Dawn R. Hendricks, Ph.D.. Rationale for parent implemented intervention Obstacles to parent implementation Measures of effectiveness for parent.

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Dawn R. Hendricks, Ph.D. Slide 2 Rationale for parent implemented intervention Obstacles to parent implementation Measures of effectiveness for parent implemented intervention Skills targeted through parent implemented intervention Slide 3 Effective components of parent training programs 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Three tiered plan for parent training Slide 4 Inputs All ingredients needed for processing to occur Processing Practices Everything that is done to produce either the output or internal feedback Outputs Product produced form inputs and all efforts Receiving System Direct consumer of output External Feedback Measure of how well the output serves the needs of the receiving system Slide 5 Objective #1 Describe the Rationale to Involve Parents in their Childs Program Slide 6 Early intervention Intensive intervention Intervention agents throughout his/her lifespan Challenging behavior Generalization Slide 7 Parents of children with ASD report higher levels of stress and depression Two of the most frequently described sources of stress for family members are: Potentially disruptive behavior in public places The corresponding restrictions this behavior places on family activities Involved parents report increased feelings of competence and decreased feelings of depression and stress Slide 8 Objective #2 Barriers to Parent Implementation Slide 9 Generate a list of barriers that may prevent parent implementation Environmental Child Parent Service provider Slide 10 Scheduling Transportation Other competing priorities (e.g. children, work, sleep!) Experience / Knowledge of service provider Amount / intensity of intervention Slide 11 Parent knowledge / skills Parent readiness Parent emotional state / mental health (e.g. depression) Parent adversity factors (e.g. single parent, socioeconomic disadvantage) Parent attitude (e.g. pessimism) Parent regard towards EI / Strategies Child factors (e.g. age, severity of disability) Slide 12 Objective # 3 Describe the Measures Used to Determine the Effectiveness of Parent Implemented Intervention Slide 13 Koegel, Koegel, Harrower, & Carter (1999) & Symon (2001) Family/environment goodness of fit Parents implementation (frequency & fidelity) Parents concerns/issues/values Cost-benefit analysis Slide 14 Child Progress Immediate Long Term Slide 15 Objective # 4 Describe the Skills Targeted Through Parent Implemented Intervention Slide 16 Sufficient Evidence Base: -Reduction of problem behaviors -Improvement in adaptive behavior -Improvement in communication -Improvement in social skills -Improvement in cognitive performance -Improvement in on task behavior Slide 17 Functional Behavior Assessment Functional Communication Training Prompting Reinforcement Natural Environment Strategies Environmental Arrangement Visual Strategies Social Stories Pivotal Response Training Slide 18 Natural Environment Strategies Imitation and Modeling Joint Action Routines/Joint Attention Pivotal Response Training Prompting Reinforcement Environmental Arrangement Functional Behavior Assessment Functional Communication Training Discrete Trial / Structured Teaching Picture Exchange Communication System Slide 19 Slide 20 Describe the Components of an Effective Parent Training Program Slide 21 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Three tier plan for parent training Slide 22 Due to a sudden accident, you now are taking care of a friends elderly parent. This parent has Alzheimer's and speaks Chinese What is your immediate priority? What are your goals? Slide 23 Areas of concerns and needs regarding the child Strengths of the child and family Child behaviors that impact family functioning Parent-child interactions including type, frequency, nature, and reciprocity of interactions Family activities, routines, and physical layout of the home Supports and resources within the immediate and extended family and community Slide 24 Ask questions.lots and lots! Observe Break the day into time intervals or activities Discuss privately before IFSP Observe Skip the formalities Acknowledge claims as valid Slide 25 What is your family proud of? What is your favorite thing about your child/family? Now is your time to brag on your family What is the best time of day? Why? What is the most challenging time of day? Why? What is the favorite thing you do with your child? Tell me about dinner. How do you take care of grocery shopping? Who is there for you when things get rough? Tell me about the bed time routine. Walk me through a typical day. What opportunities does your child have to play with other children? Can you describe how his brother interacts or plays with him? Slide 26 Dinner time routine Down time Grocery store Car ride Playing in yard Toileting /diapering Slide 27 Where is this Addressed? Child and Family Activities Family identified resources, priorities and concerns Slide 28 List common areas of need by families with children with ASD. Slide 29 Address areas of concern and priority for the child, parents, and/or family members Create a positive impact on family functioning and not cause additional stress to the parents or family Can be implemented by parents with consistency Are appropriate for parents to implement in home and/or community settings 29 Slide 30 Battery of tests that any goal statement should pass in order to be effective. If not passed, the goal statement will not be effective Slide 31 A = Does the goal describe an ACCOMPLISHMENT? C = Does the team have CONTROL over achieving the goal? O = Does the goal statement describe the OVERALL goal of the team? R = Is the goal statement RECONCILABLE with the other goal statements? N = Does the goal statement describe a goal that is quantifiable? (NUMBER) Slide 32 Access to communityInteraction patternsHome disruptionSafety concernStress 32 Slide 33 Imagine a year from now, what would you like to be different in terms of__________ (stated concern, for example, childs activity level; familys child care situation; childs communication)? Imagine a year from now, are there some things you would like to stay the same? What are the kinds of things youd like to see your child do better? What would you like your child to do next in terms of ______________ (e.g., using his/her hands; learning new information; taking care of his/her own needs; understanding what is said to him/her; making his/her needs known; playing with toys)? What would you like to see happen for your family during the next # months/year? Are there concerns regarding safety? Are there times of the day that are difficult? What might need to change to make that time of day easier or more pleasant? Slide 34 Rearrange the play room Install child-proof door knob Use picture schedule for play routine Create consistent night routine Take trip to grocery store, enter door and leave Use choice board in kitchen for snack items Use visual to indicate termination of game Slide 35 Jakes sister will participate in motor exercises three times each week by modeling the exercises and interacting with Jake. Megans brother will present two choices for a play activity and will play for five minutes. Pariss mother will use a first/then board when going to the grocery store. When asking Callie a question or giving an instruction, Callies family members will first gain her attention by standing in front of her, tapping her on the shoulder, and pointing to his/her mouth. 35 Slide 36 List potential family and home goals that may be included Slide 37 Outcome place for the familys ability to assist in their childs development (family outcome) or developmental goal (child outcome) Slide 38 Incorporates intervention within the context where target behaviors occur Incorporates intervention into naturally occurring daily routines to the maximum extent possible Includes practices that have an evidence base and have been shown to be effective when implemented by parents Includes instructional practices that are compatible with parent knowledge, characteristics, routines, and preferences 38 Slide 39 Instructional strategy broken down into step-by-step directions Frequency and duration of instruction When and where to provide instruction Who will implement Materials required How long to implement Consequences / reinforcement 39 Slide 40 www.autisminternetmodules.org www.autisminternetmodules.org Parent Intervention Protocol Form Parent Implemented Behavior Intervention Plan Slide 41 Area that has the smallest effort but biggest impact Area that addresses safety Area that adds order / control Area that will increase interaction with parent Area that will increase access to the community Slide 42 Level 1 Level 2 Level 3 - Level 5- Level 4 - Cognition/play Medical, sensory, safety Communication Environmental Interaction Slide 43 Case Study List potential outcomes Prioritize items in the intervention plan Slide 44 Lena Winslow Mother of Katherine Slide 45 Three-tier approach Individualized model Slide 46 Format of training considered Content & Cognition Level of intensity balanced to the family Content & Cognition Multiple-tiers of training provided Content & Cognition Slide 47 Sense-making Examples and counter examples Substitution Problem solving Slide 48 Self-administered Programs Literature Audiovisual material Computer-delivered information Slide 49 Group-based Programs More therapist attention Cost efficient Support kinship and engagement Slide 50 Individually Administered Programs Increased flexibility Individualization of content Feedback by therapist and family Slide 51 Training Outcomes Related to Training Components ( Joyce & Showers, 2002) Components Training Outcomes Knowledge of ContentSkill Implementation Presentation/Lecture10%5% Plus Demonstration30%20% Plus Practice60% Plus Coaching / Feedback 95% Slide 52 Didactic Instruction Videotape vignettes Modeling Slide 53 Live Feedback / Coaching Role Playing / Behavioral Rehearsal Individual videotape analysis Individualized discussion of concerns / individualized problem solving Slide 54 MutualityTrustUnderstanding Slide 55 Build capacity Provide reciprocity Prioritize & focus on valued outcomes Always make the smallest change that will have the biggest impact Maximize current competence Emphasize accountability Build credibility through consistency, competence with practices/content, relationships, and time investment Be willing to change Slide 56 Inputs All ingredients needed for processing to occur Processing Practices Everything that is done to produce either the output or internal feedback Outputs Product produced form inputs and all efforts Receiving System Direct consumer of output External Feedback Measure of how well the output serves the needs of the receiving system Slide 57