THE DISABILITY
EXPERIENCE
CONFERENCE
Training Parents and Staff to Use a
Social-Communication Intervention
with Children with Autism:
A Focus on Treatment Fidelity
Johanna Taylor, M.Ed., BCBA
Alicia Mrachko, M.Ed., BCBA
School of Education, Early Intervention
PRESENTATION FOCUS
1) To present a systematic literature review of fidelity
within parent-implemented intervention studies for
children with autism.
2) To present a practicum opportunity for Masters
level students in the University of Pittsburgh Early
Intervention Program focused on teaching parents
to implement an intervention with their toddlers
with autism with high levels of fidelity.
TREATMENT FIDELITY
• The degree to which procedures are delivered as
designed, has been identified as an integral
component of intervention programs.
• High levels of treatment fidelity are key to
establishing a functional relationship between
independent and dependent variables and have
been associated with better outcomes, specifically
in parent and staff training programs.
(Bellg, et al. 2004; Sanetti & Kratochwill, 2009; Wolery, 2011)
FIDELITY WITHIN PARENT-IMPLEMENTED
INTERVENTIONS
Continued Intervention
Fidelity
Implementation
Fidelity
Intervention
Fidelity
Degree to which trainer provides
strategies to parents
Degree to which parent delivers
strategies to child
Degree to which parent provides
intervention to child over time and in
various settings
Intervention Strategies
Intervention Strategies
Intervention procedures
parent uses to teach child
Intervention procedures
parent uses to teach child
Improved child
outcomes
Generalization and
improvement in child
outcomes over time
Implementation Strategies
Training delivery methods
and characteristics
Improved parent
outcomes
LITERATURE REVIEW:
PARENT-IMPLEMENTED INTERVENTIONS
• Included peer-reviewed studies published between
January 2000 and August 2012 diagnosed with autism
spectrum disorder (ASD) under seven.
• The search resulted in a total of 20 articles.
• Aimed to identify: 1) the frequency of learning methods
used in training, 2) fidelity measurement procedures,
and 3) the extent of reporting on trainer and parent
adherence to content.
LITERATURE REVIEW RESULTS
• 15 studies reported treatment fidelity:
• 2 of the 15 studies reported implementation fidelity.
• 14 of the 15 studies reported intervention fidelity.
• 6 studies reported high fidelity criteria as 80% or above
for parents.
• Six studies measured fidelity in 100% of sessions.
• The majority of studies used a video-based coding
system to rate fidelity.
• 2 studies provided examples of the fidelity rating scale.
REVIEW RECOMMENDATIONS
Examine the relationship between adult learning methods and
child outcomes.
Dependent variables in parent training studies need to
measure the rate of behavior change in parents.
Examine the relationships between the three fidelity levels and
parent/child outcomes.
Bridge the gap between research and practice
FIRST STEPS: PITT EARLY INTERVENTION
Parent Toddler Practicum
1. Bridge research to practice
2. Train students with model of implementation fidelity,
intervention fidelity and child outcomes
3. Fidelity is monitored.
4. Not controlled for a research study
PITT PARENT-TODDLER PRACTICUM (PPTP)
FALL 2013
• Students are trained in Teaching Social Communication to
Children with Autism (Ingersoll & Dvortcsak, 2010) in a
seminar class weekly
• Targets:
• Social Engagement
• Communication
• Imitation
• Play skills
PPTP – FALL 2013
• Students meet weekly with parent/child (2 students per
family) and teach parents to implement the strategies.
• 2 hour session includes:
• didactic training,
• written materials with homework,
• modeling and
• rehearsal with feedback
PPTP AND FIDELITY
Implementation Fidelity: Supervisor rates student training
parent
Intervention Fidelity:
Supervisor rates student - feedback
Student self-rates intervention with child
Student rates parent – does not share form with parent, but
uses to guide feedback in session
Data collection on goals for child
PPTP – IMPLEMENTATION FIDELITY
PPTP FIDELITY – STUDENT INTERVENTION
PPTP FIDELITY – PARENT INTERVENTION
FUTURE DIRECTIONS
Use PPTP to examine fidelity and child outcomes in research.
Implementation
Fidelity
Intervention
Fidelity
Child outcome
REFERENCES
Bellg, A.J., Resnick, B., Minicucci, D.S., Ogedegbe, G., Ernst, D., Borrelli, B., et al. (2004).
Enhancing treatment fidelity in health behavior change studies: Best practices and
recommendations from the NIH Behavior Change Consortium. Health Psychology, 23(5),
443-451. doi: 10.1037/0278-6133.23.5.443.
Ingersoll, B. & Dvortcsak, A. (2010). Teaching Social Communication to Children with Autism.
The Guilford Press: New York, NY.
Sanetti, L.M.H. & Kratochwill, T.R. (2009). Toward developing a science of treatment integrity:
Introduction to the special series. School Psychology Review, 38(4), 445-459.
Wolery, M. (2011). Intervention research: The importance of fidelity measurement. Topics in
Early Childhood Special Education, 31(3), 155-157. doi: 10.1177/0271121411408621.
THANK YOU!
Johanna Taylor, MEd., BCBA,
Alicia Mrachko, MEd., BCBA
Graduate Student Researchers
Department of Instruction & Learning
WW Posvar Hall 5156
412-648-1317
Jpt24@pitt.edu
aam67@pitt.edu