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:

  • 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:

  • 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:

  • 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);
  • increasing joint attention(Rocha, Schreibman, & Stahmer, 2007);
  • increasing language in play(Gillett & LeBlanc, 2007; and
  • promoting the use of functional communication(MoesFrea, 2002).

Examples of behavioral skills that were the focus of interventions in the evidence-based studies include:

  • improving compliance(Ducharme & Drain, 2004);
  • increasing on-task behavior(Ducharme & Drain, 2004; OzonoffCathcart, 1998);
  • reducing aggression(MoesFrea, 2002);
  • increasing eating (Gentry & Luiselli, 2008); and
  • reducing disruptive behaviors(MoesFrea, 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:

  • increasing positive affect in parents(Koegel, Symon, & Koegel, 2002); and
  • increasing parent-child interactions(Aldred, Green, & Adams, 2004).

Who Can Implement Parent-Implemented 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:

  • 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 Parent-Implemented 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, parent-implemented 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:

  • 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:

  • parental and caregiver interviews; and
  • observations of the child, caregiver-child interactions, and daily routines.

When gathering information, practitioners identify:

  • strengths of the child and family;
  • 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.

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:

  • address areas of concern and priority for the child, parents, and/or family members;
  • 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 (MoesFrea, 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:

  • 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:

  • 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:

  • 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
  • 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:

  • 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.
  • Megan will choose between two items that are visually presented to her by pointing 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:

  • parent-child interactions (e.g., shared attention, turn-taking);
  • parents' knowledge of ASD;
  • parents' knowledge and skills related to instructional strategies that promote development and learning; and
  • parents' knowledge of behavior management strategies.

The following example of goals for a parent are both observable and measurable: