Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities

The following article was not written by myself.  It is excellent and I have included a part of it here; however to read the entire article you will need to click on the link at the end.

"The reproduction of this document is encouraged. Permission to copy is not required.


Th is publication was produced by the Technical Assistance Center on Social Emotional Intervention for Young

Children funded by the Offi ce of Special Education Programs, U. S. Department of Education (H326B070002).

Th e views expressed in this document do not necessarily represent the positions or policies of the Department of

Education. No offi cial endorsement by the U.S. Department of Education of any product, commodity, service or

enterprise mentioned in this publication is intended or should be inferred.

Suggested Citation:

Powell, D. and Dunlap, G. (2010). Family-Focused Interventions for Promoting Social-Emotional Development in

Infants and Toddlers with or at Risk for Disabilities. Roadmap to Eff ective Intervention Practices #5. Tampa, Florida:

University of South Florida, Technical Assistance Center on Social Emotional Intervention for Young Children.

http://www.challengingbehavior.org/

Roadmap to Effective Intervention Practices


Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities

Diane Powell and Glen Dunlap, September 2010

INTRODUCTION

This document is one in a series of syntheses intended to provide summaries of existing evidence related to assessment and intervention for social-emotional challenges of young children and for promoting the social-emotional competence of all young children. The purpose of the syntheses is to offer consumers (professionals, other practitioners, administrators, families, etc.) practical information in a useful, concise format and to provide references to more complete descriptions of validated assessment and intervention practices. The syntheses are produced and disseminated by the OSEP Technical Assistance

Center on Social-Emotional Interventions (TACSEI).

This synthesis considers family-focused services and practices

for promoting social-emotional development of children served in Part C. Its specific focus is on interventions that influence parenting practices for infants and toddlers with or at risk for disabilities.

The general effectiveness of early intervention services in promoting the well-being and development of children and their families has been well established through what Guralnick (1997) has termed “first-generation” research. This includes many strategies including procedures that seek to enhance child development through parent mediated interventions.
The field has now moved on to more specific “second-generation”


research questions: what works for which families and children, under what conditions? Answers to these questions can provide practitioners with specific guidance in the selection,

design and implementation of interventions and practices that produce optimal outcomes for infants and toddlers and their families. A substantial knowledge base exists regarding: 1) the role of positive interactional and parenting practices in shaping social emotional development of infants and toddlers, and 2) specific family-focused strategies and interventions that are effective in addressing social emotional competencies and challenging behavior in young children. The results of this research form the basis for this synthesis.

The development of behavioral/emotional self-regulation and the ability to establish secure attachments and positive relationships

with others during infancy and toddlerhood form the foundation for later social emotional competence and well-being (National Scientific Council on the Developing Child, 2004a). It is through interactions with others, and especially with primary caregivers, that these foundational capacities and competencies emerge. This is true for all children, both typically developing and those with or at risk of disabilities (National Scientific Council on the Developing Child, 2004b, 2008; National Research Council and Institute of Medicine, 2000). Many young children at risk for disabilities or with
identified disabilities develop social emotional competencies on an age-appropriate timeline. For others, deficits in physical, cognitive or communicative abilities may interfere with social emotional development, making early intervention to support effective caregiving practices even more critical.


The important role of family-mediated

strategies in early intervention

is well accepted as evidenced by the inclusion of parenting competencies in early intervention

theories of practice (Odom & Wolery, 2003), the recommended practices of the Division of Early Childhood of the Council for Exceptional Children (Trivette & Dunst, 2005) and in recommendations

for family outcomes in early intervenion (Bailey et al., 2006). In fact, some have argued that ensuring parent involvement and responsiveness is a necessary

component of early intervention without which child directed intervention services are unlikely to be effective (Mahoney, 2009).

The need for early intervention systems to develop the capacity to provide effective parenting interventions to families they serve has taken on heightened importance with the advent of the CAPTA and IDEA mandates for referral to Part C of children involved with the child welfare system. The developmental

and early intervention needs of infants and toddlers served by the child welfare system are well documented (Barth, et al., 2008; Rosenberg & Smith, 2008; Wiggins, Fenichel & Mann, 2007). It is estimated that these new mandates will result in large increases in referrals and enrollment of infants and toddlers with substantiated maltreatment in early intervention

systems (Derrington & Lippitt, 2008).

The teaching of nurturing, responsive interactions and effective parenting practices is central to many interventions that have demonstrated effectiveness in preventing and intervening with parents who are at-risk for child maltreatment (Baggett, Carta, et al., 2010; Chaffin & Friedrich, 2004; Geeraert, Van den Noortgate, Grietens & Onghena, 2004; Hammond, 2008). However, providing such interventions to families involved in child welfare presents new and complex challenges for early intervention systems. These challenges include engaging and serving families with severe and multiple risks; the voluntary

nature of early intervention services in contrast to the mandates and court orders that typically govern family involvement

with child welfare systems; continuity of programming for children who may experience frequent changes of placements

and caregivers; and coordinating with multiple service providers from different systems (Derrington & Lippitt, 2008; Dicker & Gordon, 2006; Rosenberg, Smith & Levinson, 2007; Stahmer, Thorp Sutton, Fox & Leslie, 2008).
While this synthesis does not focus specifically on interventions for maltreatment, it does note when an intervention has been evaluated with children experiencing trauma or maltreatment or with parents for whom child maltreatment is a concern.


PURPOSE, SCOPE AND ORGANIZATION OF THE SYNTHESIS

The purpose of this synthesis is to present summary information

on family-centered practices, and on interventions aimed at promoting positive parenting practices, teaching parenting skills, and influencing parent child interactions that have demonstrated associations with positive social emotional development

for children aged 0-3 years. The synthesis is intended to provide guidance to early intervention personnel, both those providing services to families and children within the Part C system and those working within other service frameworks.

The synthesis does not include interventions aimed primarily at communication and language outcomes for children unless the practices have also been demonstrated to enhance social emotional outcomes. It also does not include large scale, multi-component service delivery models such as Early Head Start, Healthy Families, SafeCare and Nurse-Family Partnership although it should be noted that there is a substantial literature

documenting the efficacy and effectiveness of such models in supporting multi-risk families (Chaffin & Friedrich, 2004; Geeraert et al., 2004; Love et al., 2005). Rather, the focus of this synthesis is on the parenting knowledge, skill sets and practices that have proven effectiveness and can serve as the content of parenting education delivered through these service models.

The synthesis first reviews the evidence for family-centered approaches and practices. Next it examines the literature concerning parent-child interactions and parenting behavior including knowledge gleaned from existing meta-analyses and reviews of the pertinent empirical literature. This includes both content (parenting/caregiving behaviors that impact infant/toddler social emotional outcomes) and methods (practices effective in supporting and changing caregiver behavior). This is followed by a consideration of some of the relevant intervention materials, packages, curricula and models for families of infants and toddlers that are available. Finally, factors to consider in selecting family-focused interventions are discussed.

REVIEW OF THE EVIDENCE

Family-Centered Approach and Practices

Family-centeredness refers to a philosophy of service delivery—an approach to the delivery of services based on values and beliefs regarding how professionals interact with and relate to the families they serve. While there are variations


in how family-centeredness is defined and characterized,

it typically includes: 1) treating families with dignity and respect; 2) practices that are individualized, flexible, and responsive to the expressed needs of families; 3) information sharing that enables families to make informed choices; 4) family choice regarding program practices and intervention options; 5) parent-professional collaboration and partnerships;

and 6) active involvement of family members in the mobilization of services and supports (Dempsey and Keen, 2008; Dunst, Trivette & Hamby, 2008). Similar conceptualizations

emphasizing the primary role of families and family strengths and assets-based practices can be found in DEC’s recommendations for family-based practices (Trivette & Dunst, 2005).

A family-centered approach has been well accepted in the field of early intervention from a philosophical and values-based perspective. Recent reviews and meta-analyses have provided documentation that when service delivery incorporates family-centered practices, outcomes for family and children are improved including parenting capabilities and positive child behavior and functioning (Dempsey & Keen, 2008; Dunst, Trivette and Hamby, 2006, 2007, 2008). Dunst, Trivette and Hamby (2006, 2007, 2008) classified family-centered practices as relational (clinical skills such as active listening, compassion, empathy, respect and beliefs regarding family member strengths and capabilities) or participatory (individualized,

flexible, responsive to family priorities, providing informed choices and family involvement in achieving goals and outcomes) and found in their meta-analyses that participatory

practices were most strongly linked with child outcomes including behavioral outcomes.

We now turn to a consideration of the role of parent responsiveness

and parenting behaviors in the social emotional development of infants and toddlers. Parents or other primary care providers are the key mediators of experience for infants and toddlers, and thus their influence is critical during this period of rapid development

of foundational skills and competencies."

To read or make a copy of the entire article, go to: http://www.challengingbehavior.org/do/resources/documents/roadmap_5.pdf

Autism: The right intervention for the right child

Fortunately we now know enough about Autism to know which children are most likely to benefit from intensive interventions and which types of interventions provide the most benefit for the child, considering: age of child, specific Autism Spectrum diagnosis, functioning level of the child, and willingness of the parent(s) to be active participants in treatment.

In many cases intervention can be provided for even less than $10,000.00 per year. Sometimes significantly less. If the right intervention is provided for three years to the child best suited to benefit from that intervention by a well qualified therapist properly implementing the intervention with active and continuing participation by the parent, government will literally save hundreds of thousands and in some cases even millions of dollars over the life of the child; plus it’s the right thing to do for the child and family. It’s the right thing to do fiscally, therapeutically, and humanely.
If it is the wrong intervention provided by poorly qualified interventionists without active parental(guardian) participation and without well written contextually mediated objectives, it is a disservice to the child, family, and taxpayer.
Depending on the type of intervention, the time spent by the parent can be either time set aside to specifically work on the intervention, a part of the parent and child’s typical routines, or a combination of both.
The right intervention for the right child, correctly implemented, will provide significant improvement in both functioning level and behavior.
More specific detailed information, references, and resources can be found at: http://www.bestoutcomes.blogspot.com/ and some additional linked websites.

Mental Health and Developmental Objectives Treatment Goals and Objectives PowerPoint

For those of you looking for a PowerPoint, I do have one; however, I would need to send it to you. If you wish to leave your name and e-mail address with the request in the comments section I can send you a power point; however, if you start at the beginning of the blog and work forward, that is, for the most part, the same information as is in the PowerPoint. You can bring it on line, start with the first posting and then just continue to click newer post. That will take you through the basics of the PowerPoint. Of course, additional explanation, examples, and activities, with the slides is always helpful.

Specific example of mental health or developmental disability goals and objectives

People often find this site by doing a search using the above words or something similar.

The best way to have a thorough understanding of this process is to start at the very earliest posting in this blog and move forward. The first set of postings review the basics of a training I have presented a number of times on how to write measurable behavioral objectives, goals, and plans. That is the best way to understand this very technical professional process, along with practice and ongoing feedback. You simply are not going to get what you want unless you know where you’re starting from (assessment and data) and have a very specific and clear plan (measurable behavioral objectives, goals, and plans) on how to get there.

With that said, I also realize that our world today often wants quick answers, and while sometimes the answers are simply not quick if you want the best outcomes, I’ll attempt to respond the best I am able.

While there are examples of poorly written objectives as well as well written objectives and a large example of great goals specific to young children with autism, it is impossibly to provide examples of goals and/or objectives for every situation and every child; however, it is possible to ask questions which will bring you to the right goals and objectives. If you want feedback, just write them in the comments without personally identifying information (you can make up a name) and I will respond.

Here are the questions:
What do you want the person to do? (in specific measurable terms)
How will the person know, or what cue will tell him or her it’s time to do what you want done?
How will you know it has been accomplished? (What are the specific criteria for success? {Never average over a long period of time})
That, with the name of the person will give you the basics of the objective.

The goal can be more broad and general and does not have to be quite as measurable.

For example:
Goal: John will come to school clean.
Objective: When John’s alarm rings in the morning at 6:30 A.M. , he will go directly to his drawer and pick out clean clothes, then go to the bathroom, take his shower, and put on deodorant, then the clean clothes he has chosen from his drawer. He will do this five days in a row for two consecutive weeks.

There are a number of assumptions in this goal and objective. John is obviously high functioning and has mastered the basic steps. If not, a more specific objective would have to be written for the steps. Sometimes we might include and reference a chart showing the steps for some functions such as taking a shower; however, this too would still imply that John has basically mastered the process.

The plan would detail others involved in the process to include arranging for clean clothing in the drawer and appropriate reinforcement.

This all starts though; from what you want John to do and then build from there. If you clearly know what you want the person to do. When the person will do it, to include what trigger or cue will tell the person it’s time to do…whatever it is you want the person to do. And if you have a clear and reasonable criteria for success, you have the basic information for your objective. The goal is simply the overarching, umbrella, behavior or skill you are looking for.

Any rote, prewritten, more generic objectives, are simply a terribly disservice to the child (or adult).

MEASURABLE BEHAVIORAL OBJECTIVE TEMPLATE

Please feel free to use the linked templates to create your measurable behavioral objectives and plans. If you have any questions, after completing this, you can click comments below. 

EVIDENCE BASED FAMILY CENTERED PRACTICE

PARENTS/FAMILY, THE CORE AND FOUNDATION OF A CHILD’S CONSISTENT AND LASTING PROGRESS

No matter what the condition, disability, or diagnosis of your child, while outside expertise can have a significant impact, except in some cases of severe medical need, the most significant impact will come from parents, family, and natural supports. Experts can help your child achieve his or her highest potential; but in order to make the most progress, and improve behavior when needed, any intervention must be incorporated into the natural routines of the child and family.

Typically this does not require significant or intrusive changes in family schedule; but instead requires only subtle adjustments in routines and interactions.

The result of this type of intervention is better functional outcomes for your child and increased freedom for the family to do the types of activities they would like to do with their child.



KEY PRINCIPLES of EVIDENCE BASED FAMILY CENTERED PRACTICE

1. Children of all ages learn best through natural routines and everyday learning opportunities.
Key Concepts

* Learning activities and opportunities must be functional, based on child and family interest and enjoyment

* Learning is relationship-based

* Learning should provide opportunities to practice and build upon previously mastered skills

Learning occurs through participation in a variety of enjoyable activities

2. All families, with the necessary supports and resources, can enhance their children’s learning and development.
Key Concepts

* All means ALL (income levels, racial and cultural backgrounds, educational levels, skill levels, living with varied levels of stress and resources)

* The consistent adults in a child’s life have the greatest influence on learning and development-not providers

* All families have strengths and capabilities that can be used to help their child

* All families have resources and assets, but all families do not have equal access to resources

* Supports (informal and formal, natural and paid) can and need to build on strengths and reduce stressors so families are able to engage with their children in mutually enjoyable interactions and activities

3. The primary role of the service provider (Action Plan Manager) is to work with and support family members and caregivers in children’s lives.
Key Concepts

* Providers engage with the significant adults in a child’s life to enhance confidence and competence in their inherent role as the people who teach and foster the child’s development

* Families are valued partners in the relationship with service providers

* Mutual trust, respect, honesty and open communication characterize the family-provider relationship

4. Evidence Based Family Centered Practice, from initial contacts through transition must fit the individual needs of the family and child while honoring family members’ learning styles, values, and beliefs.
Key Concepts

* Families are active participants in all aspects of services

* Families are the ultimate decision makers in the amount, type of assistance and the support they receive, within the confines of rule, law, and budget.

* Child and family needs, interests, and skills change; the child’s plan must be fluid, and revised accordingly

* The adults in a child’s life each have their own preferred learning styles; interactions must be sensitive and responsive to individuals

* Each family’s culture, spiritual beliefs and activities, values and traditions will be different from the service provider’s (even if from a seemingly similar culture); service providers must respect the family and seek to understand, not judge

* Family “ways” are more important than provider comfort and beliefs (with the exception of concerns about abuse/neglect)

5. Children’s and families’ needs and priorities determine functional outcomes, natural reinforcement, contextually mediated objectives, and appropriate supports and services, and appropriate supports and services,

Key Concepts

* Functional outcomes improve participation in meaningful activities

* Natural, logically related reinforcement, improves outcomes for families and children

* Functional outcomes build on natural motivations to learn and do; fit what’s important to families; strengthen naturally occurring routines; incorporate natural reinforcement; enhance natural learning opportunities

* The family understands that strategies are worth working on because they lead to practical improvements in child &; family life

* Functional outcomes keep the team focused on what’s meaningful to the family in their day to day activities

* Contextually mediated objectives provide better outcomes for families and children, that are the direct result of those services.

6. The family’s priorities, needs, and interests are addressed most appropriately by a primary provider who represents and receives team and community supports.

Key Concepts

* The team can include friends, relatives, and community support people, as well as specialized service providers.

* Good teaming practices are used

* One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests, strengths, and demands in a family’s life

* The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice are compatible with family life and won’t overwhelm or confuse family members

7. Interventions must be based on Key Principles of Evidence Based Family Centered Practice, validated practices, best available research, and relevant laws and regulations.

Key Concepts

* Practices are based on and consistent with Key Principles of Evidence Based Family Centered Practice

* Providers should be able to provide a rationale based on research specific to the child’s age, diagnosis, and functioning level, for practice decisions

* Programs use current research to guide practices

* Practice decisions must be data-based and ongoing evaluation is essential

* Practices must fit with relevant laws and regulations

* As research and practice evolve, policies must be amended accordingly

(The Key Principles are based on the Key Principles of practice of the Idaho Infant Toddler Program, which in tern are based on the national: AGREED UPON MISSION AND KEY PRINCIPLES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS
Developed by the Workgroup on Principles and Practices in Natural Environments, and found at:
http://www.nectac.org/~pdfs/topics/families/Finalmissionandprinciples3_11_08.pdf


Natural and artificial reinforcement

http://en.wikipedia.org/wiki/Reinforcement#Natural_and_artificial_reinforcement

Natural Reinforcement: A Way to Improve Education.

http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ448619&ERICExtSearch_SearchType_0=no&accno=EJ448619



CURRENT BEST PRACTICE IN AUTISM TREATMENT

The National Autism Center’s

National Standards Project

Findings and Conclusions

2009


Please see: http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf

Important note: This does not include the research on the Denver Model; which to date, has perhaps demonstrated the best results for a wider range of young children with Autism, using the most rigorous research methodology. Or P.L.A.Y. which is in the process of completing it’s current research project and which has shown great promise in preliminary study.

Supporting Materials and Research for

Evidence Based Family Centered Practice

Can Children with Autism Recover? If So, How?
http://www.springerlink.com/content/f080797r4t45jm16/

Abstract Although Autism Spectrum Disorders (ASD) are generally assumed to be lifelong, we review evidence that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome. Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and attention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial.

Relationship Focused Intervention (RFI): Enhancing the Role of Parents in Children’s Developmental Intervention (2009)
http://en.scientificcommons.org/52625021

Abstract
This article describes Relationship Focused Intervention (RFI) which attempts to promote the development of young children with developmental delays and disabilities by encouraging parents to engage in highly responsive interactions during daily routines with their children. This approach to intervention is based upon the Parenting Model of child development and was derived from research on parent-child interaction. Evidence is presented that RFI can be effective both at helping parents to learn how to interact more responsively with their children as well as at promoting children’s development and social emotional function. The argument is made, that although there is no research comparing the effectiveness of RFI to interventions derived from the Educational model of child development which places less emphasis on parent involvement and stresses direct instructional activities, still the effectiveness of all interventions appears to be related to the degree to which parents are involved in and become more responsive with their children. As such RFI may not simple be an alternative model for early intervention, but may reflect a paradigm shift pointing to the effectiveness of parent involvement and responsive interaction as key elements of early intervention practice.

Parent training: A review of methods for children with autism spectrum disorders
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B83X1-4VVN510-1&_user=10&_coverDate=12%2F31%2F2009&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1506906194&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5b2923bd37e3ee737cc7d3de0cf5acfc&searchtype=a

Abstract
Autism Spectrum Disorders (ASD) are common in the general childhood population, and are both serious and lifelong. Tremendous strides have been made in the treatment of these ASD in recent years, particularly with respect to psychological interventions. Given the considerable amount of time and cost involved in providing these interventions, parent training and involvement is a particularly appealing intervention option. This paper is a review and status report on evidence based methods that are available for training parents of children with ASD as therapists. Current trends and future directions are discussed.

Can one hour per week of therapy lead to lasting changes in young children with autism?
http://aut.sagepub.com/cgi/content/abstract/13/1/93

Deficits in attention, communication, imitation, and play skills reduce opportunities for children with autism to learn from natural interactive experiences that occur throughout the day. These developmental delays are already present by the time these children reach the toddler period. The current study provided a brief 12 week, 1 hour per week, individualized parent—child education program to eight toddlers newly diagnosed with autism. Parents learned to implement naturalistic therapeutic techniques from the Early Start Denver Model, which fuses developmental- and relationship-based approaches with Applied Behavior Analysis into their ongoing family routines and parent—child play activities. Results demonstrated that parents acquired the strategies by the fifth to sixth hour and children demonstrated sustained change and growth in social communication behaviors. Findings are discussed in relation to providing parents with the necessary tools to engage, communicate with, and teach their young children with autism beginning immediately after the diagnosis.

Effectiveness of a Home Program Intervention for Young Children with Autism
http://www.springerlink.com/content/w522865070k20373/

Abstract This project evaluated the effectiveness of a TEACCH-based home program intervention for young children with autism. Parents were taught how to work with their preschool autistic child in the home setting, focusing on cognitive, academic, and prevocational skills essential to later school success. To evaluate the efficacy of the program, two matched groups of children were compared, a treatment group and a no-treatment control group, each consisting of 11 subjects. The treatment group was provided with approximately 4 months of home programming and was tested before and after the intervention with the Psychoeducational Profile-Revised (PEP-R). The control group did not receive the treatment but was tested at the same 4-month interval. The groups were matched on age, pretest PEP-R scores, severity of autism, and time to follow-up. Results demonstrated that children in the treatment group improved significantly more than those in the control group on the PEP-R subtests of imitation, fine motor, gross motor, and nonverbal conceptual skills, as well as in overall PEP-R scores. Progress in the treatment group was three to four times greater than that in the control group on all outcome tests. This suggests that the home program intervention was effective in enhancing development in young children with autism.

Parent training: A review of methods for children with developmental disabilities
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VDN-4VPCVH0-1&_user=10&_coverDate=10%2F31%2F2009&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1506906710&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2f5e98d220fda0e9ae7a45d6478013b3&searchtype=a

Abstract
Great strides have been made in the development of skills and procedures to aid children with developmental disabilities to establish maximum independence and quality of life. Paramount among the treatment methods that have empirical support are treatments based on applied behavior analysis. These methods are often very labor intensive. Thus, parent involvement in treatment implementation is advisable. A substantial literature on parent training for children has therefore emerged. This article reviews recent advances and current trends with respect to this topic.

Pilot study of a parent training program for young children with autism
http://aut.sagepub.com/cgi/content/abstract/11/3/205

The PLAY Project Home Consultation (PPHC) program trains parents of children with autistic spectrum disorders using the DIR/Floortime model of Stanley Greenspan MD. Sixty-eight children completed the 8—12 month program. Parents were encouraged to deliver 15 hours per week of 1:1 interaction. Pre/post ratings of videotapes by blind raters using the Functional Emotional Assessment Scale (FEAS) showed significant increases (p 0.0001) in child subscale scores. Translated clinically, 45.5 percent of children made good to very good functional developmental progress. There were no significant differences between parents in the FEAS subscale scores at either pre-or post-intervention and all parents scored at levels suggesting they would be effective in working with their children. Overall satisfaction with PPHC was 90 percent. Average cost of intervention was $2500/ year. Despite important limitations, this pilot study of The PLAY Project Home Consulting model suggests that the model has potential to be a cost-effective intervention for young children with autism.

Using Family Context to Inform Intervention Planning for the Treatment of a Child with Autism
http://pbi.sagepub.com/content/2/1/40.abstract

Abstract:
Children with autism often engage in problem behavior that can be highly disruptive to ongoing family practices and routines. This case study demonstrated child and family outcomes related to two distinct treatment approaches for challenging behavior (prescriptive vs. contextualized) in a family raising a child with autism. The processes of behavior change directed either solely by the interventionist (prescriptive) and in collaboration with the family (contextualized) were compared. The family-directed intervention involved an assessment of family context (i.e., via discussion of daily routines) to inform the design of a behavioral support plan. Information gathered from the assessment of family routines was used to (a) help select specific behavioral strategies that were compatible with family characteristics and preferences, and (b) construct teaching methods that fit with the family's ongoing practices, routines, and interaction goals. More favorable results (i.e., reductions in challenging behavior, an increase in on-task behavior) were observed within the contextualized treatment-planning phase than were observed within the prescriptive treatment-planning phase. The procedures and results are discussed in relation to the emerging literature documenting the importance of contextualizing behavioral supports applied within

Benefits to Down's syndrome children through training their mothers.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1544420/

Abstract: This study investigated the hypothesis that training of mothers with Down's syndrome children would be beneficial both to the child and parents. The mothers were taught behaviour modification techniques based on learning theory and were given group discussions on dealing with their family or personal problems. The subjects were 16 mothers with a Down's syndrome child, divided into two groups on the basis of their child's sex and chronological and mental ages. The Griffiths Scale was used for assessment. The mothers in the treatment group received 12 sessions of training and group counseling over a 6-month period, whereas the control mothers received no additional attention except the usual routine from the general practitioner and health visitor. The result show clear gains to both the child and mother in the treatment group. The child improved, especially in language development as well as in the other areas, and the mother-gained more confidence and competence in her daily management of the child.

Natural Learning Environment Practices
http://www.coachinginearlychildhood.org/nlepractices.php

Common Mispercep­tions about Coaching in Early Intervention
http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf

Natural Supports

This represents only a very small sample of the vast research available on the subject of Evidence Based Family Centered Practice

Assessment: Targeting the treatment towards all the issues, not just the child.

When a child presents with Autism, or almost any developmental disability or social emotional issue, the tendency is often to immediately provide intervention to the child.

First, you must have a good standard assessment for diagnosis and treatment. So many developmental disabilities and mental illnesses today have well researched prescriptive treatment that it is often a huge waste of time and money when the wrong intervention is used for the child; however, just because you have the completed the right assessments for diagnosis, does not mean you have completed all the needed assessment for treatment.

In any situation where the issue/behavior is a significant issue, you must also complete a Functional Analysis of Behavior. Often, the most important intervention is not targeted directly at the child; but at the environment and setting events.

The following information is as applicable to the home as it is to the classroom.
http://www.challengingbehavior.org/do/pyramid_model.htm
http://www.challengingbehavior.org/do/resources/documents/yc_article_7_2003.pdf

For additional information see postings on this website on Functional Analyses of Behavior (Functional Behavioral Assessments) and Setting Events.

More progress for less money. Best practice, affordable therapy/intervention for Mental Health or Developmental Disabilities. Economic, Best Practice for Government Agencies and Schools: Coaching

Many states are considering making significant cuts to the amount of money they spend on therapy/intervention for children and teens with developmental disabilities or mental health diagnoses.


There is a cost effective way to help children and families; however, it requires parental responsibility. Some have argued that some families can’t be active participants in their children’s therapy. That argument is bogus and has been proven false by research. Almost ANY family can actively participate in their child’s therapy/intervention.

For children with Autism, one solution is P.L.A.Y. therapy. http://www.playproject.org/media/pdfs/PilotStudy_PLAYProject.pdf

The cost per child is approximately $2,500.00 per year as of 2008. Another option is Coaching.
P.L.A.Y. is a form of coaching; however, there are many forms of coaching in therapy and intervention.

While most of the research revolves around early childhood, there is supportive literature for this practice with older children, teens, and even adults. In fact, if you go to the bottom of: http://responsiblepracticalparenting.blogspot.com/ and use the Google Parenting and Google Scholar search engines, using key words such as: coaching, intervention, early, childhood, teens, therapy, you will find a wealth of information and research.

If you are currently spending $25,000.00 to $100,000.00 per year per child and getting poor results, consider coaching through one of the established research based models. Typically for $10,000.00 per year per child or less, you can actually get better results.

As mentioned, there are other ways of doing coaching; but the bottom line is, it is significantly more effective and significantly less expensive.

Full family centered involvement with contextualized routine based interventions in the environments natural to the child and family is the most effective way to significantly improve behaviors in the home and other natural environments and make significant progress based on the natural routines of the child and family.

If your state, school, or government entity is considering significant cut-backs in services, encourage those who make these decisions to consider a coaching model.

If we do not do something effective, the unintended consequences are going to be even more expensive.

Supplemental Materials:
http://www.coachinginearlychildhood.org/nleconcepts.php
http://www2.ku.edu/~kskits/ta/Packets/UsingPrimaryService/References.pdf
http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf
http://www.fippcase.org/


See: http://qualitytreatmentforchildren.blogspot.com/ & http://currentautismresearchhopeforautism.blogspot.com/ for additional information.