Hanen Programs: A Mediator Model for

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1 Hanen Programs: A Mediator Model for Early Language Intervention Toby Stephan, MA, CCC-SLP The Hanen Centre Part C IDEA Congress recognized an urgent need to: enhance the development of infants and toddlers with disabilities; reduce educational costs by minimizing the need for special education through early intervention; enhance the capacity of families to meet their child's needs. to the maximum extent appropriate, provide early intervention services in the natural environments IDEA Part C Section 635 (a) 2 What the experts say Active involvement by families is critical. Without it, intervention is unlikely to be successful - any short term effects are unlikely to be long-lasting. Bronfenbrenner, 1974 The earlier parents of children with disabilities are involved in intervention programs, the better the outcomes. Rossetti,

2 How to enhance family s capacity? Involve parents in their child's intervention BUT, what does involve mean? - parent observes SLP and is expected to follow his/her model - parent is the SLP s aide is taught to supplement what the SLP does in therapy OR 4 Parents as Interveners Give parents the skills to implement the intervention SLP becomes the mediator & the parent becomes the therapist 5 Presentation Objectives Define a mediator model intervention approach List 5-6 responsive interaction strategies parents learn within this model Identify key components of a teaching model that enable parents to learn to apply intervention strategies effectively Describe research that supports parent training 6 2

3 Presentation Objectives Define a mediator model intervention approach List 5-6 responsive interaction strategies parents learn within this model Identify key components of a teaching model that enable parents to learn to apply intervention strategies effectively Describe research that supports parent training 7 The Hanen Centre Not for profit/charitable Organization Service Resources Training Membership 8 Hanen Programs 9 3

4 What is Hanen s program content based on? 10 Facilitating a Child s Communication Two critical components to facilitating communication Both need to be present in order for a child to benefit 11 So what s the missing piece? 12 4

5 What s the missing piece here? 13 For children s communication to develop, they need both Interaction Language Input 14 The Hanen approach is based on Social-Interactionist theory: The child is able to process language input more easily when adult input is responsive Responsive input facilitates language g learning because it: is more motivating for the child, thereby increasing his participation in the interaction doesn t require the child to expend cognitive energy to shift gears to adult s focus 15 5

6 Responsiveness first Research: how often a parent initiates a conversation with the child is important but what matters most is, if the child initiates, whether the parent responds. 1. Interaction 2. Language input 16 Responsiveness first The central role of the parent is not to push massive amounts of language into the baby s b ears; rather, the central role of the parent is to notice what s coming from the baby, and respond accordingly. Bronson & Merryman, For children s communication to develop, they need both Interaction Language Input 18 6

7 Interaction? Language? Or Both? 19 Responsive Social Interaction Strategies First Child-centered strategies (increase child initiations) Be face to face Observe, Wait Listen (increase initiations) Follow child s lead Join in and play OWL 20 Responsive Social Interaction Strategies Second.. Interaction-promoting Match turns Imitate Cue for a turn Appropriate balance of questions and comments 21 7

8 Responsive Social Interaction Strategies And finally Language Modeling Interpret child s message Label variety of words Highlight, use repetition Expand Extend topic Hand That s your hand. Your hand is soooo dirty. 22 Presentation Objectives Define a mediator model intervention approach List 5-6 responsive interaction strategies parents learn within this model Identify key components of a teaching model that enable parents to learn to apply intervention strategies effectively Describe research that supports parent training 23 Format of Hanen Programs Combination of: group sessions for parents/caregivers; combined with individual video feedback sessions help parents practice and apply strategies successfully so child can achieve her/his communication goals 24 8

9 It Takes Two to Talk It Takes Two to Talk The Hanen Program for parents of preschoolers with expressive and receptive language delays. 25 It Takes Two to Talk Group Session 1: Let Your Child Lead Group Session 2: Follow Your Child s Lead Video Feedback #1 Group Session 3: Take Turns to Keep the Interaction Going Group Session 4: Add Language to the Interaction Group Session 5: Add Language to Build Understanding Video Feedback #2 Group Session 6: Let s Play! Group Session 7: Sharing Books Video Feedback #3 Group Session 8: Moving Forward with Music & Closing 26 Framework for Teaching Strategies Plan for home Practice, practice, practice!! (simulated and mental ) Hook the learner in establish a reason for learning Provide the information interactive, practical, relevant 27 9

10 Bob 28 Highlight Your Language Boh-lee Min-yeh Zohmp 29 Highlight Your Language: The 4 Ss: Say Less Stress Go Slow Show Repeat, Repeat, Repeat!! 30 10

11 Highlight Your Language Find examples of Dad using the 4Ss to help Luke say a two-word utterance 31 Let s try it out Partner A: Your child has finished the juice in his juice box. You are in the car (but not driving) and have no more juice for him. What are two things your child might say or do? Respond with two simple sentences, using the 4Ss. Partner B: You are blowing up a balloon and you stop blowing when you think it s big enough, but your child is making sounds and gesturing to tell you to keep on blowing it up. You re afraid the balloon will pop. What are two things your child might say or do? Respond with two simple sentences, using the 4Ss. 32 Think about applying the strategy Which of the 4 S s do you think you will focus on the most at home? Why? What can you do to help yourself remember the main thing(s) you want to try? 33 11

12 To Do at Home Plan Highlight your Language 34 Framework for Teaching Strategies Plan for home Practice, practice, practice!! (simulated and mental ) Hook the learner in establish a reason for learning Provide the information interactive, practical, relevant 35 Format of Hanen Programs Combination of: group sessions for parents/caregivers; combined with individual video feedback sessions help parents apply strategies successfully so child can achieve her/his communication goals 36 12

13 The Value of Videotaping 37 Sandra and Sean 38 Child and Parent Goals (after two group sessions) Sean s goal: to initiate more often Mom s goal: - OWL to encourage Sean to initiate - follow his lead by interpreting, imitating and commenting 39 13

14 Sandra and Sean after 2 Sessions 40 Video Feedback How does Elaine use the tape to increase Sandra s selfawareness? 41 Video Feedback What questions does Elaine ask to help Sandra develop a plan? 42 14

15 Presentation Objectives Define a mediator model intervention approach List 5-6 responsive interaction strategies used within this model Identify key components of a teaching model that enable parents to learn to apply intervention strategies effectively Describe research that supports parent training 43 Does parent-implemented intervention work? Can parents learn to apply intervention strategies effectively? Do children s language skills improve when parents are the interventionists? e t Can parents intervene as well as SLPs? Is it equally effective for children with and without intellectual disabilities (i.e., SLI, children with developmental delays, ASD)? 44 Kaiser and Roberts (2011) Meta-analysis - combined results of 18 studies that examined parent-implemented intervention Compared experimental with control groups (control groups either non-treatment, therapist- delivered, d or business as usual) Children average months (range: mos) All interventions were between weeks (less than 26 hours of parent training) All programs taught responsive strategies 45 15

16 Did parent training positively affect parents use of strategies? YES! Positive impact on... parent responsiveness parent s use of language models rate of communication with their child 46 Do parent-implemented interventions positively affect child language outcomes? YES! Positive & significant effects on: receptive & expressive language and vocabulary expressive morpho-syntax rate of communication 47 Is intervention more effective when delivered by a parent? YES... for some language constructs receptive language parents more effective expressive syntax parents more effective No significant difference in other constructs between intervention delivered by parent and SLP 48 16

17 Do the effects of parent-implemented interventions differ for children with or without intellectual difficulties? NO... except for expressive vocabulary (larger effect size for children without ID ) no difference in most language constructs for these two groups 49 Additional Meta-analyses Law, J., Garrett, Z., & Nye, C. (2004). McConachie, H., & Diggle, T. (2007). 50 Hanen Programs 51 17

18 52 References Bronson, P. & Merryman, A., (2009). Nurture shock: New thinking about children. New York, NY, Hachette Book Group. Law, J., Garrett, Z. & Nye, C. (2004). The efficacy of treatment for children with developmental speech and language delay/disorder: A meta-analysis. Journal of Speech, Language, and Hearing Research, 47, McConachie, H. & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: d A systematic ti review. Journal of Evaluation in Clinical Practice, 13, Roberts, M. & Kaiser, A. (2011). The Effectiveness of Parent-Implemented Language Intervention: A Meta-Analysis. American Journal of Speech-Language Pathology, 20, Note: There are free PDF research summaries for each of the Hanen Programs on our website, 53 Wrap Up Questions???? Visit our booth Thank you for listening 54 18

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