Session'Agenda' 1:15;*2:45pm* Recap'the'coaching'model,' - - PDF document

9/27/15' 1'

NATURALISTIC*INTERVENTION*WITH* YOUNG*CHILDREN* *

HOW*TO*PARTNER*WITH*PARENTS*TO*MAKE* MEANINGFUL*DIFFERENCES*IN*CHILDREN’S*LIVES*

' Heather'Moore,'Ph.D'CCC5SLP' University'of'Oregon' OSHA'Conference'2015'

What'will'be'talking'about'this' aJernoon?'

• Coaching'
• Intervening'within'a'coaching'framework'

– FormulaOng'a'treatment'plan'

• Goals'
• Treatment'Approach/'Strategies'
• Defining'Roles'
• Group'vs.'Individual'coaching'
• Treatment'Dosage'

– ConducOng'treatment'sessions'

• FormulaOng'a'session'plan''
• ImplemenOng'the'plan'
• ReflecOng''
• EvaluaOng'the'plan'

Session'Agenda'

• 1:15;*2:45pm*Recap'the'coaching'model,'

FormulaOng'an'IntervenOon'Plan'

• 2:45;3:00pm*Break'&'Visit'Exhibits'
• 3:00;4:30pm**Case'Examples'

9/27/15' 2'

Coaching ''

• A'voluntary,'nonjudgmental,'collaboraOve'

partnership'between'2'or'more'people'

• EssenOal'Elements'

– CollaboraOon' – ReflecOon' – Reciprocity' – Based'on'Performance' – Driven'by'Context'

Coaching'In'EI'Se]ngs'

Coach* Adult*Being* Coached*

Child* Se]ngs'and' Contexts'

Evidence5Based'Family'Coaching' PracOces'in'EI'

• Individual'approach'to'family'coaching'
• Focus'on'daily'rouOnes'with'the'family’s'materials'in'natural'

se]ngs'

• Focus'on'supporOng'family'parOcipaOon'and'building'family'

capacity'and'competence'

• Works'directly'with'the'caregiver'and'uses'effecOve'coaching'

strategies'

• Focus'on'caregiver'responsivity'and'caregiver5child'interacOons'
• Use'of'videos'for'demonstraOon'and'reflecOon'
• IdenOfy'opportuniOes'to'pracOce'across'the'day'and'in'between'

visits'

• SystemaOc'progress'monitoring'

9/27/15' 3'

EI'Coaching'Resources'

• Campbell,'P.H.,'&'Sawyer,'L.B.'(2007).''

SupporOng'learning'opportuniOes'in'natural' se]ngs'through'parOcipaOon5based'services.'' Journal(of(Early(Interven0on,(29,'2875305.'

• Moore,'H.W.,'Barton,'E.B.,'&'Chironis,'M.'(2014).''

A'program'for'improving'toddler'communicaOon' through'parent'coaching.''Topics(in(Early( Childhood(Special(Educa0on,(33,(2125224.'

• Rush,'D.D.,'&'Shelden,'M.L.'(2011).''The(early(

childhood(coaching(handbook.''BalOmore,'MD:'' Paul'H.'Brooks'Publishing.'

Case'Example:''Frazier'

• Almost'2'years'old'at'Ome'of'referral'
• Diagnosed'with'DS'
• Receiving'services'through'EI'
• Parents'goals:''Increase'spoken'and'sign'

vocabulary'in'order'to'communicate'more' effecOvely'at'home'

9/27/15' 4'

Formulate*an* IntervenQon*Plan*

Coaching'Process'

Gain*Entry* Build* RelaQonships* Gather* InformaQon* Implement* Evaluate* Formulate*a* Session*Plan* Reflect* Prepare*

Formulate'an'IntervenOon'Plan'

Discuss'opOons'with'the'family:'

– WHAT?**

– WHICH?* – WHO?**

– HOW?**

– WHEN?**'

WHAT*are*the*goals?*

• Discuss'goals'with'the'family'
• Goals'should:'

– Be'achievable'within'a'certain'Omeframe'(ZPD)' – Be'based'on'stage'of'intenOonal'communicaOon' – Make'the'most'“difference”'in'the'shortest'period'of'Ome' – Easy'for'the'family'to'understand'and'address'at'home'

9/27/15' 5' Goals'vary'by'stage'of'intenOonal' communicaOon'

Possible*PerlocuQonary*Goals*

• Increasing'Ome'in'mutual'ajenOon'
• Improving'enjoyment'when'interacOng'with'others'
• Increasing'Ome'in'sound'play'

Possible*IllocuQonary*Goals*

• Increasing'frequency'of'intenOonal'communicaOon'(communicaOve'

acts'per'minute)'

• Increasing'variety'of'gestures'
• Increasing'variety'of'sounds'
• Increasing'the'reasons'why'children'communicate'(joint'ajenOon,'

behavior'regulaOon,'social'interacOon)'

Goals'vary'by'stage'of'intenOonal' communicaOon'

Possible*LocuQonary*Goals*

• Increasing'vocabulary'across'word'classes'(nouns,'verbs,'

pronouns,'adjecOves)'

• Increasing'sentence'length'
• Increasing'Increasing'the'reasons'why'children'communicate'

(joint'ajenOon,'behavior'regulaOon,'social'interacOon)'(if'sOll' a'problem)'

• Increasing'frequency'of'intenOonal'communicaOon'

(communicaOve'acts'per'minute)'(if'sOll'a'problem)'

Goals'vary'by'stage'of'intenOonal' communicaOon'

Goals;*not*to*target?*

• Comprehension'(following'direcOons)'
• Speech'intelligibility'

9/27/15' 6' WHAT*is*the*best*intervenQon* approach?*

NaturalisQc* IntervenQons*

EMT* Hanen* LAPE* RE;PMT* PECS* Pivotal* Response* Focused* SQmulaQon*

Roberts'and'Kaiser'(2011):''Meta5 analysis'

• Purpose:**SystemaOcally'evaluate'effects'of'parent5

implemented'intervenOon'on'language'skills'of'18560' month'olds'

• Method:**Effect'sizes'for'7'language'outcomes'from'18'

studies.''Compared'for'children'with'and'without'ID'

• Results:**Effect'sizes'(g)'ranged'from'50.15'to'0.82.''

Significant'for'6/7'outcome'measures'

• Conclusions:*

– RelaOve'effects'of'PI'intervenOons'were'larger'than'TI' intervenOons' – PI'intervenOons'effecOve'for'children'with'or'without'ID' – Parent'training'had'posiOve'effects'on'use'of'strategies'

Roberts,'M.Y..'&'Kaiser,'A.P.'(2011)''The'effecOveness'of'parent5implemented'language'intervenOons:''A' meta5analyisis.''American(Journal(of(SpeechDLanguage(Pathology,(20,(pgs'1805199.'

9/27/15' 7'

Kong'and'Carta'(2011):''Synthesis'

• Purpose:**Synthesize'research'on'RII'for'children'with'or'

without'DD''

• Method:**Examined'26'experimental'or'quasi5exp'studies'
• Results:**RII'results'in'significant'posiOve'in'children’s'

emoOonal'and'social5communicaOve'outcomes'

• Conclusions:*

– RI'increases'the'rate'of'specific'target'words'and'improves' intenOonal'communicaOon' – Children'with'a'range'of'dx'improve'communicaOon'and' emoOonal'skills'when'provided'with'RII' – RII'can'improve'caregiver’s'responsiveness'across'families'with' diverse'backgrounds' – RII'can'be'implemented'in'homes,'clinics,'or'classrooms'

Kong,'N.Y.'&'Carta,'J.J.'(2011)''Responsive'interacOon'intervenOons'for'children'with'or'at'risk'for' developmental'delays:''A'research'synthesis.''Topics(in(Early(Childhood(Special(Educa0on,(Doi:'' 10.1177/0271121411426486'

Enhanced'Milieu'Teaching'' Summary'of'Research'

• Developed'out'of'incidental'teaching'
• Combined:'over'50'studies'
• Results:'

– Best'when'used'with'children'between'10'words'–'3.5'MLU' – EffecOve'for'children'with'a'variety'of'disabiliOes' – Caregivers'can'be'taught'strategies'effecOvely' – Children'whose'primary'caregivers'are'taught'strategies'do'bejer'

Hancock,'T.B.'&'Kaiser,'A.P.'(2006).''Enhanced'Milieu'Teaching.''In'R.J.'McCauley'&'M.E.'Fey'(Eds.),' Treatment(of(language(disorders(in(children'(pp.2035236).''BalOmore,'MD:''Paul'H.Brooks'

Research:''Language'and'Play' Everyday'

Moore,*Barton,*&*Chironis*(2014)*

• Use'EB'from'EMT'and'other'NaturalisOc'IntervenOons'

– Environmental'arrangement'and'posiOve'behavior'supports' – Responsive'InteracOon' – Focused'SOmulaOon'

• Conclusions'

– Group'intervenOon'(with'individual'parent'coaching)'can'be'a' great'first'level'of'response' – Maintenance'is'required'to'see'conOnued'benefits' – Parent'coaching'is'an'effecOve'way'to'teach'parents'RI' strategies'

Moore,'H.W.,'Barton,'E.B.,'&'Chironis,'M.'(2014).''A'program'for'improving'toddler' communicaOon'through'parent'coaching.''Topics(in(Early(Childhood(Special(Educa0on,(33,( 2125224.'

9/27/15' 8' Case'Example:''An'IntervenOon' Approach'for'Frazier'

• Language'and'Play'Everyday'
• Fit'criteria:''more'than'10'symbolic'words'and'

less'than'3.5'MLU'

• Variety'of'strategies'to'choose'from'based'on'

family’s'needs'

WHICH*NaturalisQc*IntervenQon*Strategies*will*work* best*for*the*family?'

• PosiOve'Behavior'Support'(PBS)'and'

Environmental'Arrangement'Strategies'(EA)'

• Responsive'InteracOon'Strategies'(RI)'
• Milieu'Teaching'Strategies'(MT)'
• Choosing'Targeted'Vocabulary'

PosiOve'Behavior'Support'Strategies'

• Strategies'include:'

– Designing'the'acOvity'to'be'fun'and'interacOve' – Following'the'child’s'interest' – Having'expectaOons'that'the'child'will' communicate' – LimiOng'distracOons'

9/27/15' 9'

Environmental'Arrangement'

The'caregiver'arranges'the'environment'in'order' to'provide'opportuniOes'for'the'child'to' communicate.'Includes'strategies'that'focus'on:'

• SelecOng'materials'
• Arranging'materials'
• Managing'materials'

'

Environmental*Arrangement*Strategies*

In*View*But*Out*

• f*Reach/*

Assistance*

Piece*by* Piece* Choices* Introduce* Something* New* Silliness*

Responsive'InteracOon'

IntervenOonist'is'taught'to'be'responsive'to'the' child’s'communicaOon'ajempts'by'using'the' following'strategies:'

• 1. WaiQng*and*idenQfy*the'child’s'communicaOon'

ajempts'

– Do'not'direct'or'ask'test'quesOons'

• 2. ConQngently*and*consistently*responding*to*the*

child*in*order*to*teach*something*new*

– Child'nonverbally'communicates,'adult'LinguisOcally' Maps'(within'TLT)' – Child'says'word/ujerance,'adult'expands'ujerance''

Yoder'et'al'(1995),'Fey'et'al.'(2008)'

9/27/15' 10' EA'and'RI:''Learning'opportuniOes,'no' required'outcomes'

Adult'creates'

• pportunity'

and'waits' Child'iniOates' communicaOon' verbally'or' nonverbally' Adult'maps'or' expands' Natural' consequence'

Milieu'Teaching'(MT)'

Behavioral'shaping'towards'a'desired'goal,' through:'

• Models''

– Say'the'word(s)'you'want'the'child'to'say'with'a'clear'expectaOon.''Could' include'a'“say”'prompt'(not'preferable)'

• Mand;model5'A'verbal'prompt'in'the'form'of'a…'

– QuesOon5'“What'do'you'need?”' – Choice5'“juice'or'milk?”' – Mand5'“Tell'me'what'you'want”'

• Time;delay*

– Delayed'response'with'clear'expectaOon' – Cloze'procedure5'“I'want'some'_____”,'“you'have'two'_____'(while' poinOng'to'the'child’s'shoes)”'

'

EA,'RI,'and'MT'

Adult'creates'

• pportunity'

and'waits'

Child'' communicates' but'doesn’t' meet'target' Adult'uses'MT' strategies'' Child' says' target' ' Child' doesn’t' say' target' ' Adult'expands' ujerance'to' demonstrate' more'advanced' language'and' provides'natural' consequence'

Or'

9/27/15' 11'

Targeted'Vocabulary'

Target'words'chosen'to'build'iniOal'vocabulary' by:'

– Relevance'and'frequency' – Syllable'shape' – Sound'repertoire' – Word'class'

Frazier:''Strategies'

• PosiOve'Behavior'Supports'and'Environmental'

Arrangement'

– Parents'excelled'at'PBS' – Need'to'increase'opportuniOes'for'communicaOon,' especially'in'play'

• Responsive'InteracOon'

– Parents'excelled'at'responsivity' – Needed'to'work'on'waiOng'and'responding'and'expansion'

• Milieu'Teaching'

– Not'yet'

• Targeted'Vocabulary'

– Pick'words'across'word'classes'(according'to'goals)'

WHO*will*implement*the*plan?*

• How'do'we'engage'all'the'caregivers?'
• The'more'people'involved,'the'higher'the'

dosage' Frazier5'both'parents,'grandparents,'daycare'

9/27/15' 12'

HOW*will*we*implement*the*plan?*

• Parent'Groups'

– Pros' – Cons'

• Individual'coaching'

– Pros' – Cons'

• Hybrid'of'both?'

HOW*will*we*implement*the*plan?'

• Frazier5'individual'therapy'

WHEN?**How*long*should*the* intervenQon*last?*

• Research'is'lacking'
• Consider'large'dosage'upfront'
• Maintenance'is'required'

9/27/15' 13'

Formulate*an* IntervenQon*Plan*

Coaching'Process'

Gain*Entry* Build* RelaQonships* Gather* InformaQon* Implement* Evaluate* Formulate*a* Session*Plan* Reflect* Prepare*

Frazier'Session'1'

• Formulate'a'Session'Plan'

– Discuss'EA'strategies'and'determine'interest' – Agree'on'plan'

• Implement'

– Discuss'EA'strategies'(handout)' – Watch'parent5child'videos'and'idenOfy'use'of'EA'strategies'

• Reflect'

– Which'strategies'were'used'in'the'video' – Which'strategies'could'be'used'in'the'future'

• Evaluate'

– What'would'the'parents'like'to'do'to'pracOce'the'strategies'at' home?' – How'will'we'know'the'strategies'are'successfully'being'used?'

Frazier'Session'3'

• Formulate'a'Session'Plan'

– Discuss'Progress' – Remind'them'overall'plan' – Agree'on'session'plan'

• Implement'

– Pick'target'words' – Discuss'RI'strategies'and'choose'2'to'pracOce'(define'roles)' – PracOce'use'of'target'words'and'RI'strategies''

• Reflect'

– Parents'reflect'on'use'of'strategies'and'target'words' – SLP'shares'data'

• Evaluate'

– What'would'the'parents'like'to'do'to'pracOce'the'strategies'at'home?' – How'will'we'know'the'strategies'are'successfully'being'used?'