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Dawn R. Hendricks, Ph.D..  Rationale for parent implemented intervention  Obstacles to parent implementation  Measures of effectiveness for parent.

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Presentation on theme: "Dawn R. Hendricks, Ph.D..  Rationale for parent implemented intervention  Obstacles to parent implementation  Measures of effectiveness for parent."— Presentation transcript:

1 Dawn R. Hendricks, Ph.D.

2  Rationale for parent implemented intervention  Obstacles to parent implementation  Measures of effectiveness for parent implemented intervention  Skills targeted through parent implemented intervention

3  Effective components of parent training programs 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Three tiered plan for parent training

4 Inputs All ingredients needed for processing to occur Processing Practices Everything that is done to produce either the output or internal feedback Outputs Product produced form inputs and all efforts Receiving System Direct consumer of output External Feedback Measure of how well the output serves the needs of the receiving system

5 Objective #1 Describe the Rationale to Involve Parents in their Child’s Program

6  Early intervention  Intensive intervention  Intervention agents throughout his/her lifespan  Challenging behavior  Generalization

7  Parents of children with ASD report higher levels of stress and depression  Two of the most frequently described sources of stress for family members are: Potentially disruptive behavior in public places The corresponding restrictions this behavior places on family activities  Involved parents report increased feelings of competence and decreased feelings of depression and stress

8 Objective #2 Barriers to Parent Implementation

9  Generate a list of barriers that may prevent parent implementation Environmental Child Parent Service provider

10  Scheduling  Transportation  Other competing priorities (e.g. children, work, sleep!)  Experience / Knowledge of service provider  Amount / intensity of intervention

11  Parent knowledge / skills  Parent readiness  Parent emotional state / mental health (e.g. depression)  Parent adversity factors (e.g. single parent, socioeconomic disadvantage)  Parent attitude (e.g. pessimism)  Parent regard towards EI / Strategies  Child factors (e.g. age, severity of disability)

12 Objective # 3 Describe the Measures Used to Determine the Effectiveness of Parent Implemented Intervention

13 Koegel, Koegel, Harrower, & Carter (1999) & Symon (2001)  Family/environment goodness of fit  Parents’ implementation (frequency & fidelity)  Parents’ concerns/issues/values  Cost-benefit analysis

14 Child Progress  Immediate  Long Term

15 Objective # 4 Describe the Skills Targeted Through Parent Implemented Intervention

16 Sufficient Evidence Base: -Reduction of problem behaviors -Improvement in adaptive behavior -Improvement in communication -Improvement in social skills -Improvement in cognitive performance -Improvement in on task behavior

17 Functional Behavior Assessment Functional Communication Training Prompting Reinforcement Natural Environment Strategies Environmental Arrangement Visual Strategies Social Stories Pivotal Response Training

18 Natural Environment Strategies Imitation and Modeling Joint Action Routines/Joint Attention Pivotal Response Training Prompting Reinforcement Environmental Arrangement Functional Behavior Assessment Functional Communication Training Discrete Trial / Structured Teaching Picture Exchange Communication System

19

20 Describe the Components of an Effective Parent Training Program

21 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Three tier plan for parent training

22  Due to a sudden accident, you now are taking care of a friend’s elderly parent.  This parent has Alzheimer's and speaks Chinese What is your immediate priority? What are your goals?

23  Areas of concerns and needs regarding the child  Strengths of the child and family  Child behaviors that impact family functioning  Parent-child interactions including type, frequency, nature, and reciprocity of interactions  Family activities, routines, and physical layout of the home  Supports and resources within the immediate and extended family and community

24  Ask questions….lots and lots!  Observe  Break the day into time intervals or activities  Discuss privately before IFSP  Observe  Skip the formalities  Acknowledge claims as valid

25  What is your family proud of?  What is your favorite thing about your child/family?  Now is your time to brag on your family…  What is the best time of day? Why?  What is the most challenging time of day? Why?  What is the favorite thing you do with your child?  Tell me about dinner.  How do you take care of grocery shopping?  Who is there for you when things get rough?  Tell me about the bed time routine.  Walk me through a typical day.  What opportunities does your child have to play with other children?  Can you describe how his brother interacts or plays with him?

26  Dinner time routine  Down time  Grocery store  Car ride  Playing in yard  Toileting /diapering

27  Where is this Addressed? Child and Family Activities Family identified resources, priorities and concerns

28  List common areas of need by families with children with ASD.

29  Address areas of concern and priority for the child, parents, and/or family members  Create a positive impact on family functioning and not cause additional stress to the parents or family  Can be implemented by parents with consistency  Are appropriate for parents to implement in home and/or community settings 29

30  Battery of tests that any goal statement should pass in order to be effective. If not passed, the goal statement will not be effective

31 A = Does the goal describe an ACCOMPLISHMENT? C = Does the team have CONTROL over achieving the goal? O = Does the goal statement describe the OVERALL goal of the team? R = Is the goal statement RECONCILABLE with the other goal statements? N = Does the goal statement describe a goal that is quantifiable? (NUMBER)

32 Access to communityInteraction patternsHome disruptionSafety concernStress 32

33  Imagine a year from now, what would you like to be different in terms of__________ (stated concern, for example, child’s activity level; family’s child care situation; child’s communication…)?  Imagine a year from now, are there some things you would like to  stay the same?  What are the kinds of things you’d like to see your child do better?  What would you like your child to do next in terms of ______________ (e.g., using his/her hands; learning new information; taking care of his/her own needs; understanding what is said to him/her; making his/her needs known; playing with toys…)?  What would you like to see happen for your family during the next # months/year?  Are there concerns regarding safety?  Are there times of the day that are difficult? What might need to change to make that time of day easier or more pleasant?

34 Rearrange the play room Install child-proof door knob Use picture schedule for play routine Create consistent night routine Take trip to grocery store, enter door and leave Use choice board in kitchen for snack items Use visual to indicate termination of game

35  Jake’s sister will participate in motor exercises three times each week by modeling the exercises and interacting with Jake.  Megan’s brother will present two choices for a play activity and will play for five minutes.  Paris’s mother will use a first/then board when going to the grocery store.  When asking Callie a question or giving an instruction, Callie’s family members will first gain her attention by standing in front of her, tapping her on the shoulder, and pointing to his/her mouth. 35

36  List potential family and home goals that may be included

37  Outcome –place for the family’s ability to assist in their child’s development (family outcome) or developmental goal (child outcome)

38  Incorporates intervention within the context where target behaviors occur  Incorporates intervention into naturally occurring daily routines to the maximum extent possible  Includes practices that have an evidence base and have been shown to be effective when implemented by parents  Includes instructional practices that are compatible with parent knowledge, characteristics, routines, and preferences 38

39  Instructional strategy broken down into step-by-step directions  Frequency and duration of instruction  When and where to provide instruction  Who will implement  Materials required  How long to implement  Consequences / reinforcement 39

40   Parent Intervention Protocol Form  Parent Implemented Behavior Intervention Plan

41  Area that has the smallest effort but biggest impact  Area that addresses safety  Area that adds order / control  Area that will increase interaction with parent  Area that will increase access to the community

42 Level 1 – Level 2 – Level 3 - Level 5- Level 4 - Cognition/play Medical, sensory, safety Communication Environmental Interaction

43  Case Study List potential outcomes Prioritize items in the intervention plan

44  Lena Winslow  Mother of Katherine

45  Three-tier approach  Individualized model

46 Format of training considered Content & Cognition Level of intensity balanced to the family Content & Cognition Multiple-tiers of training provided Content & Cognition

47  Sense-making  Examples and counter examples  Substitution  Problem solving

48  Self-administered Programs Literature Audiovisual material Computer-delivered information

49  Group-based Programs More therapist attention Cost efficient Support kinship and engagement

50  Individually Administered Programs Increased flexibility Individualization of content Feedback by therapist and family

51 Training Outcomes Related to Training Components ( Joyce & Showers, 2002) Components Training Outcomes Knowledge of ContentSkill Implementation Presentation/Lecture10%5% Plus Demonstration30%20% Plus Practice60% Plus Coaching / Feedback 95%

52  Didactic Instruction  Videotape vignettes  Modeling

53  Live Feedback / Coaching  Role Playing / Behavioral Rehearsal  Individual videotape analysis  Individualized discussion of concerns / individualized problem solving

54 MutualityTrustUnderstanding

55  Build capacity  Provide reciprocity  Prioritize & focus on valued outcomes Always make the smallest change that will have the biggest impact  Maximize current competence  Emphasize accountability  Build credibility through consistency, competence with practices/content, relationships, and time investment  Be willing to change

56 Inputs All ingredients needed for processing to occur Processing Practices Everything that is done to produce either the output or internal feedback Outputs Product produced form inputs and all efforts Receiving System Direct consumer of output External Feedback Measure of how well the output serves the needs of the receiving system

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