This study examined the fidelity of implementation by four Head Start teachers using the teaching strategies of constant time delay, enhanced milieu teaching, and system of least prompts with children with and without disabilities in an inclusive early childhood setting. The teachers worked with the researcher to determine appropriate skills to target for each teaching strategy. A multiple probe across behaviors design replicated across four teachers was used to determine the effects of teachers’ fidelity of implementation of evidence-based teaching strategies. The results showed that Head Start teachers could implement systematic teaching strategies with fidelity. The study also examined if children with and without disabilities can make progress towards their target skills. The results showed that children were able to make progress towards their target skills.

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<p dir="ltr">ABSTRACT</p><p dir="ltr">Individuals with autism spectrum disorder (ASD) experience deficits in social communication skills, but the literature suggests that addressing early communication at a young age can result in a myriad of positive outcomes later in life. Early intervention and intensive applied behavior analysis therapy have become commonplace for many, but those supports are costly and may not be accessible to all. Additionally, even for those that do have access, an emphasis is being placed on caregiver-mediated interventions (CMIs) that can be implemented outside of sessions with service providers. Research indicates that CMIs can help children generalize skills to routines and contexts within their natural home environment. CMIs that directly target natural play routines, such as Enhanced Milieu Teaching (EMT), have been repeatedly implemented successfully by caregivers to improve both caregiver implementation outcomes and child expressive communication.</p><p dir="ltr">Despite the benefits, most CMI interventions for children with ASD have been delivered primarily to mothers, although fathers have reported that they also want access to supports. Barriers that prevent all caregivers from engaging in CMIs are extensive, but additional hurdles exist for fathers, including providers not prioritizing their access to relevant information, inflexible in-person session hours, and provider biases. Many of these barriers can be addressed through the use of modifications and teleahealth service delivery. This study aimed to explore the effectiveness of a father-mediated telehealth EMT intervention delivered via a collaborative practice-based coaching (PBC) partnership. We incorporated modifications to meet the specific needs and desires of fathers, including short weekly coaching sessions over Zoom, flexible scheduling inside and outside of traditional business hours, initial background information on ASD and the principles of operant conditioning, a focus on typical father-child play routines, asynchronous supports to supplement coaching sessions, and video training models of fathers acting as the intervention agent. Two father-child dyads completed the study, which utilized a multiple baseline across behaviors design with four intervention tiers to teach separate EMT implementation strategies. Fathers uploaded two 5-min videos engaging with their child in a chosen play routine each week, and implementation fidelity and child expressive communication were coded. Visual analysis of father data and descriptive analysis of child communication was used to determine the effects of the intervention. Additionally, father well-being and ASD knowledge were assessed via pretest and posttest surveys.</p><p dir="ltr">Results indicate that fathers can successfully implement the EMT intervention with their children with ASD. As a result of improvements in father implementation, substantial increases in child expressive communication occurred. However, the intervention may not have had an influence on father well-being outcomes, as survey responses improved for one participant but worsened for the other. This study provides evidence that EMT delivered to caregivers–and particularly fathers–via telehealth-based PBC may be ideal to address the needs of children with ASD and their families.</p>

In this study, the author examined the effects of training four parents from low-socioeconomic environments to use Enhanced Milieu Teaching (EMT) with their young children with language impairment. The investigator used a modified Teach-Model-Coach-Review method to teach parents to use the following EMT strategies during 8-10 individualized, home-based sessions: matched turns, expansions, time delays and milieu teaching prompts. A single-case multiple-baseline design across-behaviors replicated across four parent/child dyads was used to evaluate the parents' use of the EMT strategies. Child language outcomes were also assessed using pre- and post-intervention language samples. All parents learned and demonstrated use of each language support strategy to set criterion levels. Results from this study indicated a functional relation between the brief parent-implemented language intervention training and parents’ use of language support strategies. Additionally, all four children demonstrated gains in expressive language. Additional research is needed to assess fidelity and dosage of parents’ use of strategies on specific child language outcomes and to determine how to facilitate maintenance of parents’ use of strategies over time.

Huvudsyftet med studien har varit att utvärdera hur en fem timmar lång kommunikationsutbildning riktad till sjukgymnaster på habilitering påverkar sjukgymnasternas kommunikativa stil i interaktion med barn/ungdomar som på grund av cerebral pares saknar tal. Utbildningen utformades som en inlärningsmodell i åtta delmoment (åttastegsmodellen). I utbildningen och studien ingick sex habiliteringssjukgymnaster som interagerade med var sitt barn/ungdom som till följd av cerebral pares kommunicerar med alternativt och kompletterande kommunikation (AKK) i form av kommunikationskartor. Interaktionen videofilmades vid tre separata tillfällen: en inspelning före utbildning, en inom två veckor efter utbildningen samt en sista filmning tre månader efter avslutad utbildning. Analys av videomaterialet gjordes med hjälp av en kombination av kvantitativ och kvalitativ analysmetod. Analysformuläret KOMMUNIKATIV användes för att analysera sjukgymnasternas kommunikation och kompletterades med en mer detaljerad kvalitativ samtalsanalys (Conversation Analysis, CA) där interaktionen mellan individerna analyserades. Utöver detta besvarade sjukgymnasterna en enkät. Utbildningens utformning baserades på tidigare forskning i form av av miljömodifierande strategier, responsiv kommunikationsstil samt AKK-modell i form av att pekprata. Resultatet av KOMMUNIKATIV påvisade en statistiskt signifikant förändring av sjukgymnasternas kommunikativa beteende efter avslutad utbildning. Det fanns även en fortsatt mätbar, men inte statistiskt signifikant, förändring mellan andra och tredje mättillfället. Sjukgymnasterna möjliggjorde, efter utbildning, att barnen/ungdomen i större utsträckning kunde kommunicera med sin kommunikationskarta. De pekpratade i större utsträckning och var mer lyhörda för barnets/ungdomens kommunikation. Endast en av tio kommunikativa förmågor som analyseras i KOMMUNIKATIV försämrades: sjukgymnastens förmåga att förtydliga sig. Samtalsanalysen bekräftade den kvantitativa analysen på flera sätt och visade att barnet/ungdomen efter utbildning anpassade sig till sjukgymnasternas förändrade beteende och uttryckte sig i längre fraser. Interaktionsmönstret ändrades från att före utbildning vara mer styrt av sjukgymnasten till att barnet/ungdomen efter utbildning kunde införa nya ämnen och delta i reparerande sekvenser. Samtalsanalysen visade även hur sjukgymnasterna ändrade sin användning av en engagerad röstkvalitet. Före kursen användes den i flera olika kontexter, inklusive problematiska kommunikativa kontexter där den snarare förvärrade problemen. Efter kursen varierade sjukgymnasterna sina strategier för att lösa olika typer av problematiska situationer, och undvek därmed i högre grad kommunikativa problem. Åttastegsmodellen som provades i genomförandet av kursen var framgångsrik på två olika sätt. Dels medgav den att varje deltagare fick en individuell målsättning baserad på en förmätning, och dels medförde modellen ett aktivt lärande vilket bidrog till att befästa den nya kunskapen. En slutsats av utvärderingen är att en interventionsutbildning enligt åttastegsmodellen med fördel kan användas för att lära ut kommunikativa strategier till habiliteringspersonal. / The main purpose of this study was to examine how a five hour communication course given to physiotherapists working at a habilitation center changes their communication when interacting with non-speaking children and teenagers with cerebral palsy. An instructional model for teaching learning strategies in eight steps was tested. Six physiotherapists took part of a five hour communication course on three occasions. The course contained receptive communication, environmental arrangements and aided language stimulation as suggested by previous research. Interaction between physiotherapist and child/teenager communicating with a communication board was videotaped just before the course, within two weeks after the course and also three month later. The course was analyzed using a combination of quantitative and qualitative methods. KOMMUNIKATIV is a quantitative method measuring ten communication abilities of the physiotherapists. Conversation Analysis (CA) was used as a detailed qualitative complementary analysis to KOMMUNIKATIV in order to examine the interaction between physiotherapist and child/teenager. Results from KOMMUNIKATIV showed a statistically significant change within two weeks after the course. Continued changes were measured between the second and the third point of measure but that change was not statistically significant. These results strongly indicate that the physiotherapists adopted a more receptive communication style after the course. They made it possible for the child/teenager to communicate with the communication board and they increased the number of AAC-modeling. One aspect, the physiotherapists’ ability to simplify the communication, declined from the first to the second and third point of measure. The child´s/teenager´s communication adapted in some ways to the changed communicational behavior of the physiotherapists. After the course, the child/teenager used longer phrases and started to make repairs. The detailed interaction analysis verified the change in communicative behavior in several ways. One significant change was the way the physiotherapists used an engaged voice quality to encourage the child/teenager to respond to requests for action. Before the course this voice quality was used in many different contexts, including communicatively problematic contexts, where it increased the problems. After the course the physiotherapists used a more varied set of strategies to solve problematic situations, thereby avoiding communicative problems. The instructional model for teaching communicative strategies in eight steps that was used in the study was successful in two ways. Firstly, the model provides the possibility to set individual goals for each member based on preassessments. Secondly, this model enables active learning which seem to consolidate the new ability. A conclusion from the evaluation of the eight step model is that it can be used for teaching communicative strategies to professionals.