JCPSLP Vol 21 No 2 2019 DIGITAL Edition

parents to implement strategies with their children and positive outcomes have been reported (Knutsen et al., 2016; Parsons, Cordier, Vaz, & Lee, 2017). This foundational work provides a rationale for expanding telepractice to encompass training of parent groups, potentially increasing service access and providing opportunities for connection between families of children with ASD. Aims The purpose of this study was to determine the feasibility and value of migrating HMTW-based intervention from face- to-face to telepractice delivery, using readily available technologies. It involved the following research aims: 1. To identify suitable technologies for telepractice delivery of the HMTW-based group intervention. 2. To evaluate the feasibility of telepractice delivery of HMTW-based group intervention and participant perceptions of the approach. Materials and methods The technological elements of the project required implementation across two distinct phases and the research design included both quantitative and qualitative components. Phase 1: Telepractice technology assessment and trial involved a quantitative approach to test various technology configurations and to subsequently select the highest rated option for pilot delivery of the intervention. Phase 2: Telepractice delivery of HMTW-based intervention used a mixed method, case study approach involving two parents and the clinician. This enabled the feasibility of the approach to be confirmed and perceptions of both clinician and parent participants to be described. Parent participants received a preliminary, home-based consultation with the clinician prior to online intervention delivery. Phase 1: Telepractice technology assessment and trial The technology assessment aimed to identify and test readily available video-conferencing technology for use in delivering the intervention. This encompassed technology that supported synchronised group training across several locations and allowed online, real-time observation, coaching, video-recording and playback of individual parent–child interactions. As a bidirectional process, supportive technology for both clinician and participants needed to be considered. Two intervention components required suitable telepractice technology. The first involved video- conferencing for real-time, interactive group parent training. This component assumed parents would be at home, using typically available devices such as laptops or tablets with audio and video capability to participate in training sessions. The clinician would deliver the training by facilitating group interactions and sharing PowerPoint slides and videos. The second training component encompassed video- conferencing and capture to provide individual feedback to participants during parent–child interactions. The clinician needed to observe parent–child interaction in real time and provide online coaching. Interaction video required capture and storage for playback, enabling discussion between parent and clinician after parent-child interaction ended. Captured video required editing and sharing to demonstrate

A significant Australian review into effective early intervention models for children with ASD identified the importance of teaching across settings and people (Prior et al., 2011). This review highlighted parents’ need for both information and support when receiving intervention, including parent training and opportunities to learn from other parents’ experiences (Prior et al., 2011). The relatively low utilisation of parent-mediated approaches reported indicates substantial scope for expansion of parent training and group programs by SLPs as potential ways to increase intervention access and quality. Hanen More Than Words ® The Hanen More Than Words ® (HMTW) program (Sussman, Drake, Lowry, & Honeyman, 2016) is a parent-mediated, group training program for parents of children with ASD. It is a manualised, replicable social-communication intervention with an emerging evidence base (Carter et al., 2011; Girolametto, Sussman, & Weitzman, 2007; McConachie, Randle, Hammal, & Le Couteur, 2005). HMTW is commonly used in Australia and 1621 Australian SLPs have been trained in the approach (A. J. Iancovitz, personal communication, 7 November 2018). HMTW comprises eight parent group training sessions interspersed with three individual video-feedback and coaching sessions. Intervention strategies both structure and support parent–child interaction and social-communication development. The HMTW parent training approach aims to address crucial elements of successful intervention namely intensiveness, timeliness and sustainability. It involves key components of effective intervention by involving families, offering support from other parents, providing partnership between the parent and clinician, and emphasising implementation of the intervention at home (Prior & Roberts, 2012). Migration of HMTW content to telepractice delivery may expand the utility of the approach to mitigate service access barriers that families face. Telepractice service delivery “Telepractice is the application of telecommunications technology to deliver clinical services at a distance by linking clinician to client, caregiver, or any person(s) responsible for delivering care to the client, for the purposes of assessment, intervention, consultation and/or supervision” (Speech Pathology Australia, 2014). Telepractice has evolved as technical capacity has improved and is becoming established in both speech- language pathology practice and in provision of services for people with autism (Sutherland, Trembath, & Roberts, 2018). A significant factor driving the adoption of telepractice within the ASD population is the existing inconsistency in provision of timely and adequate diagnostic and intervention services (Braddock & Twyman, 2014; Ruggero et al., 2012). Considering the impediments for families seeking timely, evidence-based services for their children with ASD, it is clear that innovative service delivery methods such as telepractice need to be further developed and tested (Theodoros, 2012). Ninety-seven per cent of Australian households with children were connected to the internet in 2017 (Australian Bureau of Statistics, 2018). The expansion of intervention services via internet technology, therefore, offers realistic opportunities in Australia. The majority of research into telepractice-based, early ASD intervention to date has involved training individual

Ken Clarke (top) and Deepti Aggarwal

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JCPSLP Volume 21, Number 2 2019

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