JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Despite efforts within this project to consider and maximise the accessibility of the group telepractice approach, it remains clear that limitations to adoption of the approach will continue to exist. These may include limitations in access to internet and technology, connectivity in regional and remote areas, cultural and educational factors, personal preferences and previous experiences with either face-to-face or telepractice-based intervention. Further research to address these areas is recommended. Participant satisfaction with telepractice HMTW-based intervention was high. Although reports of participant satisfaction within current literature is limited, early trends indicate that parents express satisfaction with telepractice approaches, particularly when telepractice intervention involves clinician assistance (Ingersoll, Wainer, Berger, Pickard, & Bonter, 2016). Despite the promise of telepractice-based services, it is recognised that technology and computer literacy remain obstacles to its adoption by some people (Kruse et al., 2018). Including parent satisfaction measures in future research will help clarify factors influencing parent experiences and contribute to the developing knowledge base. Small participant numbers in this pilot limited analysis of skill-based outcomes. The clinician perceived that gains made by participants were similar to those observed in face-to-face groups and parents reported that both group and individual sessions were very helpful. Broader research results regarding autism-specific, parent- mediated intervention and telepractice-based approaches, although limited, show increases in parent knowledge, intervention fidelity, and improvements in children’s social-communication (Beaudoin, Sébire, & Couture, 2014; Parsons et al., 2017). Available literature suggests that improvements in parent–child interaction can occur following parent-mediated intervention including increased parent synchronicity and shared attention, with possible increases in child comprehension levels (Oono et al., 2013). This research project was developed as a precurser to more comprehensive research involving telepractice delivery of HMTW to larger groups. The project demonstrated that telepractice-delivered HMTW is a feasible, potentially effective and desired intervention method. Considering these findings along with current research evidence, it is feasible that improvements in parent and child communication could occur through participation in future telepractice-delivered group-intervention training. Future research into telepractice-delivered HMTW will include measurement of communicative changes in both children and parents as well as investigation of parent perceptions of the approach. It is anticipated that larger numbers of participants may impact the quality of telepractice training. Limitations identified in the current study such as access to technology and elements with potential to degrade the telepractice experience including group interaction and audio/visual factors will require proactive consideration and problem-solving for future study. In the context that there are currently 7616 certified practising SLPs in Australia (L. Young, personal communication, 9 November 2018), the potential for expansion of telepractice-delivered training approaches such as HMTW is significant. Families face considerable barriers when accessing suitable intervention services for their children and group-based telepractice approaches may provide a way for more children with ASD and other communication challenges to access intervention earlier.

Further research into delivery methods supporting families to access intervention is warranted. Acknowledgements This feasibility study was supported by provision of laboratory facilities and project seed funding from the Institute for a Broadband-Enabled Society, University of Melbourne. The authors wish to thank the parents who participated in the project and associates at Clear Messages Pty Ltd for providing clinical facilities, equipment and IT support. References Aggarwal, D., Garnett, R., Ploderer, B., Vetere, F., Eadie, P., & Davidson, B. J. (2015). Understanding video based parent training intervention for children with autism . Paper presented at the Proceedings of the Annual Meeting of the Australian Special Interest Group for Computer Human Interaction, Parkville, Vic, Australia. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). Arlington, VA, US: American Psychiatric Publishing, Inc. Australian Bureau of Statistics. (2018, 28 April 2018). Household use of information technology, Australia, 2016–17 . Retrieved from http://www.abs.gov.au/ausstats/ abs@.nsf/mf/8146.0 Barbaro, J., & Dissanayake, C. (2013). Early markers of autism spectrum disorders in infants and toddlers prospectively identified in the Social Attention and Communication Study. Autism , 17 (1), 64–86. Beaudoin, A. J., Sébire, G., & Couture, M. (2014). Parent training interventions for toddlers with autism spectrum disorder. Autism Research and Treatment , 2014, 839890. Braddock, B., & Twyman, K. (2014). Access to treatment for toddlers with autism spectrum disorders. Clinical Pediatrics , 53 (3), 225–229. Bradshaw, J., Steiner, A. M., Gengoux, G., & Koegel, L. K. (2015). Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders , 45 (3), 778–794. Carlon, S., Carter, M., & Stephenson, J. (2013). A review of declared factors identified by parents of children with autism spectrum disorders (ASD) in making intervention decisions. Research in Autism Spectrum Disorders , 7 (2), 369–381. Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s “More Than Words” in toddlers with early autism symptoms. Journal of Child Psychology & Psychiatry , 52 (7), 741–752. Centers for Medicare and Medicaid Services. (1996). The health insurance portability and accountability act of 1996 (HIPAA) . Retrieved from http://www.cms.hhs.gov/hipaa Early Childhood Intervention Australia. (2016). National guidelines: Best practice in early childhood intervention . Sydney, NSW: Early Childhood Intervention Australia. Girolametto, L., Sussman, F., & Weitzman, E. (2007). Using case study methods to investigate the effects of interactive intervention for children with autism spectrum disorders. Journal of Communication Disorders , 40 , 470–492. Ingersoll, B., Wainer, A., Berger, N., Pickard, K., & Bonter, N. (2016). Comparison of a self-directed and therapist- assisted telehealth parent-mediated intervention for children with ASD: A pilot RCT. Journal of Autism & Developmental Disorders , 46 (7), 2275–2284.

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology