The concentration of services in urban areas compounds the geographic and logistical barriers faced by families living in rural and underserved communities (Machalicek et al., 2016). Caregiver-implemented interventions are Part C compliant because they (a) occur in natural settings, (b) provide family training and counseling, and (c) advance family understanding of child development (Division of Early Childhood, 2014; Salisbury, Woods & Snyder, 2018; Woods, Wilcox, Friedman & Murch , 2011).Caregiver Implemented Interventions are effective approaches to early language intervention for young children with language and communication impairments (Carter et al., 2011; Kaiser & Roberts, 2013; Roberts & Kaiser Romski et al., 2010) .
Both transactional and social interactionist theories of language development contribute constructs that support caregiver-implemented interventions. A more recent meta-analysis (Heidladge et al., under review) extended the findings of Roberts & Kaiser (2011) by including studies conducted since 2010, limiting the meta-analysis to randomized controlled trials, examining the interventions in different contexts (shared reading and play routines), and including studies of children at risk of language impairment secondary to low socioeconomic status (SES). A promising application of telepractice in EI involves using video teleconferencing to deliver caregiver-implemented interventions (Boisvert et al., 2010; Hall & Bierman, 2015; . Knutsen et al., 2016).
Although telepractice has been suggested as a promising model to improve access to EI services for children in rural and low-resource communities, the efficacy of such interventions remains untested (McDuffie et al., 2016; Meadan et. al. 2016). . The following intervention programs were implemented: Denver Telehealth Early Start Model (Vismara et al. Reciprocal Imitation Training (Wainer et al) Naturalistic Parent-Implemented Intervention (McDuffie et al and Parent-Implemented Communication Intervention Internet-based (i-PICS; al., 2016).
C, VTC Meadan et al
C, VF, VTC Vismara et al
Meadan et al., (2016) included three multiple baseline behavioral designs and Vismara et al. 2012) and Wainer and Ingersoll (2015) each included one multiple baseline participant design. To address the potential for positively biased NAP estimates for multiple baseline designs, the cutoff for large estimates was set at 0.96, and the cutoff for small estimates was set at 0.93 (Peterson-Brown et al., 2012). Currently, there are no empirically derived and interpretable criteria for small, medium, and large estimates of the WC-SMD effect size (Shadish et al., 2015).
Importantly, additional research is needed to (a) demonstrate the effectiveness of telepractice for improving caregiver strategy use and child language outcomes, (b) examine moderators of treatment effectiveness, and (c) optimize existing empirically supported caregiver-delivered telepractice interventions . service provision (Baggett et al. 2010; Knutsen et al., 2016; Hall, Culler, Frank-Webb, 2016; Molini-Avejonas et al., 2015). EMT is a fully developed intervention with a treatment manual, treatment intensity recommendations, an empirically supported caregiver teaching framework (Teach-Model-Cach-Review; Roberts et al., 2014), and procedural fidelity measures. Second, caregiver training used the Teach-Model-Coach-Review (TMCR) learning framework (Roberts et al., 2014).
TMCR is a research-based instructional framework that has been used to teach and coach caregivers in five studies of caregiver-implemented EMT (Kaiser & Roberts, 2013; Roberts & Kaiser, 2015; Roberts, et al., 2014; Wright , et al. al., 2013). Using a blended service delivery model combined the benefits of in-person instruction, modeling and coaching, with the efficiency and flexibility of telepractice service delivery (Baggett et al., 2010; Cohn & . Cason, 2012; Knutsen et al., 2016).
CHAPTER II
During the SPA, the child and the interventionist sat opposite each other while the interventionist presented five standard toy sets. The use of EMT strategies was conceptualized as a dyadic variable because caregiver responses were partially shaped by the child's communication and play behaviors. Target conversation was a spoken verbal response with the same number of content words as the child's target MLU.
Learning criterion for expansions was met when the caregiver expanded more than 40% of the child's statements in three out of four consecutive sessions. As the child communicated, the caregiver provided access to an object, performed an action that interested the child, or prompted specific language using environmental instruction (Kaiser & Hampton, 2016). All time delay strategies were rated on a three-point scale, taking into account the caregiver's adherence to the steps of the strategy and the child's interest.
The caregiver does not give the requested object/action to the child at the end of the Time Delay. All milieu teaching episodes were rated on a three-point scale, with considerations for the caregiver's adherence to the rapid sequence and the child's interest. At the end of the Milieu episode, give the child the prompted and requested object/action.
During the intervention condition, Jessica showed an increase in level for four EMT strategies: matching turns, extensions, time delays, and milieu teaching episodes. During the intervention condition, Jessica met learning criterion for matching turns, extensions, time delays, and milieu teaching episodes. Jessica met learning criterion for the four EMT strategies taught during the intervention condition.
Her strategy use remained at levels at or above the learning criterion during 90% of the intervention sessions (19/21). Caregiver strategy use was judged to be associated with increases in children's communication acts if the child's data showed a latent increase in level and/or an accelerating therapeutic trend within one month of the caregiver meeting the matched phrase learning criterion. Is caregiver use of EMT strategies during telepractice education associated with increases in child lexical diversity (number of different words) during caregiver-child interactions.
Use of the caregiver strategy was judged to be associated with an increase in the child's number of different words if the child's data showed a latent level increase and/or an accelerating therapeutic trend within one month of the caregiver beginning learning criterion for matched turns was met. This increase in level and the gradual acceleration of the trend continued through the remainder of the intervention sessions as Elena learned the remaining EMT strategies (range = 3 – 12). Although this was the desired outcome, the use of a responsive interaction style during the intervention condition supported the child's communication skills.
Second, the current design is insufficient to establish a functional relationship between the intervention and child outcomes.
Responsive
How is _____ communicating now?
Why is _____ communicating now?
Noticing and responding to all communication teaches your child that their communication is important to you. Language is most meaningful when it is related to what your child is doing OR in response to what your child is communicating.
Matched Turns
- Review target strategy and role play
- Pick toys and talk about how you will play and engage, notice and respond,
- Watch your child play and look for
- Practice with your child for 15 minutes
What the adult says is more meaningful since the adult and the child are doing the same action and language. Choose a toy and talk about how you want to play and engage, notice and respond, play and engage, notice and respond, and take turns with the toy.
