Exploring coaching and follow-up supports in community-implemented caregiver-mediated JASPER intervention

Although a growing number of caregiver-mediated intervention models for families with children with autism are being examined in efficacy trials, few have been transferred to community implementation. Furthermore, little testing has explored implementation strategies to support caregivers’ strategy use with their children. In partnership with a publicly funded intervention agency in Canada, this pilot project explored intervention implementation strategies and follow-up supports. Dyads were randomized at entry to coaching or observe then add coaching and at intervention exit to individual or group follow-up booster. The caregiver-mediated Joint Attention, Symbolic Play, Engagement and Regulation intervention was provided by agency staff to a diverse community sample of families with young children awaiting or diagnosed with autism spectrum disorder. Independent agency staff delivered assessments and recorded a caregiver–child interaction. Blinded raters scored children’s initiations of joint attention, play actions, joint engagement, and caregivers’ strategy implementation. Practitioners implemented the intervention and coaching strategies well ( M = 83%). Overall, caregivers made significant gains in strategy use and children showed significant growth in joint engagement, play diversity, and joint attention across conditions through public caregiver-mediated intervention services. Caregivers’ strategy use supported gains in children’s joint engagement. Lay abstract The next step for communication interventions for young children with autism include coaching/teaching for caregivers that have been tested in university clinics and testing these interventions in real world systems with early intervention providers who serve children and families in their communities. However, there are few projects that have tested how well the intervention can be transferred to community providers and what types of progress children and caregivers make in these services. This project took place in partnership with a community early intervention agency in the province of Ontario, Canada. The agency provided government-funded public health services. The agency was funded to take part in a pilot program to try out one of four early intervention models that included coaching for caregivers and was designed to support children’s social engagement, play, and communication skills. The team decided to test two ways to start the intervention: (a) begin with observation of the practitioner for 4 weeks and then start coached practice with the child and (b) start coaching immediately. The team also tested two ways to support families for 3 months after intervention: (a) group booster sessions and (b) individual visits. The practitioners delivered the intervention well ( M = 83%), and overall, caregivers and children made significant gains by the end of intervention in both observation + coaching and coaching. Attendance for follow-up boosters was variable with fewer families attending groups. More research is needed to test different strategies and roles to individualize interventions for caregivers with a range of goals and learning styles.

Musical interaction, social communication, and wellbeing

Music plays a prominent role in human interaction, and is thought to have broad impact on social, emotional, and intellectual competencies, and on personal wellbeing. In order to better understand how, why, and under what conditions music affects wellbeing, this chapter summarizes recent work that demonstrates specific aspects of wellbeing that are positively affected by joint engagement in music. In particular, the chapter focuses on the role of synchrony experience in enhancing social-emotional attitudes and behaviors. The chapter introduces a working model that aims to explain the processes by which synchrony during joint music-making may help to develop and refine social-emotional competencies, suggesting the potential for enhanced wellbeing. The case is made for a future multi-disciplinary approach to researching direct links between synchrony experience and wellbeing, as well as to understanding the most effective ways to use musical interaction to enhance wellbeing.

Pilot Randomized Controlled Trial of the WHO Caregiver Skills Training in Public Health Services in Italy

Parents of children with ASD (N = 86; mean age 44.8 months; 67 boys) were randomized to either WHO Caregiver Skills Training (CST) delivered in public health settings in Italy or enhanced treatment-as-usual. Primary blinded outcomes were 3-months post-intervention change scores of autism severity and engagement during caregiver-child interaction. CST was highly acceptable to caregivers and feasibly delivered by trained local clinicians. Intention-to-treat analysis showed a large and significant effect on parent skills supporting joint engagement and a smaller significant effect on flow of interaction. Expected changes in child autism severity and joint engagement did not meet statistical significance. Analysis of secondary outcomes showed a significant effect on parenting stress, self-efficacy, and child gestures. Strategies to improve the effectiveness of CST are discussed.

Designing an App to Support Families’ Joint Engagement with Media: Design Principles and Lessons from Research

In this paper, our collaborative project team shares design principles and lessons learned from research for designing an app to support families’ joint engagement with media and promote powerful shared learning experiences. We provide a rationale, based on research literature, for why a second-screen app in particular addresses our project goals. In addition, we describe the Splash and Bubbles for Parents app components as well as the co-design process and design-based research studies conducted to inform its design and development. Finally, our team offers design principles grounded in findings from our research that may be useful to app developers and researchers interested in continuing and expanding on this work.