Supporting Parents In Early...

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?

Developmental Approaches

Behavioral Approaches

Transactional Model of Child Development

Federal and State Recs for

Parent Involvement

Parent Empowerment

and Self-Efficacy

Improved Child and Family Outcomes

How are Parents Usually Involved?

Developmental Approaches

Behavioral Approaches

Treatment Initiation

Goal Selection

Treatment Delivery

Intervention for Young Children with ASD

Developmental Approaches

Behavioral 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 Approaches

Behavioral Approaches

Naturalistic Developmental Behavioral Interventions

Naturalistic Developmental Behavioral Interventions

Developmental Approaches Behavioral Approaches

NDBI

Schreibman et al., 2015

Naturalistic Developmental Behavioral Interventions

Developmental

Consideration of developmental

level Child led

Natural environment

Behavioral

Systematic prompting

Systematic Reinforcement

Environmental arrangement

Naturalistic Developmental Behavioral Interventions

Ingredients

Environmental ArrangementNatural Reinforcement

Child Initiated Teaching

Following the Child‘s Lead

Modeling

Balanced Turns

Effective Prompting

Why Use NDBI in Early Intervention?

Contextual fit

Language and Communication

Gains

(Stadnick et al., 2015)

Improved Long-term Outcomes

(Estes et al., 2015)

Family Involvement

Developmentally Appropriate

Family Involvement in Early Intervention

Therapist-Mediated

Intervention

Parent-Mediated Intervention

Parent-Mediated Interventions in ASD

Child-focused Intervention Targets and Strategies

Parent Coaching

Parent Coaching in Early Intervention

Parent Coaching is a Common Component to all

Efficacious Parent-Mediated Interventions

Improved Child

Outcomes

Increased Parent

Treatment Fidelity

Increased Parent

Engagement and Self-Efficacy

Parent Coaching

What is Parent Coaching?

Observation

ReflectionAction

Hanft, Rush, & Shelden, 2004

Adult Learning Theory

Adult Learning Principles

Adults need to know why they should

learn something

Adults learn by doing

Adults learn best when the

subject is of immediate

use

Need to be involved in

the planning for instruction

Adults are problem-

solvers

Knowles, 1984

Coaching Strategy Description

Authentic Learning

Experiences

Learning opportunities occur as part of real-life

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

In-vivo Feedback Practitioner observes parent’s use of a technique and

provides immediate feedback

Reflection Practitioner engages parent in self-evaluation and

assessment of performance

Parent Coaching & Adult Learning Theory

Dunst & Trivette, 2009

Parent Coaching in Community Settings

Therapist-Mediated

Intervention

Parent-Mediated Intervention

Parent Coaching in Community Settings

Early intervention providers spend the majority of their time in

traditional child-focused intervention.

Study 1:

70% of EI providers’ time was child-focused, rather than focused on the parent.

(Campbell & Sawyer, 2007)

Study 2:

EI providers spent less than 1% of the session coaching parents.

(Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007)

Study 3:

23% of parents of children receiving EI reported receiving coaching.

(Aranbarri et al., 2017)

Parent Coaching in Community Settings

Research to Practice Gap

Why Does This Gap Exist?

Providers

Pedagogical Views

Training

Parents

Preferences and Expectations for Treatment

Competing Demands

Intervention

Intervention Complexity

Treatment Goals

Bridging The Gap

Bridging The Gap

NDBI

Parent Coaching

Partnering with Parents

Knowledge sharing Practitioner/Parent Partnership

Shared Decision Making

Family Goals and Preferences

Environmental Context

Clinical Evidence and

Expertise

Shared Decision Making

Improving Parent Self-Efficacy

Simplifying Interventions

Guided Practice

Frequent Feedback

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.

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?

Parents should NOT be expected to become therapists through parent coaching.

Stahmer & Pellecchia, 2015

THANK YOU!

Questions?

pmelanie@upenn.edu