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Family Guided Routines Based Intervention Manual

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Family Guided Routines Based Intervention Manual

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This manual reviews the SS-OO-PP-RR coaching framework. It is a great resource to review before diving into a parent coaching model.

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The building consensus questionnaire is a great resource to use when starting with a new family/client. Use the questionnaire to gain more information regarding the child's daily routines and activities.

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E is for Everyday Learning Opportunities

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E is for Everyday Learning Opportunities

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This handout is a great resource to share with families in order to establish consensus on the importance of utilizing a parent coaching model.

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The Coaching in Early Intervention handout reviews "I do" "We do" "You do" model. This is another great resource to share with families when working to build consensus.

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The chart below is a wonderful resource to share with families when building consensus on utilizing a parent coaching and routines based learning model.

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The video linked below is a great introduction to Assistive Technology video to share with parents. The information included in the video explains what AT is and showcases a few different types of assistive technology.

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The video below is a quick and easy way to introduce assistive technology to families.

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Understanding Assistive Technology: Simply Said

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The article linked below reviews the switch of parents and SLPs roles in speech therapy. The article discusses how parents can influence their child's language development. It also shares studies on parent implementation in therapy services.

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Traditionally, speech therapy with preschoolers involved parents bringing their child to a speech-language pathologist at a clinic. After an assessment, if the speech-language pathologist recommended it, the parent would bring the child for regular speech therapy. In this case, the sessions would be conducted by the speech-language pathologist, who would use specific techniques and strategies to improve the child's communication. The parent would sit and watch the therapy, either in the room or behind a 2-way mirror. After the session, the parent would be given activities to practice with the child at home.

Over the last several years, the roles of the speech-language pathologist and parent have changed a great deal. Parents are no longer observers of the therapy; they are an essential part of their child's intervention. This shift in roles is based upon the following:

Children learn to communicate during everyday activities and conversations with the important people in their lives - mainly their parents

Parents have many more opportunities to interact with their child in meaningful everyday situations than a therapist does

Parents know their child best and are her/his first teacher

Parents are no longer observers of the therapy; they are an essential part of their child's intervention.

Hanen Programs recognize parents as "key players" in their child's intervention. The programs are designed to help parents learn how to promote their young child's communication at home. Under the guidance of a Hanen Certified speech-language pathologist, parents learn to use specific language-building strategies with their child during everyday activities. These strategies both motivate the child to communicate and help him develop more mature communication skills. There is no structured teaching involved. "Therapy" happens whenever parent and child are together, and the child learns while communicating about all the things that are most interesting, familiar and important to him.

In this way, "speech therapy":

is extended into every part of the child's day

involves communication between child and parent, not child and therapist

involves play and daily activities (such as mealtime, bath time and bed time) that are familiar and meaningful to the child, instead of unfamiliar clinic-based activities

can happen on an ongoing basis in the child's comfortable surroundings

is motivating and fun for the child!

When the speech-language pathologist teaches parents language strategies that parents then use whenever they are with their child, "therapy" becomes a natural part of the family's interactions with their child. This is known as "parent-implemented intervention".

But does this really work? Are parents able to:

make a difference in their child's progress?

help their child as much as a speech-language pathologist can?

Many parents wonder about their ability to help their child. They might feel that a speech-language pathologist, who has specialized training, would be better able to teach their child. But this is not necessarily the case...

A recent journal article by two researchers from Vanderbilt University, Megan Roberts and Ann Kaiser, reviewed 18 different studies which evaluated parent-implemented intervention offered to groups of parents. Eight out of these 18 studies were based on Hanen Programs. The remaining studies were on other programs in which parents were trained to promote their child's communication.

How parents influence their child's language development

The authors begin their article by citing research that shows that children's communication improves when parents:

interact more with their child

respond to their child's attempts to communicate

use "child-directed speech" (talk about what the child is focused on or interested in, using simplified, melodic speech)

emphasize important words in a sentence (e.g. "you're eating a BANANA!")

expand on what the child has said (e.g. Child says, "Key". Parent says, "Yes that's the key for the car."

The Review of Studies on Parent-Implemented Intervention

Parent-implemented intervention is effective not only because the parent plays a key role, but because intervention becomes an ongoing process; every interaction with the child becomes an opportunity to build his or her language learning.

The authors explain that many studies have shown that parents can be taught how to promote their child's communication, and that their children improve as a result. However, Robert and Kaiser wanted to look at all the studies together to see whether all parent-implemented intervention programs had the same or similar results. They also wanted to compare the results of several of these studies, ensuring that children with a wide variety of communication difficulties were represented, such as:

children with Language Impairment

children with Autism Spectrum Disorder

children with Developmental Delay

The children's progress in the 18 studies included in the review was compared to the progress of children in a "control group", who received:

no therapy; or

therapy delivered by a speech-language pathologist; or

other types of services in the community

What the Study Review Found

1. As a result of participating in parent-implemented training programs, parents successfully learned the strategies and used them when interacting with their child.

2. Parents had a positive effect on their child's communication development. Parents' use of strategies led to improvements in their child's expressive skills (nonverbal communication as well as speech), understanding, vocabulary, grammar, and the frequency with which their child communicated.

3. Parents were just as effective at helping their child as speech-language pathologists were. In fact, parents were actually more effective than speech-language pathologists when working on improving the child's understanding of language and grammar.

4. Children with a variety of language difficulties made good progress when their parents were trained to help them. This includes children with Language Impairment, Autism Spectrum Disorder, and Developmental Delay.

Bottom Line: Parents Make a Difference!

This study shows that children with a variety of communication difficulties make good progress when their parents learn to use specific techniques designed to improve the children's communication skills. It also shows that trained parents are as effective - if not more effective in some cases - than speech-language pathologists at helping their child. This confirms that parents should be partners with speech-language pathologists in the therapy process.

Research shows that children with communication difficulties make the most progress when they receive early intervention. The best kind of early intervention involves the parents and is intensive. Parent-implemented intervention is effective not only because the parent plays a key role, but because intervention becomes an ongoing process; every interaction with the child becomes an opportunity to build his or her language learning. As Kaiser and Robert's review shows, Hanen Programs and other programs that provide effective training to parents, can make a significant difference to a child's language outcomes.

Note regarding ongoing speech therapy services: Parent-implemented intervention in these studies lasted on average 26 hours over many weeks. After the parent-implemented program ends, many children still require ongoing speech therapy. While the children show improvement in their communication skills, parents still need guidance from the speech-language pathologist as the child's skills change and develop. The kind of intervention offered will vary; it may involve consultation to parents, direct therapy or offering parents a program to implement in the home.

References

Roberts, M., & Kaiser, A. (2011). The Effectiveness of Parent-Implemented Language Intervention: A Meta-Analysis. American Journal of Speech-Language Pathology, 20, 180-199.
For more than 35 years, The Hanen Centre has taken a leading role in the development of programs and resources for parents and professionals to help all preschool children develop the best possible language, social and literacy skills, including those children with or at risk of language delays and those with developmental challenges such as Autism Spectrum Disorder, including Asperger Syndrome.

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Parents as Speech Therapists: What a New Study Shows

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Traditionally, speech therapy with preschoolers involved parents bringing their child to a speech-language pathologist at a clinic. After an assessment, if the speech-language pathologist recommended it, the parent would bring the child for regular speech therapy. In this case, the sessions would be conducted by the speech-language pathologist, who would use specific techniques and strategies to improve the child's communication.

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This article discusses use of coaching in a child's natural environment. The article provides a few coaching strategies and tips for working with a child during their everyday routines and activities.

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If it's May, it must be Better Hearing and Speech Month (#BSHM), and we're thrilled to kick off the festivities by two Illinois-based SLPs, Dr. Jill Senner and Matt Baud. They have a wealth of AAC experience and have generously shared their expertise here in several previous posts. Today, we welcome them back as they share some advice on helping staff use AAC in natural settings.

Enjoy!
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Put Me in, Coach: Coaching AAC Use in the Natural Environment

"Help, I already trained the team and the device is still not being used outside of my sessions."

Sound familiar? We hear this a lot. This actually is quite common if one key training element is missing. In fact, without this critical instructional component, there's only about a 5% chance that the strategies you're teaching will actually be used in the natural environment. What is the essential ingredient to maximizing your training efforts? Read on to find out!

By now most of us recognize that communication partner instruction is a fundamental part of AAC implementation. Whether you're working with classroom staff at school or directly with families at home or in a clinic, implementation features are as important as intervention features to establish evidence-based practice (EBP). In other words, to provide EBP, how you teach communication partners is as important as what you teach them.

The evidence suggests that the use of multiple training elements results in optimal learner outcomes. Perhaps you're already including strategy description, strategy demonstration, verbal practice and controlled practice in your workshops or in-services. What on earth has been overlooked? Coaching! When trainers include coaching, research indicates that the use of targeted strategies in the natural environment can increase to about 95%!

Coaching involves going (virtually or in person) into the natural environment such as the home or classroom, observing the parent or school staff member, and providing performance feedback. Coaching is collaborative and developing a partnership with the person(s) you're coaching is fundamental.

Coaching Tips

Get to know the person you're coaching. Ask what his or her typical day is like. This will give lots of information on naturally occurring communication opportunities. Find out what the person already knows about AAC and what his or her primary concerns are. Perhaps ask, "What would you like to know about AAC?"

Offer choices. The individual receiving coaching has his or her own opinion regarding what activities, time of day, or what skills he or she wants to target first. Allow the individual to choose when possible.

Be an active listener. If the individual you're coaching says something confusing like, "Johnny knows the device better than I do," make sure you understand what the person is really trying to tell you. You can ask clarifying questions like, "Could you tell me more about that?" or try paraphrasing, "I think what you're saying is that you need some time to learn where words are on the device. Is that right?"

Demonstrate the targeted strategy during a naturally occurring activity. Conducting a short "model lesson" is part of the coaching cycle. If you want to teach a parent to provide partner-augmented input (i.e., aided language input) during mealtime, first let them watch you model (for a brief period) at lunch. Then let them try the strategy while you to watch them.

Give precise and informative feedback. We use language from the SMoRRES mnemonic to provide communication partners feedback on PAI. This way we're all using the same vocabulary and we can be precise with our feedback. For example, "I noticed that when Suzie pointed to the water fountain, you honored her request and modeled 'want drink.' Good use of respect and reflect." Evaluative feedback like, "good job," or "awesome" isn't as helpful.

Encourage reflection. Ask questions like, "How do you think that went?" or "What do you think we need to work on next time?" to support communication partners in thinking about their own performance. If you have an idea, approach it collaboratively. For example, "What do you think would happen if you expanded (i.e., added a word or two) when Sophia says a single word on her device?"

Link the child's positive response to the partner's behavior. Often partners may be so focused on what they're supposed to do with the device that they might not notice the effects of their strategy use on the child. When you observe the child communicating as a result of something the partner has done, point it out to the partner. For example, "Wow, when you handed Joshua the unopened juice box and provided an expectant pause, he asked you for help!"
Coaching Resources:

Jim Knight and his colleagues at the Instructional Coaching group have a number of free coaching videos, presentations worksheets designed for school teams. (Check out their resources here.)

Edutopia has numerous articles and videos to help with instructional coaching in schools. (Click here to visit their site.)

The Hanen Centre has numerous resources on collaborating with parents. (Take a look at their resources here.)

Remember, the next time you're planning a training, make sure to get out there and do some coaching!

Learn more from Jill and Matt here.
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Jill E Senner, PhD, CCC-SLP is a speech-language pathologist with over 20 years of experience working with children with complex communication needs. She is the owner/director of Technology and Language Center where she specializes in providing augmentative and alternative communication (AAC) and assistive technology (AT) services including assessment, consultation and training, and workshops/lectures. Dr. Senner has presented at numerous national assistive technology conferences and has taught graduate courses in AAC and swallowing disorders. She has published research in the areas of AAC, siblings and disability, and swallowing disorders in cerebral palsy.

Matthew R Baud, MS, CCC-SLP, has been working with AAC for over 15 years. He currently is the Assistive Technology Coordinator at Niles Township District for Special Education (NTDSE) performing evaluations, trainings and coaching communication partners. Matthew also has his own AAC private practice working with individuals with complex communication needs from birth through adulthood. He is an adjunct professor at Saint Xavier University where he teaches a graduate course in AAC and has presented at national and state conferences. Matthew has published research in the areas of AAC.

This post was written by Carole Zangari

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How We Do It: Coaching AAC Use in the Natural Environment

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If it's May, it must be Better Hearing and Speech Month (#BSHM), and we're thrilled to kick off the festivities by two Illinois-based SLPs, Dr. Jill Senner and Matt Baud. They have a wealth of AAC experience and have generously shared their expertise here in several previous posts.

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The article below discusses two types of parent coaching via tele-intervention- synchronous and asynchronous.

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If I had a crystal ball, I wouldn't be at all surprised if it told us that telepractice in AAC is here to stay. My guess is that when schools and clinics re-open there will still be a role for remote AAC services. That's why I am so pleased that guest authors Jill Senner and Matthew Baud are returning to these pages to share their approach to using tele-AAC to educate and coach parents.
Tele-AAC for All
With social distancing, local shelter in place orders, and general concerns about the health of our high-risk clients who use AAC, most of us have made an abrupt transition to providing AAC therapy via telehealth. Doing direct therapy using video conferencing platforms might be going swimmingly for some clients who will sit and attentively gaze at the books, games, and other materials you present remotely. However, what about your younger clients? Or kiddos who need lots of movement? Or kiddos who have screen fatigue after a full day of e-learning? You can't very well bounce on a ball, swing, cook a snack, or jump on a trampoline remotely... or can you?

It all boils down to reframing your approach to intervention. We have evidence that when parents are educated in strategies to support AAC, such as partner-augmented input (PAI), AAC modeling increases, parents and children become more comfortable with their devices, parents report an increase in AAC use at home, and children use more words on their devices. In essence, parent education IS the intervention... and coaching is the key to parent education.

However, before we jump right into coaching during a session, parents need to understand what strategy you want them to use, why you want them to use it, and how to use it. Successful parent education programs include multiple training elements such as those found in Kent-Walsh & McNaughton's (2005) instructional model. All of these elements can easily be provided via telehealth - either in asynchronous (i.e., recorded) or synchronous (i.e., live) formats. Some families benefit from a hybrid approach incorporating both asynchronous and synchronous training components.

We use a variety of asynchronous training materials to teach families to model AAC. To provide a description of the strategy, we use a PAI handout and a video describing what PAI is, why it's important to use, and how to provide it. We also have shorter videos highlighting the SMoRRES (slow rate, model, respect and reflect, repeat, expand, stop) mnemonic.

Strategy Demonstration can be done by showing videotaped models of parents providing PAI at home (or using simulated models like this one of tickles). Sources for videos of parents modeling at home include:

Next, we provide controlled practice opportunities. For example, providing the parent with a list of words, phrases, or sentences to practice on the speech generating device. They can also participate in a videotaped controlled practice exercise. Interactive platforms like Seesaw, Google Classroom, or Microsoft Teams can be used to organize the materials you're assigning.

However, simply reading handouts and watching videos is typically insufficient to change parent modeling behavior in the home. In the educational model we use, coaching the parent to use PAI with his or her child makes up the majority of instruction and is critical for generalization.

Live coaching can be provided via a videoconferencing platform, with the therapist watching the parent interact with the child engaged in an activity together such as playing on the swing, folding laundry, cooking, or jumping on a trampoline. When coaching the parent, be sure to actively listen, provide precise and informative feedback, and encourage reflection. Additional information on coaching can be found in our May 2019 post, " Coaching AAC Use in the Natural Environment." Remember that modeling PAI for the parent during live videoconferencing is part of the coaching cycle. If you're not sure how to do this with the technology you have, check out our tips and tricks video.

If coaching cannot be done live, fear not, it can also be conducted in an asynchronous manner. The parent can videotape a short interaction with his or her child and then upload clips to a secure file-sharing platform. Optimally, the parent would watch the video as would the therapist (not at the same time) and then the clinician would coach over the phone or email. However, evidence suggests that sooner is better than later so try to connect about the uploaded video within 24 hours if possible.

It is critical to remember that parents may be trying to work from home, may be working outside of the home, may have other children trying to do e-learning, and may have limited technology in the home that needs to be shared among family members. Furthermore, many families are experiencing a loss of supports for their child with a disability. Before assigning parent instruction, collaborate with families to find out if it's something they want to try and get input as to a realistic amount of time they can commit to learning. One benefit of asynchronous telehealth is that it allows parents to watch and read materials at their own convenience and at their own pace, which can make a world of difference to families in these uncertain times.

Jill E. Senner, PhD, CCC-SLP is a speech-language pathologist with over 20 years of experience working with children with complex communication needs. She is the owner/director of Technology and Language Center where she specializes in providing augmentative and alternative communication (AAC) and assistive technology (AT) services including assessment, consultation and training, and workshops/lectures. Dr. Senner has presented at numerous national assistive technology conferences and has taught graduate courses in AAC and swallowing disorders. She has published research in the areas of AAC, siblings and disability, and swallowing disorders in cerebral palsy.

Matthew R. Baud, MS, CCC-SLP, has been working with AAC for over 15 years. He currently is the Assistive Technology Coordinator at Niles Township District for Special Education (NTDSE) performing evaluations, trainings and coaching communication partners. Matthew also has his own AAC private practice working with individuals with complex communication needs from birth through adulthood. He is an adjunct professor at Saint Xavier University where he teaches a graduate course in AAC and has presented at national and state conferences. Matthew has published research in the area of AAC.

You can learn more from Jill and Matt here.

This post was written by Carole Zangari

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If I had a crystal ball, I wouldn't be at all surprised if it told us that telepractice in AAC is here to stay. My guess is that when schools and clinics re-open there will still be a role fo...

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The video below discusses the different types of Assistive Technology.

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Tips on how to utilize partner-augmented input or aided language stimulation or listed on this document. It's a great resource to share with families when beginning to work on modeling with AAC.

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The Family Fun YouTube page has a lot of great AAC modeling videos, including book modeling with AAC.

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The AAC Modeling at Home page has several different videos on how to model AAC at home including in the kitchen, pantry, bathroom, bedroom, backyard, and more!

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If you're looking for ideas for how to support AAC learning at home, today's post will be a real treat. AAC SLP, Jeanna Antrim, co-author of our TELL ME About It series, created a set of short instructional videos with prAACtical ideas for modeling AAC at home.

Bedroom & Closet

Backyard Bubbles

Backyard Garden

In the Sandbox

Board Games: Sequence for Kids

Board Games: Pop the Pig

If you like these wonderful suggestions, check out more from Jeanna:

Filed under: Video of the Week

This post was written by Carole Zangari

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If you're looking for ideas for how to support AAC learning at home, today's post will be a real treat. AAC SLP, Jeanna Antrim, co-author of our TELL ME About It series, created a set of short instructional videos with prAACtical ideas for modeling AAC at home.

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The Lotsacomptons YouTube page has a variety of videos showcasing how the family models use of a high-tech AAC device to their son. They showcase aided language stimulation during different activities such as baking cookies and reading books.

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Excerpts from everyday life in an average family of 15. Join us for new videos each week about faith, family, homeschooling, special needs, AAC, adoption and...

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This YouTube page is another family run page that showcases how they use AAC with their daughter.

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Combining Technology Access, Communication, and Real life Learning--on YouTube!

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The Possibilities of Assistive Technology

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The Possibilities of Assistive Technology

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This handout discusses what types of assistive technology is available, as well as assistive technology in the school setting.

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I love this video for giving parents an idea of types of low-tech AAC that they can create with household items.

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This handout outlines the amount of time a child would need to learn language if they were only given language models during speech therapy services. The math is a powerful reinforcer to share with parents to build consensus on utilizing a coaching model.

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Core Word of the Week from the Center for AAC and Autism outlines how we can model core vocabulary words throughout daily play activities and routines.

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Assessment of Family Activities and Routines

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Assessment of Family Activities and Routines

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The Assessment of Family Activities and Routines is a great informal assessment/conversation starter to review with new families. It is helpful in gaining more information on the child's activities and routines in the home environment.

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Cara Kit Assessment of Caregiver Activities and Routines

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The connecting with families handout gives tips on how to stay focused and responsive during parent coaching sessions. The resource also touches on tips for conversations including active listening strategies.

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This video is a part of a video series by Rachel Madel, who gives tips to SLPs for parent coaching. In this video, she discusses how to systematically determine vocabulary targets with a student's family.

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This video is a part of a video series by Rachel Madel, who gives tips to SLPs for parent coaching.  In this video, she discusses using the strategy of wait time during sessions to encourage use of independent language.

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Attaching Language to Avoidance Behaviors

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Attaching Language to Avoidance Behaviors

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This video is a part of a video series by Rachel Madel, who gives tips to SLPs for parent coaching.  In this video, she discusses modeling language during avoidance behaviors.

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Attaching Langauge to Avoidance Behaviors

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Prioritizing Spontaneous Speech over Prompted Speech

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Prioritizing Spontaneous Speech over Prompted Speech

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This video is a part of a video series by Rachel Madel, who gives tips to SLPs for parent coaching.  In this video, she discusses how to prioritize independent communication productions and decrease prompting.

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Prioritizing Spontaneous Language over Prompt Dependent Communication

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This video is a part of a video series by Rachel Madel, who gives tips to SLPs for parent coaching.  In this video, she discusses how to start using a low-tech core board with your child.

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Parent Coaching: Integrating a Communication Board

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This Super Duper handout is a parent friendly printable that describes Assistive Technology devices and services.

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The Prompting Hierarchy is essential in reviewing with families before utilizing AAC in the home environment. We want to stress to our families that we do not want our students to become prompt dependent.

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Tips for active listening during coaching sessions

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Tips for active listening during coaching sessions

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The active listening handout is a wonderful resource that provides strategies to ensure that therapists are engaging in active listening throughout their parent coaching sessions.