coaching approach · 2018. 4. 4. · coaching characteristics application evidence to support the...

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Highlights and Challenges of the Coaching Approach to Speech & Language Intervention with Infants and ToddlersBecca Jarzynski, M.S. CCC-SLP & Tammy Stearns, M.S.E.

Introductions

Coaching Characteristics Application

Evidence to Support the Coaching Approach Relationship-based intervention

Speech & language outcomes for parent-implemented interventions

Highlights and Challenges of the Coaching Approach Case scenarios

Brainstorming

Solutions

Resources

Coaching Approach5 characteristics

Coaching is….

“Coaching is an adult learning strategy that is used to build the capacity of a parent or colleague to improve existing abilities, develop new skills, and gain a deeper understanding of his or her practices for use in current and future situations

(Hanft, Rush, & Shelden, 2004; Rush, Shelden, & Hanft, 2003).

“Two primary goals of coaching:

1. Support learners in making positive changes in their interactions with young children through a process of observation, action, & reflection

2. To ensure that child/family outcomes are actually achieved”

(Rush, Shelden, & Hanft, 2003)

Who is your thick line?

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“Evidence-Based Practices”

5 Characteristics of Coaching:

• Joint Plan• Observation• Action/Practice• Reflection• Feedback

“Coaching is not a step-by-step process. A coach must apply research-based characteristics in a fluid manner while following the lead of the coachee. Coaching uses the 5 characteristics of coaching over time rather than involving a prescribed sequence of the characteristics”

(Rush & Shelden, 2011).

Joint Planning

Agreement by both the coach and learner on the actions to be taken by the coach and/or learner or the opportunities to practice between coaching visits.

Observation

Coach observes the parent & child

OR

Parent observes the coach and the child

Action/Practice

Spontaneous or planned events that occur within the context of a real-life

situation thatprovide the learner with

opportunities to practice, refine, or analyze new or

existing skills.

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Reflection

Follows an observation or action and provides a

parent an opportunity to analyze current strategies and refine her knowledge

and skills.

1. Awareness-• What are you currently doing?• Tell me what you already know about….

2. Alternative-• Would you like to try this or that?• What else might work?

3. Analysis• How do you think that went?• How did that compare to your expectations?

4. Action• Which option would you like to try? • What resources do you need?

4 types of reflective questions

Feedback

Information provided by the coach based on direct

observations of the learner by the coach,

actions reported by the learner, or information

shared by the learner to expand the learner’s

current level of understanding about a

specific evidence-based practice

1. InformativeSharing information

2. AffirmativeNoncommittal acknowledgement to let the learner know that she has been heard

3. Evaluative A judgement of what the coach sees or hears from the learner

4. DirectiveTelling the learner what to do

4 types of feedback

Evidence to support coaching

Developmental Science &Relationship-based Intervention

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http://developingchild.harvard.edu/resources/building-adult-capabilities-to-improve-child-outcomes-a-theory-of-change/

Building Adult Capacities to Improve Child Outcomes

Neurons to Neighborhood

Children’s emotional and social development is as important to school readiness as their cognitive and language development


Human relationships, and the effects of relationships are the building blocks of healthy development Neurons to

Neighborhood

Young children’s relationships with their primary caregivers have a major impact on their cognitive, linguistic, emotional, social, and moral development


The cumulative burden of multiple risk factors and sources of stress compromises the capacity of a caregiver to promote sound health and development. The buffering function of protective factors and sources of support enhances it.


The ability of caregivers to attend to the individualized needs of young children is influenced by both their internal resources (emotional health social competence, intelligences, educational attainment, personal family history) and the external circumstances of their lives (family environment, social networks, employment status, economic security, experience with discrimination).

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One of the most consistent associations in developmental science is the association between economic hardships and compromised child development

Everyday Learning Opportunities

Once a week therapy = 1% of the life of a 1 year old

Each daily activity (feeding, diapering, baths, lap game) is experienced 2000 times during the first year of a child’s life

20 everyday activities = 40,000 learning opportunities by age 1

Preschoolers participate in 50 different kinds of every day activity = 100,000 learning opportunities/year

Evidence to support coaching

Speech and Language Outcomes of Parent-Implemented Interventions

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Roberts, M. & Kaiser, A. (2015)

Early Intervention for Toddlers with Language Delays: A Randomized Controlled Trial, Pediatrics

Toddlers, aged 24-42 months & their caregivers

Randomly assigned to: Intervention group

“Usual care” control group

Parents taught to use Enhanced Milieu Training within everyday routine

3 months of parent training Teach-Model-Coach-Review

Roberts, M. & Kaiser, A. (2015)

Early Intervention for Toddlers with Language Delays: A Randomized Controlled Trial, Pediatrics

Results: “Toddlers in the intervention arm were less likely to meet the criteria for language delay after intervention than toddlers in the control arm”

After 3 months of intervention:

75% of toddlers in the control arm were delayed

51% of toddlers in the intervention arm

Roberts and Kaiser (2011)

The Effectiveness of Parent-Implemented Language Intervention: A Meta-Analysis

Meta-analysis of studies of parent-implemented interventions for children: Between the ages of 18 and 60 months

With both primary and secondary language impairments

Included studies that compared parent-implemented interventions to: No intervention

Therapist-implemented interventions



Results: When compared to a control group, parent-implemented intervention had positive, significant effects on:

receptive and expressive language skills,

receptive and expressive vocabulary,

expressive morpho-syntax,

rate of communication when compared to a control group.



Results: There was no difference between parent- and therapist-implemented intervention for :

Overall language

Expressive language

Expressive vocabulary

Rate of communication



Results: There was a difference between parent- and therapist-implemented intervention for :

Receptive language

Expressive morpho-syntax

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Results: For the majority of language constructs (i.e., overall language, expressive language, receptive language, and rate of communication), there were no significant differences between children with and without intellectual disability



Results: Parent training also had positive effects on parent use of intervention strategies, with the largest effect on parent responsiveness

Buschmann, A. et al. (2009) & Buschman, A. et. al. (2015)

Parent based language intervention for 2-year-old children with specific expressive language delay: A randomized controlled trial (2009).

Long-Term Effects of a Parent-Based Language Intervention on Language Outcomes and Working Memory for Late-Talking Toddlers (2015)

58 late-talking children between the ages of 24-27 months

Randomly assigned to parent-implemented treatment or no-treatment group

Parents in tx group completed seven 2-hours group session that taught them to use language facilitation strategies

Measured results 12 months later (2009) and 2 years later (2015)

Buschmann, A. et al. (2009) & Buschman, A. et. al. (2015)

Parent based language intervention for 2-year-old children with specific expressive language delay: A randomized controlled trial (2009).

Long-Term Effects of a Parent-Based Language Intervention on Language Outcomes and Working Memory for Late-Talking Toddlers (2015)

Results:

12 months after tx onset, children in intervention group outperformed the children assigned to the no-tx group on:

Parental report measure of vocabulary, morphology, syntax,

Norm referenced clinician administered tests of vocabulary and syntax

75% of children in the tx group no longer met criteria for late talking, while only 44% of children in the no-tx group no longer met criteria.

2 years later:

74% of the 4-year-old children in the tx-group showed receptive and expressive language abilities within the typical range compared with 50% of the no-tx group

The odds of “catching up” were 2.83 times higher if parents were trained than if they did not receive the intervention

Girolametto, L. et al. (1996)

& Girolameto, L.

et al. (1997)

Interactive focused stimulation for toddlers with expressive vocabulary delays. (1996)

Effects of lexical intervention on the phonology of late talkers. (1997)

25 total children – 23-33 months old

Late-talkers

Randomly assigned to receive intervention immediately or following a waiting period

Parent-training in general language stimulation + focused stimulation

Girolametto, L. et al. (1996)

& Girolameto, L.

et al. (1997)

Interactive focused stimulation for toddlers with expressive vocabulary delays. (1996)

Effects of lexical intervention on the phonology of late talkers. (1997)

Results:

Mothers used significantly fewer words/minute, shorter utterances, and more target words (Girolametto, 1996).

Children had significantly larger vocabularies, used a significantly greater number of different words (both target and control words) produced more multiword combinations than the children in the control group (Girolametto, 1996).

Indirectly resulted in significant gains in phonology – children who received the intervention produced more complex syllable shapes and expanded their phonetic inventory to include more consonant sounds (Girolametto, 1997).

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Ha, S. (2015)

Effectiveness of a parent-implemented intervention program for young children with cleft palate

26 children with cleft palate

Parent-implemented group and no-tx group

3 months of parent training + parent-implemented intervention

Parent-training:

Audio samples of speech problems

Language stimulation strategies

Communication strategies

Ha, S. (2015)

Effectiveness of a parent-implemented intervention program for young children with cleft palate

Results:

Children who received a parent-implemented intervention exhibited significant improvement in:

expressive vocabulary size,

number of total words, and

mean length of utterance

The intervention group also showed a decrease in the percentage of compensatory misarticulation following the intervention, whereas the control group showed an increase in the percentage of compensatory misarticulation.

References and Resources

Brown, J. and Woods, J. (2015). Effects of a Triadic Parent-Implemented Home-Based Communication Intervention for Toddlers. Journal of Early Intervention, 37 (1) 44-48.

Buschmann, A. Joos, B., Rupp, A., Feldhusen, F. Pietz, J. & Philippi, H (2009). Parent based language intervention for 2-year-old children with specific expressive language delay: A randomized controlled trial. Archives of Disease in Childhood, 94, 110-116. doi: 10.1136/adc.2008.141572

Buschmann, A., Multhauf, B., Hasselhorn, M., Pietz, J. (2015). Long-Term Effects of a Parent-Based Language Intervention on Language Outcomes and Working Memory for Late-Talking Toddlers. Journal of Early Intervention. Vol. 37(3) 175–189 DOI: 10.1177/1053815115609384

Fenichel, E. (2001). From Neurons to Neighborhoods: What’s in It for You? Zero-to-Three. April/May, 8-13. Retrieved from: http://main.zerotothree.org/site/DocServer/21-5_Fenichel.pdf?docID=12681http://fipp.org/

Resources and References

Girolameto, L., Pearce, P.S., & Weitzman, E. (1997). Effects of lexical intervention on the phonology of late talkers. Journal of Speech, Language, and Hearing Research (40) 338-348.

Ha, S. (2015). Effectiveness of a parent-implemented intervention program for young children with cleft palate. International Journal of Pediatric Otorhinolaryngology (79), 707-715.

Hanft, B.E., Rush, D.D. & Shelden, M.L. (2004). Coaching families and colleagues in early childhood. Baltimore, MD: Paul H Brookes Publishing Company.

Hart, B. & Risley, R. (2000). Meaningful Differences in the Everyday Experience of Young American Children. Baltimore, Maryland: Paul H. Brooks Publishing.


Kaiser, A & Roberts M. Parent-Implemented Enhanced Milieu Teaching with Preschool Children Who Have Intellectual Disabilities. Journal of Speech, Language, and Hearing Science, 56, 295-309.

National Research Council Institute of Medicine. (2000). From Neurons to Neighborhoods.Washington, D.C: National Academy Press.

Paul, D., & Roth, F. (2011). Guiding Principles and Clinical Applications for Speech-Language Pathology Practice in Early Intervention. Language Speech and Hearing Services in Schools, 42, 320-330.

Roberts, M. And Kaiser, A. (2015). Early Intervention for Toddlers with Language Delays: A Randomized Controlled Trial. Pediatrics, 135 (4). DOI: 10.1542/peds.2014-2134

Roberts, M., & Kaiser, A. (2012). Assessing the Effects of a Parent-Implemented Language Intervention for Children with Language Impairments Using Empirical Benchmarks


Roberts, M. & Kaiser, A. (2011). The Effectiveness of Parent-Implemented Language Intervention: A Meta-Analysis. American Journal of Speech-Language Pathology, 20, 180-199.

Rush, D.D., Shelden, M.L. & Hanft, B.E. (2003), Coaching families and colleagues: A process for collaboration in natural settings. Infants and Young Children, 16 (1), 33-47.

Rush, D., Shelden, M., Raab M. (2008). A Framework for Reflective Questioning When Using a Coaching Interaction Style. CASEtools, 4 (1), 1-7. Retrieved from: http://fipp.org/static/media/uploads/casetools/casetool_vol4_no1.pdf

Rush, D. & Shelden, M. (2005) Evidence-Based Definition of Coaching Practices CaseinPoint, 1 (6), 1-6. Retrieved from: http://fipp.org/static/media/uploads/casecollections/caseinpoint_vol1_no6.pdf

Rush, D. and Shelden, M. (2011). The Early Childhood Coaching Handbook. Baltimore, MD: Paul Brookes Publishing.

Wetherby. A., Guthrie, W., Woods, J. Schatschneider, C., Holland, R., Morgan, L., & Lord, C. Parent-Implemented Social Intervention for Toddlers With Autism: An RCT. Pediatrics, 134 (6), p. 1084 (10).

Wilcox, J. & Woods, J. (2011). Participation as a Basis for Developing Early Intervention Outcomes. Language, Speech, and Hearing Services in Schools (42): 365-378.

http://main.zerotothree.org/site/DocServer/21-5_Fenichel.pdf?docID=12681http://fipp.org/

Framework for Reflective Questioning

Question Content

Question Type

Awareness

Analysis

Alternatives

Action

Knowledge/

Understanding (What you know)

What do you know about…?

What is your current understanding of (topic, situation)?

Probes (examples):

How did you come to believe this?

How does that compare to what you want to know about…?

How is that consistent with (standards, evidence)…?

What do you know now after trying…?

How does that compare with what you

originally thought?

How could you find out about…?

What different things could you do to learn more about …?

What are other ways to view this for next time?

How do you plan to learn more about..?

What option do you choose? Why?

How are you going to put that into place?

Probes(examples):

What resources do you have?

What supports will you need?

Where will you get them?

Practice

(What you did)

How are you currently doing…? Why?

What kinds of things did you do (have you

done so far)? Why?

What kinds of things did you try? Why?

What kinds of things are you learning to do?

What did you do that worked well?

Probes(examples):

What is the present situation in more detail?

Where does that occur most often?

When did you first notice this?

How is that consistent with what you intended to do (wanted to do)? Why?

How is that consistent with standards? Why?

What else could you have done to make

practice consistent with standards? Why?

What would you do differently next time?

How might you go about doing that?

What different ways could you approach this?

Probes(examples):

What would it take for you to be able to do…?

What would you need to do personally in order to do…?

What do you plan to do?

When will you do this?

What option did you choose?

Probes(examples):

What types of supports will you need?

What resources do you have?

What would it take for you to be able to do…?

What would you need to do personally in order to do…?

Outcomes (What was

the result)

How did that work for you?

What happened when you did…? Why?

How effective was it to do that?

What did you achieve when you did that?

What went well?

Probes(examples):

How do you feel about that?

What do you think about…?

How much control do you have over the outcome?

How did you know you needed to do something else?

How did that match (or was different from)

what you expected (or wanted) to happen?

Why?

How do these outcomes compare to

expected outcomes based on standards of

practice? What should happen if you’re

really doing (practice)?

What brought about that result?

What else might happen when you do …?

Why?

What different things could you have done to get expected outcomes?

What might make it work even better next time?

Which option could get the best result?

What do you plan to do differently next time?

Probes(examples):

What types of supports will you need?

What resources do you have/need?

Where will you get them?

Evaluation (What about

the process)

What opportunities were useful to you in

achieving… (or in learning…)? In what

way? How was it useful? Why?

What supports were most helpful?

What about the supports were most helpful?

Probes(examples): How do you feel about that? What do you think about…? How was that consistent with what you expected?

What other opportunities would be useful?

What opportunities do you want to access? How will you access those opportunities?

Probes (examples):

What resources do you need?

Where will you get them? Source: The Early Childhood Coaching Handbook by Dathan D. Rush, Ed.D., CCC-SLP, and M’Lisa L. Shelden, PT, Ph.D.

Copyright © 2011 by Paul H. Brookes Publishing Co, Inc. All rights reserved.

The Coaching Quick Reference Guide

Characteristic: Observation What the Coach Does The coach observes the coachee within the context of his/her everyday activities.

What the Coachee Does The coachee observes the coach model a behavior or activity in the context of an everyday activity

with an explicit understanding of what and why he or she is watching.

Characteristic: Action What the Coach Does The coach supports the coachee in practicing, refining, and/or analyzing new or existing skills during real-life situations that occur during coaching interactions and between coaching visits.

What the Coachee Does The coachee tries new ideas or actions that either were previously discussed and planned with the coach or resulted from a previous coaching conversation.

Characteristic: Reflection What the Coach Does The coach uses reflective questions to assist the coachee in analyzing the current situation, and then encourages the coachee to generate alternatives and actions for continually improving his/her knowledge and skills, thereby achieving the desired outcomes.

What the Coachee Does The coachee determines what worked or did not work and why it did or did not during the observation and/or action, as well as generates ideas for next steps.

Characteristic: Feedback What the Coach Does The coach uses noncommittal acknowledgment when it is appropriate to affirm what the parent or care provider says or does. He/she provides positive feedback when it is necessary. He/she shares information to build on the coachee’s knowledge and skills.

Characteristic: Joint Planning What the Coach Does The coach begins every coaching conversation by reviewing the previous joint plan and asking what the coachee did between conversations to implement the plan.

What the Coachee Does The coachee share what he/she has tried or accomplished between coaching conversations.

What the Coach Does The coach ends every coaching conversation with a plan of who is going to do what by when, based on the actions and ideas discussed.

What the Coachee Does The coachee identifies what he/she wants to try or accomplish between coaching conversations and suggests when the next conversation should be scheduled.

Rush and Shelden, 2011

FOR HANDOUT WSHA Presentation SlidesQuik_Ref_Coaching _Guide_June 2013

coaching approach · 2018. 4. 4. · coaching characteristics application evidence to support the...

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