Family Collaboration & Home Programming

1. Family Collaboration & Home Programming Alyssa Blum Elena Garcia-Albea Hannah Kaplan Catherine Taylor

2. Why Parent Collaboration? • Research Findings • Program Models & Approaches • What’s Missing? • Home Programming • Tips for Teachers & Parents • Working with Parents • Providing Positive & Corrective Feedback • How To Handle Potentially Difficult Situations • More Research • Parent / Consumer Feedback & Surveys • Parent Interviews Topics

3. Research Findings • Why? • What? • How? • Considerations

4. WhyParent Collaboration? • Generalization • Home Sweet Home • Stressors • Component of comprehensive programs • Social Validity

5. Why?Generalization • Generalization across settings for children with autism does not typically occur unless programmed for (Handleman and Harris, 1979; Handleman and Harris 1980; Koegel, Egel, Williams, 1980) • Generalization between home and school for children with autism typically requires programming (Harris and Handleman, 1983) • Parents less likely to continue parent training with no generalization (vicious cycle) (McClannahan and Krantz, 1982)

6. Why?Home Sweet Home • Increase on-task time-40 hours (Lovaas, 1987) • Consistency (Iovannone,Dunlap, Huber, Kincaid,2003) • Need “better than average” contingency management skills” (McClannahan and Krantz, 1982)

7. Why?Stressors • Hastings and Johnson, 2001 • Studied predictors of stress levels for parents • of children with autism • Parents of children with autism scored higher on Parent and Family Problems, Depression, and Pessimism than other parents of typically developing or mild to moderate cognitive impairment. • More symptomology, less social support, fewer adaptive coping mechanisms , and less belief in teaching methods correlate with higher scores in Parent and Family Problems, Depression, and Pessimism • We can help provide support groups, suggest importance of existing resources, help them accept that “negative events occur and that they need to be dealt with”, “putting a more positive spin on problems so as not to unnecessarily discourage family members”

8. Why?Stressors • Koegel, Bimbela, Schreibman, 2007 • Parent training in 2 conditions: Which one delivers better family interaction outcomes (lower stress) • Individual Target Behavior: discrete trials, clear tasks and instruction, functional reinforcers for response, shaping and prompting • Pivotal Response Training: child chooses materials, intersperse maintenance, attempts to respond correctly • were also reinforced, use only naturally occurring reinoforcers intrinsic in part of task being taught. • Video of dinnertime was scored through Positive Interaction Rating Scale • PRT condition showed increases in happiness and interest, lower stress during interactions, more positive style of parent-child communication

9. Why?Comprehensive Programs • PCDI, LOVAAS, Alpine Learning Group, Douglas Developmental all have parent collaboration as a major component of their program

10. Why?Social ValidityWolf, 1978 • 1. The social significance of the goals. Are the specific behavioral goals really what society wants? • 2. The social appropriateness of the procedures. Do the ends justify the means? That is, do the participants, caregivers and other consumers consider the treatment procedures acceptable? • 3. The social importance of the effects. Are consumers satisfied with the results? All the results, including any unpredicted ones?

11. Why?Social ValidityWolf, 1978 • “If the participants don't like the treatment then they may avoid it, or run away, or complain loudly. And thus, society will be less likely to use our technology, no matter how potentially effective and efficient it might be.”

12. What types of skills can parent’s benefit from training? • (should be skills that parents want) • DTT • Incidental Teaching (NLP, Time Delay) • Sibling Interaction • Photographic Activity Schedules/ Leisure/Play • Nonfunctional behaviors-aggressive, self-injurious, stereotypy, noncompliance, “voluntary belching”, “playing radio at appropriate volume” • Daily living-feeding, sleeping, chores, phobias • Academics • Community??

13. Howis training facilitated? • Lecture/didactic, model, practice, feedback (McClannahan and Krantz, 1982) • Multiple exemplars • (Crocket, Fleming, Doepke, Stevens, 2005; Koegel, Glahn, Nieminen, 1978) • Pyramidal training (Kuhn, Lerman, Vorndran, 2003)

14. How?McClannahan Krantz, 1982 • Establish a positive parent/home • programmer relationship • trainer serves as prompt and • reinforcer for parent participation • (high levels of reinforcement) • trainer is provided with materials on answers to frequently asked questions and materials related to frequently encountered problems with parent training • adequate follow-up support for parents

15. How?McClannahan Krantz,1982 • Selection of Child Target Behaviors • Parent involvement for children’s • needs and intervention goals: • “informed and non-coerced consent” • Parents often fail to report significant child problems because they have adapted: important to provide home programmers with techniques for obtaining parent participation in interview • Home programmers encourage parents to choose goals that will lead to success initially. Next is dangerous or highly disruptive behaviors

16. How?McClannahan Krantz, 1982 • Treatment Begins in School • Ensures that the kinks are worked out so that parents are not confused and frustrated when they implement at home • Parents come and observe new procedures • Parents rehearse procedures • Parent feedback • Advantages of being at school: eliminates interferences and increases parent attention, availability of professionals, training trainers

17. How?McClannahan Krantz, 1982 • Parent Implementation At Home • Generalization of parent skills from school to home is facilitated when home programmer directly supervises initial use of intervention procedures at home • Parent training in home increases reinforcing value of parents • Trainers must establish guidelines for interactions • Package should be set up with all materials necessary for successfully implementing program • As parents skills improve, more programs can be added

18. How?McClannahan Krantz, 1982Data Collection • Baseline: When parents take baseline data it may eliminate the need for formal intervention • Parents need to submit data weekly in a timely fashion • Many parents were not returning data so a prompting model was created

19. How?McClannahan Krantz, 1982 • Data Prompting Procedure • Data sheets were expected to be in by Monday morning • Administration checked for data sheets Monday morning • If received there were no further prompts and positive praise was often given • If data sheets were not received, home programmer sent note home asking them to send it in tomorrow • If data sheets were received on Tuesday, no further prompts • If data sheets were not received, administrator called parents and have a “brief pleasant conversation”: any illnesses or special problems? • If data sheets were received on Wednesday, no further prompts • If data sheets were not received, phone call from home programmer: problems related to data collection or intervention procedure? Immediate home visit needed? • Continue to check for data sheets

20. McClannahan Krantz, 1982

21. How?McClannahan Krantz, 1982External Review • Professionals from beyond the • treatment agency • Assess individualized home programs delivered by parents: effectiveness and appropriateness • More than 2/3 of the home program were considered successful • None were considered inappropriate

22. How?Multiple ExemplarsCrocket, Fleming, Doepke, Stevens, 2005; Koegel, Glahn, Nieminen, 1978 • Some parents are able to generalize training skill from one intervention to another with little training • Others are unable to do so • Providing multiple exemplars increases generalization • Determining what parents need and do not need multiple exemplars can help with cost efficiency

23. Multiple ExemplarsKoegel, Glahn, Nieminen, 1978

24. How?Pyramidal Training Kuhn, Lerman, Vorndran, 2003 • Primary caregiver trains other family members • More cost efficient way of training multiple family members • Primary caregiver training 1: written and verbal instruction, role play, immediate and delayed feedback • Primary caregiver training 2: taught to give written and verbal instruction, role play, immediate and delayed feedback • Other caregiver training: primary caregiver instructed other caregivers to implement treatment using specified procedures • 1 out of 3 students was successful

25. How?Pyramidal Training Kuhn, Lerman, Vorndran, 2003 • Most caregivers achieved very high accuracy of responses when implementing procedure

26. How?Pyramidal Training Kuhn, Lerman, Vorndran, 2003 • Only one out of the three students exhibited significant decrease in behavior with all three caregivers

27. Family Context (Moes, Frea, 2002) Parental Perspective (Geiger, Smith, Creaghead, 2002) Non-adherence (Allen, Warzak, 2000) Considerations

28. Program Models/Approaches

29. Alpine Learning Group(ALG) Family Involvement • 3 hours per month school observation • Attendance at monthly parent meetings • Home visits by family consultant

30. Family Consultation • Goals: • Ensure stimulus generalization • Assist families in teaching functional skills • Address problem behavior • Ensure parents/caregivers can use the techniques necessary to increase skills and address problem behavior

31. Alpine Offerings • Upon Enrolling: • Offered weekly home visits (during first year) • Participation in a didactic parent training course • Second Year: • Home visitation every other week • Third Year and throughout: • One home visitation per month

32. Assessment of Home and Community Functioning • At time of Enrollment: • Home and community skills assessment conducted. Domains include: self-care, leisure skills, domestic skills, receptive and expressive language, community skills, and problem behavior. • Working Together: • Family consultants work with parents in prioritizing objectives and identifying relevant teaching strategies. • Example: Parent’s may want their child to be involved in a community recreation program- ALG family consultant may be required to visit the recreation site and train personnel there.

33. Parent Visits • ALG- open door policy: • Parent’s can observe as often as they like (minimum of 3 hours is required each month) • Clipboard with questions about their visit * “Did you achieve the goals of your visit?” • Interactions are minimal to none with teaching staff and learner’s during visits- set time aside for training sessions • Communication: * Daily communication book, e-mail or telephone contact

34. Parent Meetings • Monthly group meetings (Parents, directors, and teachers) • Average of 8 held yearly • Topics: ALG policies and procedures, Agency issues, current topics and issues, and general programming issues.

35. Consumer Evaluation • Annual basis: • Formally asked to share concerns or compliments to ALG programs (anonymous consumer evaluation) *Rate overall effectiveness of intervention services by responding to a written questionnaire Example: “How satisfied are you with the amount of cooperation and assistance you have received from ALG administrative staff this school year?”

36. Princeton Child Development Institute(PCDI) • Parents are welcomed for school visits • Home Programmer-regularly visits the home • Consent for new intervention (parents observe, collect data, and implement with assistance) • Program comes home when target skills are acquired at school.

37. Upon returning home from schoolexamples: • A 9-year old learns to remain independently engaged in leisure activities for longer time periods. • A 10-year old helps unloading the dishwasher, setting the table and folding towels. • A 12-year old completes homework assignments with minimal assistance. • A young teenager independently follows an activity schedule to complete a workout (treadmill) • An older adolescent independently wakes up when his alarm clock rings, makes his bed, showers, and shaves with minimal supervision.

38. Behavioral Contracts help the children: • Arrive at school with completed homework assignments, school lunches THEY made the previous evening, wristwatches (appointment-keeping skills), wallets, notes from parents, vacuumed room etc. • These independent performances are valued by parents and they expand the student’s opportunities to hold jobs in the future.

39. Douglass Developmental Disabilities Center(DDDC) • Parent training sessions (first enrolled) • Visits twice a month from a home-school consultant • Focus of training sessions: principles of ABA, elaboration on behavioral teaching, and prioritizing goals • Generalization checks and community based learning experiences.

40. Communication • Weekly phone calls* • Exchanges of data* • Monthly clinics* • Support services • Four times a year evening meetings • Yearly conference (Douglass Organization for Occupational and Related Educational Services DOORS)

41. Summary of all 3 Programs • School visitation offered (some required) • Home visitations are done • Parent meetings/clinics or support groups offered • Training is offered (or required) • *Satisfaction rating and concerns* (not all)

42. Group Discussion What is missing?

43. Home Programming

44. Purpose of Home Programming • Provides training and support for parents • Promotes Generalization of Skills • Teaches families to be successful!

45. Home Programming • Develop a relationship • Design an Individualized Program • Begin instruction in school setting • Begin a home baseline • Parents observe program at school • Parents implement program at school • Parents implement program at home • Follow-up services provided

46. Components of a Home Program • Develop a Parent-Home Programmer Relationship • Introduction • Provide rationales • Describe components of home programming • Expectations • Frequency of visits • Discuss convenient times for home/school visits • Stress importance of collaboration

47. Components of a Home Program • Identify Target Behaviors & Design an Individualized Program • Select annual goals • Prioritize goals • Under-promise and over-deliver • Obtain parental consent on all programs

48. Components of a Home Program • Begin instruction in school setting • Conduct Baseline • Revise response definition • Monitor performance • Examine reinforcement procedures • Consider WHERE instructional procedure will eventually be used. PLAN accordingly.

49. Components of a Home Program • Begin a home baseline • Revise individualized program for home setting • Prepare necessary materials • Data sheets • Reinforcement system • Stop watch / timer • Clipboard • Train parents on data collection • Response definitions • Practice data collection with them (role play) • Take IOA

50. Components of a Home Program • Parents observe program in school • BEFORE parents arrive: • Make sure to fine-tune individualized program if necessary • Observe learner’s performance • Anticipate possible questions