THE DISABILITY EXPERIENCE CONFERENCE

Training Parents and Staff to Use a Social-Communication

Intervention with Children with Autism:

A Focus on Treatment Fidelity

Johanna Taylor, M.Ed., BCBAAlicia Mrachko, M.Ed., BCBASchool of Education, Early

Intervention

PRESENTATION FOCUS1) To present a systematic literature

review of fidelity within parent-implemented intervention studies for children with autism.

2) To present a practicum opportunity for Masters level students in the University of Pittsburgh Early Intervention Program focused on teaching parents to implement an intervention with their toddlers with autism with high levels of fidelity.

TREATMENT FIDELITY• The degree to which procedures are

delivered as designed, has been identified as an integral component of intervention programs.

• High levels of treatment fidelity are key to establishing a functional relationship between independent and dependent variables and have been associated with better outcomes, specifically in parent and staff training programs.

(Bellg, et al. 2004; Sanetti & Kratochwill, 2009; Wolery, 2011)

FIDELITY WITHIN PARENT-IMPLEMENTED INTERVENTIONS

Implementation Fidelity

Degree to which trainer provides strategies to parents

Implementation StrategiesTraining delivery methods and

characteristics

Intervention Fidelity

Degree to which parent delivers strategies to child

Intervention StrategiesIntervention procedures

parent uses to teach child

Continued Intervention Fidelity

Degree to which parent provides intervention to child over time and in

various settings

Intervention StrategiesIntervention procedures

parent uses to teach child

Improved parent outcomes

Improved child outcomes

Generalization and improvement in child outcomes over time

LITERATURE REVIEW: PARENT-IMPLEMENTED INTERVENTIONS• Included peer-reviewed studies published

between January 2000 and August 2012 diagnosed with autism spectrum disorder (ASD) under seven.

• The search resulted in a total of 20 articles. • Aimed to identify: 1) the frequency of learning

methods used in training, 2) fidelity measurement procedures, and 3) the extent of reporting on trainer and parent adherence to content.

LITERATURE REVIEW RESULTS• 15 studies reported treatment

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

REVIEW RECOMMENDATIONSExamine the relationship between adult

learning methods and child outcomes. Dependent variables in parent training

studies need to measure the rate of behavior change in parents.

Examine the relationships between the three fidelity levels and parent/child outcomes.

Bridge the gap between research and practice

FIRST STEPS: PITT EARLY INTERVENTION Parent Toddler Practicum1.Bridge research to practice2.Train students with model of

implementation fidelity, intervention fidelity and child outcomes

3.Fidelity is monitored.4.Not controlled for a research study

PITT PARENT-TODDLER PRACTICUM (PPTP)FALL 2013

• Students are trained in Teaching Social Communication to Children with Autism (Ingersoll & Dvortcsak, 2010) in a seminar class weekly

• Targets:•Social Engagement•Communication• Imitation• Play skills

PPTP – FALL 2013• Students meet weekly with parent/child (2

students per family) and teach parents to implement the strategies.•2 hour session includes:• didactic training,• written materials with homework,• modeling and • rehearsal with feedback

PPTP AND FIDELITYImplementation Fidelity: Supervisor rates student

training parentIntervention Fidelity:

Supervisor rates student - feedbackStudent self-rates intervention with childStudent rates parent – does not share form with parent, but uses to guide feedback in session

Data collection on goals for child

PPTP – IMPLEMENTATION FIDELITY

PPTP FIDELITY – STUDENT INTERVENTION

PPTP FIDELITY – PARENT INTERVENTION

FUTURE DIRECTIONSUse PPTP to examine fidelity and child outcomes in research.

Implementation Fidelity

Intervention Fidelity

Child outcome

REFERENCESBellg, A.J., Resnick, B., Minicucci, D.S., Ogedegbe, G., Ernst, D.,

Borrelli, B., et al. (2004). Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology, 23(5), 443-451. doi: 10.1037/0278-6133.23.5.443.

Ingersoll, B. & Dvortcsak, A. (2010). Teaching Social Communication to Children with Autism. The Guilford Press: New York, NY.

Sanetti, L.M.H. & Kratochwill, T.R. (2009). Toward developing a science of treatment integrity: Introduction to the special series. School Psychology Review, 38(4), 445-459.

Wolery, M. (2011). Intervention research: The importance of fidelity measurement. Topics in Early Childhood Special Education, 31(3), 155-157. doi: 10.1177/0271121411408621.

THANK YOU!Johanna Taylor, MEd., BCBA, Alicia Mrachko, MEd., BCBA Graduate Student ResearchersDepartment of Instruction & LearningWW Posvar Hall 5156412-648-1317Jpt24@pitt.eduaam67@pitt.edu