teaching parents new skills to support their young children's

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9 Teaching Parents New Skills to Support Their Young Children’s Development Ann P. Kaiser, PhD; Terry B. Hancock, PhD Teaching parents new skills to support the development of their young children with developmen- tal disabilities has been controversial in the field of early intervention even though there is considerable empirical evidence supporting this approach. We propose that teaching parents to implement family-centered interventions can be highly effective by: (a) allowing parents to choose when to learn new skills; (b) teaching parents strategies that are empirically based, well-matched to their child’s developmental needs, and intended to be implemented in naturally occurring interactions between parents and children; and (c) teaching parents in a skillful and individualized manner. We outline the skills that parent educators need in order to be effective, then, we discuss a model for preparing professionals to teach parents. Throughout this article, we draw on empirical data and anecdotal examples from our ongoing research on teaching parents naturalistic language intervention strategies. Key words: naturalistic language interventions, parent education, parent- implemented interventions, professional training P ARENTS ARE their children’s first and most enduring teachers. In the course of normal development, parents support their children’s language, social, and academic development (Hart & Risley, 1995). There is systematic evidence over the last 30 years that teaching parents specific strategies to support their children’s development can be effective. Beginning in the late 1960s, researchers have reported positive effects of parents’ imple- mentation of behavior management strategies with children who have conduct disorders (Dumas, 1989; Webster-Stratton & Hammond, 1990), mental retardation (Kaiser, Hemmeter, Infants & Young Children Volume 16, Number 1, pp. 9–21 © 2003, Lippincott Williams & Wilkins, Inc. Ann P. Kaiser, PhD Professor Terry B. Hancock, PhD Research Assistant Professor Department of Special Education Vanderbilt University Nashville, Tennessee This investigation was supported in part by grants from NIMH (MH5429), ACYF (90YM002), NICDS (P50DC03282), and NICHD (30HD15052 & 5R01HD27583–05). We gratefully acknowledge the support of the Milieu Teaching Group at Vanderbilt University and the collaboration of parents and children who participated in our research. & Hester, 1996), and autism (Schreibman, Kaneke, & Koegel, 1991), as well as children who have been labeled at-risk because of poverty (Wahler, 1980) and children who are developing typically but present a range of difficult behaviors (Kazdin, Esveldt-Dawson, French, & Unis, 1987). A variety of training methods, including directly training indi- vidual parents in behavioral procedures, teaching parents in groups, and using written manuals with limited direct consultation, have been shown to be effective in changing parent and child behavior (Kaiser, Hemmeter, Ostrosky, Alpert, & Hancock, 1995; Kovitz, 1976; Wahler, Cartor, Fleischman, & Lambert, 1993; Webster-Stratton, 1992). Parents of de- velopmentally delayed and high-risk infants have been taught to increase systematically their responsiveness and consistency in read- ing infants’ behavior cues with resulting im- provements in the children’s very early social communication (Barnard, 1997; Seifer, Clark, & Sameroff, 1991). Finally, parents have learned to implement a range of naturalistic language intervention strategies successfully (Hemmeter & Kaiser, 1994). In spite of this evidence, interventions to teach parents specific skills to support child Author's responses to comments and questions about this article http://depts.washington.edu/isei/review/response_kaiser.htm

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Page 1: Teaching Parents New Skills to Support Their Young Children's

Teaching Parents New Skills 9

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Teaching Parents NewSkills to Support Their YoungChildren’s Development

Ann P. Kaiser, PhD; Terry B. Hancock, PhD

Teaching parents new skills to support the development of their young children with developmen-tal disabilities has been controversial in the field of early intervention even though there isconsiderable empirical evidence supporting this approach. We propose that teaching parents toimplement family-centered interventions can be highly effective by: (a) allowing parents to choosewhen to learn new skills; (b) teaching parents strategies that are empirically based, well-matchedto their child’s developmental needs, and intended to be implemented in naturally occurringinteractions between parents and children; and (c) teaching parents in a skillful and individualizedmanner. We outline the skills that parent educators need in order to be effective, then, we discussa model for preparing professionals to teach parents. Throughout this article, we draw on empiricaldata and anecdotal examples from our ongoing research on teaching parents naturalistic languageintervention strategies. Key words: naturalistic language interventions, parent education, parent-implemented interventions, professional training

PARENTS ARE their children’s first andmost enduring teachers. In the course of

normal development, parents support theirchildren’s language, social, and academicdevelopment (Hart & Risley, 1995). There issystematic evidence over the last 30 years thatteaching parents specific strategies to supporttheir children’s development can be effective.Beginning in the late 1960s, researchers havereported positive effects of parents’ imple-mentation of behavior management strategieswith children who have conduct disorders(Dumas, 1989; Webster-Stratton & Hammond,1990), mental retardation (Kaiser, Hemmeter,

Infants & Young ChildrenVolume 16, Number 1, pp. 9–21© 2003, Lippincott Williams & Wilkins, Inc.

Ann P. Kaiser, PhDProfessorTerry B. Hancock, PhDResearch Assistant ProfessorDepartment of Special EducationVanderbilt UniversityNashville, Tennessee

This investigation was supported in part by grants fromNIMH (MH5429), ACYF (90YM002), NICDS(P50DC03282), and NICHD (30HD15052 &5R01HD27583–05). We gratefully acknowledge thesupport of the Milieu Teaching Group at VanderbiltUniversity and the collaboration of parents andchildren who participated in our research.

& Hester, 1996), and autism (Schreibman,Kaneke, & Koegel, 1991), as well as childrenwho have been labeled at-risk because ofpoverty (Wahler, 1980) and children who aredeveloping typically but present a range ofdifficult behaviors (Kazdin, Esveldt-Dawson,French, & Unis, 1987). A variety of trainingmethods, including directly training indi-vidual parents in behavioral procedures,teaching parents in groups, and using writtenmanuals with limited direct consultation, havebeen shown to be effective in changing parentand child behavior (Kaiser, Hemmeter,Ostrosky, Alpert, & Hancock, 1995; Kovitz,1976; Wahler, Cartor, Fleischman, & Lambert,1993; Webster-Stratton, 1992). Parents of de-velopmentally delayed and high-risk infantshave been taught to increase systematicallytheir responsiveness and consistency in read-ing infants’ behavior cues with resulting im-provements in the children’s very early socialcommunication (Barnard, 1997; Seifer, Clark,& Sameroff, 1991). Finally, parents havelearned to implement a range of naturalisticlanguage intervention strategies successfully(Hemmeter & Kaiser, 1994).

In spite of this evidence, interventions toteach parents specific skills to support child

Author's responses to comments and questions about this articlehttp://depts.washington.edu/isei/review/response_kaiser.htm

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development have been controversial in thearea of early intervention (Mahoney et al.,l999). Several arguments against teaching par-ents strategies for early intervention havebeen proposed: (a) parents should not beasked to abandon their primary role as aparent in order to be their child’s teacher(Turnbull & Turnbull, 1990); (b) children’sdevelopment is best served by providingfamily-centered services that support parentsand address the needs they identify as mostcritical (Dunst & Leet, 1987); and (c) it isstigmatizing to parents when professionalspresume that parents do not have sufficientskills to support the development of theirchildren with disabilities (Greene, 1999).While there is theoretical and empirical evi-dence that clearly supports a family-systemsapproach to early intervention (Dunst, 1999),there is no empirical evidence indicating thatteaching parents strategies to support theirchildren’s development necessarily conflictswith a family-centered approach to early inter-vention (Kaiser et al., 1996).

Given the considerable empirical data indi-cating that teaching parents more effectiveinteraction strategies can improve develop-mental outcomes and decrease problem be-havior, we have chosen to focus on theconditions for optimizing parent teachingwhen professionals choose this approach.First, we discuss when teaching parents newstrategies for supporting the development oftheir children is a good idea. Next, we outlinethe skills that parent educators need in orderto be effective teachers of adults. Then, weprovide specific strategies parent educatorsshould consider in planning for effective inter-ventions with parents. Lastly, we discuss amodel for preparing professionals to teachparents. Throughout this article, we draw onempirical and anecdotal examples from ourongoing research on teaching parents strate-gies for naturalistic language teaching.

Since 1983, the authors have been engagedin research on naturalistic strategies for sup-porting early communication in young chil-dren with developmental disabilities. Ourapproach, milieu teaching, involves teachingchildren new communication forms in the

context of everyday conversation. Child inter-ests and activities set the occasion for teach-ing. The adult models new language, expandschild’s utterances, and gives meaningful com-municative feedback to the child’s attempts tocommunicate. In addition, the adult uses (egmodeling, manding and modeling, time de-lays, and incidental teaching) to prompt func-tional production of new communicationforms by the child (see Delaney & Kaiser,2001; Hemmeter & Kaiser, l994; Kaiser, l998;Kaiser, Hancock, & Nietfeld, 2000). Becausethis approach is designed to be used inconversations and in everyday interactions, itis ideally suited for parents to use to supporttheir children’s communication development.

We have examined applications of milieuteaching by therapists, parents, and classroomteachers, but our research has focused primarilyon examining changes in child communicationskills resulting from parent-implemented milieuteaching and related naturalistic communica-tion approaches (Delaney & Kaiser, 2001; Kai-ser, 1993; Kaiser et al., 2000). We have alsoconducted studies addressing strategies fortraining professionals to work with parents(Hester, Kaiser, Alpert, & Whiteman, 1996;Kaiser, Hester, Alpert, & Whiteman, 1995). Inthe course of conducting these studies, we havetrained more than 40 special educators, psy-chologists, social workers, and speech patholo-gists who have then taught over 200 parents inour programs. Participants involved in thesestudies have included preschool children (ages21⁄

2 to 6) with a wide range of disabilities

(language delays, global developmental delays,behavior problems, mental retardation, au-tism), and their mothers, fathers, grandparents,and nannies from a wide range of economic andeducational backgrounds. Typical parents inour research have been mothers with slightlymore than a high school education who workfull time and who have two children.

To date, approximately, 94% of the familieswho began the parent-implemented milieuteaching program with us have completed it. Ofthose parents who completed the intervention,almost all (97%) reached criterion levels ofperformance during teaching sessions while theparent interventionist was present. Parents gen-

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eralized some of their newly trained skills tointeractions at home, although there has beenvariability in the extent to which skills weregeneralized and maintained over time andsettings (Kaiser et al., 1995; Kaiser, Hancock, &Hester, 1998). About 90% of the participatingchildren have shown generalization andmaintenance of newly learned language skillswhen observed at home. More than half ofthose children have demonstrated significantgains on global measures of language devel-opment immediately after the interventionand at follow-up points up to 6 month later(Hemmeter & Kaiser, 1994; Kaiser et al., 1995;Kaiser et al., 1998; Kaiser et al., 2000).

Our current research has two foci. First, weare studying the effects of combining therapist-implemented and parent-implemented En-hanced Milieu Teaching (EMT) to maximizechild communication development across set-tings and time with preschool children whohave mental retardation (Kaiser, Hancock,

Solomon, Windsor, & Howard, 2000). Second,we are examining the preventive effects ofteaching low-income parents of preschoolerswith language delays and behavior problems tosupport their children’s communication andsocial skills (Delaney & Kaiser, 2001; Hancock,Kaiser, & Delaney, in press).

Table 1 provides an overview of the goalswe teach adults and the rationale for each goalin terms of supporting children’s communica-tion. Our experience in teaching parents de-rives from systematic implementation of amanualized intervention; the target of theintervention is to increase children’s func-tional communication in everyday interac-tions. Our interactions with parents go be-yond teaching them a communicationintervention. They include consultation abouttheir children’s educational goals and pro-grams, facilitating children’s entry into school,and accessing resources in the community tosupport families and children.

Table 1. Enhanced Milieu Teaching: Goals and Rationale for Parent Intervention

Goal Rationale

Balance turns Create a conversational framework for interaction

Give children an opportunity to respond Encourage child-initiated utterances

Be responsive to child verbal behavior Meaningful, related responses encourage child communicationand provide context-specific language models

Follow the child’s lead Engaging with the child in preferred activities providesopportunities to model meaningful language in a context

Give simple, clear instructions Children respond best if the instruction/command is at theirlanguage level and requests only one response

Give a limited number of instructions Giving instructions only for “important” behaviors increaseschild compliance and increases child communication

Decrease negative verbal responses Negative behavior by parent models negative behavior forthe child and creates negative affect in the interaction

Praise often Children learn from positive consequences and praisemakes interactions affectively more positive

Talk at the child’s target level Specific language forms are learned through modeling incontext

Use Milieu Teaching procedures Prompting production of language in conversation teachesfunctional skills

Expand child utterances Children learn new forms when more elaborate modelsbuild on their own utterances and the immediate context

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Table 2. When is Teaching Parents a Good Idea?

Individuals Criteria

When parents: • Are interested in participating• Consider being involved a priority for themselves and their child• Have sufficient time and energy to participate• Are willing to make a relatively long term commitment• Are supported by other family members and close friends

When children: • Are highly likely to benefit from the parent’s newly learned skills• Have developmental needs that can be addressed through parent-implemented

intervention• Are responsive to the parent and enjoy interacting with her

When parent educators: • Value parents as co-participants in the training process• Set goals for parent and children with the family• Have real expertise in the skill area to be trained• Are skilled in teaching parents new skills• Are open to feedback from the parents

WHEN TEACHING PARENTS IS A GOODIDEA

All parents can learn new and effectivestrategies for supporting their child’s develop-ment, but not every parent is ready or willingto learn new strategies at a particular point intime. Table 2 indicates when parent teachingis likely to be successful. First, parents mustchoose to participate. In making a choice,parents set their own priorities and make acommitment to learning new skills. Second,parents must consider being involved in learn-ing new skills important for their children’sdevelopment. Third, they must have sufficienttime and energy, as well as logistical support(e.g., transportation, child care) to make arelatively long-term commitment to learningand producing new skills with their children.Although parent teaching programs vary inlength, many take 10 or more sessions to teachnew skills. It is important for parents to knowthe exact amount of time that will be requiredbefore they make a commitment to participate.Parent teaching is likely to be especially effec-tive when the parents’ engagement in theprogram is supported by other family membersand close friends. Teaching parents in groupscan provide support that is both functional andsocial and this support will enhance parentparticipation and learning (Kaiser et al., 1995).

Parent teaching is a good idea when certainconditions exist for their children who will bethe targets of the teaching efforts. If childrenare highly likely to benefit from the parents’newly learned skills and this benefit can beshown through empirical evidence, parentsare more likely to participate. When childrenhave specific developmental needs that canbe addressed through parent-implementedintervention and parents understand theseneeds, parents will perceive their participa-tion to be highly important. While parent-implemented interventions can improve theparent-child relationship and increase parentresponsiveness to the child (Delaney & Kaiser,2001), it is easier for parents to begin a parent-teaching program when their children arealready responsive to parent overtures andthey enjoy spending time with their children.

Finally, parent teaching is a good idea whenthe adults who will serve as parent educatorsvalue parents as co-participants in the trainingprocess and work to set collaborative goalswith the parents for themselves, the child, andthe family. As we discuss in the remainder ofthis article, parent teaching is a good idea onlywhen the adults serving as teachers have realexpertise in the intervention procedures theywill teach parents (e.g., supporting children’scommunication development), are skilled inteaching parents, and are open to feedback

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from and dialogue with parents about theteaching process, its goals, and outcomes.

WHAT PARENT EDUCATORS NEED TOKNOW

The role of the parent educator is complexand challenging. It is different from otherprofessional roles such as teacher or casemanager, although it may include aspects ofthese roles. Figure 1 shows the minimal set ofskills required for parent educators to beeffective in teaching parents new strategies tosupport their children’s development. Theskills can be grouped into three general areas:(a) skills in doing the intervention with chil-dren, (b) skills in teaching parents to do theintervention, and c) skills in managing theparent teaching process. At the core of theseskills is the parent educators’ fluency in thespecific intervention they will teach parents.Fluency requires mastery of the specific childintervention procedures, understanding of theconceptual basis of the intervention and itscore assumptions, and the ability to presentinformation about the intervention in a waythat is understood by the parents and isapplicable to the individual children. Parent

educators must be able to implement theintervention with children, to instruct parentsin performing the intervention, and to trouble-shoot with parents in their use of it, in orderto provide specific feedback, coaching, andguidance toward effective implementation.

For example, when a parent educatorteaches a mother to implement EnhancedMilieu Teaching (EMT) with her 3-year-oldchild with a significant language delay, theeducator must first be able to implement theEMT procedures effectively with the targetchild. The parent educator’s skill and experi-ence in the EMT intervention allows her tomodel the procedures with the child, providesthe practical knowledge about the types ofadaptations that may be required for this childto learn, and establishes with the parent thecredibility of both the EMT procedures and theparent educator. In addition to experience inimplementing EMT, the parent educator must:(a) have conceptual knowledge of the proce-dures so that she can talk to the parent aboutthe rationale for each aspect of the teachingprotocol, (b) place the intervention in theframework of the child’s current developmen-tal characteristics, (c) relate the parent’s behav-ior to the goals of the intervention and the

Figure 1. Skills for Teaching Parents.

Collaborative GoalSetting with Parents

Skills for Teaching Parents

Strategies for EvaluatingParent and Child Progress

Responsive InteractionStyle with Parents

Knowledge of theEmpirical and

Conceptual Basis ofIntervention

Fluent Implementation ofthe Intervention with the

Child

Knowledge andImplementation of

Ancillary Procedures toSupport Intervention

Fluency in PresentingInformation and Giving

Feedback

Ability to AnalyzeParent Implementationand Provide Corrective

Feedback

Adapting Intervention toSpecific Parent and Child

Skills and Needs

Teaching to FacilitateGeneralization to EverydaySettings and Maintenance

Overtime

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family’s goals for the child and themselves, and(d) answer the parent’s questions. These skillslink the parent educator’s ability to perform theintervention directly to her skills in teaching theparent to implement the intervention.

Strategies for teaching parents are summa-rized in the box “Strategies for TeachingParents.” Teaching parents requires skills thatare different from those required to teachchildren; however, there are important pointsof overlap. Creating a safe learning environ-ment requires establishing rapport with theparent and acknowledging the unique situa-tion of the adult learner. In the Milieu Teach-ing Project, we speak frankly with parentsabout the challenges of being an adult learner,and we often report our own experiences inlearning new language teaching skills. We

encourage parents to talk with other parentswho have gone through the program, and weshare stories of other parents’ challenges andsuccesses. By focusing on their children’sneeds and creating support for the children’sdevelopment, we place parents’ learning ofnew skills in the context of their goals for theirchildren and their families. The rationale foreach parent behavior is presented in terms ofthe opportunity it offers for child learning. Forexample, expanding children’s utterancesgives the children the opportunity to learnelaborated language when their cognition andattention are already focused on a specificevent; expansions take advantage ofchildren’s momentary readiness to learn newinformation.

Individual teaching sessions with parentsare planned to make efficient use of the timeand to tailor the presentation of informationand the practice of new techniques to fit theparent’s specific needs and skills. Some gen-eral principles for teaching parents are ap-plied consistently across the individualizedsessions. First, we teach using concrete posi-tive examples of the desired behavior. Parenteducators model the specific skill, show vid-eotapes of the parent doing the skill or otherparents with similar children performing thestrategy. Scripted examples, cartoons or pho-tos with key words, and videotapes of theprocedures are given to the parents to takewith them. The principles of responsive inter-action (Weiss, 1981) that are core to EMT areused in teaching parent educators to: (a) listencarefully to what the parent says; (b) respondto the content, affect, and timing of theparent’s communication; (c) balance turns inconversations; (d) teach in response to theparent’s behavior and communication; (e)give positive, descriptive feedback; and (f) askfor clarification when the parent’s behavior orcommunication is unclear.

In teaching new information, we first teachthe principle (e.g., balance turns in conversa-tions), then the specific applications (e.g.,limiting parent talk, pausing to give the childa turn, nonverbal mirroring). We illustrate theprinciple with positive examples from theparent and child’s videotaped sessions. We

Strategies for Teaching Parents

• Create a safe and supportive environment forlearning

• Set goals for the child and for the parentcollaboratively with parent

• Focus on the child and the child’s develop-ment first, changing parent behavior second

• Apply principles of responsive interaction ininteractions with parent: listen, respond,balance turns Teach to parent: behavior andcommunication, praise, omit negativefeedback, ask for clarification

• Plan content and activities of individualsessions and the sequence of sessions toinsure mastery of key behaviors

• Teach both the behavioral principle and thespecific application; provide multipleexamples

• Teach by using concrete, positive examples;provide supporting materials to illustrateexamples

• Include practice in implementing theprocedures with the child in each session

• Coach and give specific feedback to supportparent during practice with child

• Teach for generalization and maintenance;when possible teach across settings, involveother caregivers, provide booster sessions

• Adjust teaching style, teaching methods,criterion performance levels of parent andchild, and feedback to the individual parent

• Invite formal and informal feedback fromparent at frequent intervals

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model with the child and then ask the parentto role play with the parent educator andpractice with the child. Because the goal ofthis training is use of the EMT procedures athome and in everyday interactions with thechild, we teach with generalization and main-tenance as outcome goals. The parent is askedto generate examples of times when she canuse each procedure at home and to keep notesabout her use of the procedures betweentraining sessions. The “What HappenedNotes” are the anchor for conversations be-tween the parent educator and the parentabout the adaptations of EMT that are neededto make the procedures effective in teachingnew communication skills at home.

Parent educators must have skills in coach-ing and giving parents feedback in their use ofthe target skills being taught. Coaching sup-ports the parents in being immediately suc-cessful in implementing the newly learnedskills. Parent educators provide assistance toparents while still staying in the backgroundof the parent-child practice interactions. Forexample, the parent educator may quietly

prompt the parent through a milieu teachingepisode or remind the parent to praise anddescribe the child’s behavior while the parentplays with the child. In order to coach effec-tively and give differential feedback about theparent’s use of the procedures, the parenteducator must know each step of the interven-tion procedures and be able to troubleshootthe parent’s application of the procedureswhile watching the parent-child interaction.Beginning parent educators may need toanalyze videotapes of parents practicing theintervention outside the teaching sessionswith parents. Coaching is most effective whenparent educators offer suggestions while par-ents are practicing; however, this requiresmastery and fluency in the intervention andskill in tactfully providing precise informationto parents. Using an implementation checklistthat provides a step-by-step analysis of theintervention will help parent educators focuson parents’ performance and give feedbackfor correct implementation (see Table 3 for anexample of an EMT checklist). Sharing theimplementation checklist with parents can

Table 3. EMT Implementation Checklist

NotObserved Poor Excellent

1. Environmental arrangementPlay area is well organized 1 2 3 4 5Selection of activities 1 2 3 4 5Length of activities is appropriate 1 2 3 4 5Arrangement encourages engagement 1 2 3 4 5Activity available 1 2 3 4 5

2. Parent style and affectParent responds quickly to child 1 2 3 4 5Parent is warm and positive 1 2 3 4 5Parent listens to child 1 2 3 4 5Parent often at child’s eye level 1 2 3 4 5Parent offers redirects gently, but firmly 1 2 3 4 5

3. Behavior managementRules are clear 1 2 3 4 5Environmental arrangement encourages

appropriate behavior 1 2 3 4 5Parent provides choices for instructional follow through 1 2 3 4 5Parent anticipates disruptions, and problems 1 2 3 4 5Parent redirects rather than discourage 1 2 3 4 5Instructions are brief, clear 1 2 3 4 5

continues

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16 INFANTS AND YOUNG CHILDREN/JANUARY–MARCH 2003

Table 3. Continued

NotObserved Poor Excellent

Parent follows through on instructions 1 2 3 4 5Parent provides positive feedback for child behavior 1 2 3 4 5Time out is used appropriately 1 2 3 4 5Time out is used effectively 1 2 3 4 5Difficult child behavior is handled effectively 1 2 3 4 5Most parent attention is for positive behavior 1 2 3 4 5

4. Enhanced Milieu TeachingParent engages in conversation with child 1 2 3 4 5Parent talks at child level 1 2 3 4 5Parent responds to content of child talk 1 2 3 4 5Parent seeks clarification when child meanings are

not understood 1 2 3 4 5Parent expands child utterances 1 2 3 4 5Parent responds to child requests 1 2 3 4 5Parent talks about what child is doing 1 2 3 4 5Parent balances turns with child 1 2 3 4 5Parent engages in child’s activity 1 2 3 4 5Parent prompts language at target levels 1 2 3 4 5Parent prompts language at target levels 1 2 3 4 5Intervention occurs in response to child requests 1 2 3 4 5Parent follows through on prompts for language 1 2 3 4 5List prompting techniques observed: 1 2 3 4 5Model 1 2 3 4 5Mand 1 2 3 4 5Time delay 1 2 3 4 5Incidental teaching 1 2 3 4 5Parent stops prompting when child loses interest 1 2 3 4 5

5. Summary of observationChild receives an appropriate amount of parent’s attention 1 2 3 4 5Child’s communication with adult is supported 1 2 3 4 5Opportunity 1 2 3 4 5Quality 1 2 3 4 5Levels of prompting 1 2 3 4 5Positive responding 1 2 3 4 5Child’s behavior is well managed 1 2 3 4 5Child is encouraged to participate in activities 1 2 3 4 5Child’s affective environment is positive 1 2 3 4 5

sometimes help them in both understandingthe intervention procedures and in viewingparent educators’ feedback as systematic andrational.

Feedback to parents must be individualizedto fit their skill in the intervention, theirlearning style, their education and readinglevels, and the level of rapport and comfortbetween parents and parent educators. Mostfeedback should be positive, encouraging,and specifically descriptive rather than gen-eral. Feedback at the beginning of a sessionemphasizes what parents have learned inprevious sessions and children’s progress.

Feedback during a teaching session occursduring and after parents practice with theirchildren. Most feedback is verbal descriptionsof what parents are doing correctly; however,summary level feedback using graphs, com-pleted implementation checklists, or shortwritten progress notes also are provided. Pre-and post-training videotapes, transcriptions ofparent-child interactions, and graphs and testdata showing child’s progress provide parentswith permanent products indicating theirlearning and the effects of their learning ontheir children’s behavior and development.Some parents are not comfortable receiving

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praise and direct positive feedback. Review-ing videotapes can be an excellent teachingactivity that provides many opportunities forpositive feedback to parents, but not all par-ents enjoy seeing themselves on videotape.Parent educators may ask parents what formsof feedback they prefer, but they must also beattentive to parents’ responses and makeadjustments immediately to insure that theprocess of receiving feedback is positive forindividual parents.

PLANNING IS KEY TO SUCCESSFULPARENT EDUCATION

Successful parent education requires plan-ning and preparation for individual sessionsand for the series of teaching sessions. Goalsetting during an initial meeting defines thetasks for parents and parent educators.Timelines and teaching formats are addressedduring the first session so that parents knowhow many teaching sessions will occur, howlong each session will last, and what will occurin each session. The responsibilities of parenteducators and parents are discussed and awritten summary of the timeline, the goals,and responsibilities of the participants areprovided. For example, the parent agrees: (a)to come to the 20 EMT training sessions, (b)lasting about 45 minutes each, (c) scheduledfor 2:30 p.m. on Tuesdays, (d) at herdaughter’s child care, and (e) to notify theparent educator at least 4 hours in advance ifshe needs to cancel the session. The parenteducator agrees: (a) to provide 20 sessions oftraining, (b) at the time noted, (c) to bring thematerials needed for each session, (d) toprovide written summaries of the childprogress after the training is completed, and(e) to call the parent each week to discussimplementation of the procedures at home.

For each session, parent educators preparea lesson plan, an implementation checklist,and a parent feedback form. Parent educatorsset up the room before parents arrive so thattheir time together is focused exclusively onlearning the intervention. In a typical EMTparent teaching session, about 15 minutes isdevoted to reviewing child and parent’s

progress and introducing new information.Role playing or viewing videotapes may beused to provide concrete examples of the newinformation. The parent is invited to askquestions, report progress at home or modifythe proposed agenda to fit her concerns.Typically, the target child is not present duringthis parent teaching period. The child joins theparent for a period of practicing the new skills.The parent educator may model new strate-gies with the child, or the parent and child mayspend the entire 15 to 20 minutes interactingwhile the parent practices the new strategies.Parent-child interactions are videotaped forreview by the parent educator after the ses-sion. The parent educator coaches and givesbrief feedback while the parent and childinteract. During the last 10 to 15 minutes of thesession, the parent is invited to reflect andevaluate the practice session. The parent edu-cator provides information in response toparent comment and concerns and additionalfeedback about the parent’s implementationof the procedures. A few minutes are spentplanning for interactions at home and briefhomework assignments may be made. Time isset for a follow-up phone consultation later inthe week. Sessions always end with summarylevel positive feedback to the parent about herbehavior and her child’s progress.

Efficient and effective parent teaching re-quires outside preparation in addition to thetime spent with parents. It is typical to spendmore than twice as much time in preparationfor teaching parents as is spent on the actualinstruction with parents. If videotapes of theparent-child interaction have been made, theparent educator will code or systematicallyreview those tapes to assess parent progress inlearning the new skills and child progressresulting from the parent’s implementation ofthe intervention procedures. Parent behaviormust be evaluated in reference to specificcriterion behaviors indicative of learning theintervention. Based on this assessment ofprogress, the goals for the next session will bedetermined and the materials needed to meetthese goals will be selected. Parents are givenmaterials that might include videotapesamples, transcriptions of the parent-child

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interaction, handouts summarizing new infor-mation, homework to promote generaliza-tion, role playing activities, and selection oftoys or activities to be used in the parent-childinteraction. When parents are having particu-lar difficulty with some aspect of the interven-tion (e.g., completing milieu teaching epi-sodes correctly or modeling talk exactly at thechild’s target level), the parent educator mayneed to analyze parent performance verycarefully and create an error analysis andfocused teaching plan to help the parent learnthe specific skill. Reviewing parents’ notesfrom their use of the intervention strategies athome (e.g. “What Happened Notes”) also helpthe parent educator understand and addressany difficulties parents may be having.

Keeping systematic clinical notes on eachsession, observing parent and child progress,noting parent concerns and successes, andreviewing these notes prior to each session,helps the parent educator stay focused on theneeds of a particular family. Individualizationof the education process should occurthroughout the sessions based on parent feed-back and on the parent educator’s continuingassessment of the teaching/learning process.Forms for brief written feedback at the end ofeach session and more substantive feedbackat the mid and end points of the trainingshould supplement the parent educator’s on-going evaluations.

Preparing Parent Educators

Professionals from a variety of disciplinesserve as parent educators, but few programsprepare professionals as parent educators.The box “Overview of Professional Prepara-tion for Teaching Parents” provides a compre-hensive overview of a professional trainingprogram to prepare parent educators. Mostparent educators will not have access to suchcomprehensive preparation and will need tocraft their own training by blending theirdisciplinary preparation with an apprentice-ship in parent education.

Parent educators must be able to place theskills they propose to teach parents in thecontext of children’s development and fami-lies’ goals. Disciplinary preparation focuses

on the development of young children, andeffective intervention training in family-cen-tered support is foundational to becoming aparent educator. In addition, parent educatorsneed knowledge of and experience in apply-ing the specific child intervention strategiesthey will teach parents. Demonstrations of thisknowledge should be didactic (e.g., showingcompetency in written and oral examinationscovering the intervention procedures, thetheoretical basis, and the rationale for usingthese procedures with children) and practical(e.g., meeting performance criteria in actuallyusing the intervention with young children).Simply put, parent educators cannot teachwhat they do not know, and demonstratingtheir didactic and pragmatic knowledge isessential preparation for teaching parents

Parent educators need specific training inthe process of parent teaching which includes:(a) working collaboratively with parents in alearning context, (b) setting goals and select-ing strategies for parent education, (c) teach-ing specific intervention skills, (d) coaching,and giving feedback, (e) evaluating parentand child progress, and (f) teaching for gener-alization and maintenance. The skills outlinedin Figure 1 and the principles summarized inthe box “Strategies for Teaching Parents” mustbe acquired.

Parent education is a clinical skill and, thus,apprenticeship type training that includespratica and supervision is recommended. Inpreparing parent educators, we have devel-oped a sequence for training that includes: (a)demonstrating criterion-level knowledgeabout the content of the intervention, (b)demonstrating criterion levels on behavioralcoding for observations of parents who areimplementing the intervention, (c) practicingthe intervention with at least two differentchildren until performance criteria are met, (d)co-teaching at least two parents with an expe-rienced parent educator, and (e) closely su-pervised parent teaching with at least twomore parents. We emphasize behavioral cod-ing of the intervention because this helps newparent educators learn the intervention at ahigh level of precision and because it teachesthem to watch and analyze parent behavior as

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Teaching Parents New Skills 19

Overview of Professional Preparation for Teaching Parents

Course Work• Core courses in discipline (e.g., special education, speech/language, physical therapy)• Child development 0–8, including atypical development• Family processes and ecology, including parenting children with disabilities, and the influence of parents on

development• Instructional strategies for young children• Human developmental counseling for adults and families• Applied behavior analysis, including principles of behavior change, data collection, and analysis

Child Practicum• Assessment and intervention with children 0–3, 4–8 (two or more experiences; with emphasis on one-to-one

teaching)• Specialty practicum with target population and disciplinary focus (e.g., language intervention with toddlers

who have SLI; language intervention with preschoolers who have autism)

Parent Practicum• Working with parents of young children during assessment, home visits, early intervention, classroom, or

program participation; IFSP/IEP process• This practicum emphasizes family-centered services; communication with parents across contexts, responsive

listening, and arranging functional support for families

Apprenticeship in Parent Teaching• Content of intervention• Strategies for teaching parents the specific content of the intervention• Practice intervention with child to criterion levels with feedback and coaching• Observe and support ongoing child and parent intervention• Collect data from intervention sessions• Co-train with an experienced parent educator• Coaching, feedback, and supervision during co-training; ideally feedback will be data based (implementation

of parent teaching procedures, parent change, child change)• Supervised teaching with at least two additional families• Support and supervision during first year of independent teaching (data, coaching and feedback as needed,

planning and problem solving with professional peers)

a basis for giving exact feedback and coachingto the parent. New parent educators are vid-eotaped working with children and receivethe same kind of feedback that they will laterbe giving parents so that they have the expe-rience of being an adult learning a new skillwith children. We also videotape new parenteducators while they work with parents andgive them specific feedback on their strategiesfor (a) building rapport with parents throughresponsive interaction strategies, (b) accuracyof new information and responses to parentquestions, (c) use of positive examples forteaching new skills, and (d) strategies forcoaching and providing feedback to parents.

Typically, professionals who come with soliddisciplinary knowledge and good parent com-

munication skills require about 9 months oftraining in an apprentice/mentoring relation-ship before they are ready to teach parents aspecific intervention independently. Even ex-perienced parent educators benefit from the useof manualized intervention protocols and par-ticipation in a supervised clinical workinggroup. Unique challenges arise with families,and consultation with a more experiencedparent educator and collaboration with otherparent educators provide ongoing professionalsupport. Supervised training in an apprentice-ship model is intensive and time consuming;however, it is likely to lead to high levels of skillin teaching parents, the desired developmentaloutcomes for children, and positive evaluationsof the teaching/learning process by parents.

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20 INFANTS AND YOUNG CHILDREN/JANUARY–MARCH 2003

While these guidelines for effective practicewith parents have been drawn from empiricaldata and anecdotal examples from our ongoingresearch on teaching parents naturalistic lan-guage intervention strategies, the principlesoutlined in this article are still applicable in anearly intervention community program setting.In a research context where the work is drivenby a specific study protocol, these principlesmay be applied more intensively and preciselythan is necessary in a community setting. Theprinciples themselves though are extremelyimportant to consider any time an adult (theinterventionist) is working with another adult(the parent) to effectively support the optimaldevelopment of a child with special needs.While delivering services in children’s naturalenvironments can be challenging for interven-tionists working in families’ homes, the skillsoutlined in this article should help support theefforts of parent educators in delivering thoseinterventions. Early intervention program ad-ministrators can use information from this ar-ticle as a guide for the kind of supports that areimportant to provide interventionists workingwith parents. While it may not be realistic forinterventionists to spend as much planning timeas is necessary to deliver a precise researchprotocol, community program administrators

can communicate the importance of planningby allowing parent educators time in theirweekly schedule for preparation. It would alsobe important for parent educators who work inthe field to have professional ongoing supportby partnering with someone else in the programwho works with parents or with a parenteducator from another early intervention pro-gram in the same community. This partneringwould provide the important ongoing supportneeded for professionals as they develop theskills necessary to work effectively with parents.

During the last 15 years, we have systemati-cally evaluated parents’ perceptions of theirparticipation in parent-implemented milieuteaching. These evaluations occur at the endof training and 6 months after the training iscompleted. Uniformly, parents tell us thattheir child made progress in the intervention,that they enjoyed learning new skills, and thatthey would recommend the program to otherparents (Delaney & Kaiser, 2001; Hemmeter &Kaiser, l994; Kaiser et al., 2000). Parents’ posi-tive evaluations and data on child progressindicate that well-prepared parent educatorscan teach parents strategies to promote theirchildren’s development in ways that also ac-knowledge and support the unique talents andsituations of individual parents.

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