JCPSLP Vol 22 No 2 2020

more manageable. One parent pointed out a positive outcome from combining group training with personalised coaching was that they have seen “significant improvement in a short time as a result”. Although there were comments that the “techniques sound[ed] very complex at the beginning”, parents reflected on the competency they gained through regular practice and that it became “quite normal to do it”, and at that point, they saw improvement. One parent described the experience of integrating new knowledge in this way: The workshops were quite overwhelming in a sense that I was not able to integrate that [knowledge of naturalistic interaction practices i.e., ELOs and CLTs] into action, but you [SLP] coming here, and coaching me to do the stuff, has become a lot easier for me to understand. It is always the theory; interacting it and converting it into action [that] was a bit challenging, but as soon as I got there, it was quite an easy-flowing process. Parent reflections were supported through discussions based on the SLP’s observations of the parent–child interaction and through video feedback. Parents reported that watching the video of their planned interactions with their child provided them with opportunities for self-discovery and experience sharing, which they regarded as useful in gaining confidence. They felt that video feedback and focused observations were effective strategies to evaluate what they did well and to consider which strategies or skills they could target. Although two parents reported the video feedback as being overwhelming at the start, the general feedback from all parents was that it was beneficial in reflecting on how their use of interaction promoting strategies and naturalistic interaction practices enhanced their interactions with their child. One parent said: When I am playing, sometimes I don’t remember what I’ve said or what I am doing. But having the videos and looking back on them and actually seeing. I remember at the start of this; I was asking a lot of questions – closed kind of questions, either yes or no answers. It has been good to see it, knowing that is what I do and that is not really helping him. Coaching conversations naturally created opportunities for planning, reflection, and problem-solving of ways to embed naturalistic interaction practices into everyday activities and routines. One parent explained how the support from the SLP during home visits, equipped them to consider how they could apply CLTs during mealtimes and everyday conversations. The parent stated: I try and do the whole ABC thing, like “would you like chips or a biscuit?” and anything he is trying to do, I’ll try and make it, so it is a complete learning trial, even into everyday things to try and get him talking more. Positive family outcomes Parents reported seeing improvements in the child’s participation in everyday routines, increased understanding of spoken language, progress towards their child’s social communication goals, and improved behaviour. They also referred to improvements in family quality of life, which included a reduction in stress in their home, and feeling that their family life was more relaxed. Parents noticed changes in how they managed challenging behaviours at home, communicated expectations, and had a shared understanding of what to do. Families reported feeling more confident in participating in community activities and seeing

which involved the use of more descriptive and specific vocabulary, as well as learning that “the skill to describe things, encourages conversation”. They described how they learned about the benefits of engaging in interactions that were initiated by the child. One parent explained that they learned “to do what he [the child] is interested in, rather than trying to start something that is not really what he wants to do, because he is interested for longer when it is something he wants to do”. Parents shared how they discovered a variety of ways to interact and play with their child. By attending the workshops, they received valuable guidance on how to support their child’s use of targeted skills, using ELOs and CLTs. It was evident in parents’ comments that they had developed an understanding of the benefits of using embedded and naturalistic interaction practices. Here is an example of one parent explaining how they were using a CLT: I am talking about the ABC [complete learning trial], like when I make a comment [provide an antecedent] and he [child] repeats what I am saying [uses words, but does not use the targeted word], and then I affirm what he says, and then we go over it [provide additional help or a prompt], and when he doesn’t [no response from the child], I have that in the back of my mind that okay, we have to exit now [provide feedback] because obviously, he is not responding, so we will try it again later. Parent feedback about learning how to create CLTs and introduce ELOs, was overwhelmingly positive, reflected in their description of the intervention as being “amazing” and “incredible”. One parent commented, “I have loved it” and affirmed the usefulness of CLTs by stating, “just knowing how to try and start something and to keep it going, and the benefits of closing it off and giving praise at the end definitely helps.” Space and time to plan and reflect Parents shared that the training workshops not only provided them with the opportunity to acquire new skills but also offered them space and time to plan for and create an individualised plan while reflecting on how they would apply their skills in interactions with their child at home. They described the importance of a personalised intervention plan, but also mentioned that having devoted time to consider how they would embed these strategies within interest-based play activities at home, was very valuable. One parent mentioned: So, the Tuesday nights were great for actually thinking about what I do away from him as well, which was good and thinking about what I can do. Thinking about what we were discussing and then how it relates to my son. Another parent stated that: “It kind of gets you to do it; gets you to make time to play, to do different things, and a variety of things as well, not just do the same thing. I think if you plan it, you do it”. Support for strategy use through coaching Parents commented on the value of the home visits, as providing them with opportunities to put theory into practice. They reflected on how important it was for them to gain a better understanding of the concepts they learned formally, through practice and individualised guidance from the SLP. They recognised the value of receiving systematic guidance in the use of interaction promoting strategies and the implementation of ELOs and CLTs during the home visits. Specifically, the opportunity to receive individualised coaching from an SLP made strategy application at home

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JCPSLP Volume 22, Number 2 2020

Journal of Clinical Practice in Speech-Language Pathology