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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
