JCPSLP Vol 22 No 2 2020

Parent-implemented interventions often highlight the importance of offering regular opportunities to parents to practise using strategies, while receiving feedback on their implementation, either through direct observations or video feedback (Kemp & Turnbull, 2014; Meadan, Ostrosky, Zaghlawan & Yu 2009; Stephan, 2015; Stephan & Manning, 2017). When parents are encouraged to plan for and create learning opportunities for their child, they should also be given opportunities to practice, receive feedback, and reflect on their implementation of these practices. As parents gain confidence and competence, they are well- positioned to develop independent and generalised use of these strategies. Over the last decade, speech-language services have shifted from a therapist-led approach to an emphasis on family capacity-building practice, guiding SLPs to integrate parent-implemented interventions in their practice with families and ensure they offer built-in opportunities for training and coaching. Although embedded and naturalistic interventions are widely supported, the systematic nature of CLTs and ELOs has had limited attention in conventional speech-language services. This article highlighted that parents from this study were appreciative of the opportunity to gain knowledge and mastery in supporting their children with more systematic and precise practices, leaving them empowered and supported. Positive feedback from parents on their successful application of CLTs and ELOs in interactions with their child at home when given intensive training and individualised support has important implications for clinical use by SLPs who regularly support young children on the autism spectrum. Findings from this study suggest that parents can be supported in using more systematic practices in their interactions with their child and that SLPs are well placed to offer families these specialised training and individualised coaching interventions. This study has limitations in terms of validity and generalisability. Given that this study recruited a small sample of parent–child dyads, the results cannot be generalised to a larger population whose demographics and characteristics vary greatly. Furthermore, the informal feedback from parents in this study was collected by the primary researcher, who also implemented the intervention, which may have influenced the parents’ responses. This paper, therefore, highlights the need for more research into the impact of SLP interventions that offer parents opportunities to learn how to maximise naturally occurring activities and routines, and successfully and independently embed naturalistic interaction practices. Summary and conclusions This paper provides SLPs with unique insights into the perspectives and experiences of a small group of parents who participated in an embedded social communication intervention. Parent feedback highlighted the value of intensive training paired with individualised coaching support to not only enhance their interactions with their child, but also achieve positive child and family outcomes. For SLPs, this article has emphasised the value of integrating training and coaching opportunities for parents of young children on the autism spectrum into their practice, in particular offering parents individualised support in applying and generalising interaction promoting strategies and naturalistic instructional practices into their routines and activities at home. We have learned from parents that they value gaining knowledge of using more systematic practices, but they also value having 1:1 coaching support

improvements in the way they talked with their partners about their child’s communication needs. One parent confirmed, “I think even in my relationship with my husband; we are both calmer as well. We have more harmony; we have better communication around things.” Another parent noted that they had seen changes in their child’s behaviour in other community settings, for example, “even his Daycare has said it has been like a switch for him, overnight he is talking more.” All parents spoke about seeing positive differences in their child’s social communication skills and specifically noted increased use of spoken language within everyday activities. Discussion Data generated from informal conversations with parents offered valuable insight into how useful parents found the combined experience of gaining knowledge of embedded and naturalistic interaction practices through workshop training, and receiving individualised coaching support provided by the SLP. Parents described their experiences of learning how to plan for, and implement more systematic, and precise interaction practices during naturally occurring and interest-based interactions with their child. The intervention yielded positive child and family outcomes, as reported by parents. A core component of the intervention was to train and coach parents to use naturalistic interaction practices. Parents reflected positively on their experiences of learning to use ELOs and CLTs in their interactions with their child. They perceived that gaining knowledge and experience in creating and implementing ELOs and CLTs enabled them to capitalise on natural learning opportunities, which in turn resulted in positive outcomes for the child. This finding aligns with research evidence that children are more likely to gain targeted skills when the structure and predictability of interactions are increased (Salisbury et al., 2018; Sandall et al., 2000; Snyder et al., 2013; Snyder et al., 2015; Snyder et al., 2018). Parent feedback also suggests that they valued gaining knowledge about embedded and naturalistic interaction practices through SLP facilitated workshops paired with receiving individualised feedback in their use of more systematic and precise practices within their interactions with their child at home. Individualised planning and discussions during the workshops were reported as being helpful in supporting them to reflect on how they could use ELOs and CLTs with their child at home. Furthermore, follow-up individualised coaching from an SLP brought the knowledge to life when they received scaffolding to integrate their learned knowledge of naturalistic interaction practices such as ELOs and CLTs in their home environment. One of the insights offered by parents was that individualised coaching improved their understanding of, and confidence with using more systematic and precise practices. Parents acknowledged that the workshop content related to ELOs and CLTs were overwhelming and complicated at the beginning, but opportunities for individualised planning and coaching support including video feedback from an SLP during the home visits made it more manageable. This finding suggests that, in addition to gaining knowledge, parents need access to individualised support to become confident and develop competency in applying this knowledge. This finding is echoed in the literature on parent capacity-building practices where coaching and individualised planning are considered critical for supporting independent use of a set of skills with the end of goal of empowerment (Mataiti, van Bysterveldt, & Miller, 2016; Stephan, 2015; Stephan & Manning, 2017).

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JCPSLP Volume 22, Number 2 2020

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