Working with Caregivers

1. Working with Caregivers

2. Common Frustrations with Partner Interactions • Discussion: What are a few “less than ideal” partner behaviors you have observed?

3. Common “approaches” to partner instruction • “Talking” about need to change partner behavior • Offering suggestions of how to change behavior • Asking “how’s it going” with implementing discussed strategies • Discussion: Why are these problematic?

4. Changing behavior is difficult! • Developing Knowledge • When you tell or show someone how to do something • Developing Skills • When the person you are teaching has hands on practice

5. Skill Selection • Common Problems with skill selection: • Focus on what is wrong with partner instead of improving client behaviors • Change too many partner behaviors at once • Change too many client behaviors at once • Change too many client/partner behaviors in too many settings or situations at once • Failure to link changes in partner behavior to identifiable, measurable changes in client

6. Skill Selection • If you simply focus on what the communication partner is doing “wrong” • It will make them feel bad or get defensive • May not result in improved client communication

7. Client and Partner Skill Selection Guidelines • Focus on client outcomes during instructional sessions with partners • Identify partner techniques that will result in desired skills • Select client and partner skills that change quickly and are easy to identify and quantify • Practice the selected techniques before teaching it to the partner • Start small; expand after initial success

8. Selecting Partner Skills Example (Binger & Kent-Walsh) • Discussion: What else???

9. Partner Instruction • Consider your approach • Hanen Program • Ann Kaiser’s partner instruction program • LAPE • imPAACT Program

10. ImPAACT (Binger et al., 2008& 2010, Kent-Walsh et al., 2010) • Improving Partner Applications of Augmentative Communication Techniques • Developed by Kent-Walsh, Binger and colleagues • Based on instructional program guidelines developed by Kent-Walsh and McNaughton (2005) • Designed to teach communication partners to facilitate early language and communication skills of children using AAC • 8-step model used initially within 1-2 highly specific contexts

11. ImPAACT program • Step 1: Pre-test and commitment: • Provide examples “with” and “without” use of targeted strategy • Pre and post video • Demonstrate with client • Discuss differences in adults behavior and client’s behavior

12. ImPAACT program • Step 2: Strategy Description • Provide partners with handout depicting the techniques the communication partner is learning • Describe each part of technique

13. ImPAACT program • Step 3: Strategy Demonstration • Clinician demonstrates how to use the strategy • Clinician uses “think aloud” statements • Use role play! • Clinician pretends to be the communication partner • Communication partner pretends to be client • More powerful than simply telling or showing someone how to do something

14. ImPAACT program • Step 4: Verbal practice of strategy • Helps partner: • Memorize strategy • Depend less on handout • Integrate new info

15. ImPAACT program • Step 5: Controlled practice and feedback • Additional role play: • Clinician plays client and communication partner plays self • Clinician provides feedback and guidance • “Errorless learning” approach (don’t let partner make mistakes)

16. ImPAACT program • Step 6: Advanced Practice and Feedback • Partner works with client directly • Use structured, controlled environments • Identify 1-2 contexts to begin • Consider routines already happening in home/life • Activity should last no longer than 10-15 min • Clinician sits in background and provides feedback • Continue with “errorless learning” approach • Fade feedback as partner masters strategy • Provide opportunity for practice in natural environment

17. ImPAACT program • Post-term and commitment to long term strategy use • Review before and after video • Elicit discussion (positive changes, problem solving continued barriers) • Generate an action plan to ensure: • Partner will continue using new skills • Client performance will be maintained over time

18. ImPAACT program • Step 8: Generalization of strategy • Communication partner and client practice using new skills across wider range of settings • New vocabulary • Plan to ensure these are developed

19. Generalization Examples(Binger, Kent-Walsh)

20. Binger, C. and Kent-Walsh, J. Selecting skills to teach communication partners (pdf) • Binger, C., Berens, J., Kent-Walsh, J., & Hickman, S. (2008). The impacts of aided AAC interventions on AAC use, speech, and symbolic gestures. Seminars in Speech and Language, 29, 101-111. • Binger, C., Kent-Walsh, J., Berens, J., Del Campo, S., & Rivera, D. (2008). Teaching Latino parents to support the multi-symbol message productions of their children who require AAC. Augmentative and Alternative Communication, 24(323-338). • Binger, C., Kent-Walsh, J., Ewing, C., & Taylor, S. (2010). Teaching educational assistants to facilitate the multi-symbol message productions of young students who require AAC. American Journal of Speech-Language Pathology, 19, 108-120. • Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23, 30-43. • Binger, C., Maguire-Marshall, M., & Kent-Walsh, J. (2011). Using aided AAC models, recasts, and contrastive targets to teach grammatical morphemes to children with developmental delays who use AAC. Journal of Speech, Language, and Hearing Research, 54, 160-176. • Kent-Walsh, J., Binger, C., & Malani, M. (2010; invited). Teaching partners to support the communication skills of young children who use AAC: Lessons from the ImPAACT Program. Early Childhood Services, 4 (3), 155-170. • Kent-Walsh, J., & McNaughton, D. (2005). Communication partner instruction in AAC: Present practices and future directions. Augmentative and Alternative Communication, 21, 195-204.