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Naturalistic Communication Intervention KidTalk Tactics Project Vanderbilt University and Florida State University Juliann Woods and Ann Kaiser, Co-PIs. CEC April 2010. KTTP Model Components . KTTP Model Over Time. Naturalistic Communication Intervention Birth to 5 years.
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Naturalistic Communication InterventionKidTalk Tactics ProjectVanderbilt University and Florida State UniversityJuliann Woods and Ann Kaiser, Co-PIs CEC April 2010
KTTP Model Over Time Naturalistic Communication Intervention Birth to 5 years Empowering Parents as Communication Team Leaders
Basic Premises of the KTTP Model • Parents are their child’s first communication partners • Incorporate EMT strategies throughout routines and preferred activities at home and in the community to increase child communication outcomes (Blending FGRBI and EMT) • Teachers and service providers support child communication across settings • Incorporate EMT throughout the child’s daily schedule in community settings • Address needs for intervention dosage, child generalization • KTTP Communication teams include families, providers across agencies, and communication coaches • Advocate for families to promote continuity of early communication intervention • Coordinated transitions and continuity in communication intervention between Parts C and B - Enhanced by the parent’s leadership of the communication team
Who is Participating? Down syndrome, Language delay, DD, CP, ASD, Dandy Walker, Cri du Chat, William’s syndrome , Vater’s syndrome Children enroll between 12 and 33 months • Eligible for Part C services • Have a significant communication delay • Parents who are willing to participate and consent • Attend or receive services from collaborating site: • High Hopes Inclusive Preschool and Therapy Clinic (VU) • Susan Gray School (VU) • Big Bend Early Steps Program (primarily home based) (FSU) • Early Head Start (FSU)
Participants Level 1: Introduction Level 2: 6 sessions + coaching Level 3 :Individualized to child
Who is Delivering the Intervention? 8 Communication coaches ECE, ECSE, and SLPs BA, M.Ed, grad students 1-11 years of EI or related experience Trained in KTTP model Each communication coach Facilitates parent learning Coaches teachers and service providers Coordinates team, transition planning with leadership from parents Conducts assessments, data collection, data based feedback
How is the Intervention Being Delivered? Coaches teach EMT in family-identified and child-preferred routines and play activities • 24 sessions at home (1-2 x/week) Parent coaching continues based on parent and child needs • Less frequent through age 5 • Adapted to child and family priorities • Expand routines, activities • Addresses child’s communication mode Parent assumes role as leader, decision maker in communication teams Plan with family for and support transition
What a typical Home Visit looks like: Setting the Stage • Greet family/child, gather updates, plan for activities for the session. • Reaffirm family priorities and leadership role. Observation and Opportunities • Join parent and child in planned routines. Observe and support parent participation. • Using a variety of coaching strategies, enhance use of targeted EMT strategies in multiple routines. Problem-Solving, Planning and Reflecting • Problem-solve to develop best contextual fit regarding strategy, child’s goals and parent implementation. • Reflect on what works, when and problem solve what is next. • Summarize and plan for implementation between visits.
Coaching Strategies in Home Activities and Routines Coaching sequence completed within at least 2 categories and 3 routines per home visit
Strategies used during the home routine of pretend play (feeding baby) Materials: babies, feeding bottles, napkins, brush lotion Choices: Have materials in sight but out of reach Kelsey’s Goals • Engage in pretend play sequences • Use 2-3 word phrases to request and comment When Kelsey doesn’t use2-3 word phrases, prompt her communication by pausing, asking her to use her words and finally saying the phrase for her to repeat. • Respond to all of Kelsey’s words and gestures. • Expand single words to 2-3 word phrases • Imitate her pretend play actions and describe what you do. Use 2-3 word phrases mostly to comment on what Kelsey and you are doing together
Parent Coaching and Implementation • Parent coaching implementation fidelity has been high • Parent learning of the strategies has been consistent across families and contexts • Child outcomes vary • Age of Entry • Diagnosis/Disability • Degree of Motor Involvement
Vanderbilt Parent Implementation Fidelity Across 8 Families Completing Intervention 24
Overall IGDI Data Total Communication (Weighted) Number of communicative gestures, vocalizations, single and multiple words.
How is the Intervention Being Delivered? Teacher and Service Provider Training
Summative Teacher & Service Provider Training Evaluation *Rated on a 0 – 5 Scale
KTTP Model Over Time: Lily Empowering parents as communication team leaders
Communication Across the Community: Lily’s Initial Communication Team (2008)
Training, Teams and Transition: A Case Study • Collaboration can be challenging with multiple people providing services from multiple providers. • KTTP created Google pages to share information among parents and providers outside the structure of formal meetings and reports.
Take turns sharing at Circle Time Initiate interactions with peers Communicate wants and needs to unfamiliar adults These are our family’s dreams for Kelsey’s communication Drink independently from open cup at snack Engage in more back and forth communication Engage in dramatic play sequences with peers
Childcare at Mom’s Gymn Playdates with TJ and Danni Shopping at Target Communication Across Kelsey’s CommunityMy community is expanding as I start a new program! Kelsey’s Home Kelsey,Ian (brother) Angee (mom) and Tom (dad) Favorite Restaurant Red Elephant OT at Tallahassee Memorial Zoinks Pappy & Nonni’s Kelsey’s School Annsworth Academy
Getting to Know Kelsey I can: • Sign over 150 words that I typically use • Verbally express myself through words and simple phrases • Follow simple 1-step commands • Sing familiar songs and join in finger play • Identify colors and count to 10 • Share some simple knock-knock jokes! I’m working on: • Expanding my vocabulary • Consistently using 3-4 word/sign phrases to request and comment • Drinking independently from open cup • Taking turns with friends • Engaging in complex dramatic play sequences What Where When With How I enjoy: • Pretending to be a doctor with Dad by “checking’ him and giving him shots • Singing and dancing with mom while watching my favorite shows, and in the car while picking up Ian from school. • Helping mom clean the house and fold laundry • Helping take care of our family pet Squirrel the cat. • Reading books and naming pictures with Ian
Environmental Arrangement Responding Modeling Practice Establish routines Activity Dreams and Scenes for Communication Routines and Strategies At Home At School • Set beginning & ending • Use same words & materials • Repetition • Functional Outcome • Interesting materials • Offering choices • Inadequate portions, assistance needed • Silly situations • Pause after taking a turn • Imitate what Emma is doing (mirroring) • Participate along with Emma • Verbally respond to verbal & non-verbal communication • Verbally describe actions • Use single words & 2-3 word phrases • Add another word to Emma’s single words and signs • Model verbal words when she signs • Use least to most prompting • Open-ended questions • Choice questions • Time delay • Prompting Emma to “say ____” when she points/ vocalizes • Provide correction or expansion as giving Emma a requested material/ action
Strategies used during the home routine of Feeding Squirrel (Family Chore) • When it’s time to feed Squirrel let Kelsey know she needs to help. • Have materials in sight but out of reach. Kelsey’s Goals • Follow 2 step directions independently • Use 2-3 word phrases to request and comment When Kelsey doesn’t use2-3 word phrases, prompt her communication by pausing, asking her to use her words and finally saying the phrase for her to repeat. • Respond to all of Kelsey’s words and gestures. • Expand single words to 2-3 word phrases • Describe what she’s doing as well as what you want her to do. Use 2-3 word phrases mostly to comment on what Kelsey and you are doing together
Transition Planning • Transitions occur at different points in times for families • Transition into group care at age 3 • Transition into Part B at age 4 • Transition into public school settings at age 4 or 5 • Transition planning is individualized for the family • Goal: an informal, functional, family directed process • Supporting children’s continued communication development is central to KTTP involvement in transitions • Goal is to empower parents to provide leadership in the transition that reflects family’s priorities, their child’s unique communication needs, and the resources available in community • Transition is an ongoing process as settings, providers, and programs change
Outcomes and Challenges • Parents learn EMT and use in multiple, diverse routines and activities • Child progress varies based on child and family variables • Motor involvement, health, family time available • Frequency of communication is an essential outcome for young children • Early communication behaviors for prelinguistic and motor-involved children are not well represented in standard measures • Determining mode, across settings and providers • Initial outcomes of teacher and service provider training are very promising • Facilitating communication across agencies, providers and families is challenging • Provider background, time and accessibility • Part B policies
For More Information… • Ann.Kaiser@vanderbilt.edu • jwoods@fsu.edu Slides from this presentation will be available at KidTalk.org.
