Training Parents in Jasp-EMT: Using Empirical Benchmarks to Evaluate Generalization and Maintenance of EMT Strategies

Background:   Implementation fidelity in parent-implemented early communication interventions is essential to ensuring effects of children’s language outcomes. Although many studies report changes in parent use of trained strategies, few compare parent performance to empirical benchmarks for effective implementation. Fidelity benchmarks provide a standard for evaluating parent implementation beyond demonstrating changes in use of strategies from pre to post-treatment. JASP-EMT (Joint-Attention, Structured-Play, Enhanced Milieu Teaching) is a social communication intervention that blends EMT (Enhanced Milieu Teaching) with JASPER (Joint-Attention, Structured-Play, Engagement, Behavior Regulation), two interventions that have been found effective in improving communication and related skills in young children with autism. Because interventions employing both therapists and parents may help children accelerate their language development and use, determining the extent to which parents can learn, generalize and maintain use of the strategies is important. 

Objectives:  The purpose of this study was to evaluate effects of training parents in the EMT component of the JASP-EMT intervention by examining parent fidelity of six intervention strategies from pre-intervention to post-intervention and maintenance of these skills at the 3-month follow-up testing point: 1) matched turns; 2) responsiveness; 3) expansions; 4) target level language; 5) time delays; and 6) milieu prompting episodes. Parent strategy use was compared to empirical benchmarks for effective EMT implementation.

Methods:   The participants in this study were the parents of 20 minimally-verbal children with autism ages 5-8 who received parent training as part of a larger randomized trial of JASP-EMT. Child participants received 1-hour intervention sessions twice per week with a therapist for a total of 48 sessions. Parent training occurred in two phases. During phase 1 (24 sessions), parents observed the sessions while children received the intervention from a therapist. During phase 2 (24 sessions), parents were trained individually and practiced with the child while receiving coaching and feedback. Parent fidelity in EMT strategy use was measured during each intervention session; generalization was measured in Caregiver-Child Interaction sessions (CCX) administered at post-intervention (session 48) and maintenance was measured in CCX sessions at the 3-month follow-up.

Results:  Parents significantly improved their use of all six strategies from pre-intervention to post-intervention. They generalized strategy use to the CCX and maintained use at the follow-up. Five of six strategies were generalized and maintained at or near benchmark levels: matched turns (criterion=50%; 56.4% post-intervention, 55.7% follow-up), responsiveness (criterion=80%; 85.7% post-intervention, 84.8% follow-up), expansions (criterion=40%; 45.1% post-intervention, 44.7% follow-up), target level language (criterion=50%; 46.9% post-intervention, 48.2% follow-up), and time delays (criterion=80%; 73.9% post-intervention, 73.1% follow-up). Percentage correct milieu episodes was below criterion at post-intervention and follow-up (criterion=80%; 29.3% and 30.0%, respectively). 

Conclusions:  Results indicate parent training was highly effective for teaching parents EMT strategies to support child communication, although additional training may be required for long-term use of milieu episodes. Future studies should focus on improving generalized performance by training across settings to ensure parents have skills for supporting emerging communication skills.  Given the strong positive outcomes in this study, future studies should examine the usefulness of empirical benchmarking for parent use of intervention strategies.