Assignment: Naturalistic Language Interventions

Assignment: Naturalistic Language Interventions

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Assignment: Parent Implemented Naturalistic Language Interventions

Early language development is largely impacted by every- day conversations between parents and their children (Hart & Risley, 1995; Kaiser & Roberts, 2011; Roberts & Kaiser, 2011). Language development is likely directly related to the quality and quantity of the language input received, which occurs within the context of social interactions and is

Table 1. LAPE Evidence-Based Family Coaching Practices.

Evidence-based Practices LAPE example

1. Individualized approach to family coaching The individual home sessions were structured according to the family’s needs. Parents chose the strategies they wanted to practice.

2. Focus on daily routines with the family’s materials in natural settings

The individual home sessions were scheduled during routines the family identified. The coaches supported the parents in using the strategies during daily routines.

3. Focus on supporting family participation and building family capacity and competence

Initial group sessions focused on early language and play development and how parent interactions can influence development. Group sessions also allowed parents to support each other’s efforts at home. Improvements in caregiver confidence were measured over time.

4. Identify functional child outcomes a discussion about the family’s priorities

At the beginning of the training we asked parents to identify a functional goal for their child. To meet this goal, parents identified strategies they wanted to work on and specific words they wanted to help their children say each week.

5. Works directly with the caregiver and uses effective coaching strategies

During individual sessions, targeted strategies were reviewed and parents practiced the strategies with their children while their coach observed. If needed, coaches modeled strategies. After each practice activity, parents reflected on their use of the strategies and ways they could incorporate them into daily routines. Then coaches provided specific feedback, support, and suggestions.

6. Focus on caregiver responsivity and caregiver–child interactions

Parents were taught to identify times when their children were initiating communication. Then they were taught take conversational turns with their children during play and daily interactions.

7. Use of videos for demonstration and reflection

Parent–child interactions were recorded prior to intervention. After the responsive strategies were introduced, parents watched the videos and rated their use of each strategy. Then the coaches reviewed and discussed the videos again with the parents.

8. Identify opportunities to practice across the day and in between visits

At the end of each group and individual training, parents identified strategies they will use and target words they will teach in the coming week.

9. Systematic progress monitoring Parents completed a daily log to rate their use of each strategy and a weekly log to note their child’s progress on targeted vocabulary.

Note. LAPE = Language and Play Everyday. Source. Evidence-based Practices are adapted from Dunst and Kassow (2007), McWilliam (2010), Powell and Dunlap (2010), Rush and Shelden (2011).

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individually determined. Parent education programs that focus on supporting child language development can be highly effective (Kaiser & Roberts, 2011). Naturalistic lan- guage interventions focus on teaching parents to embed language-enhancing strategies into daily routines and play. Common characteristics of naturalistic teaching strategies include: using direct and natural reinforcement, focusing on functional skills, using a variety of materials, and following the child’s interests and lead (McGee, Morrier, & Daly, 1999). The use of these strategies allow for authentic learn- ing experiences and greater generalization of language skills (Kashinath, Woods, & Goldstein, 2006). Research indicates that naturalistic teaching strategies are feasible— meaning parents can implement them with high fidelity, and effective—meaning they are functionally related to improvements in child language development (Roberts & Kaiser, 2011).

Evidence-based naturalistic teaching approaches include enhanced milieu teaching (EMT; Hancock & Kaiser, 2006) and responsive education-prelinguistic milieu teaching (RE-PMT; Warren et al., 2006). EMT is a hybrid approach that incorporates environmental arrangement, responsive interaction, and milieu strategies to increase expressive and pragmatic language in children with emerging language skills. Several studies suggest that parent-implemented EMT is an effective and efficient intervention for late- talking toddlers (Kaiser, Hancock, & Nietfeld, 2000; Kashinath et al., 2006; Roberts & Kaiser, 2011). In addi- tion, parents consistently learned the strategies and reported feeling confident in their ability to use EMT following training (Peterson, Carta, & Greenwood, 2005). RE-PMT uses the same intervention strategies as EMT but focuses on teaching prelinguistic language skills (i.e., intentional, non- verbal communication). The research on RE-PMT indicates it also is an effective, parent-implemented intervention for children (Fey et al., 2006; Yoder & Warren, 2002).

Research also supports implementing these approaches with parents during individual and group trainings. Group training, with individualized supports, allows information to be shared in a quick and concise format, provides space and time for shared parent support, and might be less costly (Carter et al., 2011; Kaiser, Hemmeter, Ostrosky, Alpert, & Hancock, 1995). However, the most popular group training programs (e.g., Hanen Centre, 2011) are costly for interven- tionists, not well suited for current Part C systems, and might not be effective for all families because they are not easily individualized (Carter et al., 2011). Furthermore, although there are empirically supported intervention approaches for enhancing parents’ capacity to promote their child’s language development, there is a significant research to practice gap. Recent research indicates evidence-based practices are not being implemented in EI, and the amounts of services families receive are fewer than recommended (Dunst & Trivette, 2009b; Hebbeler, Spiker, & Kahn, 2012;

Stahmer & Mandell, 2007). Additional research is needed to examine strategies for improving parent education curri- cula that can be cost-effective and efficiently implemented by practitioners within a variety of community settings.

The purpose of this manuscript is to describe the devel- opment of a parent-education program, Language and Play Everyday (LAPE). The first and second authors developed LAPE to address a community need for an efficient and cost-effective, community-based parent-education pro- gram, focused on increasing parents’ use of naturalistic language-enhancing strategies and improving communica- tion skills in their toddlers’ with expressive communication delays. The community need paralleled national research on Part C EI services. That is, research has shown that the ser- vices families receive through Part C were fewer than rec- ommended, and not all eligible children and families were being served (Dunst & Trivette, 2009b; Hebbeler et al., 2012; Hume, Bellini, & Pratt, 2005). For example, the National Early Intervention Longitudinal Study (NEILS; Hebbeler et al., 2007) found families received an average of 1.5 hours of Part C services per week, families missed about one fourth of their scheduled visits, and the amount of fund- ing per child has decreased by an estimated 50% over the last decade (Hebbeler et al., 2012). This report concluded that overall, families received relatively few face-to-face services. Moreover, for 44% of the families, the services focused only on the child, rather than the family, which is unlikely to have a larger impact on the child’s development. LAPE was developed to address this community need by using a cost-effective, group format to teach parents to: (a) identify and respond to their children’s communication attempts, (b) provide opportunities for their toddlers to communicate, and (c) use developmentally appropriate lan- guage. Specific strategies and supports were identified based on the individual needs of each child and family. The components of the program, evaluation procedures, pro- gram outcomes, and implications for future research and practice are described.