JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Measurement and evaluation in practice

Telepractice delivery of an autism communication intervention to parent groups A feasibility study Robyn Garnett, Bronwyn Davidson, Patricia Eadie, Ken Clarke and Deepti Aggarwal

Evidence suggests that early intervention improves communication and developmental skills in children with autism. Families face barriers accessing intervention including geographic isolation, service availability and cost. Telepractice can address these barriers and expanding telepractice services may enable more families to access intervention. This research investigated the feasibility of telepractice to deliver intervention based on Hanen More Than Words (HMTW) to groups of parents of children with autism. Suitable technologies, design implications and participant perceptions were evaluated. Assessment of technology preceded delivery of intervention. Observation of telepractice sessions and participant interviews enabled qualitative analysis of telepractice delivery and participant perceptions. The intervention, including group training and individual video feedback, was delivered via telepractice to two parents. Participants expressed satisfaction with the approach and parents reported increased confidence in helping their children communicate. Telepractice delivery of HMTW-based intervention was feasible. Results indicated that delivery to larger groups is viable, with potential to increase parent intervention skills and child social-communication outcomes. A utism spectrum disorder (ASD) is a complex neurodevelopmental condition characterised by social communication and interaction difficulties across contexts with restricted, repetitive behaviours and interests (American Psychiatric Association, 2013). Many children are diagnosed with ASD and prevalence is estimated between 1.5% and 2.5% in Australia (Randall et al., 2015). Children can be reliably diagnosed with ASD at 2 years (Barbaro & Dissanayake, 2013; Veness et al., 2012). Research demonstrates that early intervention can be

effective for these children across a range of domains including social interaction, expressive and receptive communication, play, motor skill and cognitive development (Bradshaw, Steiner, Gengoux, & Koegel, 2015; National Autism Center, 2015). Emerging evidence regarding ASD intervention emphasises that intense (15–25 hours weekly), timely and sustained intervention is necessary for positive outcomes (Roberts, Williams, Smith, & Campbell, 2016). Barriers such as geographic isolation, inadequate social supports, service availability and cost often prevent families from accessing intervention that meets these criteria (Carlon, Carter, & Stephenson, 2013). Parent-mediated intervention Investigation into effectiveness of ASD intervention types, delivery methods and intensity is ongoing and parent- mediated intervention is one approach that has undergone significant growth during the last decade (Oono, Honey, & McConachie, 2013). It has been shown to be effective in increasing adult responsiveness to the child with ASD and in improving child communication outcomes such as joint attention and language. (Bradshaw et al., 2015; National Autism Center, 2015; Oono et al., 2013). Parent-mediated approaches can increase the intensity of intervention, generalisation of learned behaviours and potentially increase parent insight, empowerment and confidence in supporting their child’s development (Wainer, Hepburn, & McMahon Griffith, 2017). When considering service access issues, parent-mediated intervention may help overcome barriers such as service intensity and cost. The approach is further supported by best practice recommendations in early childhood intervention (Early Childhood Intervention Australia, 2016). Parent-mediated approaches require training of parents to implement strategies with their children that facilitate skill development (Roberts & Kaiser, 2011). Although paediatric speech-language pathologists (SLPs) are involved in parent training, a survey of paediatric SLP services in Australia revealed that 83% of children received individual therapy, but only 13% of services involved parent training and 7% group programs (Ruggero, McCabe, Ballard, & Munro, 2012). Factors limiting the adoption of parent-mediated approaches by SLPs are largely unknown; however, parent resistance to engage in non-direct therapy, funding models, clinical experience, and limited clarity of evidence (especially for children over 4 years of age) may all be impacting uptake of these approaches (Tosh, Arnott, & Scarinci, 2017).

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS AUTISM INTERVENTION PARENT TRAINING TELEHEALTH TELEPRACTICE

Robyn Garnett (top), Bronwyn Davidson (centre) and Patricia Eadie

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology