Exploring the Coaching Process and Routine Context of Early Social Interaction (ESI), a Parent-Implemented Intervention for Toddlers with ASD

Background: There is a critical need for systematic measurement and analysis of how parents are taught to use intervention strategies and supports as a part of parent-implemented interventions for young children with ASD. Advancing beyond broad protocol descriptions to data that represents the actual implementation may provide the foundation for examining differential mediating effects of parent-implemented interventions.

Objectives: The purpose of this study was to explore and quantify the caregiver coaching process of the Early Social Interaction Parent-Implemented Intervention (ESI PII). Specifically, coaching behaviors used by interventionists, the caregiver’s role in intervention, and the routine context for which intervention was provided were measured in video-recorded intervention sessions across the nine-month home-based intervention.

Methods: Video-recorded home intervention sessions were independently coded in 30-sec intervals for three mutually exclusive and exhaustive coding sets: coaching strategies, caregiver role, and routine context. Initial analysis was completed for 41 interventionist-parent-child triads (n=20, Florida; n=21, Michigan) across four time points (months 1, 3, 6, & 9). Operationally defined coaching behaviors were categorized as general coaching strategies (conversation and information sharing, observation, joint interaction) and specific strategies (direct teaching and demonstration, guided practice with feedback, caregiver practice with feedback, and problem solving and reflection). The parent’s role in intervention was coded as leader, partner, participant, observer/listener, and not present. The routine context was measured across the ESI activity categories of play with toys/objects, play with people, meals and snacks, caregiving, book sharing, and family chores.

Results: Aggregate data analysis demonstrated that the interventionists used a variety of general and specific coaching strategies. The combined strategies of direct teaching and demonstration with narration (10%), guided practice with feedback (12%), and caregiver practice with feedback (12%) represented 34% of the intervention, which is almost double the amount of time spent in conversation and information sharing (18%). Parents demonstrated an active role throughout the the intervention, demonstrated by 75.34% time as partners, 14.05% of time as leaders, and 7.07% of time as participants compared negligible time as observers (1.37%) or not present (1.07%). Majority of the intervention time (77.61%) was comprised of the triads actively participating in a routine (as opposed to planning or reviewing the activity). Within that active participation, the following routine contexts were proportionally represented: play with toys/objects (39.91%), play with people (7.56%), meals and snacks (16.11%), caregiving (8.08%), book sharing (13.36%), and family chores (1.31%).

Conclusions: The results provide a quantifiable understanding of the process used to teach parents within ESI PII, indicating that interventionists used a combination of coaching strategies that supported the parent in an active role across varied routine contexts to increase their capacity to independently support their child’s learning between sessions with the provider. The results provide evidence that ESI PII aligns with the National Research Council (2001) and IDEA Part C recommendations of parent involvement and embedded instruction across meaningful activities. These findings have important implications for extending measurement in parent-implemented interventions to include the process and context used to teach parents.