Caregiver-Mediated Early Years Programs

Toddlers may already be able to make sounds or use words or phrases, but that is not required. Children should be able to move (walk, crawl, reach) towards preferred items or activities and to hear others speaking.

Learning Objective: To enhance the caregiver’s ability to create an environment that supports their child’s social communication development by using natural opportunities throughout their regular daily routines.

Targeted Skills: Intentional, functional vocal communication directed to others and sharing meaningful, positive emotions with others.

The Social ABCs is based on Pivotal Response Treatment principles and strategies integrated with parent/caregiver responsiveness training. Social ABCs focuses on specific activities and skills that are most relevant to toddlers during daily play and caregiving routines, taking into account the developmental and behavioural features of Autism Spectrum Disorder. Caregivers and coaches work collaboratively through a positive coaching model.

The caregiver will be encouraged to embed strategies into everyday play activities and caregiving routines between sessions. The caregiver may be required to complete some assessments, surveys, diaries, or other supplemental documents as part of the intervention and/or program evaluation.

Social ABCs coaching sessions involve a parent or caregiver, their child, and a trained coach. In the individual model, sessions involve instructive teaching from a trained coach, supported by a parent manual and individual discussions, and hands-on practice with live, direct coaching while the caregiver and child engage in natural play-based activities and daily routines.

Project ImPACT is for young children with autism and related social communication delays. Project ImPACT targets nonverbal communication skills, joint attention and engagement, gesture use, imitation, and functional and symbolic play.

Project ImPACT targets four core sets of social communication skills: social engagement, communication, imitation, and play. Project ImPACT makes learning fun for your child by using preferred activities such as bath time, mealtime and playtime to learn new skills. This program puts an emphasis on empowering the caregiver to learn strategies to support their child at home, giving the child many more hours of learning and practice. Project ImPACT also includes an optional unit on managing challenging behaviour.

Project ImPACT uses an easy-to-follow acronym, F.A.C.T.S., to explain the strategies being taught. These strategies build on one another.

F = Focus on your child, follow their lead and imitate them

A = Adjust your communication, use animation, model and expand

C = Create opportunities, playful obstruction, balanced turns, communicative temptations

T = Teach new skills, use prompts and rewards, prompts for using communication, projects for understanding communication, prompts for imitation, prompts for expanding play

S = Shape the interaction-whether at home or in the community, caregivers can use the different parts of the program that best fit.

Caregivers will be involved in developing goals for their child in collaboration with the Project ImPACT coach. Caregiver participation includes attending weekly individual or group sessions (with the child attending part of the session). The number of sessions per week will vary depending on which service delivery option the family chooses.

Caregivers will be asked to read assigned chapters and/or complete exercises in the caregiver manual prior to each session (approximately 15 to 30 minutes per week). In addition, caregivers will be asked to dedicate 15 to 20 minutes per day to practice F.A.C.T.S. strategies with their child. Lastly, the caregivers will actively participate in the service by talking to their coach about their needs, concerns and/or any questions they may have.

Individual Sessions:

One intervention technique will be introduced each session through:

• Written information
• Brief description of technique
• Demonstration of technique with child
• Opportunity for caregiver practice technique

Feedback Group Sessions format:

• Check in and set the session agenda (5% of the session)
• Review the Practice Plans (10% of the session)
• Introduce the new techniques, show video examples, and facilitate discussion (70% of the session)

Plan for practice and coaching (15% of the session)

PLAY Project is designed for children at all levels of need. Within the Ontario Autism Program (OAP) caregiver-mediated program, intervention will focus on children with a diagnosis of Autism from 12 months to 48 months of age who are communicating at a variety of levels, from no words up to and including sentences.

PLAY Project coaches start intervention with assessment. They will complete developmental profiles to ensure they are targeting the appropriate skills across different developmental domains, including:

• social interaction
• communication
• play
• pre-academic
• adaptive skills.

Caregivers and PLAY consultants/coaches engage in child directed play, using activities specifically designed to suit the child’s developmental level. The PLAY consultant/coach will model using different strategies to expand play and communication, however most of the session will involve the caregivers playing and interacting with their child using the strategies they have learned from the PLAY consultant/coach. Once per month for ten minutes, the PLAY consultant/coach will video record the caregiver playing with their child and for 5 minutes of the session the parent or caregiver will record the Play Consultant modelling the strategies with their child. The Play Consultant then takes the video clips and creates a Play Plan which is forwarded to the caregivers after the session along with the video clips. The Play Plan sets out the goals for the child for the coming month and also plots the child’s progress month over month. There are seven steps to the PLAY project:

1. An introduction to PLAY principles and methods

2. Creating a unique child profile

3. Development of a PLAY plan

4. Coaching, Modeling, and Feedback

5. PLAY time

6. Review (written & video)

7. Revising and updating the PLAY plan

The advantage of PLAY Project is that caregivers do not need any specific materials, just what they have already in the home. At least one parent/caregiver will need to be present during the home/centre visit and available to participate during each PLAY session. In between appointments caregivers are encouraged to play with their child using the recommended strategies for up to 2 hours per day, in small doses (e.g., 15 min) during daily routines and play. Caregivers are encouraged to ask questions, share successes, and challenges with their PLAY consultant/coach throughout the intervention, during appointments and in-between appointments.

A typical PLAY Project session involves the PLAY consultant, the parent/caregiver, and the child. The PLAY consultant will often start by checking in with the parent/caregiver to see how the intervention has been going and answer any questions the parents may have. Then the PLAY Consultant will play with the child demonstrating the individual strategies that are appropriate for their child’s developmental level. Once the parent/caregiver has had an opportunity to observe the PLAY consultant they will have an opportunity to practice those strategies in play with their child while the PLAY consultant is there to coach them. The PLAY consultant will video record the parent/caregiver playing with the child for 10 minutes and then the parent video records the PLAY consultant playing with the child for 5 minutes. These video clips form the basis of the Video Review Form and Play Plan that is sent to the parent/caregiver following the session (the videotaping occurs once per month and the Play Plan is sent once per month).