Involving Caregivers of Autistic Toddlers in Early Intervention: Common Practice or Exception to the Norm?

Abstract

Purpose: Family-centered practice (FCP) is a core component of early intervention (EI) associated with improved child and family outcomes, but little is known about community-based speech-language pathologists' (SLPs') inclusion of families in EI. Many caregivers of autistic children experience caregiving-related stress, making these intervention principles especially critical to the provision of optimal services. This study aimed to characterize EI SLPs' use of FCP coaching strategies and the quality of caregiver–SLP relationships. Method: Participants included 25 families with an autistic toddler and their EI SLP. One intervention session for each SLP–family dyad was recorded and coded for the SLP's use of FCP coaching strategies. Caregivers and SLPs completed surveys about their working alliance, caregiver perceptions of family-centered care, and SLPs' approach to FCP. Results: SLPs primarily use child-directed strategies without caregiver involvement. When involving caregivers, SLPs infrequently use coaching strategies that are important for caregiver learning and collaboration (e.g., joint planning and guided practice with feedback). However, caregivers perceived their child's services to be highly family-centered, and caregivers and SLPs rated their working alliance to be of high quality. Conclusions: The presence of strong caregiver–SLP working alliances alongside infrequent usage of effective coaching strategies indicates that SLPs may engage caregivers in ways that are perceived to be highly collaborative but are not optimal for caregiver involvement in all aspects of their child's services (goal setting and implementation of intervention). Consideration of family preferences and SLP beliefs about FCP will inform ways to disseminate FCPs needed to optimize families' capacities to support their child's development. Supplemental Material: https://doi.org/10.23641/asha.20113550

Evidence-Based Implementation of the Family-Centered Model and the Use of Tele-Intervention in Early Childhood Services: A Systematic Review

“…In the case of the family-centered model of care, its principles [ 22 , 25 ] facilitate the establishment and maintenance of the therapeutic bond, which enables both families and children attending the service to have positive feelings throughout the intervention process [ 21 , 41 , 42 , 44 , 55 , 59 , 64 , 65 ]. The inclusion of the family as an active agent in the process is the fundamental principle that relates to the intentional relationship model where the interpersonal dynamics or the interaction between the practitioner–family–child triad has the power to enable or inhibit that active participation during the process [ 21 , 55 ]. This is different from other models of care such as the person-centered model [ 81 ] or the system-centered model [ 82 ], where interaction with the family is merely relational [ 47 ].…”