The disability experience conference

1. The disability experience conference

2. Training Parents and Staff to Use a Social-Communication Intervention with Children with Autism: A Focus on Treatment Fidelity Johanna Taylor, M.Ed., BCBA Alicia Mrachko, M.Ed., BCBA School of Education, Early Intervention

3. Presentation focus • To present a systematic literature review of fidelity within parent-implemented intervention studies for children with autism. • To present a practicum opportunity for Masters level students in the University of Pittsburgh Early Intervention Program focused on teaching parents to implement an intervention with their toddlers with autism with high levels of fidelity.

4. Treatment fidelity • The degree to which procedures are delivered as designed, has been identified as an integral component of intervention programs. • High levels of treatment fidelity are key to establishing a functional relationship between independent and dependent variables and have been associated with better outcomes, specifically in parent and staff training programs. (Bellg, et al. 2004; Sanetti & Kratochwill, 2009; Wolery, 2011)

5. Fidelity within Parent-Implemented Interventions Implementation Fidelity Degree to which trainer provides strategies to parents Intervention Fidelity • Degree to which parent delivers strategies to child Continued Intervention Fidelity • Degree to which parent provides intervention to child over time and in various settings Intervention Strategies • Intervention procedures parent uses to teach child Intervention Strategies • Intervention procedures parent uses to teach child Implementation Strategies Training delivery methods and characteristics Generalization and improvement in child outcomes over time Improved child outcomes Improved parent outcomes

6. Literature Review: Parent-implemented interventions • Included peer-reviewed studies published between January 2000 and August 2012 diagnosed with autism spectrum disorder (ASD) under seven. • The search resulted in a total of 20 articles. • Aimed to identify: 1) the frequency of learning methods used in training, 2) fidelity measurement procedures, and 3) the extent of reporting on trainer and parent adherence to content.

7. Literature review results • 15 studies reported treatment fidelity: • 2 of the 15 studies reported implementation fidelity. • 14 of the 15 studies reported intervention fidelity. • 6 studies reported high fidelity criteria as 80% or above for parents. • Six studies measured fidelity in 100% of sessions. • The majority of studies used a video-based coding system to rate fidelity. • 2 studies provided examples of the fidelity rating scale.

8. REVIEW RECOMMENDATIONS • Examine the relationship between adult learning methods and child outcomes. • Dependent variables in parent training studies need to measure the rate of behavior change in parents. • Examine the relationships between the three fidelity levels and parent/child outcomes. Bridge the gap between research and practice

9. First steps: Pitt Early Intervention • Parent Toddler Practicum • Bridge research to practice • Train students with model of implementation fidelity, intervention fidelity and child outcomes • Fidelity is monitored. • Not controlled for a research study

10. Pitt Parent-Toddler Practicum (PPTP)fall 2013 • Students are trained in TeachingSocial Communication to Children with Autism (Ingersoll & Dvortcsak, 2010) in a seminar class weekly • Targets: • Social Engagement • Communication • Imitation • Play skills

11. PPTP – Fall 2013 • Students meet weekly with parent/child (2 students per family) and teach parents to implement the strategies. • 2 hour session includes: • didactic training, • written materials with homework, • modeling and • rehearsal with feedback

12. PPTP and FIdelity • Implementation Fidelity: Supervisor rates student training parent • Intervention Fidelity: • Supervisor rates student - feedback • Student self-rates intervention with child • Student rates parent – does not share form with parent, but uses to guide feedback in session • Data collection on goals for child

13. PPTP – Implementation Fidelity

14. PPTP Fidelity – student intervention

15. PPTP Fidelity – Parent Intervention

16. Future Directions • Use PPTP to examine fidelity and child outcomes in research.

17. References • Bellg, A.J., Resnick, B., Minicucci, D.S., Ogedegbe, G., Ernst, D., Borrelli, B., et al. (2004). Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology, 23(5), 443-451. doi: 10.1037/0278-6133.23.5.443. • Ingersoll, B. & Dvortcsak, A. (2010). Teaching Social Communication to Children with Autism. The Guilford Press: New York, NY. • Sanetti, L.M.H. & Kratochwill, T.R. (2009). Toward developing a science of treatment integrity: Introduction to the special series. School Psychology Review, 38(4), 445-459. • Wolery, M. (2011). Intervention research: The importance of fidelity measurement. Topics in Early Childhood Special Education, 31(3), 155-157. doi: 10.1177/0271121411408621.

18. Thank you! • Johanna Taylor, MEd., BCBA, • Alicia Mrachko, MEd., BCBA • Graduate Student Researchers • Department of Instruction & Learning • WW Posvar Hall 5156 • 412-648-1317 • Jpt24@pitt.edu • aam67@pitt.edu