Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching

Purpose: Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. Method: A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. Results: Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). Conclusion: Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. Supplemental Material: https://doi.org/10.23641/asha.17774819

Enhanced Milieu Teaching with Phonological Emphasis: A Pilot Telepractice Parent Training Study for Toddlers with Clefts

Objective: the purpose of this study was to evaluate the effects of training caregivers to use intervention strategies from the Enhanced Milieu Teaching with Phonological Emphasis (EMT + PE) program, delivered via telepractice, and to examine the effects on child speech and language outcomes for children with repaired cleft lip +/− palate (CL/P). Design: A multiple baseline within subject design across parent behaviors was replicated across three participating dyads. A pre–post intervention comparison was provided with a non-cleft twin. Participants: Three mother-child dyads participated in this study. Children ranged in age from 21 to 27 months at the beginning of the study and all had a diagnosis of CL/P. A noncleft twin without CL/P was assessed pre- and post-intervention to provide a normative comparison. Results: Parents demonstrated a positive intervention effect by substantially increasing their use of EMT + PE intervention strategies during telepractice intervention sessions (Tau 0.675 to 1.1333). Following the conclusion of intervention, parents were able to maintain their use of strategies once direct coaching had been discontinued. Children demonstrated increased talking rate, improved speech production and expanded expressive vocabulary measures over the course of intervention. Speech and language development of a child without cleft palate was provided as a comparison. Conclusions: Parents were trained through telepractice to effectively deliver EMT + PE speech and language facilitation strategies that resulted in increased language and speech outcomes for their children with CL/P.

Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication

Purpose This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice service delivery model. Method Four caregivers and children with language delays aged 18–27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver–child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach–Model–Coach–Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words. Results There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children. Conclusion Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies. Supplemental Material https://doi.org/10.23641/asha.14977605

The Effect of Enhanced Milieu Teaching on Vocabulary Acquisition for Korean American Children With Down Syndrome

Children with Down syndrome (DS) often exhibit delays in cognitive and linguistic development. In response to the increasing number of culturally and linguistically diverse populations with disabilities in the United States and need for evidence-based interventions with cultural adaptations, this study examined the effects of enhanced milieu teaching on targeted vocabulary acquisitions of four Korean American children with DS. Each child’s language preference, linguistic developmental trajectory, and preferred play themes/toys were considered as core methods of cultural adaptation. The results indicated that the use of targeted vocabularies increased among all children with DS and were maintained at higher levels than baseline. Implications for teaching language skills to culturally and linguistically diverse children with DS are discussed.

Examining Social Communication Effects of a Picture Communication Board in a Child With Autism

Purpose Augmentative and alternative communication (AAC) systems have been shown to increase requesting and protesting among minimally verbal children with autism spectrum disorder (ASD). However, there is a lack of research on using AAC to address social communication in ASD. Additionally, most previous research on AAC involves expensive, difficult-to-access technology. Enhanced milieu teaching and joint attention, symbolic play, engagement, and regulation interventions have been combined to successfully improve social communication in ASD. The purpose of this study is to examine the impact of introducing a low-technology, picture-based communication board using enhanced milieu teaching with joint attention, symbolic play, engagement, and regulation on social communication. Method An A-B-A-B single-subject design was implemented with a minimally verbal boy with ASD aged 3;4 (years;months). Three baseline sessions were followed by six intervention sessions and then repeated. Outcome measures included frequency of communicative acts, percentage of communication acts using AAC, and percentage of communication acts that were social. Visual analysis in combination with Tau-U effect sizes was used to evaluate the effects of intervention. Results Clear and immediate effects on frequency of communication (Tau-U = 0.97) and adoption of the AAC system (Tau-U = 1.00) were observed. The intervention did not clearly impact social communication (Tau-U = 0.17). Conclusions This study extends previous research indicating that AAC can quickly increase communication frequency to low-technology, accessible systems. The intervention dosage may have been insufficient to affect social communication, and further research should consider whether picture communication boards can positively influence social communication in young children with ASD.