Tools for Talking: A Collaborative Approach to Parent Training for Promoting Language Development in Infants and Toddler

1. Tools for Talking:A Collaborative Approach to Parent Training for Promoting Language Development in Infants and Toddlers Kittie Butcher, MSU Extension, Clinton County Katie Strong, MSU, Communication Sciences and Disorders

2. Outcomes of today’s presentation • Identify roles of speech-language pathologist, parent educators, and other team members in training parents on language promotion strategies • Identify available tools for establishing program on promoting language development • Understand the value of collaborating with university level students, early childhood partners, and parent leaders in the training process to promote an interactive team in support of children’s outcomes

3. Traditional Model of Training of Students in Speech-Language Pathology Conflicts with Early Intervention Philosophy and Expectations Traditional Medical Model Family Centered Practice Bruder & Dunst (2005) • Disorder focused • Clinical setting preferred • Clinician driven therapy • Treatment directly focused on ‘patient’ or ‘client’ • Skill set is kept within specialist and shared only with ‘patient’ or ‘client’ • Focus on family support • Natural environments • Cross disciplinary models of service delivery • Service coordination • Development of IFSPs

4. Role of SLP in Early Intervention(ASHA 2008) • Impact of IDEA Part C • Broader focus on children's successful participation in the activities and routines that they engage in at home and in community settings • SLP in variety of roles • Direct service provider, consultant, service coordinator, resource locator, advocate, insurance liaison, administrator, policy maker • Federal mandates and general practice patterns support the goal of enhancing developmental outcomes for the targeted population of infants and toddlers. • Practices featuring family-centered, culturally sensitive, developmentally appropriate, and collaborative components have been deemed desirable • There is no one model or precise set of therapeutic approaches that can guide all early intervention services.

5. Guiding principles for services to infants and toddlers with disabilities (ASHA 2008) • Family centered and culturally and linguistically responsive • Developmentally supportive and promote children's participation in their natural environments • Comprehensive, coordinated, and team based • Based on the highest quality evidence available

6. WKAR Talaris Parenting Counts Grant Supports from Grant • Early Head Start, MSU Extension, Clinton and Eaton Counties & Eaton County Early Childhood Connections • Goal - present parent training to families enrolled in programs • Exploring • Communication • Stress • Emotion Coaching • “Train the trainer" format to expand outreach efforts • Training materials • Videos • Handouts • Website • Research Spotlights • Food • Book for each family to practice with at training and then take home

7. Functions of the SLP in Infant/Toddler and Family Services (ASHA 2008) • The SLP is qualified to provide services to • Families and their children who are at risk for developing, or who already demonstrate, delays or disabilities in language-related play and symbolic behaviors, communication, language, speech, and/or swallowing and feeding. • In providing these services, the SLP may participate in the following primary functions • Prevention • Screening • Evaluation and assessment • Planning, implementing, and monitoring intervention • Consultation with and education for team members, including families and other professionals • Service coordination • Transition planning • Advocacy • Advancing the knowledge base in early intervention.

8. Strategies for supporting and enhancing early child communication (ASHA 2008) Directive Interaction Strategies Responsive Interaction Strategies • Adult structures interactions by selecting ways to elicit a particular communicative act, expecting and supporting the child in the interaction to gain the desired response and often providing a tangible reward for correct performance. • Encourage the child's engagement and interaction, to provide opportunities for child-initiated behavior, and for reciprocity and balanced turn taking with communication partners.

9. Strategies for supporting and enhancing early child communication (ASHA 2008) One size does not fit all • Continuum of service delivery models may include combinations of clinician-delivered and parent-implemented interventions that are individually designed in conjunction with the family for their infant/toddler. • In some instances, it may be determined that the best approach is for the SLP to provide services directly to the child in a one-on-one format • With others, it may be best for the SLP to teach caregivers and/or other team members providing direct services to implement communication and language-enhancing strategies • In yet other cases a combination of these two approaches may be warranted. • Irrespective of the approach, however, it is essential that the SLP and family collaboratively determine what is best given the child's needs and family priorities.

10. Collaborative partnership with the family and other team members (ASHA 2008) Engages Implements Joins Embeds Consults Monitors • The SLP selects among the available approaches and strategies, provides direct implementation of intervention, shares information and resources, offers information to family members to enhance informed decision making, and implements practices that enhance family confidence and competence.

11. Talk Tools Workshop

12. Goals of Talk Tools WorkshopParent Participants • Increase knowledge and value of daily interactions with their child and the impact on language development; language is a turn taking activity that can be embedded in daily routines. • Increase understanding of expressive language and receptive language skills. • Practice language support tools modeled by video clips and hands-on activities with feedback from language coaches.

13. Goals of Talk Tools WorkshopStudent Participants • Expanding experience in sharing information in language intervention • Learning to value of partnering with parents and increasing comfort level with parents • Using parent as a partner model in speech intervention • Increasing knowledge and skills in language intervention • Developing value for collaboration with interdisciplinary providers • Begin exposure to service delivery that differs from traditional medical model • Looking for where language can fit into daily tasks, developing props for parents to practice these skills

14. Selection of Language Coaches • Student volunteers from MSU CSD473 Childhood Phonological Disorders Class • 1 Student Leader - Honors Option • Assisted in organization of materials, pre-workshop trainings, communication with other Language Coaches, wrap-up session • 6 additional students • 1-2nd year MA student • 3-1st year MA students • 2-Undergradaute seniors

15. Language Coach Training Initial 60-minute training Second 60-minute training • Review of language development for 2-3 year olds • Provide additional reading resources • Talarismaterials • ASHA supplements • Practiced modeling language for output • Brainstormed on ideas for activities to use during Talk Tools training • Homework • Reading material • Developing scenarios and equipment for hands on practice with parents • Discussion and Q/A on • What types of children may attend • Disorders • What intervention already done • Assembled practice kits for hands on activities with parents • Practiced with at least 2 different kits • Language modeling strategies • Providing feedback to parents • Explaining concepts to parents

16. Strategies Taught for Modeling Language Repetition Exaggerated Phrasing Slow Rate Anticipatory Pauses Expanding Language Labeling actions & objects

17. Now…It’s your turn to get in the kitchen Share your ideas with someone sitting next to you. Take 5 minutes for this task. • List 5 daily activities that you could model with a family you are currently working with. • Expand one of the activities on your list • What materials are needed? • What are the target words or sounds? • How would this interaction with the parent look?

18. Language Activities • Car ride • Snack time • Taking a bath • Getting dressed in the morning • Getting ready for bed • Making and eating dinner • Laundry • Grocery shopping • Changing a diaper • Watching sports/tv • McDonalds • Reading a book • Playtime • Cleaning

19. Look Who’s Talking – Helpful Parenting Tips(Talaris 2008) • Talk to your little one early, & talk to her often. Get up close so she can see how your lips move. Babies are wonderful copycats. • Use “parentese." It’s a way of drawing out your vowels and changing the tone of your voice from high to low, like “hello baaaabeeeee!” • Don’t be afraid to repeat yourself, over and over again. Favorite songs, nursery rhymes, and the words to favorite books give children lots of practice hearing the sounds of the language. • When she babbles, don’t be embarrassed to babble right back. Babies learn early to take turns with you in making sounds. Think of these as conversations!

20. What a Chatterbox! – Helpful Parenting Tips (Talaris 2008) • Remember that young children recognize & understand many more words than they can say. • Talk to your child often. Point out the cats, balls, & other objects in her life. Talk about what you’re doing throughout the day. Follow her lead and describe the things she points to. • As children learn new words, they may not say them quite right at first. Rather than correcting them, help them by repeating the word after they say it, so that they can hear it again. • Help build a child’s vocabulary by adding details to the objects and events of the day. For example, if she says “ball” you could add, “Yes, that’s right, it’s a ball. It’s a red ball that bounces.” Use a rich vocabulary when you talk about things. • Tired of talking? Try reading. It can be a fun way to be close to your child!

21. Talking on the Go: Everyday Activities to Enhance Speech and Language Development(Dougherty & Paul 2007) • Loaded with everyday activities to enhance speech and language development in four major areas: • building vocabulary • listening and speech production • reading and writing readiness • participation in conversations • Offers simple and fun suggestions for parents and caregivers to use in a variety of settings. Activities are geared for children from birth through age five. • CD included in the book for easy access in printing handouts for parents and caregivers

22. Ongoing Debate… What does evidence say on modeling language (van Kleeck et. al in press) Telegraphic Input Grammatical Input • (Susan is/I’m) feeding the baby • (The baby is) drinking milk (from the bottle) • (This is/Here is) my baby • (Mommy) feed(ing) (baby) • (Baby) drink(ing) (milk) (from) (bottle) • This (is) my baby Dad: Bucket (picks up bucket) Child:Bucket Dad: Bury the bucket (digs hole) Daddy’s going to bury the bucket. (buries in sand) Where’s the bucket? Child: Where? Dad: Where? Where’s the bucket?

23. Language Modeling (van Kleeck et. al in press) Bottom Line: Ongoing support from consultants is vital in helping parents shift their skills based on their child’s needs at the time of intervention. Child: Ball Adult: Say, throw the ball. Child: Throw ball. Adult: Okay, I’ll throw the ball. Lexically and relationally simple, but grammatically well-formed utterances that are highly redundant in structure and content, characteristic of 2-year old language production

24. Talk Tools TrainingNuts and bolts of planning • Participant identification • Language delayed children currently in Early On • Home visit recruiting identified by Early On Consultant • Invitations at initial evaluations for Early On eligibility • Language delayed children, who at the time were not receiving special education services • Flyers sent to Head Start, Great Parents Great Start, Community Play Groups • Advantages • Typical language learners – strategies appropriate for these groups • Parents self identified as wanting support for their child’s language development • Disadvantages • Some parents with children whose needs were more complex that the content of this training (e.g., ASD) • 36 participants – including student language coaches

25. Agenda for “Tools for Talking” Seminar2-hour seminar • Dinner (not included in 2-hour time frame) • Welcome, explanation of grant and community partners (15 minutes) • Introduction of presenters • Instructions for completion of necessary paperwork • Introduction of parents and student participants, each individual will introduce self and share their (child’s) favorite book or toy. • View “Parentese” video clip (30 minutes) • Group discussion of video • Activity of using learned strategies with book (provided by grant) for each parent/s to take home with them. MSU students to assist with small group facilitation. • View “Parentese” video clip again for further discussion • Break (5 minutes)

26. Agenda for “Tools for Talking” Seminar2 hour seminar (continued) • Transition to application to daily life. (30 minutes) • Discussion of balance between “Parentese” - expressive activities and “Keep Talking” – Receptive activities. Practical strategies on how parents can put this into their daily routines with their children. Opportunities for modeling. • Information on speech sound development for parents with questions on articulation • Language modeling activity with MSU students and parents (20 minutes) • Model language using props for daily activities (ideas to include: bath time, meals, getting in car seat, getting dressed, folding laundry, putting away groceries) • View “Keep Talking” video clip – (30 minutes) • Group discussion of video • Language expansion activity with props again with MSU students as group facilitators. Emphasizing level of child to engage in participation. • View “Keep Talking” video clip again for further discussion • Conclusion (5 minutes) • Final questions? • Thank you for attending • Completion of course evaluation

27. Workshop Participant Feedback What did parents think? What did student “language coaches” think”?

28. What is the most important thing you learned from today’s workshop? “To take sentences (phrases) kids are saying and expand to add one or two words to it.” “That all along I was doing the right thing for my son, and that’s reassuring.”

29. List one thing you will do as a result of this workshop “To be more interactive during regular tasks around the house that will make my child feel more involved.” “Slow down, talk directly to my child, and do not talk over their skill level.”

30. What did you like about the workshop? What would you add? • “Being able to communicate with others and connect, share ideas, relate, etc. It’s okay to be a little silly.” • “The students working with the parents was very good.” • “Having the students help reinforce the ideas being presented was beneficial.”

31. What did you like about the workshop? What would you add? • “The center around our relationships with our children.” • “The assistance from grad and undergrad students. It was helpful for me to practice out loud to others to see if what I am doing is correct.”

32. “Parents want info - great turn out.” Feedback from colleague who attended workshop in response to “What is the most important think you learned from today’s workshop

33. What did students say? • Skills learned • Improvising • Just talking to parents • Confidence boost • Reinforced that this is for all children • Liked the 2 trainings – and the recap, just enough information.

34. Our thoughts on this workshop Advantages Future thoughts and ideas • Collaborative effort • Reinforcement of information on home visits, play groups and home visits • Efficiency • Home visits • Consultation with SLP • Parent support and networking • Increased awareness and skills for students • Language coaches • Parent leaders • Other EO staff • Day care providers • Increased partnerships • Universities • Other training centers • Community agencies

35. Before you leave…. Thank you for your participation today! • Take out your postcard from your white envelope of handouts • Write your name and address on the label • Write out a few thoughts on your postcard regarding • How you may use this information in your own setting • Identify potential collaborators

36. References & Resources Apel, K. & Masterson, J.J. (2001). Beyond baby talk. Roseville, CA: Prima Publishing. American Speech-Language-Hearing Association. (2008). Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Technical Report [Technical Report]. Available from www.asha.org/policy. American Speech-Language-Hearing Association (2006). Speech, language, and hearing milestones. DVD Bruder,M.B. & Dunst, C.J. (2005). Personnel preparation in recommended early intervention practices: Degree of emphasis across disciplines. Topics in Early Childhood Special Education, 25(1), 25-33. Childress, D.C. (2004). Special instruction and natural environments. Infants and Young Children 17(2), 162-170. Dougherty, D. & Paul, R. (2007). Talking on the go: Everyday activities to enhance speech and language development. American Speech-Language Hearing Association.

37. References & Resources Talaris Institute (2008). Look who’s talking! Babbling babies are learning how to make sounds! Research Spotlight, Parenting Counts. Talaris Institute (2008). Talking to baby: The magical sounds of “parentese” make it the preferred language for babies. Research Spotlight, Parenting Counts. Talaris Institute (2008). What a chatterbox! Learning new words can happen quickly! Research Spotlight, Parenting Counts. Talaris Research Institute (2005). It’s a wabbit! Rhymes and songs help children learn the sounds of words. Research Spotlight. Talaris Research Institute (2005). Look who’s talking: Babbling babies are learning how to use their lips, tongues, mouths and jaws to make sounds before they make words. Research Spotlight. Van Kleeck, A., Schwarz, A.L., Fey, M., Kaiser, A., Miller, J. & Weitzman, E. (in press). Should we use telegraphic or grammatical input with children in the early stages of language development who have language impairment? A meta-analysis of the research and expert opinion. Journal of Speech-Language Pathology.