Parent-Implemented Intervention
Overview
Children with ASD require intensive intervention to develop skills in development such
as communication, social interaction, joint attention, as well as a wide range of other
social skills (Koegel, Bimbela, & Schreibman, 1996). They often present with behaviors
that cause disruption to ongoing family practices and routines. While parents describe
many benefits of living with and raising a child with ASD, parents of children with ASD
report greater amounts of stress and depression than do parents of children who are
typically developing or who have other developmental disorders (Hastings & Johnson,
2001; Lee, Harrington, & Louie, 2008). Parents of children with ASD often help their
children with ASD acquire skills while simultaneously coping with a range of stressors
(Gray, 2002).
Given the complexity of ASD and the challenges parents face, it is often beneficial and
even necessary for them to implement intervention strategies in the home or
community. Direct parent involvement has become widely accepted as part of a total
autism intervention program (Iovannone, Dunlap, Huber, & Kincaid, 2003; Levy, Kim, &
Olive, 2006; National Research Council, 2001). Research has demonstrated that when
parents serve as active participants in their child's treatment, positive results are
obtained (e.g. Aldred, Green, & Adams, 2004; McConachie, Randle, Hammal, & Le
Couteur, 2005; Symon, 2005).
Parent-implemented intervention:
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facilitates earlier initiation of intervention;
provides continual opportunities for learning in a range of situations;
aids in generalization of skills
promotes consistent management of behaviors.
Additionally, positive effects can extend beyond child behaviors and impact parents and
families through increased parent confidence, reduced stress, and improved family
functioning (Aldred, Green, & Adams, 2004; Koegel, Bimbela, & Schreibman, 1996;
Koegel, Symon, & Koegel, 2002).
With parent-implemented intervention, parents are taught to use individualized
intervention practices with their child to help them acquire/increase skills and/or
decrease interfering behaviors associated with ASD. Goals are individualized to
address the specific needs of the child and the concerns and strengths of families.
Putting parent-implemented intervention into action involves a multi-step process that
includes determining the needs of the family, outlining goals, developing an intervention
plan, and training parents to apply the intervention. Parent-implemented intervention
includes collaboration between family members and practitioners to carry out all parts of
the process.
This module will define each step of the process for parent-implemented intervention,
discuss specific procedures and practices within each step, and provide examples that
can be used as models for parents and practitioners as they work with individuals with
ASD.
What is Parent-Implemented
Intervention?
In parent-implemented intervention, parents use intervention practices with their child to
teach positive skills and/or reduce interfering behaviors in the home or community.
Parents collaborate with practitioners to develop goals and a corresponding intervention
plan. Parents learn how to implement the intervention through a structured training
program.
A number of outcomes can result from parent-implemented intervention. While the focus
will probably be on improving child behaviors, focus can include improving the function
of the family as a whole. With parent-implemented intervention, additional goals may be
created for the parents and/or other family members. Such goals may improve the
quality of family relationships and interactions and increase the ability for family
members to adapt to spontaneous situations.
For the child with ASD, parent-implemented intervention can be used to increase
communication skills and reduce problem behavior. In the area of communication,
parent-implemented intervention has been used to increase social communication skills,
initiations, conversation skills, spontaneous language, use of augmentative and
alternative communication, joint attention, language during play, and functional
communication. In the area of behavior, parent-implemented intervention has been
used to reduce aggression and disruptive behaviors.
Parent-implemented intervention is a system that consists of six essential steps:
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determine the needs of the family;
outline goals;
develop the intervention plan;
train parents;
implement the intervention; and
monitor progress.
Each step contains specific practices and procedures designed to successfully guide
parents and practitioners.
Parent-implemented intervention is an ongoing and complicated process. Goals and
intervention practices will need to be adjusted over time to fit the changing needs of the
child, parents, and family. Once parents have completed the steps of the process and
have successfully implemented intervention practices with their child, other behaviors
can be targeted and interventions taught. In later applications, the parent-implemented
intervention process may be modified incorporating only those steps that are needed.
Parent-Implemented Intervention Across
the Lifespan
Parent-implemented intervention meets evidence-based practice criteria for children
with ASD in preschool and elementary school. It has been shown to be effective for
children as young as two and as old as nine years of age.
Parent-implemented intervention can be used in the home or community to teach a
number of skills and to reduce interfering behaviors. Once parents learn the practices
and procedures for implementing intervention, any skill in any can be targeted.
Therefore, once parents learn to effectively implement intervention with their child with
ASD, they can continue to use this practice throughout their child's development.
Goals of Parent-Implemented
Intervention
The literature on parent-implemented intervention for children with ASD has steadily
grown in recent years. Currently, there is convincing support for parent-implemented
intervention designed to (a) increase communication and (b) reduce interfering
behavior.
Examples of communication skills that were the focus of interventions in the
evidence-based studies include:
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increasing social communication skills (Aldred, Green, & Adams, 2004;
McConachie, Randle, Hammal, & Le Couteur, 2005; Symon, 2005);
initiating communication (Aldred, Green, & Adams, 2004; Koegel, Symon, &
Koegel, 2002);
increasing conversation skills (McConachie, Randle, Hammal, & Le Couteur,
2005);
increasing spontaneous language (Charlop-Christy & Carpenter, 2000; Symon,
2005);
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increasing joint attention (Rocha, Schreibman, & Stahmer, 2007);
increasing language in play (Gillett & LeBlanc, 2007; and
promoting the use of functional communication (Moes & Frea, 2002).
Examples of behavioral skills that were the focus of interventions in the evidencebased studies include:
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improving compliance (Ducharme & Drain, 2004);
increasing on-task behavior (Ducharme & Drain, 2004; Ozonoff & Cathcart,
1998);
reducing aggression (Moes & Frea, 2002);
increasing eating (Gentry & Luiselli, 2008); and
reducing disruptive behaviors (Moes & Frea, 2002).
Parent-implemented intervention has been used to improve the adaptive
functioning of parents and improve the quality of family relationships and
interactions. Examples of parental or family skills that were the focus of
interventions in the evidence-based studies include:
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increasing positive affect in parents (Koegel, Symon, & Koegel, 2002); and
increasing parent-child interactions (Aldred, Green, & Adams, 2004).
Who Can Implement ParentImplemented Intervention?
Parent-implemented intervention can be used by parents of children with ASD who have
been trained by teachers and other practitioners to use particular intervention strategies
in the home and community. Although parent-implemented intervention effectively
promotes positive outcomes for children and youth with ASD, it can be extremely
challenging due to the amount of training and academic preparation needed by
professionals to ensure that parents use the interventions correctly.
At a minimum, professionals who train parents should:
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be able to effectively implement any intervention strategy with the learner with ASD
that they ask a parent to do;
demonstrate effective behavior management and joint attention skills with the
learner with ASD;
be able to accurately describe the procedures and the reasons for the intervention
to the parent, adapting as needed and answering questions;
have strategies for building rapport and mutual respect with parents; and
be able to problem solve with parents when they or their child is having difficulty.
Who Can Benefit Most From ParentImplemented Intervention?
Parent-implemented intervention can be used by parents of children with ASD in the
home or community. A number of results can arise from parent-implemented
intervention, with improved child outcomes being the ultimate goal. In addition, parentimplemented intervention can provide benefits to the parents and/or family members by
increasing parental confidence, reducing stress, and improving positive parent-child
interactions. Parent-implemented intervention may have an enduring effect on the entire
family.
Parent-implemented intervention also provides benefits to professionals who support
children with ASD. Professionals can collaborate with parents to develop appropriate
goals and intervention plans that promote optimal child development and learning.
Through parent-practitioner collaboration, parent-implemented intervention leads to
more comprehensive and effective treatment because it provides intervention in multiple
environments with multiple opportunities for learning, as well as generalization of skills
(Levy, Kim, & Olive, 2006).
How is Parent-Implemented Intervention
Conducted?
Parent-implemented intervention consists of six essential steps:
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determine the strengths, needs, and priorities of the family;
select goals;
develop the intervention plan;
train parents;
implement the intervention; and
monitor progress.
For parent-implemented intervention to be successful, collaboration between the
practitioner and parents is critical. Practitioners use family-centered planning in each
step of the process. Family-centered planning is based on collaborations between
families and professionals that facilitate the optimal development of the child and
address the concerns and priorities of families. When using family centered practices,
parents are not only involved in the process, but are empowered to make meaningful
decisions.
Step-By-Step Instructions
With parent-implemented intervention, parents implement individualized intervention
practices with their child to increase positive learning opportunities and acquisition of
important skills (Koegel, Symon, & Koegel, 2002). Parents learn how to implement such
practices in their home and/or community through a structured parent training program.
While parent-implemented intervention has been used to address many different areas
of development, the research base most strongly supports parent-implemented
intervention designed to (a) increase communication in children with ASD and (b)
reduce interfering behavior. In the area of communication, parent-implemented
intervention has been used to increase social communication skills, conversation skills,
spontaneous language, use of augmentative and alternative communication, joint
attention, and interactions in play. Regarding behavior, parent-implemented intervention
has been used to improve compliance, increase eating, and to reduce aggression and
disruptive behaviors.
For parent-implemented intervention to be successful, a partnership between
practitioners and parents is critical. For the partnership to be effective, family-centered
planning is essential for all parts of the process, including needs identification, goal
development, intervention plan development, parent training, and intervention delivery
(Brookman-Frazee, 2004). Family-centered practices involve collaboration among
parents, other primary caregivers, and professionals that facilitates the optimal
development and learning of the child and addresses concerns of families. When using
family-centered practices, parents are fully involved in the process, leading to
empowerment to make meaningful decisions.
The step-by-step instructions that follow provide an in-depth description of each step
needed to effectively use parent-implemented intervention.
Step 1: Determine the Strengths, Needs,
and Priorities of the Family
Each child with ASD is unique and each family has its own individual circumstances and
needs. To develop an effective and workable intervention plan, the practitioner must first
gain thorough knowledge of the child with ASD and the qualities, including the unique
cultural context of each family.
Practitioners determine the strengths, needs, and priorities of individual families
through:
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parental and caregiver interviews; and
observations of the child, caregiver-child interactions, and daily routines.
When gathering information, practitioners identify:
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strengths of the child and family;
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concerns, needs, and priorities regarding the child;
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; and
supports and resources within the immediate and extended family and
community that may be available to assist in carrying out interventions.
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When gathering this information, it is important for practitioners to be responsive and
sensitive to the unique cultural context of each family. This responsiveness includes
consideration of ongoing practices, routines, values, and interactions that occur within
the family.
To accurately determine family needs, a family information form may be helpful to guide
identification and prioritization of goals. A copy of the Family Information Form can be
found in the "Forms for Parent-Implemented Intervention" handout.
Step 2. Selecting Goals
Step 2 involves helping parents implement intervention by identifying the desired goal or
goals for intervention. Practitioners, parents, and other team members select the
specific goals that the child will work towards achieving. Goals and objectives on
individualized education programs (IEPs) or individualized family service plans (IFSPs)
should be priorities.
Practitioners, parents, and other team members select goals that:
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address areas of concern and priority for the child, parents, and/or family
members;
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will have a positive impact on family functioning and not cause additional
stress to the parents or family;
can be implemented by parents with consistency; and
are appropriate for parents to implement in home and/or community settings
(Moes & Frea, 2000).
A number of goals can be achieved through parent-implemented intervention. While
most interventions will probably target improvement in behavior, improving function that
includes the parents and family may be considered. Appropriate goal selection has
major implications for not only the design of the intervention plan, but also its success.
It will be essential to document goals and to monitor their implementation. An example
of a goal development form can be found in the "Forms for Parent-Implemented
Intervention" handout. In addition, practitioners must assure that intervention goals are
written in observable and measurable terms and that parents had input into their
selection, understand the goals, and have written copies of the goals.
Practitioners assure that goals:
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are written in observable and measurable terms;
were selected in partnership with parents;
are shared in written format with parents and all team members; and
address generalization and maintenance of skills.
Although short-term goals ensure that immediate concerns and areas of need are
identified for children, parents, and other family members, it also is important to include
strategies that promote generalization and maintenance of target skills. Practitioners
should work with parents to identify routines and activities where target skills can be
addressed. For example, one family might work on requesting during meals (requesting
food, drink), in the bath (requesting more toys, more water), and at bed time (requesting
favorite book or stuffed animal). Additional strategies that can be used to promote
generalization and maintenance are provided throughout this module.
Child Goals
The aim of parent-implemented intervention is to promote child progress and may
include a range of results. Goals for children may be broad focus or may be specific in
nature. For example, one set of parents may work with their child on getting through
daily routines and following directions throughout the day, while another set of parents
may focus specifically on developing a pleasant and efficient bath time routine.
Practitioners, parents, and other team members consider the following when
selecting goals for the child:
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IEP or IFSP goals that are appropriate for parents to implement in home
and/or community settings;
goals that will increase communication/language skills; and
goals that will increase positive behavior and reduce interfering behaviors.
Practitioners, parents, and other team members prioritize goals related to
behaviors that:
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are a safety concern;
cause disruption in the home;
would increase interactions (type, frequency, nature, and reciprocity of
interactions);
would increase access to the community; and
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require instruction in the home and/or other community settings for
generalization.
Practitioners also select goals that will result in the greatest impact on not only the
child's performance, but also on the parents and family. Consideration must be given to
identifying goals that are realistic and that will not lead to additional stress for families.
The following examples illustrate observable and measurable child goals:
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Jake will use a spoon to feed himself pudding, yogurt, and other thick foods for a
minimum of 10 bites during snack time throughout a two-week period.
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Megan will choose between two items that are visually presented to her by pointing
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to the desired item during the two hours she is at home with her mother each
weekday morning on at least three occasions during a one-week period.
Callie will name three things she did at school, using two word phrases, when
asked by her parents on four out of seven opportunities over a two-week period.
Parent Goals
In addition to child goals, it may be helpful to identify goals for parents to achieve. With
parent-implemented intervention, parents should not only assume the role of instructor,
but also the role of learner. Through parent goals, skills can be acquired that will have
an enduring and profound effect on child progress as well as parental mental health.
Practitioners, parents, and other team members consider the following when
determining parent goals:
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parent-child interactions (e.g., shared attention, turn-taking);
parents' knowledge of ASD;
parents' knowledge and skills related to instructional strategies that promote
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development and learning; and
parents' knowledge of behavior management strategies.
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The following example of goals for a parent are both observable and measurable:
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Megan's parents will present two choices a minimum of five times throughout the
day and will honor her choice, during a two-week period.
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Polyte's mom will write out and post the steps for cleaning up his room and will
provide a special reward immediately when Polyte completes the steps during a
two-week period.
When asking Callie a question, her father will first gain her attention by standing in
front of her, tapping on her shoulder, and pointing to his mouth.
Family Goals
The family can be the most powerful and enduring influence on a child with ASD. All
family members and their daily functioning can be impacted by the presence of a child
with ASD. There also may be areas in which immediate and/or extended family
members can provide meaningful and helpful support to children with ASD and their
families. Therefore, it may be helpful to outline goals targeting increased knowledge and
skills for individual family members.
The definition of family members and their roles will be different for each family. For
some families, members may include just parents and siblings; however, for others,
extended family members, friends, or neighbors may play a critical role.
Practitioners, parents, and other team members identify goals for individual
family members who may be involved in implementing the learner's intervention
plan.
The following example goals for family members are both observable and measurable:
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Jake's sister will participate in his motor strengthening exercises three times each
week for one month by modeling the exercises and interacting with Jake.
Megan's babysitter will present two choices for all meals and play activities and will
honor her choice every day for two weeks.
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.
Step 3. Developing the Intervention Plan
Once the goals have been developed, an intervention plan can be created. The plan
provides specific steps that parents can easily implement. The intervention plan
includes:
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the instructional strategy, broken down into step-by-step directions;
the frequency and duration of instruction; and
when and where to provide instruction.
Each intervention plan includes a customized set of rules designed to address individual
child, parent, and family goals. Parent priorities, family characteristics, daily routines,
and home situations guide the intervention and strategies employed (Moes & Frea,
2000). The parents' ability to implement the intervention and intervention costs are
further considerations (Koegel, Koegel, Harrower, & Carter, 1999). By individualizing the
plan, the intervention team can target a specific goal or behavior, incorporate a
combination of evidence-based strategies, tailor a plan to family characteristics, and
focus on the context of intervention implementation.
When developing an intervention plan, practitioners work with family members to plan
for the long-term success of the intervention. It is essential that practitioners take into
account the "goodness of fit" between the intervention plan, the child and family, as well
as the environment(s) where the intervention will be implemented. Practitioners and
parents develop an intervention plan that focuses on:
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providing children with choices (activity and material selection);
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establishing and maintaining satisfying relationships with others at home and in the
community (e.g., social interventions, use of turn-taking, preferred materials);
community participation (i.e., implementing interventions within naturally occurring
routines and activities); and
developing personal independence and competence (Cosden et al., 2006).
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Developing intervention plans that provide a good fit between the child/family,
intervention strategies, and contexts where the intervention will be implemented
supports the long-term use of intervention strategies as well as learning, development,
and generalization of skills. Activities then are planned to support parents' use of the
intervention plan during daily routines and activities.
Practitioners and family members plan activities that:
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increase child motivation;
use direct, natural reinforcers;
vary tasks and materials;
reinforce communication attempts;
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use incidental teaching;
use multiple examples of the target skill; and
use naturalistic teaching strategies (Koegel, O'Dell, & Koegel, 1987).
When teaching parents how to implement interventions at home and in the community,
practitioners can help parents focus on:
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turn-taking during daily routines/activities;
using objects and activities that are familiar to the child with autism (e.g., favorite
toys, swinging, taking a bath);
using a variety of materials that are interesting to the child so that he/she can
choose what to use during the intervention activity;
modeling the target skill; and
providing natural reinforcement when the child uses the target skill correctly (e.g.,
access to the desired item, acquiring help after asking for it).
When parents and practitioners plan activities that use these types of interaction
strategies, increased learning and generalization occurs. Furthermore, these types of
interaction strategies can be easily taught to parents, are easy to implement, and can
be sustained over time with little additional support needed from practitioners (Koegel,
O'Dell, & Koegel, 1987).
Practitioners develop a plan for promoting generalization and maintenance of
target skills at home and in the community.
A key component of the long-term success of parent-implemented intervention is to
develop a plan for promoting generalization of skills in a variety of settings and with a
variety of individuals. To accomplish this, practitioners must help parents identify
numerous settings in which the target skills can be used. This often is accomplished by
having parents tell the practitioner about their day. For example, practitioners can ask
parents what types of things happen on most mornings or what types of activities they
like to do with their children (McWilliam, Cripe, Hanft, Sheldon, & Rush, 2005). This
information then can be used to identify specific routines and activities where the
intervention strategies can be implemented. The goal is for the target skill to be
addressed numerous times across the day; thus promoting generalization of skills.
When developing the intervention plan, practitioners gather information from
families regarding:
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the interests of the child and the family members; and
daily routines and activities.
Practitioners also must help parents identify a variety of individuals who can work on
target skills across the day, such as another parent, a grandparent, or a babysitter. A
generalization plan ensures that children use target skills throughout the day as
consistently as possible across settings and with numerous individuals so that the use
of target skills does not become situation-specific (i.e., child uses target skill only with
one parent or during a certain routine).
Practitioners, parents, and other team members develop an individualized
intervention plan for the child and family that:
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targets the identified child, parent, and family goals;
is consistent with the parents' ongoing practices, routines, values, and
interactions;
incorporates intervention within the setting where target behaviors occur;
incorporates intervention into the day's natural routines as much as possible;
includes practices that have an evidence base and have been shown to be
effective when implemented by parents;
includes instructional practices that uses the parents' knowledge,
characteristics, and preferences and will not cause added stress; and
addresses generalization of target skills.
The intervention plan outlines step-by-step instructions for parents so that they know
how to implement the intervention.
Practitioners develop step-by-step instructions for individual practices that
include the following information:
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target skill or behavior;
who will implement the intervention;
where the intervention will be implemented;
when the intervention will be implemented (the minimum amount of
instruction, both frequency and duration, parents are to implement per day or
week);
how long the intervention will be implemented (define how parents know
when the intervention session or instructional trial is completed);
materials required;
any steps needed to prepare the intervention;
strategies to be used;
prompting levels to be used; and
items to use as reinforcers and reinforcement schedule.
An example of a parent intervention steps of use form is provided in the "Forms for
Parent-Implemented Intervention" handout. This form can be used when the goal is to
increase skills or promote positive behaviors. For parents whose priority goal is to
reduce interfering behaviors (e.g., repetitive, stereotypical, disruptive) in the home or
community, a functional behavior assessment (FBA) may be needed. After the FBA has
been completed, the Parent-Implemented Behavior Intervention Plan form, included in
the forms handout, may be helpful to practitioners and families. This document can be
used to list and prioritize goals as well as the specific details of the intervention plan.
Practitioners and parents design a data collection system to monitor progress
toward meeting goals. Because parents need to focus their time on their child,
the ultimate goal is to develop a data collection system that:
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takes family characteristics into account;
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is simple and too the point;
is quick and easy to implement;
can be implemented in the setting of natural routines; and
can be analyzed quickly.
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Data collection will be based on goals and targeted skills and behaviors. Practitioners
create data sheets that are individualized and focus on the child's target goals. Parents
should be provided with detailed instructions for data collection, including when and how
often to take data. To track progress on learning the skill or reduction of an interfering
behavior, data may be collected using a variety of strategies. There are several basic
types of data collection appropriate for parents, including:
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log book documentation;
occurrence data; and
frequency data.
Log Book Documentation
One primary form of data collection is ongoing documentation through a log book. Log
book entries allow parents to track the implementation of intervention and document
changes in behavior. Log book entries can include the following information:
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dates of intervention implementation;
times of intervention implementation;
individual who implemented intervention;
noted changes in behavior; and
concerns, questions, and reflections.
Log book entries are useful when:
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parents require an easy and quick format for data collection;
parents are unable to take data on the child's behavior when it actually occurs and
need a system that allows data recording at a convenient time;
a description or narrative is useful;
a system is needed for parents to track the actual implementation of intervention;
and
parents need a place to record questions, concerns, and reflections to guide
dialogue with one another regarding intervention implementation.
A sample list of items that can be recorded in a log book is provided below. This list is
not exhaustive, but can be used to help guide selection of a data collection system. It
includes:
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parent implementation of a behavioral plan;
parent stress level and triggers for increased stress;
grandmother's use of environmental modifications;
sister's interaction during play;
aggression during clean up of toys;
noncompliance during the bed-time routine;
on-task behavior during homework;
interaction with sister during play;
use of an augmentative communication system during the day;
attempts to communicate desires;
efforts to initiate an interaction; and
attending during a story read by the parent.
An example of a log book entry data sheet is provided in the "Data Collection Sheets for
Parent-Implemented Intervention" handout.
Occurrence Data
Occurrence data allow the parent to document whether the behavior occurred or did not
occur during a specified interval of time. When taking occurrence data, the following
must be included:
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the specific behavior to be recorded;
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the specific observation interval for the specific behavior (The observation
interval may be any given unit of time. For example, an entire day may be the
interval for a parent who is working on documenting whether the child requested to
use the bathroom, while the dinner hour may be the interval for a parent who is
tracking spontaneous comments.);
the format for documenting the occurrence of a behavior (In some cases, a
check mark may be used to indicate the behavior occurred. In others, parents may
document the specific behavior. For example, for a parent who is documenting child
requests to use the bathroom, a tally mark may be used; while the parent who is
tracking spontaneous comments may record exactly what the child said).
Occurrence data collection is useful when:
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the intervention strategy is targeting the acquisition of a behavior that is currently
rare and results in a need to record any occurrence of the target behavior;
the intervention strategy is newly introduced and results in the need to track
whether the strategy increased the occurrence of the target behavior;
the intervention strategy is targeting the reduction of a behavior that is currently rare
and results in a need to record any occurrence of the target behavior;
the frequency of the target behavior is too high to record each occurrence;
the parents are unable to take data on the child's behavior every time it occurs,
resulting in data for at least some specific time intervals; and
a system is needed to document the target behavior only during a specific activity
(e.g., dinner, playtime with peer).
Below is a sample list of behaviors that can be recorded when using an occurrence data
collection system. Again, this list is not exhaustive, but can be used to help guide
selection of a data collection system. Potential behaviors include:
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occurrence of self-stimulatory behavior during homework;
occurrence of aggression in the home setting;
occurrence of disruption when getting ready for bed;
pointing at a preferred object;
showing the parent a picture he/she colored;
requesting to use the bathroom;
responding to a peer's attempt to play;
exchanging a picture to request a snack;
commenting on a play activity;
stating an activity he/she did at school; and
initiating a conversation about a specific topic.
Examples of an occurrence data sheet are provided in the "Data Collection Sheets for
Parent-Implemented Intervention" handout.
Frequency Data
Frequency data allow parents to document how many times the behavior occurred
during a specified interval of time. When taking frequency data, the following must be
included:
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the specific behavior to be recorded;
the specific observation interval; and
the format for documenting the occurrence of a behavior.
There are two ways to take frequency data:
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the parent to make a tally mark each time the behavior occurs; and
the parent to document the specific behavior.
For example, when taking data on the number of times the child did not do what was
asked, the parent may make a tally mark to record its occurrence. On the other hand,
when taking data on when a child spontaneously labels objects, the parent may write
down each item the child describes.
Frequency data collection is useful when:
o
o
o
o
the intervention strategy focuses on learning a new behavior, and it is important to
ensure the occurrence of the target behavior is increasing;
the intervention strategy focuses on the reduction of a behavior, and it is important
to ensure the occurrence of the target behavior is decreasing;
the intervention strategy targets behavior in multiple situations, and compares the
occurrence of the behavior across environments and activities; and
the intervention strategy is targeting the generalization of the target behavior across
a variety of situations, and compares the occurrence of the behavior across
environments and activities.
A sample list of behaviors that can be recorded using frequency data collection
procedures is provided below. It includes:
o
occurrence of aggression during clean-up activities;
o
occurrence of throwing objects in the home environment;
occurrence of saying "no" during home work;
occurrence of self-injurious behavior;
pointing to a desired object;
taking a turn when playing a game with peers;
exchanging a picture to request a snack;
verbally requesting using three or more words in a sentence;
o
o
o
o
o
o
o
o
o
labeling an item in a book;
commenting on a play activity; and
asking a question.
Examples of a Frequency Data Sheet are provided in the "Data Collection Sheets for
Parent-Implemented Intervention" handout.
Step 4. Training Parents
Once an intervention plan is developed, parents are taught how to implement the
intervention through a structured parent training program (Johnson et al., 2007).
However, before beginning a parent training program, practitioners must possess a
certain level of training and experience to ensure the highest quality training. Having
highly trained individuals conduct the training program will help parents implement
interventions accurately.
Practitioners who conduct parent trainings should possess the following skills:
o
o
o
o
o
the ability to implement any intervention with a child that will be used by
parents;
excellent behavior management and joint attention skills with children;
the ability to accurately describe the rationale and procedures for the
intervention to parents in terms that are easy to understand;
the ability to build rapport and mutual respect with parents; and
the ability to problem solve efficiently with parents when they or their child is
having difficulty.
Practitioners and parents develop an individualized training program that will result in
parent learning and implementation of the intervention. When creating the training
program, teachers/practitioners consider the (a) training format, (b) training location, (c)
training components, and (d) amount and duration of training.
Training Format
Prior to parent training, practitioners and parents choose one of the following
formats for instruction (Brookman-Frazee, Stahmer, Baker-Ericzen, & Tsai, 2006):
o
o
o
individual (i.e., training is provided to parents or caregivers of a single child and
may occur in a home, school, or clinic setting);
group (i.e., training is provided to parents of at least two unrelated children at the
same time); or
combination (i.e., training is provided to parents using both the individual and
group format).
Training Location
Practitioners and families choose one or more of the following locations for
training parents to implement the intervention:
o
o
o
o
home (child's primary residence);
community (any setting outside of the home);
clinic (any laboratory, university, or treatment center); or
school (any educational setting).
Training Components
Practitioners provide individualized training programs that incorporate an
assortment of components designed to educate and instruct. Most parentimplemented intervention programs include educational instruction provided in a
lecture style or discussion format. This instruction typically is used to describe
the strategies and intervention procedure in detail and to allow parents to ask
questions and discuss concerns. In addition, effective parent-implemented
intervention also includes one or more of the following components:
o
feedback and coaching. Feedback is given directly to parents as they implement
the intervention with their child. Emphasis is placed on skills implemented correctly.
For skills that need improvement, direct and immediate input and corrective
strategies are provided, allowing parents to change and improve implementation in
real time.
o
modeling. Specific procedures are demonstrated to the parents during training
sessions. Modeling preferably occurs with the target child, but may also be done
with another child or adult. The goal is for parents to observe the target behavior or
skill being implemented correctly and successfully. Some parents may find it helpful
to have both correct and incorrect examples of the behavior and/or skill.
o
role playing and behavioral rehearsal. Parents practice the intervention strategy
or skill with someone other than their child. This strategy should be combined with
feedback and coaching. This allows parents to practice and perfect the intervention
prior to implementing with their child.
o
documentation through a log book or data collection. Parents track the
behaviors targeted, hours of implementation, and/or the specific performance of the
child and note successes as well as any problems or concerns. Entries should be
reviewed with the trainer as needed.
o
video analogies. Parents review examples of the strategy and may follow-up by
discussing the video and steps of the intervention. This strategy provides an
alternative to live modeling.
o
video analysis. Parent and trainer review a video clip of the parent/child and
follow-up with feedback. Input is provided regarding skills implemented correctly as
well as those that need improvement. Parents can ask questions, discuss concerns,
and review progress made.
Amount and Duration of Training
The goal of parent training is for the parents to learn to implement intervention
strategies consistently over time, across family settings, and with a variety of behaviors
when direct support from service providers is no longer available. Therefore, the amount
and duration of parent training are highly unique.
Practitioners and families determine an appropriate amount and duration of
training based on:
o
o
o
o
child characteristics;
parent characteristics;
family characteristics; and
peer-reviewed articles that have demonstrated the minimum amount of
intervention needed to achieve goals.
When creating a parent-implemented intervention program, the following factors guide
the decision-making process:
o
intervention plan. The intervention plan and considerations used to create it
ultimately guide the parent training component of parent-implemented intervention.
Some skills may be successfully taught to groups in a school, program, or clinical
setting, while other components require more individualized attention. Certain
concerns or behaviors unique to a specific child may warrant one-to-one parent
training as it provides the ability for individualized problem-solving as well as more
intensive instruction;
o
parents' preferences. Parents may have a preference regarding the training
program used due to family commitments, convenience, travel considerations, as
well as other personal factors;
parents' learning characteristics. Parental learning style, ability to retain
knowledge, application, and generalization of skills may determine the path of the
best training program. The intensity and detail of instruction, as well as the ability to
practice strategies in ways specifically relevant to the parents must be considered
(Koegel, Koegel, Harrower, & Carter, 1999);
need for parent collaboration. Some parents may benefit from interacting with
o
o
o
o
other parents. Opportunities for parents to collaborate and learn from each other
may be a valuable component that complements direct support and training from
practitioners (Sofronoff, Leslie, & Brown, 2004);
geographical location of the family. Families live various distances from service
providers who offer intervention to children with ASD. Geographical constraints are
important considerations when designing training for parents;
cost of training. Creating an efficient and cost effective way to provide training is
important for many parents and for practitioners trying to provide services to a
greater number of children with autism spectrum disorders (Koegel, et al., 2002).
It is critical to monitor parent progress during training. As noted, duration of training
varies depending on the unique situation. Over time, parents are expected to become
more independent and master targeted skills and strategies. It is therefore necessary to
collect data that document whether parents are implementing interventions consistently
and correctly to identify areas that may need more attention. An example of a parent
intervention fidelity form is provided in the Module Documents.
Step 5. Implementing the Intervention
Parents implement the intervention plan as designed. When and where to implement
instruction should be outlined in the intervention plan; however, changes in the plan
may be needed after implementation begins. In some cases, parents will first learn skills
in clinical or professional development settings that they can then implement within
naturally occurring routines at home.
Parents implement the intervention with their children daily, or as designated in
the plan.
As much as possible, parents implement the intervention within naturally
occurring routines and interactions.
If possible, for those interventions that cannot be done in their natural settings,
parents should implement instruction at the same time each day in a relatively
quiet area that is free from distractions.
Having a consistent time and place for these activities will help parents implement the
intervention with greater frequency and will help children know what is expected of
them. When implementing the intervention, practitioners also must work with parents to
ensure that interventions are being implemented within natural routines. That is, parents
and other family members address target skills within ongoing routines in the home and
community.
Examples
o
o
a parent might work on labeling objects during a walk in the neighborhood.
a parent might address choice-making at snack (e.g., "Do you want milk or juice?"),
when reading books ("Do you want this book or this book?"), and when playing with
a sibling ("Do you want to play with dinosaurs or cars?").
By using intervention strategies within ongoing routines and activities, parents and other
family members promote the generalization and maintenance of skills, promoting growth
and development over time.
Step 6. Progress Monitoring
To assure that this evidence-based practice is implemented correctly and consistently,
practitioners will hold discussions with parents in order to monitor implementation of the
intervention, as well as to monitor child progress. Practitioners present this part of
parent-implemented intervention to families in a positive manner that relieves any
concerns or misunderstandings about its purpose. Progress monitoring is used to
improve implementation to make the achievement of goals more efficient, not to monitor
the performance of parents.
Please see the handouts, "Forms for Parent-Implemented Intervention" and "Data
Collection Sheets for Parent-Implemented Intervention." The resources provided in
these handouts will assist in collecting data needed to monitor both parent
implementation and child progress.
Forms provided include: Family Information Form, Goal Development Form, Parent
Intervention Protocol Form, and the Parent Intervention Fidelity Form. The Parent
Intervention Fidelity Form will be of particular value in assessing whether or not parents
are implementing the strategies according to the intervention plan.
Data sheets provided include: Log Book Entry Data Sheet, Occurrence Data Sheet, and
Frequency Data Sheet. Blank data sheets as well as accompanying examples of
completed data sheets. All of these resources should be helpful in gathering baseline
(pre-intervention) and ongoing data to monitor child progress.
The following practices help to assure that data are accurately collected and are used to
make informed adjustments to parent-implemented intervention.
Practitioners and parents use progress monitoring data to evaluate whether
theintervention is impacting target skills.
Practitioners and parents use progress monitoring data to adjust intervention, if
needed.
Practitioners and parents monitor parents' implementation of the
interventionusing fidelity checklists and adapt training/support as needed.
As parents demonstrate mastery over training content, practitioners
systematically reduce the frequency of parent training sessions based on:
o
o
child progress; and
parent performance.
Practitioners slowly increase the amount of time between sessions until a mutually
agreed upon interval is reached.
In the final phase of implementation, every effort should be made to maintain or
enhance positive gains and help parents to generalize to other behaviors.
Practitioners provide parents with additional opportunities to learn how to
implement intervention, improve intervention, ask questions, and solve problems.
Ongoing supervision and collaborative problem-solving help parents provide effective
intervention and feel confident about their abilities to facilitate their children's skill
development.
Practitioners promote ongoing supervision and collaboration by providing at
least one of the following:
o
o
continued contact with the practitioner. Practitioners maintain an intermittent
training or meeting schedule;
parent training booster sessions. Practitioners conduct training sessions that
target specific content or strategies to ensure that child progress continues. The
frequency and duration of such trainings may fluctuate over time. The need for
training should be continuously evaluated and determinations made based on child,
parent, and family needs and priorities;
o
o
o
o
documentation. Through the use of a log book or data sheet, parents can
document the behaviors targeted, hours of implementation, and/or the specific
performance of the child and note any problems or concerns. The log book or data
sheet can then be shared with the practitioner and used as a forum for discussion
and problem-solving;
video analysis. Parents can videotape intervention sessions with their child to
share with the practitioner and use as a forum for discussion and problem-solving;
observation. The practitioner can schedule a time to observe parent-implemented
intervention and provide training and recommendations in real time;
email and phone correspondence. Information can be shared with the
practitioner, and problem-solving can occur via email or phone.
Case Studies
Module authors have provided two case examples to demonstrate parent-implemented
interventions.
Tomeika is a three-year-old girl. She was recently diagnosed with autistic disorder.
Tomeika is able to make many vocalizations and is able to say one recognizable word.
Tomeika will say juice, which she pronounces as "oos." Throughout the day, Tomeika
cries and falls to the floor to gain access to food, obtain a favorite toy, or when she
wants to be picked up. Her parents, Mr. and Mrs. Williams, would like for Tomeika to
communicate her desires with words, but do not know how to help her.
Connor is a five-year-old boy with Asperger disorder. Connor currently attends a
general education kindergarten classroom. Connor's parents, Mr. and Mrs. Hoffman,
have difficulty getting Connor ready for school. When Connor is supposed to be getting
ready for school, he becomes distracted and reads books on trains or airplanes. When
his parents attempt to redirect him, he verbally refuses to stop reading and get ready for
school. Mr. and Mrs. Hoffman have sought the support of the behavioral specialist who
provides support to students with ASD.
Tomeika
Case Study: Tomeika
Tomeika is a three-year-old girl. She was recently diagnosed with autistic disorder.
Tomeika is able to make many vocalizations and is able to say one recognizable word.
Tomeika will say juice, which she pronounces as "oos." Throughout the day, Tomeika
cries and falls to the floor to gain access to food, obtain a favorite toy, or when she
wants to be picked up. Her parents, Mr. and Mrs. Williams, would like for Tomeika to
communicate her desires with words, but do not know how to help her.
Tomeika recently began attending an early childhood special education classroom for
students with ASD in the Hampton County Public School System for six hours a day,
four days a week. On Wednesdays, Tomeika and her peers do not go to school.
Instead, on this day, Tomeika's teacher, Mrs. Dell, has parent-teacher conferences
either at school or in her students' homes. During the conferences, Mrs. Dell discusses
educational programming, student progress, areas of concern, and also provides
training to parents.
Step 1. Determine the Needs of the
Family
During the first few weeks of class, Mrs. Dell has learned a great deal about Tomeika
and her strengths, learning style, and specific needs. As Mrs. Dell prepares for her first
parent-teacher conference, she decides she would like to learn more about the needs of
Tomeika's family. Mrs. Dell understands that needs in the home may differ from those in
the school environment, so she wants to take the time to get to know about Tomeika's
home situation before providing input and training to her parents.
Mrs. Dell and Tomeika's parents decide to hold the first parent-teacher conference in
Tomeika's home. Her parents will probably be more comfortable at home, and Mrs. Dell
will have the opportunity to see Tomeika at home and to observe home routines and
activities. During the parent-teacher conference, Mrs. Dell discusses Tomeika's school
program and progress she has made during the first few weeks. Next, the three adults
discuss home concerns. Mrs. Dell wants to ensure she has an accurate and thorough
understanding of the parents' concerns and priorities, so she uses a Family Information
Form (see Resources section) to interview the parents. While completing the interview,
Mrs. Dell focuses on gathering information regarding Tomeika's strengths, parent-child
interaction patterns, and primary areas of concern. Additionally, Mrs. Dell gathers
information regarding typical family activities and daily routines.
Once the interview is completed, Mrs. Dell observes Tomeika for approximately one
hour. She observes Tomeika eating lunch, playing independently, and playing with her
father on the swing set.
Step 2. Selecting Goals
During the second parent-teacher conference, Mrs. Dell works with Mr. and Mrs.
Williams to create appropriate home goals for Tomeika. The three adults review the
concerns raised at the previous parent-teacher conference. They prioritize the goals
and identify those that will have the greatest impact on family functioning. Mr. and Mrs.
Williams are most concerned about Tomeika's ability to communicate her wants and
needs consistently in the home. Second, they would like to see her reduce the
occurrence of interfering behavior, including screaming, crying, and falling to the floor.
Once goals are identified, they write the goals in observable and measurable terms so
everyone has a clear understanding and can monitor the target skill accurately. The
following goals are developed by the team:
o
Tomeika will verbally request (one word) at least five desired items or
activities at home each day for five of seven days for two months.
o
Tomeika will verbally request desired items (one word) instead of exhibiting
interfering behavior (crying, screaming, dropping to floor) and will
demonstrate no more than three occurrences of interfering behavior per week
for two months.
Through discussion and observation, it was determined that Tomeika would benefit the
most from learning to request the following:
o
o
o
o
o
up (for being picked up);
chip;
cookie;
movie; and
swing.
Additionally, Tomeika's parents said that they would like to increase the number and
type of interactions they have with her. The following goals were developed by the
team:
Mr. and Mrs. Williams will:
o
o
o
o
model language throughout the day by labeling objects and actions at least
five times each day for two months;
read bed time stories to Tomeika three times each week for two months;
play concept development games during bath time three times each week for
two months; and
provide Tomeika with the opportunity to request a desired item a minimum of
five times a day for two months.
Step 3. Developing the Intervention Plan
Using information derived from the interview, observation, and ongoing discussions,
Mrs. Dell creates an intervention plan for Mr. and Mrs. Williams. She is particularly
thoughtful about this step because Mr. and Mrs. Williams both work and have another
child. Mrs. Dell outlines a plan that provides a description of when and where to provide
instruction. Additionally, she provides step-by-step instructions on how intervention is to
be implemented.
Mrs. Dell believes the intervention should take place within the context of Tomeika's
natural routines. Tomeika will encounter most of her target items on a regular basis
allowing her parents to take advantage of naturally occurring opportunities. Further, it
will be easy for her parents to create additional requesting opportunities throughout her
day. Since the items are all motivational for Tomeika, Mr. and Mrs. Williams believe it
will be feasible to offer the target items at least 10 times per day within her daily routine.
Mrs. Dell decides that naturalistic intervention will be an appropriate instructional
strategy to teach the parents. Naturalistic intervention has been demonstrated to be an
effective instructional strategy and parents of children with ASD have used this strategy
to successfully teach requesting. Additionally, natural routines are designed to be
included into naturalistic intervention.
Next, Mrs. Dell creates a data collection system that is succinct and easy to implement
in the home. She decides to have Mr. and Mrs. Williams keep frequency data for both
the requesting of desired items as well as the occurrence of interfering behaviors. Mrs.
Dell carefully crafts a data sheet for requesting. She lists the five target items (up, chip,
cookie, movie, and swing) and provides a column to make a tally mark each time
Tomeika verbally requests the item during the course of the day. Next, she creates a
data sheet for interfering behavior. This data sheet is similar to the requesting data
sheet making it easy to implement. On this sheet, Mrs. Dell lists the problem behavior
and provides a column to make a tally mark each time Tomeika demonstrates the
behavior during the day.
Step 4. Training Parents
Now that the intervention plan has been created, Mrs. Dell is ready to begin training Mr.
and Mrs. Williams. The three adults work together to develop an individualized training
program that will result in parent learning and implementation of the intervention. When
creating the training program, the team first considers the training format and location.
They decide the parents should receive individualized training in their home since that is
where the intervention will be implemented. Second, they consider the amount and
duration of training. The team outlines a training schedule that offers two hours of
training each week for four consecutive weeks. Once the four weeks are completed, the
team will evaluate progress and outline further training as needed. Lastly, the team
considers training components.
Mrs. Dell provides a tremendous amount of input regarding how best to train Mr. and
Mrs. Williams. She wants to be sure the training components are appropriate for this
specific intervention plan and also address the Williams' learning style. Mrs. Dell
decides to provide approximately 30 minutes of training in a conversational format to
supply the parents with foundational information on the intervention strategy and data
collection system. All other training was conducted using a hands-on approach with
Tomeika present. This training consists of Mrs. Dell modeling the intervention, then
providing opportunities for both Mr. and Mrs. Williams to practice. Mrs. Dell provides
coaching to the parents and gives immediate feedback regarding tasks they performed
correctly as well as areas needing improvement. At the end of each training session, the
three adults spend approximately 10 minutes recapping the day's training and
identifying the training needs for the upcoming week.
Step 5. Implementing the Intervention
As the training sessions are provided, Mr. and Mrs. Williams diligently implement the
interventions throughout the week. They take advantage of natural opportunities when
Tomeika desires one of the target items and are able to provide many additional
opportunities for her to request each day. They begin modeling language by labeling a
wide array of objects and actions Tomeika encounters. They add pleasant bath time
and story time routines. Over time, they begin to feel more comfortable with
implementing the interventions and are able to incorporate the goals seamlessly into
their typical daily routines. As they implement the intervention, they are careful to
complete the data sheets and note major successes with Tomeika as well as concerns
and questions.
Step 6. Progress Monitoring
Mrs. Dell wants to be sure Tomeika's parents are being consistent with the steps of the
intervention. Approximately once a week, Mrs. Dell uses the "Parent Intervention:
Fidelity of Implementation Form" (see documents resource section) to evaluate and
document their progress. Each time, she scores the checklist, reviews the results with
Mr. and Mrs. Williams, provides positive comments, and makes suggestions for areas of
improvement.
During each training session, Mr. and Mrs. Williams show Mrs. Dell the data they have
collected and notes. The team analyzes the data to ensure Tomeika is progressing.
Further, Mrs. Dell provides answers to their questions.
After the four-week training period, Mr. and Mrs. Williams feel confident about their
ability to implement the intervention with Tomeika. The team agrees that training on
naturalistic intervention can be reduced to once a month. During the monthly training
sessions, the parents and teacher review data and discuss progress and next steps.
Mrs. Dell wants to help the parents generalize this strategy and intervention plan to
other behaviors. Therefore, during the monthly training sessions, she discusses
additional needs and concerns, outlines new goals, and provides additional training to
help them implement the intervention effectively. Additionally, Mrs. Dell has made it
clear that Mr. and Mrs. Williams can e-mail her anytime with immediate questions.
After eight weeks of implementing the intervention in the home, Tomeika is now
consistently verbally requesting "up," "swing," and "cookie," which she pronounces as
"oo-kee". She will sometimes request "chip," but often requires her parents to provide a
verbal prompt. During this time, her parents have seen a significant decrease in the
occurrence of interfering behavior, as she now demonstrates this behavior on average
less than two times per week. Her parents are thrilled with her progress. Because
Tomeika has shown progress on making verbal requests, the team has identified two
additional items to target- "ball" and "bath." Her parents are eager to begin work on
these new items.
Connor
Case Study: Connor
Connor is a five-year-old boy with Asperger Disorder. Connor currently attends a
general education kindergarten classroom. Connor began speaking in full sentences by
eighteen months of age. He has an extensive vocabulary and enjoys talking with adults.
Connor demonstrates intensive interest in both trains and airplanes and enjoys reading
books on these topics. Connor often becomes distracted by his intense interests and
attempts to talk about trains or airplanes at inappropriate times.
Connor's parents, Mr. and Mrs. Hoffman, have difficulty getting Connor ready for school.
When Connor is supposed to be getting ready for school, he becomes distracted and
reads books on trains or airplanes. When his parents attempt to redirect him, he
verbally refuses to stop reading and get ready for school. Consequently, Mrs. Hoffman
provides physical assistance with all steps of his morning routine, even though he can
do most of the steps on his own. The morning routine of having to provide physical and
verbal prompts for dressing, brushing teeth, and eating breakfast creates a great deal of
stress for Mr. and Mrs. Hoffman, as well as Connor.
Mr. and Mrs. Hoffman have sought the support of the behavioral specialist who provides
support to students with ASD, Mr. Adams, in their local education district. Mr. and Mrs.
Hoffman have met with Mr. Adams to discuss their concerns and to secure
recommendations for helping Connor get ready for school independently.
Step 1. Determine the Needs of the
Family
Mr. Adams schedules a consultation with Mr. and Mrs. Hoffman. The purpose of the
consultation is to learn more about their concerns and needs. Further, he would like to
learn more about the family dynamics, Connor's strengths, interaction patterns between
Connor and his parents, and current strategies used at home. Mr. Adams wants to
ensure he has an accurate and thorough understanding of the parents' needs and
priorities, therefore, he uses a Family Information Form to interview them. Mr. Adams
takes notes while interviewing the parents. Because the morning routine is such a
difficult time and results in elevated stress for all family members, Mr. Adams spends a
great deal of time focusing on this time of the day, gathering detailed information about
the routine.
Mr. Adams would really like to see the morning routine for himself to gain additional
information. However, he realizes his presence in the morning may likely alter Connor's
behavior, and his observation may not provide a realistic view of the situation. He
discusses this with Mr. and Mrs. Hoffman, and the three adults decide that Mr. Hoffman
will video record the morning routine. To ensure sufficient footage is provided, Mr.
Hoffman agrees to video record three separate mornings.
Step 2. Selecting Goals
After viewing the videos, a second consultation is scheduled. This consultation takes
place in Mr. Adams' office. The purpose of this consultation is to outline appropriate
goals for Connor as well as his parents. The parents and Mr. Adams outline a number
of goals to make getting ready for school more pleasant and efficient. Next, they
prioritize the goals based on the immediate impact on the family. Mr. Adams writes the
goals in observable and measurable terms:
o
o
Using a visual schedule, Connor will independently dress himself in 5
minutes or less every week day morning, putting on pants, shirt, socks, and
shoes for two months.
Using a visual schedule, Connor will independently use the bathroom and
brush his teeth every week day morning in 5 minutes or less for two months.
Additionally, it was determined Connor's parents would benefit from goals designed to
improve their ability to redirect him effectively and increase his cooperation during daily
routines. The team develops the following goals:
o
o
o
o
On week day mornings, Connor's parents will review the visual schedule
(photos and words) that depict the steps of brushing his teeth and getting
dressed with Connor after he has eaten breakfast and prior to going upstairs
to get ready.
When Connor independently completes his morning routine, his parents will
provide praise and time to play with his trains.
When giving directions to Conner, his parents will first make sure they have
his attention by getting close to him and stating his name.
When Connor follows simple directions given by either parent anytime during
his day, his parents will praise him for following directions.
Step 3. Developing the Intervention Plan
Using information derived from the interview, videos, and ongoing discussions, Mr.
Adams creates an intervention plan in collaboration with Mr. and Mrs. Hoffman. Taking
into account the needs of the family, he develops a plan that is easy to implement and
will ultimately reduce family stress. This is especially important since the intervention
plan will be implemented in the morning when stress can already be high.
The intervention plan provides step-by-step instructions for implementation. The
intervention will take place within the natural morning routine and will employ a variety
of instructional strategies. First, a task analysis will be used, outlining the steps Connor
is to complete. For example, in his first goal, Connor is to get dressed independently.
The task analysis contains the following steps:
o
o
o
o
o
o
remove pajamas;
put pajamas on hook in bathroom;
put on pants;
put on shirt;
put on socks;
put on shoes.
By creating and using a task analysis, the steps are clearly outlined and are
implemented in the same order each time. Additionally, Connor can use the task
analysis as a visual support to provide direction through the steps. Second, the plan
includes a description of how to prompt Connor effectively through the steps of the
routine. Third, reinforcement is used to increase motivation and encourage compliant
behavior.
Mr. Adams creates a data collection system that is succinct and easy to implement in
the context of the morning routine. He decides to have Mr. and Mrs. Hoffman keep
occurrence data for each step of the routine. Because the intervention is being
implemented in the morning, Mr. Adams knows the data must be collected quickly. Mr.
Adam crafts one data sheet for getting dressed and a second data sheet for toileting
and brushing teeth. On each data sheet, he lists the steps Connor is to complete and
provides a column to make a check mark if Connor completed the step independently.
Step 4. Training Parents
The three adults work together to develop a training program. Mr. Adams suggests
using a combination training approach and Mr. and Mrs. Hoffman agree. First, Mr. and
Mrs. Hoffman receive three hours of instruction on prompting strategies and
reinforcement. They receive this instruction in a group format with other parents of
children with ASD. The training takes place in Mr. Adams' office.
Second, they receive individualized hands-on instruction to teach implementation of the
intervention with Connor in two-hour blocks for four consecutive weeks. After much
consideration, the team decides to conduct the hands-on training in Mr. Adam's office.
Mr. and Mrs. Hoffman expressed this desire because they believe there are a number of
distractions in the home that would impede training effectiveness. Mr. Adams wants to
ensure they are able to transfer learned skills to the home. Once again, he recommends
video recording intervention sessions. Mr. and Mrs. Hoffman agree and are happy with
the arrangement.
During the individual instruction, Mr. Adams provides a video analysis of the home
tapes. After the analysis, he models various steps of the intervention and provides
opportunities for both Mr. and Mrs. Hoffman to practice. Mr. Adams provides coaching
to the parents and gives immediate feedback. At the end of each training session, the
three adults spend approximately 10 minutes recapping the day's training and outlining
goals for the upcoming week.
Step 5. Implementing the Intervention
After completion of the training and one week of the individual training, Mr. and Mrs.
Hoffman begin implementing the intervention at home. At the completion of the session,
they collect data and write down questions and concerns. They videotape intervention
sessions two times a week.
Step 6. Progress Monitoring
Mr. Adams is able to monitor Mr. And Mrs. Hoffman's performance through the video
analysis conducted each week. He provides written and verbal feedback regarding
steps implemented correctly as well as areas targeted for improvement. To ensure
Connor is progressing, the three also analyze data. During each session, Mr. Adams
provides the opportunity for Mr. and Mrs. Hoffman to ask questions and share concerns.
Over time, Mr. Adams makes minor adjustments to the intervention plan as needed.
After the four-week training period, Mr. and Mrs. Connor feel confident about their ability
to implement the intervention. Connor has made tremendous progress towards his
goals. The team determines it is time to identify new goals. The team continues to focus
on the morning routine, as this area is still problematic. Even though Connor will now
get dressed, use the bathroom and brush his teeth with few reminders, he still requires
a tremendous amount of assistance and redirection to eat breakfast.
The team develops the following new goals:
o
Connor will independently eat his breakfast in 10 minutes or less every week
day morning.
With the incorporation of the new goal, the team decides to extend the training for
another two weeks. This allows Mr. and Mrs. Hoffman to receive coaching and feedback
on the new goals.
After two weeks, Connor has made additional progress. Connor will now get dressed,
use the bathroom, and brush his teeth independently. He requires more prompting and
redirection to eat breakfast, but progress is being made and the Hoffmans continue to
work diligently.
Once again, the team decides to re-address Connor's goals. They outline two additional
goals related to daily routines. Because Mr. and Mrs. Hoffman have received such
intensive training, they feel confident they can apply their newly acquired skills to these
situations. To ensure the Hoffmans effectively apply the intervention, the team
schedules monthly follow-up training sessions. Mr. and Mrs. Hoffman agree to bring
videos that will be used for video analysis. Additionally, Mr. Adams provides his e-mail
address and phone number in case they have questions that need immediate attention.
Summary
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With parent-implemented intervention, parents directly use individualized
intervention practices with their child in the home or community to improve child
performance.
Parent-implemented intervention can be used with young children with ASD.
Parent-implemented intervention can be used to increase communication skills and
reduce interfering behaviors.
Families and practitioners collaborate to develop and carry out all steps of the
process in order to facilitate the optimal development and learning of the child and
address concerns and priorities of families.
Practitioners, parents, and other team members outline observable and measurable
goals for the child that address areas of concern, will have a positive impact on
family functioning, parents can implement with consistency, and are appropriate for
parents to implement in the home and/or community settings.
In addition to child goals, it may be helpful to outline goals for parents and family
members to achieve during the instructional and training process.
An individualized intervention plan is created that is designed to address the child,
parent, and family goals. The intervention plan considers parents' routines and
practices, incorporates intervention in the natural routine to the maximum extent
possible, utilizes evidence based practices, and includes practices that will not
cause additional stress.
Parents are taught how to implement the intervention through an individualized
parent training program that incorporates an assortment of training components
designed to educate and instruct.
As parents implement the intervention, practitioners monitor both child progress and
parents' implementation of the intervention and adapt the intervention plan as
needed.
o
As parents demonstrate mastery over the intervention, practitioners help parents
enhance positive gains and generalize to other behaviors through collaborative
problem-solving.
Frequently Asked Questions
Q. How do I ensure that I am using family-centered planning when using parentimplemented intervention?
A. Practitioners ensure the use of family-centered planning by involving parents in all
parts of the intervention process, including:
o
o
o
o
o
o
identification of strengths, needs, and priorities;
goal development;
intervention plan development;
parent training;
intervention delivery; and
progress monitoring.
Practitioners collaborate with families to ensure they are providing input and are
empowered to make meaningful decisions. Practitioners gain thorough knowledge of
the child with ASD and family needs through interviews, observations, and ongoing
discussion.
Q. How do I know if the outlined goals for parent-implemented instruction are
clear enough?
A. The best way to be sure you have clearly defined the goal you are targeting is by
putting it to the test with another adult. If the definition is precise and clear, you and
another adult should be able to observe the child using the behavior and consistently
agree on whether or not the child is correctly demonstrating the target behavior. If you
and another adult do not agree on the target behavior, then the description of the
behavior should be modified to eliminate any discrepancies.
Q. What areas are appropriate to target through parent-implemented
intervention?
A. Parent-implemented intervention can be used to increase/improve communication
skills and/or reduce interfering behaviors. In the area of communication, parent-
implemented intervention has been used to increase social communication skills,
conversation skills, spontaneous language, use of augmentative and alternative
communication, joint attention, and interaction in play. In the area of behavior, parentimplemented intervention has been used to improve compliance, reduce aggression,
increase eating, and reduce disruptive behaviors.
Q. How do I determine the child's goals to target during parent-implemented
intervention?
A. There are a number of factors that must be considered when determining child goals.
Each child with ASD is unique. Additionally, each family has its own specific
circumstances and needs. Therefore, every effort must be made to ensure goals are
individualized and address parents' areas of concern. Practitioners gain a thorough
understanding of family concerns by conducting interviews, observations, and engaging
in ongoing discussions. Behaviors impacting family functioning should be of high
priority. Teams should consider targeting those behaviors that:
o
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are a safety concern;
cause disruption in the home;
would result in increased interaction (type, frequency, nature, and reciprocity of
interactions);
would increase access to the community; and
require instruction in the home for generalization.
The child's Individualized Education Plan or Individualized Family Service Plan should
be reviewed to identify goals that are appropriate for parents to implement in home
and/or community settings.
Q. What types of intervention strategies should parents use in the home with their
child with ASD?
A.It is best for parents to use evidence-based practices that have been shown to be
effective when implemented by parents. Consult peer reviewed journals to determine
appropriate strategies and gain information regarding the specific features of the
strategy. Further, care should be taken to recommend practices that will not cause
additional stress and that are compatible with parent knowledge, characteristics, and
preferences. Strategies that can be incorporated into typical home routines and
activities should be used whenever possible.
Q. How often should parent-implemented intervention occur?
A. There is not an absolute amount of intervention parents should implement with their
child. The frequency and duration of intervention will be highly individualized and be
based on the unique needs of the family. To the maximum extent possible, parents are
to implement the intervention daily within naturally occurring routines, activities, and
interactions. The practitioner works with parents to develop an intervention plan they
can implement consistently. The intervention plan will outline specifically when and for
how long intervention should take place.
Q. How do I monitor child progress to ensure the parent-implemented
intervention is effective?
A. Parents need to focus on their child. Therefore, a data collection system must be
simple and easy to implement in the context of natural routines while collecting enough
information to determine whether the intervention strategy is effective. To track progress
on acquisition of a skill or reduction of an interfering behavior, there are three
recommended types of data collection appropriate for parents. Log book entries allow
parents to track the implementation of intervention and document changes in behavior
through a brief narrative. Occurrence data allow the parent to document whether the
behavior occurred or did not occur during a specified interval of time. Frequency data
allow parents to document how many times the behavior occurred during a specified
interval of time. Each of these data collection systems require minimal time by the
parents to record pertinent information about the child's performance.
Q. How much training should a parent receive when conducting parentimplemented intervention?
A. Due to each family having a unique set of circumstances, the duration of training will
vary considerably. Training is to be based on family characteristics as well as any
specific preferences the parents express. For example, family commitments,
convenience, travel considerations, costs, as well as other personal factors may impact
the training schedule. Parental learning style, ability to retain knowledge, application,
and generalization of skills will also impact the optimal training program. Another
consideration is the complexity of the intervention plan as some interventions may
require more intensive instruction than others.
Q. How do I reduce training with parents who are showing mastery over the
intervention?
A. As parents demonstrate mastery over training content, practitioners systematically
and slowly reduce the frequency of parent training sessions. As training is decreased, it
is important for practitioners to continue to monitor parent performance to ensure they
are able to provide effective intervention with less support. Once training ends,
practitioners provide ongoing supervision through a variety of strategies designed to
help parents generalize their skills to other behaviors. Such strategies include providing
intermittent training sessions, reviewing written documentation, analyzing videos of
intervention sessions, observing intervention sessions, as well as engaging in ongoing
email or phone correspondence.
Discussion Questions
[ Export PDF with Answers | Export PDF without Answers ]
1. Why is it important for parents of children with ASD to
implement intervention strategies?
A correct answer should include a statement such as:
o
Given the complexity of ASD and the challenges parents face, it is often
beneficial, and necessary, for parents to implement intervention strategies
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o
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in the home or community environment.
Parent-implemented intervention: allows intervention to be initiated at an
earlier age, provides continuous opportunities for learning in a range of
situations, aids in generalization of skills, and provides consistent
management of behaviors.
Direct parent involvement has become widely accepted as part of a total
autism intervention program. Research has demonstrated that when
parents serve as active participants in their child's treatment, positive
effects in child performance occur.
Positive effects can extend beyond child behaviors and impact parents
and families through increased parent confidence, reduced stress, and
improved family functioning.
2. Why is it important to ensure that parent-implemented
intervention includes family-centered planning and involves
the parents in every step of the process?
A correct answer should include a statement such as:
o
o
o
Given the complexity of ASD and the challenges parents face, it is often
beneficial, and necessary, for parents to implement intervention strategies
in the home or community environment.
Parent-implemented intervention: allows intervention to be initiated at an
earlier age, provides continuous opportunities for learning in a range of
situations, aids in generalization of skills, and provides consistent
management of behaviors.
Direct parent involvement has become widely accepted as part of a total
autism intervention program. Research has demonstrated that when
parents serve as active participants in their child's treatment, positive
effects in child performance occur.
o
Positive effects can extend beyond child behaviors and impact parents
and families through increased parent confidence, reduced stress, and
improved family functioning.
3. When training parents, how should you determine the
content and duration of the training program?
A correct answer should include a statement such as:
o
The amount and duration of parent training programs are to be
o
individualized. The goal of parent training is for parents to learn to
implement intervention strategies consistently over time, across settings,
and with a variety of behaviors when direct support from service providers
is no longer available.
The appropriate amount and duration of training should be based on
child, parent, and family characteristics, any specific preferences
expressed by the parents, personal factors including family commitments,
convenience, travel considerations and costs, parents' learning style and
thecomplexity of the intervention plan.
o
It is critical to monitor parent progress as training is conducted. Over time,
parents should be expected to become more independent and master
targeted skills and strategies. As parents demonstrate mastery over
training content, practitioners systematically reduce the frequency of
parent training sessions. Practitioners slowly increase the amount of time
between sessions until a mutually agreed upon interval is reached.
4. Describe a family that you think would benefit from parentimplemented intervention. What child goals need to be
targeted for intervention? What parent goals need to be
targeted for intervention? What family goals need to be
targeted for intervention?
Answers to this question will vary. Each answer should be supported by
content derived from the module, but should vary based on the individual
child and family being described. Generally, when using parentimplemented intervention, goals address areas of concern and priority for
the child, parents, and/or family members. Further, goals are developed
that will have a positive impact on family functioning, will not cause
additional stress to the parents or family, can be implemented by parents
with consistency, and are appropriate for parents to implement in home
and/or community settings.
5. Continuing your answer to the previous question, think of a
family who would benefit from parent-implemented
intervention. Develop an intervention plan that provides
step-by-step instructions for parents so they know how to
implement the intervention. Justify your answer based on
the family's individual characteristics.
Answers to this question will vary. Each answer should be supported by
content derived from the module, but should vary based on the individual
family being described. Generally, the intervention plan should include:
o
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o
o
o
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the target skill or behavior;
who will implement the intervention;
where the intervention should be implemented;
when the intervention should be implemented (the minimum amount of
instruction, both frequency and duration, parents are to implement per
day or week);
how long the intervention should be implemented (define how parents
know when the intervention session or instructional trial is completed);
materials required;
any steps needed to prepare the intervention;
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strategies to be used;
prompting hierarchy to be used; and
reinforcement schedule.
Citation and References
If included in presentations or publications, credit should be given to the authors of this
module. Please use the citation below to reference this content.
Hendricks, D. R. (2009). Parent-implemented intervention for children with autism
spectrum disorders: Online training module. (Chapel Hill, NC: National Professional
Development Center on Autism Spectrum Disorders, FPG Child Development Institute,
UNC-Chapel Hill). In Ohio Center for Autism and Low Incidence (OCALI) Autism
Internet Modules, www.autisminternetmodules.org. Columbus, OH: OCALI.
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