Supporting Parents In Early Intervention Melanie Pellecchia, PhD, - PowerPoint PPT Presentation

Supporting Parents In Early Intervention Melanie Pellecchia, PhD, BCBA, NCSP Assistant Professor of Psychology in Psychiatry Penn Center for Mental Health University of Pennsylvania, Perelman School of Medicine February 27, 2019

Why Focus on Parent Involvement in Early Intervention? Improved Child and Family Outcomes Parent Federal and Developmental Behavioral Transactional Empowerment State Recs for Approaches Approaches Model of Child and Self- Parent Development Efficacy Involvement

How are Parents Usually Involved? Treatment Initiation Goal Selection Developmental Behavioral Approaches Approaches Treatment Delivery

Intervention for Young Children with ASD Developmental Behavioral Approaches Approaches

Developmental Approaches to Early Intervention Key aspects: ▪ Teach within developmental sequences ▪ Foster child’s initiative and spontaneity ▪ Follow the child’s lead ▪ Connect new experiences with existing knowledge ▪ Teaching in everyday routines and natural contexts

Behavioral Approaches to Early Intervention Key aspects: ▪ Learning is a product of antecedents and consequences ▪ Complex skills are broken down into small parts and taught in isolation ▪ Systematic shaping of behavior ▪ Environmental arrangement needed to promote optimal learning ▪ Therapist led

Conflicting Paradigms? Developmental Behavioral Approaches Approaches

Naturalistic Developmental Behavioral Interventions

Naturalistic Developmental Behavioral Interventions NDBI Developmental Behavioral Approaches Approaches Schreibman et al., 2015

Naturalistic Developmental Behavioral Interventions Developmental Consideration of Natural developmental Child led environment level Behavioral Systematic Systematic Environmental prompting Reinforcement arrangement

Naturalistic Developmental Behavioral Interventions Ingredients Environmental Arrangement Natural Reinforcement Modeling Child Initiated Teaching Effective Prompting Following the Child ‘s Lead Balanced Turns

Why Use NDBI in Early Intervention? Language and Improved Long- Communication term Outcomes Contextual fit Gains (Estes et al., 2015) (Stadnick et al., 2015) Developmentally Family Appropriate Involvement

Family Involvement in Early Intervention Therapist- Parent-Mediated Mediated Intervention Intervention

Parent-Mediated Interventions in ASD Parent Child- Coaching focused Intervention Targets and Strategies

Parent Coaching in Early Intervention Parent Coaching is a Common Component to all Efficacious Parent-Mediated Interventions Increased Increased Parent Improved Parent Parent Engagement Child Coaching Treatment and Self- Outcomes Fidelity Efficacy

What is Parent Coaching? Observation Action Reflection Hanft, Rush, & Shelden, 2004

Adult Learning Theory Adults need to know why they should learn something Adults are Adults learn problem- by doing solvers Adult Learning Principles Adults learn Need to be best when the involved in subject is of the planning immediate for instruction use Knowles, 1984

Parent Coaching & Adult Learning Theory Coaching Strategy Description Authentic Learning Learning opportunities occur as part of real-life Experiences problems or challenges Joint Planning Parent is actively involved in selecting goals and strategies for learning Demonstration Practitioner models use of a technique through role- plays and actual application Practitioner observes parent’s use of a technique and In-vivo Feedback provides immediate feedback Reflection Practitioner engages parent in self-evaluation and assessment of performance Dunst & Trivette, 2009

Parent Coaching in Community Settings Therapist- Parent-Mediated Mediated Intervention Intervention

Parent Coaching in Community Settings Early intervention providers spend the majority of their time in traditional child-focused intervention. Study 1: Study 3: Study 2: 70% of EI providers’ 23% of parents of EI providers spent less time was child-focused, children receiving EI than 1% of the session rather than focused on reported receiving coaching parents. the parent. coaching . (Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007) (Campbell & Sawyer, 2007) (Aranbarri et al., 2017)

Parent Coaching in Community Settings Research to Practice Gap

Why Does This Gap Exist? Providers Parents Intervention Preferences and Pedagogical Intervention Expectations Views Complexity for Treatment Competing Treatment Training Demands Goals

Bridging The Gap

Bridging The Gap NDBI Parent Coaching

Partnering with Parents Knowledge sharing Practitioner/Parent Partnership

Shared Decision Making Family Goals and Shared Decision Making Preferences Clinical Environmental Evidence and Context Expertise

Improving Parent Self-Efficacy Frequent Feedback Guided Practice Simplifying Interventions

Meaningful Treatment Goals Relevant Practice Opportunities

Important Considerations Parent coaching should NOT be used to answer the question: How can we maximize opportunities for treatment? Parent Coaching should NOT be a replacement/substitute for other treatment hours. Parents should NOT be expected to become therapists through parent coaching. Focus of Parent Coaching should be: How can we best support parents in improving family functioning? How can we empower parents to support their child’s complex needs? Stahmer & Pellecchia, 2015

THANK YOU! Questions? pmelanie@upenn.edu