2012 American Community Survey (Kids Count Data Center)                                                         

Presentation Outline

1. Research supporting parent involvement1. What have parents and researchers reported in

successful interactions?2. How to apply the research to the field

1. 8 ways to improve therapeutic outcome3. Case study

1. Looking at an example of how to make therapy more successful by increasing parent and teacher involvement

Background

• Development:▫ Bilingual SLPs ▫ Home-based ECI Services▫ Need for family involvement When families are involved in the intervention

process, language enrichment is ongoing rather than during “therapy” only (Rosetti, 2001)

Without family involvement, intervention is unlikely to be successful (Bronfenbrebrenner, 1974)

Learner Objectives

Participants will list, identify, describe…

1. the importance of family involvement2. factors affecting parent involvement3. theoretical models of social systems4. strategies to increase family involvement in

intervention

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1. Importance of Family Involvement

Researcha. Language enrichmentb. Empowermentc. Self-Efficacyd. Why family participation is critical

a. Language Enrichment

• Parents use of language-based strategies leads to ▫ Increased receptive language skills in the first year

(Baumwell, Tamis-LeMonda & Bornstein, 1997) ▫ Increased receptive and expressive language skills in

the second and third years of life (Olson, Bates & Bayles, 1986)

▫ Greater receptive vocabulary at 12 years of age (Beckwith & Cohen, 1989)

a. Language Enrichment (cont’d)

• Mother’s use of labeling and increased periods of interaction lead to increases in receptive vocabulary and greater expansion of expression in older children (Tomasello & Farrar, 1986)

• Participation by fathers in early childhood programs has been shown to be beneficial to the child, father and other family members (Frey, Fewell, & Vadasy, 1989; Krauss, 1993)

b. Empowerment

• Empowering parents increases their likelihood of accessing information pertaining to their child’s development

c. Self-efficacy

• Empowerment leads to self efficacy or the belief that they can make a difference in their child’sdevelopment (Dempsey & Dunst, 2004)

d. Why participation is critical

• When families are involved in the intervention process, language enrichment is ongoing rather than during “therapy” only (Rosetti, 2001)

• Without family involvement, intervention is unlikely to be successful (Bronfenbrebrenner, 1974)

Models of Service Delivery: Find a balance

Consultative Model

Child Focused Model

Not on the same pageDifferent Perspectives

Teacher and Family Perspective

The therapist just plays with

my child.

They just sit and talk with

me and do nothing with

my child.This is all too overwhelming.

I forget what to do after the

therapist leaves.

I don’t have time in my day

to do this.

Speech Pathologist Perspective

Families don’t always follow through with

my suggestions.

I can’t get families to

incorporate ideas into daily

routines.

I don’t have easily accessible

resources to share with families.

Many times families don’t

keep appointments.

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2. Understanding families

• Demographics • Theoretical models of social systems• Factors affecting family involvement

Demographics – using Texas as a case study

Demographics – using Texas as a case study

Video Review

Demographics of Families Enrolled in ECI in TexasResearch

a. Economicsb. Ethnicityc. Language

d. Gendere. Reason Eligiblef. Services on IFSP

a. Economics

• Percentage of ECI children receiving Medicaid▫ 2006: 61%▫ 2008: 60.3%

• Families at 250% of the poverty level or lower▫ Approximately 84%

b. Ethnicity

Race/Ethnicity PercentHispanic/Latino 47White 38Black/African American 12Asian/Pacific Islander 2American Indian/Alaskan <1

c. Language

Primary Language PercentEnglish 81Spanish 19Other <1

d. Gender

Gender PercentMales 63

Females 37

e. Reason EligibleReason Eligible Percent Medical Diagnosis 11 Chromosomal Anomalies 35 Congenital Anomalies--Brain/Spinal Cord 16 Symptoms and Ill-Defined Conditions 14 Disorders of the Nervous System 12 Congenital Anomalies--Facial Clefts 9 Conditions Originating in Perinatal Period 7 Congenital Anomalies--Musculoskeletal 7 Developmental Delay 71 Atypical Development 18 Areas of Delay/Atypical Development Speech/Communication 67 Physical/Motor 43 Cognitive 26 Adaptive/Self-Help 21 Social/Emotional 16 Vision 2 Hearing 2 Children with more than one qualifying diagnosis 22 Children with more than one area of delay 37

f. Services on IFSP

Percent of Children with Planned Service Types Percent Service Coordination 100 Developmental Services 78 Speech Language Therapy 58 Occupational Therapy 32 Physical Therapy 25 Nutrition 12 Family Training/Counseling 5 Vision 3 Audiology 3 Psychological/Social Work 3 Medical/Nursing 1

Theoretical Models on Social Systems

Research

a. Maslow’s Hierarchy of basic needsb. Kubler-Ross’ 5 stages of grief

a. Maslow’s Hierarchy of basic needs

b. Kubler-Ross’ Five Stages of Grief

• Denial (this isn't happening to me!)• Anger (why is this happening to me?)• Bargaining (I promise I'll be a better person

if...)• Depression (I don't care anymore)• Acceptance (I’m ready for whatever comes)

Research Findings Pertaining to Family Factors

• Mothers with limited family support tend to withdraw from programs early (Luker & Chalmers, 1990)

• Mothers engaged in family conflict show lower rates of involvement (Herzog, Cherniss, & Menzel, 1986)

• Mothers engaged in substance abuse showed lower rates of involvement (Navaie-Waliser et al, 2000)

• Mothers who are anticipating a change in residence also showed lower rates of participation (National Committee to Prevent Child Abuse, 1996)

Factors Affecting Family Involvement• Family Factors▫ over which we have minimal influence but need to

understand▫ over which we have more influence

• Minimal influence▫ Social-emotional needs▫ Economic needs▫ Cultural parameters

• More influence▫ Education about disability▫ Attendance▫ Engagement in the intervention process

Provider Factors Affecting Parent Involvement

▫ Consistency and reliability▫ Quantity (amount of

services)▫ Recognizing your

assumptions▫ Understanding family

needs ▫ Engaging all family

members▫ Ability to adjust strategies

to match family style

▫ Communicating rationale for intervention techniques

▫ Clearly specifying what families should do between intervention sessions

▫ Setting expectations ▫ Staff communication▫ Staff education and

training▫ Staff turnover rates

Research Findings Pertaining to Provider Factors

• The more services a child/family receives, the more progress the child makes

• High staff turnover rates reduce family involvement ▫ Gomby (2007)

• Quantity--There were some interesting studies that showed that white families received more services than others. Hispanics were rated as more engaged. African Americans received less child-focused activities.▫ Wagner (2003)

Case Study #1: Understanding Kubler-Ross’ stages of grief

How would you work with a family that is in denial?ExampleInterventionist: Lets work on the word “more”.Parent: She says that.Interventionist: Great, how about the words, mom or

dad?Parent: She says that too.Interventionist: She only says twenty words and she is

two years oldParent: We understand what she wants

Case Study #2:A client has been diagnosed with a receptive

and expressive language disorder. How would you explain the rationale behind these suggestions and strategies?

• Roll a ball back and forth with your child.• Add a word to what your child says and

repeat the words back together.• Give your child more time to form a response.

Routine‐Based Early Intervention Guidebook

A Proven Program for Improving Communication Skills with Activities in English and Spanish

Click here to view on Amazon.com

3. Connecting Therapy to Reality

Applying research to our family sessions

How do we improve outcomes?

We know it’s important, how do we do it?

1. Provide specific instructions 2. Provide a rationale3. Keep it simple and

consistent4. Have it pertain to a family

event or routine5. Set expectations6. Have something written7. In their native language8. Follow through

• Make sure caregivers understand:▫ WHAT?▫ HOW? ▫ WHY?

• Assess the caregivers • Give positive reinforcement• Take risks

Daily Routines

Daily Routines

• 12 daily routines • Frequency and consistency • More natural • Extra time is not needed to implement strategies• Use objects in their environment as therapy

materials

Daily Routines in the Schools

• 36 yearly units▫ Colors▫ Cowboys▫ Zoo▫ Etc.

• Once per week

Daily Routines

• Each routine includes:• Speech/language focus• Examples of each strategy• Suggested target vocabulary and 6 pictures of signs• Homework sheet • Activity sheet

• The amount of time spent on each routine varies

Strategies:

Speech

Language

Language Development

Language Development

• Improved communication and bonding (Goodwyn, Acredolo, & Brown, 2000; Tompson et al., 2007)

• Children stop using sign when able to communicate orally (Pizer, Walters & Meier, 2007)

• Provide visual support during language learning

Language Development

• Frequency and consistency • The more a child hears a phrase the more likely

they are to use it• Use phrases that the child is able to imitate

Language Development

• Imitation is vital for speech and language development (Rogers & Williams, 2006)

• Teach the child how to imitate, by imitating their sounds and movements

Language Development

• Each routine focuses on different vocabulary• Multisensory learning for language targets• Label objects, actions and descriptors• Repeat object labels – the more a child hears a

word, the more likely they are to use it

Language Development

• Expand the child's utterances by adding semantic information or syntactic complexity can help their language grow.

• It is important to keep phrases simple enough that your child can repeat them.

Language Development

Speech Development

• Visual, tactile and motor cues

• Examples:

▫ Clap out syllables in words

▫ Put hand in front of mouth to feel air on plosives

Speech Development

• Auditory cues▫ Emphasize specific sounds in words▫ Melodic cues

• Model appropriate speech production▫ Break consonant clusters apart▫ Model target words slowly with emphasis

Speech Development

• Imitate sounds in the environment• Repeat an incorrect production correctly,

repeating the correct production several times

Speech Development

• Have a scavenger hunt• Label objects that begin with the same sound to

increase phonological awareness

Speech Development

• Follow the hierarchy of speech production • Help parents measure small successes

Speech Development

Example by Brianne Ruhnke on www.speakingofspeech.com

Speech Development

A case study of practical application

Script for sample session1. Review the plan and any progress

2. Select the strategy and daily routine

3. Model the strategy

4. Give the family time to practice the strategy

SMILE Example

SMILE Example

Video Review

What strategies could you observe?

A. Sign

B. Model

C. Imitate

D. Label

E. Expand

F. All of the above

What strategies could you observe?

A. Sign

B. Model

C. Imitate

D. Label

E. Expand

F. All of the above

What was the language focus, or targeted skill?

A. Turn-taking

B. Requests

C. Two-word Utterances

D. Describing

E. Contrasting – Yes/No Questions

What was the language focus, or targeted skill?

A. Turn-taking

B. Requests

C. Two-word Utterances

D. Describing

E. Contrasting – Yes/No Questions

What daily routine was being used?

A. Bath time

B. Greetings

C. Bedtime

D. Getting Dressed

E. Story time

What daily routine was being used?

A. Bath time

B. Greetings

C. Bedtime

D. Getting Dressed

E. Story time

Sample session

Important Words

Practiquen estas palabras importantes y agreguen más:

Important Words

Practiquen estas palabras importantes y agreguen más:

Data Collection Sheet

Data Collection

• What words or gestures does your child use?▫ Greetings/Saludos: Cuando saluda mueve la mano. Translation: To give a greeting, he waves his hand.

▫ Getting Dressed/Vestirse: Todavía no puede vestirse él solo. Le tengo que

ayudar. He still doesn’t get dressed on his own. I have to help

him.

Data Collection

• What words or gestures does your child understand?▫ Greetings/Saludos: Sí entiende pero no puede pronunciarlas. Translation: He does understand, but he can’t

pronounce them.

▫ Getting Dressed/Vestirse: No response

Homework at home

Homework in the schools

Homework

Homework

Homework

Homework

Activity page

Session Record Form

In SummaryTherapeutic improvements can be realized by increasing parent and teacher involvement:

1. Provide specific instructions 2. Provide a rationale3. Keep it simple and consistent4. Have it pertain to a family event or routine5. Set expectations6. Have something written7. In their native language8. Follow through

References• Goodwyn, Acredolo, & Brown (2000). Impact of symbolic gesturing on early language

development. Journal of Nonverbal Behavior, 24, 81-103.

• Kummerer, B., Lopez-Reyna, N.A., & Hughes, M.T. (2007). Mexican Immigrant Mothers’ Perceptions of Their Children’s Communication Disabilities, Emergent Literacy Development, and Speech-Language Therapy Program. American Journal of Speech-Language Pathology, 16, 271-282.

• McWilliams, R. (2007). Early Intervention in Natural Environments. Retrieved February 5, 2008 from http://naturalenvironments.blogspot.com/2007/10/toy-bags.html

• Pizer, G., Walters, K., & Meier, R. P. (2007). Bringing up baby with baby signs: Language ideologies and socialization in hearing families. Sign Language Studies, 7 (4), 387-430.

• Rogers, S. J., & Williams, J. H. G. (Eds.). (2006). Imitation and the Social Mind: Autism and Typical Development. New York: The Guliford Press.

• Rogoff, B. (1990). Apprenticeship in Thinking. Oxford: Oxford University Press.

• Thompson, R.H., Cotnoir-Bichelman, N.M., McKerchar, P.M., Tate, T.L., & Dancho, K.A. (2007). Enhancing early communication through infant sign training. Journal of Applied Behavior Analysis, 40, 15-23.

• Vygotsky, L. S. (1967). Play and its role in the mental development of the child. Soviet Psychology, 5, 6-18.

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