MSc, Occupational Therapy, Faculty of Health Sciences, University of the Witwatersrand / Infants and toddlers living in residential care facilities are at risk of developmental delay. Environmental factors contributing to this risk are the temporal context (how children spend their time) and social context (how and when caregivers interact with children). This study compared time-use patterns of children living in residential care facilities where caregiver training had previously taken place versus those in facilities where caregiver training had not taken place using a non-experimental, cross-sectional static group comparison study design. Spot observations were used to estimate time-use patterns of infants and toddlers living in residential care in Johannesburg. Results show that caregiver training increased the quantity of time infants spent with their caregivers (temporal context) and the quality of time toddlers spent with their caregivers (social context). Thus caregiver training has the potential to improve the environment in residential care facilities and can be used as an intervention strategy by occupational therapists.

There are currently over 40 million unpaid care partners in the United States, and this number is anticipated to rise in the coming years. Most often, the care partner is a family member of the care receiver who has no prior experience in the caregiving role. Due to the unexpected nature of an acquired brain injury, whether traumatic or nontraumatic, family members are often allocated to this role without any warning while simultaneously trying to process the trauma that has just occurred. Many of these new care partners do not feel adequately prepared to navigate the varying physical, cognitive, and emotional needs of a care receiver following acquired brain injury. The term “second crisis” has been identified to describe the transition from inpatient rehabilitation to discharge home as care partners are often overwhelmed and met with feelings isolation and abandonment by the healthcare system. Care partner burden can lead to poor health outcomes and quality of life for both the care partner and care receiver. The Caring for the Care Partner program proposed here aims to mitigate the challenges faced by the care dyad when transitioning home from the hospital. Through the provision of more individualized care partner training, care partners will feel increased confidence in their role. By incorporating an occupational therapy perspective, this program acknowledges the importance of client-centered care for both the care partner and care receiver. It includes utilization of a learner profile to identify learning preferences, training for staff therapists highlighting strategies to provide more individualized care, group educational sessions for care partners on common topics faced in the caregiving role, and care partner participation in individualized training sessions with the care receiver. This doctoral project (1) discusses the theoretical and evidence base in current literature used to create the foundation of the program, (2) describes a detailed program description, (3) provides an extensive evaluation plan, and (4) addresses dissemination of information and funding to highlight future directions and sustainability of the program. Caring for the Care Partner signifies the value occupational therapists can provide in offering support to the care dyad as they transition to the home environment. Through participation in all components of the program, care partners will experience increased preparedness and confidence, which results in improved health outcomes and quality of life for both the care partner and care receiver.

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This study was conducted to first evaluate the effects caregivers’ fidelity of the Cool Versus Not Cool (CNC) intervention using remote behavioral skills training (BST) and second, to evaluate subsequent treatment effects when caregivers implement intervention with their child with ASD. The components of behavioral skills training used were instruction, modeling, role-playing, and feedback. Past research has not evaluated the effects of the CNC intervention on children with ASD’s social skills when implemented by their caregivers. Thus, this research was needed to evaluate the effectiveness of remote based BST and the effectiveness of caregiver-implemented CNC intervention. Results suggested that remote-based BST is a useful training strategy to train caregivers and to support caregiver-implemented CNC to improve children with ASD’s social skills. During follow up and generalization conditions across dyads, caregiver and child skills maintained. During generalization, caregiver skills maintained when teaching new social skills for Caregiver 1 and Caregiver 2, but not entirely for Caregiver 3. / Applied Behavioral Analysis

Social impairments characteristic of Autism Spectrum Disorder (ASD) are evident in early childhood and often worsen as an individual matures (Rao, Beidel, and Murray, 2008). Despite the emphasis on early intervention and caregiver training, few evidence-based interventions explicitly address the development of social skills in preschool-aged children with ASD (DeRosier, Swick, Davis, McMillen, and Matthews, 2011; Reichow and Volkmar, 2010) and none appear to actively integrate caregivers into treatment (Reichow, Steiner, and Volkmar, 2012). Research indicates that generalization beyond a social skills group setting might occur by including caregivers (DeRosier et al., 2011). The PEERS® program is an evidence-based caregiver-assisted social skills program for adolescents and young adults (Laugeson and Frankel, 2010) that has recently been extended for preschoolers with ASD. An initial randomized controlled trial (RCT) indicated benefits from the PEERS® for Preschoolers (P4P) program, but did not examine caregiver or family outcomes. Researchers also suggest a bidirectional effect in which the family system is impacted by the child with ASD and in turn, the child with ASD is also affected by the family (Karst and Van Hecke, 2012). This study examined the P4P curriculum with 15 children with ASD and their caregivers and examined feasibility of the intervention as well as child social skills, caregiver competency, confidence, and parenting skills in working with their child, and family functioning in the context of the P4P intervention. Results suggest the feasibility of proof concept of applying the P4P curriculum to young children with ASD and their caregivers. Specifically, this 16-session intervention appears to improve social skills scores in children with ASD, which is maintained 4-6 weeks after treatment, increased scores were noted in caregiver confidence interacting with their children, as well as improved scores in their affect/animation and achievement orientation in interaction styles with their child, and noted improvements in their parenting styles overall score. Therefore, this intervention may have an impact both the child and caregiver in positive ways and these positive results are largely maintained at a follow-up after intervention completion. Future research will need to focus more on the entire family unit, as no changes were noted in the present study, and should examine the specific mechanisms that lead to these positive results regarding child social skills and caregiver interaction styles and confidence. Additionally, more work that adds to making P4P an evidence-based treatment must be at the forefront of future work. / Doctor of Philosophy / Social difficulties (e.g., initiating and/or maintaining social interactions, using and/or interpreting verbal and nonverbal social communication, such as eye contact or gestures, understanding others' thoughts and emotions) characteristic of Autism Spectrum Disorder (ASD) are evident in early childhood and often worsen as an individual matures (Baron-Cohen and Wheelwright, 2004; Frith, 2004; Rao, Beidel, and Murray, 2008). Despite the emphasis on early intervention or treatment for individuals with ASD and caregiver (e.g., parent, grandparent, etc.) training, few evidence-based interventions exist that purposefully address the development of social skills in preschool-aged children (DeRosier, Swick, Davis, McMillen, and Matthews, 2011; Reichow and Volkmar, 2010) and none appear to actively involve caregivers in treatment (Reichow, Steiner, and Volkmar, 2012). Research indicates that generalization beyond a social skills group setting might occur by including caregivers (DeRosier et al., 2011). The PEERS® program is an evidence-based caregiver-assisted social skills program for adolescents and young adults (Laugeson and Frankel, 2010) that has recently been extended for preschoolers with ASD. An initial randomized controlled trial (RCT) indicated benefits from the PEERS® for Preschoolers (P4P) program, but did not examine caregiver or family outcomes. Researchers also suggest that there is often an effect on the entire family unit of a child with ASD, which in turn has an impact on the child with ASD (Karst and Van Hecke, 2012). This study examined the P4P curriculum with 15 children with ASD and their caregivers, and examined feasibility of the intervention as well as child social skills, caregiver competency, confidence, and parenting skills in interacting with their child, and family functioning in the context of the P4P intervention. Results suggest that this 16-session intervention appears to improve social skills scores in children with ASD, and these improved scores are largely maintained 4-6 weeks after treatment. Increased scores were also noted in caregiver confidence in interacting with their children as well as in their affect/animation and achievement orientation in interaction styles, and may also improve their parenting style scores overall. Therefore, this intervention may have an impact on both the child and caregiver in positive ways. Future research should address the entire family unit, as no changes were noted in the present study, and should also examine the specific factors that lead to these positive results, as further research adds to P4P becoming an evidence-based treatment.

Applied behavior analysis (ABA) is the gold standard treatment for autism spectrum disorder (ASD), and caregivers can learn to use ABA strategies to teach skills to their children with ASD. However, some families may not be able to access synchronous training due to cost, time, or location. Asynchronous modalities, such as DVDs or internet modules, remove some of these barriers. Other asynchronous options like podcasts need additional efficacy research. We evaluated a brief podcast about positive reinforcement with three caregivers and their children with ASD. We measured correct implementation of positive reinforcement and percentage correct on a multiple-choice quiz. The caregiver's implementation of positive reinforcement was assessed with a confederate and their child before and after listening to the podcast. If the caregiver's performance did not reach the mastery criterion, we provided modeling and coaching. Two of the caregivers implemented positive reinforcement at mastery after listening to the podcast. One caregiver needed modeling and coaching. All three responded correctly to more questions on the quiz after the podcast. These preliminary data suggest that a podcast may teach ABA strategies like positive reinforcement to caregivers of children with ASD, which could reduce some barriers to accessing training.

Functional analyses (FAs) are a common tool used in the assessment and treatment of severe problem behaviors and often occur in the context of clinical settings with unfamiliar, trained staff. Previous research suggests that inconsistent outcomes can emerge when caregivers with an existing history of seeing their child’s challenging behavior are trained to implement the assessment in place of clinical staff. The purpose of the current study was to expand on existing literature by comparing FA implemented by clinical staff and caregivers in the context of a clinical setting. Results demonstrate that efficient identification of function and differentiated rates of problem behavior given the inclusion of caregivers during assessment may vary based on the child’s existing history of responding with those caregivers. Implications of results for researchers and practitioners are discussed.

The two objectives of this single-subject study were to assess how an FM system use impacts parent-child interaction in a noisy listening environment, and how a parent/caregiver training affect the interaction between parent/caregiver and child. Two 5-year-old children with hearing loss and their parent/caregiver participated. Experiement 1 was conducted using an alternating design measured three communication behaviors (e.g., child's vocalization, parent/caregiver's initiation, and parent/caregiver's response) across four listening conditions (e.g., HA+Quiet, HA+Noise, FM+Quiet, and FM+Noise). Experiment 2 was conducted using a comparison within and between conditions to re-measure the communicative behaviors across the listening conditions after the parent/caregiver training. Findings of this study point to three major conclusions. First, FM system use (i.e., FM-only mode) facilitated FM01 child's ability to maintain same level of interaction in a noisy as good as in a quiet environment. Second, parent/caregiver training enhanced the impact of FM system use for one child (FM01), although parent/caregiver initiation increased for both. Third, it is important to verify the function of both FM system and HA microphones to ensure access to FM advantage.

This study evaluated the effectiveness of a procedure for teaching a caregiver to shape vocal language in a young child with autism. A multiple baseline design was employed to assess caregiver use of shaping procedures, child vocal language progress, and the social validity of the procedures. Following baseline and introductory sessions, the coach and caregiver reviewed video from the previous session and the coach gave descriptive feedback to the caregiver about her performance. Following the review of the videotaped segment, procedures to increase skills were selected and practiced. Rates of responsive opportunity arrangement, model presentation, responsive model delivery, and responsive event delivery, as well as the child's rate of requests, vocalizations, diversity of vocalizations, and social validity were measured. Data suggested that the procedures effectively taught the skill of shaping to a caregiver, which in turn seemed to produce increases in the child's vocal responding.