Behaviors, Task Analysis, Naturalistic strategies, Ongoing Data Collection Implementation in the Natural Environment Child preferred materials, ongoing daily activities Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Parent Education and Support:

Parent Education and Support Family determined context for learning new skills Demonstration , practice, feedback offered in home and community settings Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Methods of Presenting Information:

Methods of Presenting Information Group Parent Meetings One on One in the Home Setting Self Study Materials Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Elements of Parent Training :

Elements of Parent Training Hands on Experience and Follow Up In home or community (natural environment) Model and explain with child Observe parents and provide feedback video taping Practice, Practice, Practice Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Follow up:

Follow up Family Visits Observation of parent child interactions Modeling of specific targeted skills Feedback to parents with written materials Daily Interactions with Parents (if possible) Picking up and dropping kids off Home/School communication books Team Meetings Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Curriculum Content:

Curriculum Content ABC ’ s of Behavior Teaching Your Child to Follow Directions Introduction to Reinforcement How to Use Reinforcement Planning Activities to Increase Appropriate Behaviors Deciding What to Teach Your Child Teaching Your Child New Skills Encouraging Your Child to Communicate Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Using the Training Manual:

Using the Training Manual Written in 1 st person language so the script can be read. Cues presented to key presenter on important pieces of information or activities. Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Components of Training Materials:

Components of Training Materials Training Manuals (Trainer Edition, Parent Workbook) Script, Including the Summary (TE) Example Sheets (TE, PW) Activity Sheets (TE, PW) Brining it Home (TE,PW) In a Nutshell (TE, PW) Video Overview Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

Outcomes:

Outcomes Parent Skill Training Component produces broad-based and long-lasting effects including: Family use of skills in naturalistic contexts Child behavior improvements in Active engagement Challenging behaviors Decreased levels of parental stress and depression High levels of satisfaction with the training program Outcomes maintained as families exit the program and move on to less supportive programs (Strain, 1987; Strain, 1996)

Parent Skill Training as a Component of Early Intervention Services:

Parent Skill Training as a Component of Early Intervention Services Can be used in both provider-based models and team-based models of E.I. May require a paradigm shift away from “ child-centered ” intervention Can be implemented by a variety of E.I. providers Including but not limited to SLP, OT ’ s, Behaviorists, ECSE, Soc. Workers Information from Dr. Strain and Staff from PELE Center, University of Colorado Denver

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