Best Practices in Early Intervention Services (0-5)

Annette Wragge, Teri McGill, Jamie Lewis Author

03/24/2021 Added

6 Plays

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[00:00:01.210]So good morning everyone,
[00:00:02.610]and welcome to our discussion this morning,
[00:00:05.790]in Best Practices for Early Intervention Services
[00:00:08.940]for Young Children Zero to Five with Autism.
[00:00:11.960]Before we get started,
[00:00:13.040]I thought it might be helpful if you knew who we were.
[00:00:16.270]I'm Jamie Lewis,
[00:00:17.220]I'm the Central Region Autism Coordinator.
[00:00:20.610]And I'm Teri McGill,
[00:00:21.710]and I am the Metro Region ASD Coordinator.
[00:00:25.560]And I am Annette Wragge,
[00:00:26.780]I'm the State Coordinator for the Nebraska ASD Network.
[00:00:31.870]So we have some learning targets
[00:00:33.330]and objectives for you today,
[00:00:34.580]and I'll just pause and let you look through these.
[00:00:47.850]We have had many discussions about evidence-based practices
[00:00:51.620]about natural developmental behavior intervention,
[00:00:54.740]about learning targets,
[00:00:56.390]and resources that we'd like to share
[00:00:58.270]in that discussion with you today.
[00:01:01.090]You've read through the learning objectives,
[00:01:02.940]but you'll hear much more about evidence-based practice,
[00:01:06.070]you'll hear a lot more about what are
[00:01:08.310]natural developmental behavior interventions,
[00:01:11.540]how you implement those,
[00:01:13.180]as well as some learning targets and embedded trials
[00:01:16.420]into the natural routine and family life.
[00:01:19.320]And then also we want to direct your attention
[00:01:21.180]to some resources today as well.
[00:01:24.600]So we hear a lot about evidence-based practice,
[00:01:28.780]but Annette, would you like to tell us
[00:01:31.070]kind of what evidence-based practices are,
[00:01:33.840]how we should use them,
[00:01:35.580]why we should use them,
[00:01:36.530]and then also maybe what resources are available
[00:01:39.310]to us for evidence-based practice?
[00:01:43.100]Absolutely.
[00:01:43.933]This is actually a topic that I really like talking about.
[00:01:47.820]And I think we're very lucky in the field of autism
[00:01:50.470]to have some really good guidance
[00:01:51.970]around evidence-based practices.
[00:01:54.240]So why should we use evidence-based practices?
[00:01:58.270]This one's pretty clear.
[00:01:59.610]It really is something that IDEA,
[00:02:02.870]so the Individuals with Disabilities Education Act,
[00:02:05.840]has said needs to happen,
[00:02:07.700]as well as for our young children,
[00:02:09.260]once they transitioned to elementary
[00:02:11.180]and middle and high school,
[00:02:13.010]the ESEA, the Elementary and Secondary Education Act,
[00:02:17.140]both require the schools' youth programs, curriculum,
[00:02:19.990]and practices that are based on
[00:02:22.010]scientifically based research, okay?
[00:02:24.400]And so we definitely wanna be paying attention to that.
[00:02:27.750]Furthermore, we wanna make sure we're using practices
[00:02:30.160]that really work for individuals with autism.
[00:02:33.120]So let's look at some of the resources
[00:02:34.780]that have been put together in the field.
[00:02:38.090]There are some really good documents that we have
[00:02:41.630]that give us some recommended practices,
[00:02:44.250]very specific to students with autism.
[00:02:46.810]So two that we're gonna look at today
[00:02:48.650]are the National Standards Project, as well as
[00:02:51.210]the National Professional Development Center on ASD.
[00:02:54.720]So let's go ahead and take a look at that.
[00:02:59.635]Again, as I said, we're really lucky in the field of autism
[00:03:02.780]that these very comprehensive systematic reviews
[00:03:05.820]of the literature for what works
[00:03:08.660]for individuals with autism
[00:03:10.860]and what's not effective for individuals with autism,
[00:03:13.810]have been done to give us this wealth of knowledge
[00:03:17.200]on what we consider to be evidence-based practices
[00:03:20.880]for individuals with autism.
[00:03:22.820]So back in 2009, the National Standards Project,
[00:03:26.840]that's a part of the National Autism Center,
[00:03:29.740]they did a comprehensive literature review
[00:03:32.620]looking at all the research studies
[00:03:34.180]that there were out there on practices,
[00:03:36.400]and they identified 11 treatments
[00:03:38.520]as having a really strong evidence-base.
[00:03:41.750]Then in 2010, the National Professional Development Center,
[00:03:46.920]looked at, you know, 10 years again,
[00:03:50.580]worth of literature and research studies
[00:03:52.690]on practices for individuals with autism,
[00:03:56.220]and they identify 24 practices that have an evidence-base.
[00:04:01.220]And then in more recent years, in 2014,
[00:04:04.570]and then again actually in 2017,
[00:04:07.920]both the National Standards Project
[00:04:11.100]and the National Professional Development Center
[00:04:14.750]did updated reviews of the literature.
[00:04:17.480]And we currently have 27 practices that were identified
[00:04:22.610]by and, yes, go ahead, and we'll take a look at those,
[00:04:25.630]by the National Professional Development Center
[00:04:28.970]as having an evidence-base.
[00:04:31.460]So the things that are on your screen,
[00:04:33.340]you can take a moment to look at them,
[00:04:35.211]these are practices in the field of autism
[00:04:40.460]that have been proven to show, to demonstrate,
[00:04:44.270]that they are effective for individuals with autism, okay.
[00:04:48.220]So we do have to consider, you know,
[00:04:50.176]individuals when we're selecting evidence-based practices
[00:04:54.390]and what that individual has strengths in
[00:04:56.270]and what their needs are and certainly their age range.
[00:04:59.290]And so there is some guiding information on how to select
[00:05:02.560]an appropriate evidence-based practice,
[00:05:05.070]but I think it's also really good to know that
[00:05:06.960]we have a variety of things that work and likely
[00:05:09.490]some things on the screen
[00:05:10.470]that you're already using or are familiar with,
[00:05:13.710]and those things do have an evidence-base.
[00:05:17.210]So let's go ahead and take a look at the next slide.
[00:05:22.520]This is a really cool chart that was put together.
[00:05:25.230]This one was actually in 2014,
[00:05:27.170]so I think it has 27 practices on there.
[00:05:30.300]And this short chart shows us
[00:05:32.671]kind of the acronym for the evidence-based practice
[00:05:35.570]on the left side.
[00:05:36.770]And then across the top, it looks at different areas,
[00:05:40.110]like the first column is so,
[00:05:41.670]or the first category is social.
[00:05:43.790]And in the first column, it's looking at littles, right?
[00:05:47.350]The kids that we're talking about today, zero to five.
[00:05:50.380]And highlighted in pink on this chart
[00:05:52.190]are the practices from that list of evidence-base,
[00:05:57.790]the list of 27, are the practices
[00:06:00.450]that have been determined
[00:06:01.430]to be effective for very young children,
[00:06:03.300]so kids falling in the zero to five range.
[00:06:06.540]And so we can see that
[00:06:07.990]like FCT would be functional communication training,
[00:06:12.530]PRT, Pivotal Response Treatment,
[00:06:15.540]PECS, there's some very familiar practices there
[00:06:18.580]that we know are effective for young children.
[00:06:22.070]And then again, you can take a look at this chart
[00:06:23.980]further on your own,
[00:06:25.330]but there are evidence-based practices
[00:06:27.650]identified by a variety of domains,
[00:06:29.620]such as communication, behavior, joint attention,
[00:06:33.710]play, cognitive, school readiness,
[00:06:36.360]academic, motor, and adaptive.
[00:06:38.790]And so you kind of take a look at those,
[00:06:40.830]we're not showing any in vocational and mental health
[00:06:44.360]that are appropriate for zero to five age children,
[00:06:48.560]but I actually think mental health
[00:06:49.780]there might be at some point some practices
[00:06:52.234]that are identified as having an evidence-base.
[00:06:56.820]I'm sorry, Annette,
[00:06:58.207]I just was thinking, this is all such great information,
[00:07:00.640]but then how do we learn a little bit more
[00:07:03.300]about what these interventions look like
[00:07:05.590]and how we could have a model to kind of
[00:07:07.410]show us what those would look like?
[00:07:10.406]Yeah.
[00:07:11.239]Great question, and on this very next slide.
[00:07:14.510]So I think that, you know, the groups,
[00:07:17.730]the National Standards Project,
[00:07:19.220]as well as the National Professional Development Center
[00:07:22.120]in Autism recognize that we can't just have a list
[00:07:24.720]saying these things work,
[00:07:25.695]we need more information about those things.
[00:07:28.260]So the AFIRM modules were designed to really show
[00:07:32.180]step-by-step information for practitioners
[00:07:35.400]on using those evidence-based practices.
[00:07:39.220]And so if we wanna go to that site just really quickly,
[00:07:42.390]we'll take a quick look at the modules
[00:07:44.190]and the information on there.
[00:07:46.400]There's quite a bit of information on how to select
[00:07:48.980]an appropriate evidence-based practice
[00:07:50.810]so that you're individualizing, right?
[00:07:53.040]And then if we click on the AFIRM modules
[00:07:56.000]and just scroll through,
[00:07:57.830]there's some introductory modules,
[00:08:00.320]but very quickly we move into
[00:08:04.060]reinforcement, prompting, time delay.
[00:08:07.200]These are, visual cues, antecedent based interventions.
[00:08:12.460]These are some of those evidence-based practices,
[00:08:14.890]and actually they're developing modules
[00:08:17.020]for all of the current 28 evidence-based practices.
[00:08:22.020]And so when you found one that's a good fit
[00:08:24.670]or you can check into or look at the module
[00:08:27.030]and see if it's a good fit,
[00:08:28.370]you can actually find practical information on,
[00:08:31.170]how do we take this to the home setting?
[00:08:32.900]How do we take it to, you know, a variety of environments
[00:08:35.890]that young children might be in and implement this
[00:08:38.390]evidence-based practice?
[00:08:40.860]That's a great resource.
[00:08:46.390]Okay, I think, Jamie, if it's all right,
[00:08:48.580]I'll go ahead and talk about,
[00:08:50.130]so we know that evidence-based practices
[00:08:52.120]are something we should use,
[00:08:53.600]but are there some other categories,
[00:08:55.960]some other considerations that we should be looking at
[00:08:59.900]to really make sure we're doing the very best high-quality
[00:09:03.370]early intervention program?
[00:09:05.370]And last year at our conference,
[00:09:06.700]Johanna Taylor presented on this topic.
[00:09:10.020]and, you know, in her work in early childhood
[00:09:13.321]at the University of Nebraska,
[00:09:15.350]she has identified through the literature
[00:09:17.910]some high leverage practices for autism.
[00:09:20.907]And so we just wanna highlight them,
[00:09:22.770]we're gonna actually follow up on some of these things
[00:09:25.210]throughout our training today.
[00:09:26.800]But team members, early interventionists,
[00:09:28.963]and anyone who's on the team working with young children
[00:09:32.510]with autism in school settings,
[00:09:34.900]should be trained to use Applied Behavior Analysis,
[00:09:38.030]and the reason for that
[00:09:39.550]is because of those evidence-based practices
[00:09:42.410]that we just looked at,
[00:09:43.680]the majority of them are based on practices
[00:09:47.080]that come from the field of Applied Behavior Analysis.
[00:09:50.380]And also, so we wanna make sure we're not,
[00:09:52.530]we're familiar with Applied Behavior Analysis,
[00:09:54.347]and we know what that is,
[00:09:55.510]and we know how to use those practices in those, you know,
[00:10:00.010]evidence-based interventions we're using.
[00:10:03.260]But also I'm a little bit newer to, you know,
[00:10:09.830]this, to early intervention, is this idea of
[00:10:13.210]Naturalistic Developmental Behavior Interventions.
[00:10:16.480]And I'm gonna talk a little bit more about that
[00:10:19.190]in a little bit, but we definitely want providers who are,
[00:10:21.660]all team members are familiar
[00:10:22.721]with Applied Behavior Analysis and also
[00:10:26.170]this more Naturalistic Developmental Behavior Interventions,
[00:10:28.889]which pulls from the Applied Behavior Analysis field,
[00:10:32.500]but also uses some good developmentally
[00:10:34.520]appropriate practices for young children.
[00:10:37.780]We wanna be including parents in our training.
[00:10:41.180]So if we're doing training as team members
[00:10:43.370]and early interventionists,
[00:10:44.617]we wanna include family members in that training.
[00:10:47.400]There really is really good autism specific parent support
[00:10:52.590]to help them capitalize learning opportunities
[00:10:55.830]throughout the day in interactions with their child.
[00:10:58.630]So we wanna include families in that.
[00:11:00.920]Also we want a team.
[00:11:02.660]We wanna include, you know,
[00:11:05.490]all of the folks that are working
[00:11:07.080]with our young children with autism.
[00:11:09.380]We wanna really be purposeful about that collaboration.
[00:11:12.260]Again, maybe it's we're gonna train together,
[00:11:15.440]but we're gonna look at, you know,
[00:11:16.910]maybe those AFIRM modules and decide,
[00:11:19.050]this is a practice we're doing,
[00:11:20.650]let's all make sure we know how to do it
[00:11:22.300]and implement it, you know, with good fidelity
[00:11:25.430]and agree upon our intervention approach
[00:11:27.572]so that we have buy-in from all members.
[00:11:30.210]And then also this idea of a multi-tiered system of support.
[00:11:34.160]So there's layers to our support.
[00:11:37.140]Some children need less support than others,
[00:11:39.810]so they might be considered, you know,
[00:11:41.630]more at that tier one level,
[00:11:43.440]and other individuals that we're working with
[00:11:45.900]have greater needs and require more intensity,
[00:11:49.180]maybe more team members,
[00:11:50.770]access to additional evidence-based practices.
[00:11:54.410]And so we just wanna be looking
[00:11:56.030]at those high leverage practices when we're considering
[00:12:01.500]what should early intervention look like,
[00:12:04.720]for young children with autism.
[00:12:06.000]And can you talk to us a little bit
[00:12:07.870]about the timing of early intervention and some,
[00:12:11.330]around the idea of this intensity of early intervention?
[00:12:15.460]Absolutely.
[00:12:17.270]You know, one of the things that we,
[00:12:18.710]I didn't talk about the National Research Council,
[00:12:20.950]but back in 2001, there was a great study done
[00:12:24.120]that looked at services for,
[00:12:25.798]again, young children with autism, zero to eight.
[00:12:29.610]And they really looked quite a bit at the idea of intensity
[00:12:34.040]and early identification.
[00:12:35.700]And so there's this great quote
[00:12:37.430]that talks about intensity doesn't have to mean,
[00:12:41.380]I'll let you guys read the quote,
[00:12:42.570]but it doesn't have to mean table time, right?
[00:12:44.380]Where we're just intensely working a skill and drill
[00:12:47.190]with a young child,
[00:12:48.068]but it is thought,
[00:12:49.861]it's best thought of in the context of large numbers.
[00:12:54.020]So repeated opportunities, right, in the daily routine
[00:12:59.990]for individuals with autism to gain critical skills.
[00:13:04.820]So communication opportunities embedded throughout the day,
[00:13:07.810]imitation opportunities embedded throughout the day,
[00:13:10.790]working on joint attention
[00:13:12.523]so that we have that social communication
[00:13:14.900]and interaction throughout the day.
[00:13:17.160]So intensity doesn't have to mean that we're taking little,
[00:13:20.360]you know, young children with autism,
[00:13:21.960]we might wanna work at the table on some skills,
[00:13:24.810]that's not a bad thing,
[00:13:26.060]but it's also looking at
[00:13:27.070]are we looking at their daily routine
[00:13:29.190]and embedding opportunities
[00:13:30.580]for learning throughout that day?
[00:13:32.300]That is a good intensive program for students with autism.
[00:13:35.980]And it does, I'm gonna talk later,
[00:13:37.660]take some thoughtful consideration
[00:13:40.580]and training to get there.
[00:13:41.580]And then the other takeaway
[00:13:43.130]from the National Research Council
[00:13:44.652]and really from the fields of autism in general,
[00:13:49.040]is that earlier is better.
[00:13:50.580]So we should be having conversations about concerns,
[00:13:53.410]about autism as soon as we have those concerns.
[00:13:56.770]If team members are concerned about autism,
[00:13:59.210]regardless of, you know,
[00:14:00.770]if we use the developmental delay disability category
[00:14:03.970]or the autism category,
[00:14:05.580]we need to be talking about those concerns
[00:14:07.810]because there's a very specific
[00:14:10.149]often lack of skills that are,
[00:14:12.570]and characteristics for our individuals with autism,
[00:14:16.038]and knowing that we're concerned about autism
[00:14:18.670]should guide our programming.
[00:14:21.880]That's excellent information.
[00:14:23.390]I know, and thank you for sharing
[00:14:25.210]all of that valuable information
[00:14:26.710]on evidence-based practice,
[00:14:28.090]and where the resources are,
[00:14:29.410]and help us better our practices
[00:14:31.060]and implementing those high leverage practices.
[00:14:34.150]We hear a lot about ABA,
[00:14:35.740]and I heard it in some of the things that you said,
[00:14:37.700]and it can be kind of a, hmm! What is the big deal with ABA?
[00:14:41.400]Do you mind sharing a little bit
[00:14:43.117]about Applied Behavior Analysis
[00:14:45.850]and kind of what the big deal is with ABA?
[00:14:49.260]Okay.
[00:14:50.093]Also another topic that's near and dear to my heart
[00:14:52.294]as a former early childhood special education teacher
[00:14:57.110]and also as a board certified behavior analyst.
[00:15:00.520]I feel really strongly that we,
[00:15:02.250]as educators wanna be familiar and really comfortable
[00:15:05.100]using practices from the field of, from ABA.
[00:15:09.260]So anyway, ABA,
[00:15:10.840]we are gonna do just like a really quick overview.
[00:15:13.860]Many of you are using evidence-based practices
[00:15:17.330]that are based on Applied Behavior Analysis.
[00:15:19.670]It is considered,
[00:15:20.880]because of all of the research that supports, you know,
[00:15:24.550]the interventions based on ABA,
[00:15:26.670]it's considered a gold standard treatment option
[00:15:29.190]or intervention option for the core deficits of autism.
[00:15:34.520]And Teri is gonna talk a little bit later
[00:15:36.660]about some of the, you know,
[00:15:38.913]teaching strategies that you can use throughout the day
[00:15:42.500]and that you can work with families on,
[00:15:44.207]and many of them are based on Applied Behavior Analysis,
[00:15:47.580]and they're still fun and relevant,
[00:15:49.550]and they can absolutely be very effective
[00:15:52.360]in treating some of those core issues in autism.
[00:15:56.920]Also, Applied Behavior Analysis,
[00:15:58.713]you know, we should be using it in schools,
[00:16:00.720]but it's also covered in many States by Medicaid
[00:16:03.700]and other insurance plans,
[00:16:05.350]and so sometimes families are working with private practice
[00:16:09.580]ABA providers as well.
[00:16:11.940]There's really different types,
[00:16:13.240]we're gonna talk today about
[00:16:14.610]that Naturalistic Developmental Behavior intervention
[00:16:17.680]and talk a little bit more,
[00:16:19.840]but also discrete trial training,
[00:16:21.490]where we might pick a very discrete skill
[00:16:23.450]and sit down and work with the child,
[00:16:25.500]so they know how to do that thing,
[00:16:27.050]and we might make sure we have repeated opportunities
[00:16:29.980]to present that skill to them
[00:16:31.381]and then to reinforce skill acquisition.
[00:16:34.990]And then there's some programs that use, you know,
[00:16:38.270]Applied Behavior Analysis,
[00:16:39.670]such as Pivotal Response Teaching,
[00:16:42.670]you might hear it called Pivotal Response Treatment,
[00:16:46.360]Incidental Teaching, where we're, you know,
[00:16:48.660]using more naturalistic opportunities in the environment,
[00:16:52.210]but we're also using some shaping and prompting
[00:16:55.960]and reinforcement components of Applied Behavior Analysis.
[00:16:59.500]And then there's some more manualized programs
[00:17:02.600]that we'll talk a little bit more about later,
[00:17:04.350]such as the Early Start Denver Model
[00:17:06.580]or Project ImPACT, where we kind of have
[00:17:08.680]a scope and sequence or a curriculum to follow.
[00:17:11.520]All of those things incorporate Applied Behavior Analysis.
[00:17:17.830]So is there kind of a continuum
[00:17:19.970]of these interventions that,
[00:17:23.290]when you talk about all of these,
[00:17:24.798]that would help explain kind of where our practices fall?
[00:17:30.410]Absolutely.
[00:17:31.243]Let's go to the next slide
[00:17:33.210]and take a look at this flow chart.
[00:17:36.140]So if we think about autism intervention,
[00:17:38.180]on the left side, we have, you know,
[00:17:41.340]things that are not in considered Applied Behavior Analysis.
[00:17:44.920]And so these things might be, you know,
[00:17:47.290]more developmental, naturalistic, child directed.
[00:17:50.430]In fact, many of the examples on the bottom
[00:17:52.470]on the left side of the continuum,
[00:17:54.380]such as Son-rise, Floortime,
[00:17:57.378]Relationship Development Intervention,
[00:18:00.390]are really focused on following the child's lead.
[00:18:03.680]And those have not been determined,
[00:18:05.790]they have not been substantiated in the literature reviews
[00:18:10.150]to have an evidence-base.
[00:18:12.030]And then on the other side of the continuum,
[00:18:14.980]we have, you know, Applied Behavior Analysis.
[00:18:18.170]I wanna draw your attention to the middle
[00:18:20.680]because especially for young children,
[00:18:22.800]we absolutely do wanna consider, you know,
[00:18:26.180]developmentally appropriate practices,
[00:18:28.580]naturalistic environments, things that, you know,
[00:18:31.650]activities and environments that kids might already
[00:18:34.870]just be in and learning in,
[00:18:36.817]and we wanna consider moving our learning
[00:18:39.920]to that setting versus, you know, more clinical approach.
[00:18:44.320]And so there are a couple of practices listed there,
[00:18:48.960]such as Pivotal Response Treatment.
[00:18:51.740]We're gonna talk about these a little bit later,
[00:18:53.790]but really all of these things are from the literature
[00:18:58.750]of Applied Behavior Analysis.
[00:19:00.530]But in practice,
[00:19:02.280]they are implemented in the natural environment
[00:19:05.080]with naturally reinforcing items,
[00:19:07.960]things that kids really want,`
[00:19:10.030]and kind of creating opportunities
[00:19:11.650]for skills to be acquired in the natural setting.
[00:19:14.700]So we're really, there's some good research,
[00:19:16.920]I'm gonna show you in a minute, coming out to say,
[00:19:19.330]that's where we wanna be for young children with autism.
[00:19:22.200]However, as we move to the right to more traditional ABA
[00:19:26.960]and discrete trial teaching,
[00:19:28.980]those things also have a really strong evidence-base.
[00:19:32.410]And so we might flow back and forth.
[00:19:34.380]We might, you know,
[00:19:35.213]do the naturalistic developmental behavior interventions,
[00:19:38.410]but we also might do a verbal behavior program,
[00:19:41.320]which is kind of a nice combination
[00:19:43.625]of traditional ABA and more naturalistic teaching,
[00:19:48.350]we might use curriculum such as the ABLLS, the VB map,
[00:19:51.850]PEAK Relational Training,
[00:19:53.980]and then like I said, at times,
[00:19:55.670]we might work with a family or work directly with a student
[00:19:59.530]and do some discrete trials
[00:20:01.130]such as do this, (clapping) right?
[00:20:02.790]'Cause we're gonna teach them the skill of imitating
[00:20:05.230]and all of the other skill sets that opens up
[00:20:08.570]if they could learn to do some simple imitation.
[00:20:11.420]And so we can, you know, move on that continuum
[00:20:15.760]from that middle spot over to the right.
[00:20:18.300]And we can still pull some of the things
[00:20:20.350]that we know to be effective from, you know,
[00:20:22.430]developmental and naturalistic interventions,
[00:20:25.400]but we definitely wanna be
[00:20:26.602]using Applied Behavior Analysis in our practices.
[00:20:34.010]Thank you, that helps.
[00:20:34.870]And I think in looking ahead at this slide,
[00:20:37.270]it helps me at least in being a former provider
[00:20:40.440]to kind of be able to see the sort of differences
[00:20:43.720]between what we would consider discreet trial
[00:20:45.750]and kind of what we would consider naturalistic.
[00:20:48.930]So if you don't mind talking through
[00:20:50.260]maybe just one example here on this slide and the next
[00:20:54.310]to just kind of illustrate the differences maybe.
[00:20:57.970]Yeah, I love that.
[00:20:58.980]And I love this slide because it really does show,
[00:21:01.390]like if we look in the middle there, you know,
[00:21:03.430]discrete trial format, typically the teacher's gonna say,
[00:21:06.910]I'm gonna gather these materials
[00:21:08.430]'cause I know that you need to know
[00:21:10.150]the names of these things, let's say, for example,
[00:21:12.290]so I might have objects or pictures of things,
[00:21:14.300]and I'm gonna present them to the student
[00:21:16.237]because I know they need to know
[00:21:18.097]what the names of those things are.
[00:21:20.820]And in a more Naturalistic Behavioral
[00:21:22.816]developmental program or approach,
[00:21:27.190]the learner might be playing with some things,
[00:21:29.610]and then we join them as the instructor or the teacher,
[00:21:32.690]and we use the things they've already selected
[00:21:34.870]and are really invested in,
[00:21:36.820]and we create opportunities for them
[00:21:38.870]to identify those things, you know,
[00:21:40.670]either receptively or expressively.
[00:21:42.810]So it's just a little difference,
[00:21:44.029]again, not one, you know,
[00:21:45.410]one's not bad and the other one's good,
[00:21:47.650]but with young children,
[00:21:48.860]we definitely wanna consider,
[00:21:51.388]can we use Naturalistic Behavioral interventions
[00:21:55.886]and maybe use discrete trial less frequently?
[00:21:59.470]Okay, thank you, that helps.
[00:22:00.530]Then there's some more examples on this next slide too,
[00:22:03.150]and I think for those of you
[00:22:04.690]that are participating with us today,
[00:22:06.230]these are really nice ones to look through
[00:22:07.880]and think through when you're trying to learn
[00:22:10.430]what discreet trial is
[00:22:11.640]versus maybe what Naturalistic developmental looks like.
[00:22:16.110]So would you share more with us
[00:22:17.950]about natural developmental behavior interventions?
[00:22:21.410]Because I think for a lot of us hearing this,
[00:22:24.420]maybe as providers, we're like,
[00:22:25.930]oh, we've been doing some of those things,
[00:22:27.640]but maybe it's now just having a name
[00:22:29.986]to attach to these practices
[00:22:32.520]that we feel like maybe we've been doing some of,
[00:22:35.160]but wanna learn more about.
[00:22:38.080]Yes, absolutely,
[00:22:39.370]and I think you're exactly right,
[00:22:40.620]We see a lot of good, you know,
[00:22:43.430]naturalistic developmental behavior interventions going on,
[00:22:47.237]and you know, there are people
[00:22:48.380]using many of these practices.
[00:22:50.510]However, there's some really good research
[00:22:52.800]that's come out recently.
[00:22:54.040]So if you wanna move to the next slide,
[00:22:56.150]I'll talk about one thing that came out recently.
[00:23:01.380]The American Academy of Pediatrics, in 2015,
[00:23:06.030]gave some recommendations
[00:23:07.650]for very young children with autism.
[00:23:10.210]And of course they said begin as early as possible,
[00:23:13.320]active family caregiver involvement,
[00:23:15.320]which is absolutely essential.
[00:23:17.320]I think in Nebraska,
[00:23:18.280]we're really working hard on those things.
[00:23:21.690]They also came out and said
[00:23:23.380]that our programs should have a combination
[00:23:25.390]of developmental and behavioral approaches.
[00:23:28.200]So developmental only, following the child's lead,
[00:23:31.450]setting up our environments to be, you know,
[00:23:34.330]rich with cool toys and activities, that's not enough.
[00:23:38.670]Definitely, we need to have that combination
[00:23:40.627]of Applied Behavior Analysis.
[00:23:43.000]And so the American Academy of Pediatrics
[00:23:45.500]coming out and saying this,
[00:23:46.510]I thought was really beneficial.
[00:23:48.090]Additionally, they have some other recommendations
[00:23:50.370]that we've seen before
[00:23:51.620]where we wanna rule out any other conditions,
[00:23:53.780]and we wanna focus on social communication
[00:23:57.150]and any other areas that are delayed.
[00:23:59.900]And then on the next slide, actually,
[00:24:03.680]there's also a pretty comprehensive study done
[00:24:08.200]where again they looked at validated treatments for autism,
[00:24:11.830]and for young children,
[00:24:13.300]really found that that naturalistic developmental
[00:24:15.143]behavioral intervention,
[00:24:16.670]that combination of what we know
[00:24:18.680]works in Applied Behavior Analysis
[00:24:20.980]and implementing those programs
[00:24:22.538]in more naturalistic settings is really effective.
[00:24:26.320]Another piece that came out of this research
[00:24:30.030]and looking at that kind of middle of the continuum
[00:24:33.710]with the NDBI programs is using a manualized program.
[00:24:40.420]So basically, my interpretation is that
[00:24:46.100]we don't just wanna be reacting to,
[00:24:48.060]oh, I know the student, they don't know how to imitate,
[00:24:50.700]I'm gonna teach that skill or,
[00:24:52.540]oh, I mean, those things are fine,
[00:24:54.076]but we wanna use a more comprehensive approach
[00:24:56.900]to make sure we're teaching all of the skills necessary.
[00:25:00.220]So we wanna have an assessment that shows us,
[00:25:03.420]this is the skills the child has already in place,
[00:25:06.210]and these are the skills that we need to work on next,
[00:25:09.030]and then we wanna keep building on them.
[00:25:10.580]And so there really was, there's been some good information
[00:25:14.050]coming out that manualized programs,
[00:25:16.330]and then we'll talk about a few in a minute,
[00:25:18.140]are really good, so we're not missing critical, you know,
[00:25:21.440]entire domains or skill sets.
[00:25:24.640]And then again, we're really systematically
[00:25:27.030]meeting as a team and getting trained
[00:25:29.060]so that we're creating opportunities
[00:25:31.690]in the natural environment,
[00:25:33.120]but there's a little more thought and planning
[00:25:36.090]that goes into it then again,
[00:25:38.340]just identifying one or two skills that are missing.
[00:25:41.210]So I think this is really exciting,
[00:25:43.450]it's saying definitely use, you know,
[00:25:46.230]functional natural developmental opportunities,
[00:25:49.090]but also use what we have from Applied Behavior Analysis
[00:25:52.210]to say, we're implementing programs and practices
[00:25:56.550]that we know are effective.
[00:26:01.010]Just again, this study actually, from Zwaigenbaum,
[00:26:06.460]well, I'm kinda making that up, that's Zwaigenbaum,
[00:26:09.530]I might not be pronouncing that exactly the way it is,
[00:26:11.960]but from 2015, really also reiterated the fact that
[00:26:17.147]we can use naturalistic strategies,
[00:26:20.940]we can embed opportunities for learning
[00:26:23.100]throughout the daily routine,
[00:26:26.190]but again, he also recommended using some known,
[00:26:29.849]some manualized programs so that we're not missing
[00:26:32.240]critical domains or skills,
[00:26:34.130]and that we're also doing this combination
[00:26:36.440]of naturalistic interventions and Applied Behavior Analysis.
[00:26:40.860]So there's a good research to support this.
[00:26:43.250]Yeah, and that's so exciting,
[00:26:44.960]and I'm sure there's common elements
[00:26:46.780]for the learning targets and the embedded trials.
[00:26:49.360]Can you speak to those just a little bit?
[00:26:52.510]Yeah, so what's included
[00:26:54.630]in naturalistic developmental behavior interventions?
[00:26:59.430]So your learning targets would really
[00:27:01.790]include all developmental domains.
[00:27:04.310]And so we would wanna look at, you know,
[00:27:06.950]where is this particular kiddo?
[00:27:09.020]That's kind of why the assessment piece is so important,
[00:27:12.270]but we would wanna look at
[00:27:13.390]receptive and expressive language, imitation skills.
[00:27:17.810]We might, at some point with our older young children,
[00:27:21.427]you know, look at some pre-academics,
[00:27:23.780]but we would wanna look at social
[00:27:25.312]and look across developmental domains
[00:27:27.960]and be teaching across domains.
[00:27:30.040]So that's really important.
[00:27:31.870]We would wanna program for generalization
[00:27:33.868]from the beginning.
[00:27:36.170]Especially in autism,
[00:27:37.500]we know that an individual could learn a skill
[00:27:39.980]in one particular setting.
[00:27:41.490]So maybe they learn to, you know,
[00:27:44.220]pound a hammer with the little hammer sets.
[00:27:47.830]But when they see a different hammer,
[00:27:49.710]maybe out in dad's workshop, they wouldn't, you know,
[00:27:51.910]be able to generalize that skill.
[00:27:53.630]That's just a real simplified example,
[00:27:55.940]but we wanna program for generalization from the beginning.
[00:27:59.440]So it's really important for providers
[00:28:01.140]going into the home setting that we're working on skills,
[00:28:03.530]that mom and dad are both working on that skill
[00:28:06.200]so that they can generalize across the adults,
[00:28:09.670]but that we're using different materials,
[00:28:11.540]and they're using, you know, they're identifying
[00:28:13.660]the names of things in their home setting
[00:28:15.580]and in community settings and at grandma's house.
[00:28:18.120]So generalization is, should be a priority.
[00:28:22.880]Also the skills are not taught in isolation.
[00:28:25.640]And so again, we kind of gave that example
[00:28:28.190]of discrete trial training before
[00:28:30.600]where the teacher might be pulling some items to work on.
[00:28:34.740]And it may not be the best to only learn in one setting,
[00:28:39.250]like at a table with one set of materials
[00:28:41.648]or in a very isolated manner,
[00:28:44.140]and so we're just recognizing that for our young children,
[00:28:49.160]you know, we wanna make sure that those skills
[00:28:51.070]are kind of presented in a way that makes sense
[00:28:53.290]and are related to other things.
[00:28:55.440]So not just taught in isolation,
[00:28:58.460]as they may not make the leap to, oh, you know,
[00:29:01.700]I can use that skill in the bathroom when I'm, you know,
[00:29:05.240]putting my toys in the bathtub
[00:29:06.690]or drying off or whatever it is.
[00:29:09.040]And then if we look at the learning context,
[00:29:11.930]I've kind of alluded to this throughout,
[00:29:14.060]but we really do wanna embed trials.
[00:29:16.690]So we wanna have social, emotional, meaningful interactions.
[00:29:21.210]We know that joint attention and really, you know,
[00:29:28.390]relationship development with
[00:29:30.760]our young children with autism
[00:29:32.147]and with many individuals with autism can be difficult,
[00:29:35.270]it can be something that doesn't come naturally.
[00:29:37.660]And so we wanna embed our learning trials
[00:29:40.870]into fun interactions,
[00:29:43.360]we wanna have, you know, good rapport with our student
[00:29:46.770]and really work on the parent child relationship,
[00:29:49.640]on the provider child relationship
[00:29:51.365]and those meaningful interactions
[00:29:54.120]with peers and siblings and others
[00:29:55.990]and really highlight those things.
[00:29:58.160]Natural context, I think I've talked about routines.
[00:30:00.896]Those would be common elements of an NDBI approach.
[00:30:07.459]And I know the programming elements,
[00:30:09.300]I mean, this slide shows that some of those
[00:30:11.050]are very much what you've already talked about,
[00:30:13.570]but do you talk just a little bit more
[00:30:15.710]about kind of that, the key tenants of that intervention?
[00:30:20.760]Yes, absolutely.
[00:30:21.900]So again, NDBI programs,
[00:30:25.510]we know that they would include these things.
[00:30:28.270]Skills still have to be broken down
[00:30:30.300]and taught systematically.
[00:30:31.780]So for many of our kids just learning,
[00:30:35.300]let's say a skill such as, what do I do with a baby?
[00:30:39.380]So other kids might know, okay, I rock the baby, you know,
[00:30:42.760]for a young girl or young boy,
[00:30:44.240]whoever wants to play with the baby,
[00:30:46.640]and I might lay the baby down,
[00:30:48.450]cover the baby up, feed the baby, all of those things.
[00:30:51.520]They might pick up on that,
[00:30:53.320]just by observing what others do, or, you know,
[00:30:56.330]seeing mom or dad with a younger sibling,
[00:30:59.740]but for a child with autism,
[00:31:01.130]those things might have to be broken,
[00:31:02.500]they likely, they should be broken down into steps.
[00:31:05.270]Like first we cover the baby,
[00:31:07.810]and we practice that over and over, you know,
[00:31:09.780]covering the baby, and, good job,
[00:31:11.410]you've covered the baby.
[00:31:12.563]Then we might practice rocking the baby and feeding,
[00:31:16.010]all of those things would be skills
[00:31:17.570]that we would break down into small increments
[00:31:20.790]and teach systematically.
[00:31:23.150]In addition to that I'll just highlight reinforcement.
[00:31:26.570]So we would provide, as I said, just some, you know,
[00:31:28.960]feedback it's related to that activity,
[00:31:31.700]maybe it's some praise and some excitement
[00:31:34.100]that we show them when they're doing those steps.
[00:31:36.940]But another thing that we can do with reinforcement
[00:31:39.430]is find out what it is that they want
[00:31:42.410]and get control of that.
[00:31:43.780]That's kind of a main tenant of pivotal response training,
[00:31:47.220]where we find out what it is,
[00:31:49.260]what is it that they really want.
[00:31:51.430]And so maybe it's cookies at snack time,
[00:31:53.540]and we have the cookies,
[00:31:54.580]and the skill then that they have to demonstrate
[00:31:57.070]is some form of request for that cookie.
[00:32:00.700]And then we provide that very natural reinforcement
[00:32:03.220]'cause that is the item that they're requesting.
[00:32:06.180]So we build those things into our programs.
[00:32:10.730]And then also, again, I think I've talked about this.
[00:32:13.290]It's very play-based,
[00:32:14.220]we can do this in the natural environment,
[00:32:16.200]and we can follow the child's lead on many of those things.
[00:32:20.750]Thank you.
[00:32:21.583]I think that really helps clarify
[00:32:25.300]some of those elements of NDBI.
[00:32:27.640]And I know you've been mentioning the manualized programs,
[00:32:30.670]and as a provider,
[00:32:32.910]for years in the home as an occupational therapist
[00:32:35.290]working with school teams in early intervention
[00:32:37.130]and also having a lot of training
[00:32:39.000]with what Nebraska is doing with primary coach,
[00:32:42.960]primary service provider model
[00:32:44.247]and the home visitor coaching,
[00:32:46.660]these programs, as I was reading about them,
[00:32:49.450]these kind of manualized programs
[00:32:50.880]like you were talking about, resonated in a lot of ways
[00:32:53.760]because they follow and what you're talking about
[00:32:55.966]and blend also what we're doing
[00:32:58.110]in the natural context with kids.
[00:33:00.610]They highlight how kids learn
[00:33:02.340]and also how the adults in their lives learn.
[00:33:04.170]So you had mentioned Pivotal Response Treatment.
[00:33:07.020]So just a few things in addition to that
[00:33:09.070]is doctors Bob and Lynn Koegel developed this
[00:33:12.830]as a method to systematically teach
[00:33:16.110]and apply those ABA principles to teach learners with ASD.
[00:33:20.650]And there were some basic assumptions
[00:33:22.020]about the PRT intervention,
[00:33:24.200]and that's the treatment occurs in the natural environment,
[00:33:26.550]like you've been talking about,
[00:33:28.430]with heavy family involvement,
[00:33:29.820]there's a huge parent training component here.
[00:33:32.400]And that the treatment involves
[00:33:33.720]or the intervention involves these pivotal areas,
[00:33:36.150]and those pivotal areas, like you talked about Annette,
[00:33:38.450]around motivation and to talk and engage socially
[00:33:41.510]and responding to multiple cues in the environment,
[00:33:44.247]and that child initiating the interactions
[00:33:46.720]rather than the adult.
[00:33:47.670]We know that our children are more likely to initiate more
[00:33:52.230]by doing it that way.
[00:33:54.010]And then self-management and empathy
[00:33:55.400]are also parts of pivotal response training.
[00:33:57.810]Initially it was developed for very young children
[00:34:01.476]under three, but there's been some evidence
[00:34:03.240]that shows it's also
[00:34:04.150]really beneficial for older learners too.
[00:34:08.660]And the next one on this slide
[00:34:10.410]is the Early Start Denver Model.
[00:34:13.300]This was developed by Sally Rogers and Geraldine Dawson,
[00:34:16.950]as a comprehensive behavior early intervention approach.
[00:34:19.780]It can be used with kids from 12 to 16 months,
[00:34:23.150]but the emphasis is really kind of
[00:34:25.720]around that 12 to 36 months age range.
[00:34:29.030]In this one, Annette, you had spoken about
[00:34:31.010]kind of that assessment piece that's really critical to know
[00:34:33.960]where kids are and where to head,
[00:34:35.870]and this one has a developmental assessment
[00:34:38.670]that is part of the program and the curriculum,
[00:34:41.840]and certainly this is taught
[00:34:43.204]across all those developmental domains,
[00:34:45.440]like you spoke about, has a heavy emphasis
[00:34:48.262]on supporting that relationship
[00:34:51.680]between the caregiver and the child,
[00:34:53.684]and teaching those practices
[00:34:56.210]and those strategies to the parent.
[00:34:58.600]This program really focuses heavily on shared engagement
[00:35:02.220]and joint attention, on language and communication
[00:35:06.120]all through play.
[00:35:07.600]So certainly within the natural context
[00:35:09.633]of what our kids do every day.
[00:35:12.100]And then the final one, Project ImPact,
[00:35:14.442]is probably one of the ones that's a little bit easier
[00:35:17.570]just to pick up as the manual and kind of look through it
[00:35:20.700]and recognize some practices you're already doing
[00:35:23.720]but then also build upon.
[00:35:25.640]And this one was developed by Brooke Ingersoll
[00:35:27.560]and Anna Dvortcsak, and it's Project ImPACT,
[00:35:31.520]the impact part is improving parents
[00:35:33.510]as communication teachers.
[00:35:35.360]So this program focuses, again like the others,
[00:35:38.740]on teaching parents strategies they can use
[00:35:40.710]to help their kids develop the social targets
[00:35:43.460]that they want to have them develop,
[00:35:45.290]their communication, imitation
[00:35:47.790]and play skills like we've been talking about,
[00:35:49.790]and again, all occurring within the daily routines
[00:35:52.160]and activities of the family.
[00:35:53.920]There's two manuals in this program,
[00:35:55.360]one is for the coach and one is for the parent,
[00:35:58.470]and they work really well together.
[00:36:00.423]So as you are working with the parent,
[00:36:02.800]the parent also has some, has a manual to follow as well
[00:36:06.120]in the in-betweens visits.
[00:36:08.800]This one has been recognized
[00:36:10.070]as a manualized intervention that meets criteria
[00:36:12.810]by the National Clearinghouse
[00:36:13.982]of Autism Evidence in Practice,
[00:36:16.330]so again, pulling in that evidence-based.
[00:36:20.710]Annette, can you tell us,
[00:36:22.400]we've talked about primary service a little bit
[00:36:25.060]and about the kind of coaching model, I guess in Nebraska,
[00:36:29.490]what does all of this mean when we look at
[00:36:33.650]how it all works together in our state?
[00:36:37.680]Yes, and first of all,
[00:36:39.070]thank you so much for reviewing those three programs.
[00:36:42.540]There are some resources included in the handout
[00:36:45.620]on those, and I just really appreciated that overview
[00:36:49.320]'cause sometimes it's just easier to say,
[00:36:51.080]I wanna go, you know, look at a program
[00:36:53.350]or an approach that's all included here,
[00:36:56.330]and so I really appreciate that.
[00:36:58.260]But yeah, let's talk for a minute about
[00:37:00.270]coaching and primary service provider service delivery,
[00:37:04.970]and those are really important things in Nebraska.
[00:37:08.030]So let's start with coaching.
[00:37:10.020]What we know about coaching is that, you know,
[00:37:13.710]there are many studies to suggest
[00:37:15.470]that coaching and parent training are effective,
[00:37:18.300]essential components of early intervention
[00:37:20.640]for young children with autism, right?
[00:37:23.070]So I think that's important is that again,
[00:37:24.830]we're focusing on what works.
[00:37:27.280]It's really important to say,
[00:37:28.290]we know that this is helpful.
[00:37:29.770]And actually just so you know,
[00:37:31.150]the group that did this study,
[00:37:32.730]while I think it says that there in the title,
[00:37:34.790]is from that Early Start Denver Model program as well,
[00:37:39.100]and they found, you know, really compelling evidence
[00:37:41.690]that we can coach parents into implementing
[00:37:44.580]effective interventions for their kiddos.
[00:37:47.520]So that's good,
[00:37:48.520]but let's go a little further into coaching.
[00:37:52.000]And there is guidance, so earlier I mentioned
[00:37:55.060]the National Professional Development Center
[00:37:57.090]on Autism Spectrum Disorders,
[00:37:59.210]and they actually give some really good guidance,
[00:38:02.150]they have a packet that you can download
[00:38:04.250]on coaching and evidence-based practices
[00:38:07.730]for learners with autism.
[00:38:09.370]And so they identify some elements of successful coaching
[00:38:14.030]and what should be included,
[00:38:15.482]and I'm gonna, for our purposes today,
[00:38:18.580]just focus in on that training element a little bit.
[00:38:23.130]So in the area of coaching, early intervention and training,
[00:38:27.080]they identify these four areas that are really important.
[00:38:30.850]And the first one is relevance.
[00:38:32.960]So professional development should allow educators
[00:38:36.640]to really gain or perfect skills
[00:38:39.076]that our young children with autism need.
[00:38:43.310]And so coaching content should be based on, again,
[00:38:47.610]the educator, whoever the early intervention team,
[00:38:52.060]team members or you know, maybe they're, you know,
[00:38:54.690]for primary service provider, one person in particular,
[00:38:58.470]they need to have really good skill acquisition
[00:39:01.570]and use of evidence-based practice, right,
[00:39:04.240]for the overall program improvement.
[00:39:07.270]That will allow them to really coach the parent
[00:39:10.030]to use that practice effectively,
[00:39:12.240]so that's really important.
[00:39:13.480]And again, relevance means we wanna focus
[00:39:15.600]on the things that we know work.
[00:39:17.310]So as early interventionists, we wanna be highly trained
[00:39:21.820]as we're going out to coach others on that actual skill set.
[00:39:25.220]So that's important.
[00:39:26.260]Location.
[00:39:27.420]This just means it could happen anywhere,
[00:39:29.040]we can coach in any setting, any natural environment,
[00:39:32.290]or we can invite parents in,
[00:39:34.106]and we can invite them in to do training with us,
[00:39:37.340]and we can coach and practice, you know,
[00:39:39.150]in the school environment, whatever makes sense.
[00:39:42.300]Time.
[00:39:43.133]I think this one's really important.
[00:39:45.610]To coach effectively, whether we're coaching other providers
[00:39:49.420]or we're coaching paras or coaching daycare instructors
[00:39:53.490]or daycare teachers, headstart workers, parents,
[00:39:58.700]it takes time.
[00:39:59.660]And so we need to build in time
[00:40:03.470]to coach those folks who are working
[00:40:06.010]with our young individuals with autism
[00:40:08.620]to implement evidence-based practices, right?
[00:40:10.980]And so one question that I have about that
[00:40:14.210]as I look at IFSPs and IEPs,
[00:40:16.960]is one visit per month enough time?
[00:40:20.620]And let's hope that's not the timeframe allotted,
[00:40:23.600]but we do see that occasionally.
[00:40:25.730]Is even one visit a month
[00:40:27.510]or a week enough time to coach someone,
[00:40:31.520]the parent, the caregiver, the, you know, daycare worker,
[00:40:36.140]or whomever we might be working with, you know,
[00:40:38.360]the natural environment where that child
[00:40:40.600]is spending a lot of their time?
[00:40:43.010]We have to have enough time to be able to coach them
[00:40:45.230]to implement the effective practices
[00:40:47.500]and create opportunities for learning throughout the day.
[00:40:50.380]Coaching does not happen, you know,
[00:40:52.720]without the time needed for the individual to practice,
[00:40:57.764]and to receive some feedback on using that skill.
[00:41:01.060]So we have to consider time.
[00:41:03.000]Also content.
[00:41:04.910]Coaching instruction really, you know,
[00:41:07.874]includes content on communication, maybe target behaviors,
[00:41:11.150]but again, we might be giving
[00:41:13.890]we need to give a little mini training
[00:41:15.480]about the evidence-based practice
[00:41:17.150]we want them to use.
[00:41:18.040]If they're using pecs, is there enough content
[00:41:20.880]on how to use pecs, how to fade our prompts
[00:41:24.210]how to take data on, you know, skill acquisition
[00:41:28.160]skill usage, and all of those things?
[00:41:30.960]We have to have time for all of these pieces
[00:41:34.730]for training to be effective.
[00:41:36.530]So I just wanted to draw your attention to that
[00:41:39.320]as a really good document
[00:41:40.740]from the national professional development center
[00:41:43.520]on effective coaching.
[00:41:46.190](clears throat)
[00:41:47.023]And now I wanna show just a couple,
[00:41:48.670]or share a couple of resources for ASD early intervention
[00:41:53.370]that I think are really helpful
[00:41:54.821]for providers going in and working with parents.
[00:41:58.730]One of them is a new resource,
[00:42:00.447]and I think it was developed in 2020,
[00:42:02.726]from that Early Start Denver Model team.
[00:42:06.380]And it's a parent provider video training series.
[00:42:09.330]And I went on and looked at some of these videos
[00:42:11.360]and they're really short,
[00:42:12.390]just a couple minutes long videos that they have.
[00:42:15.710]They have 16 web-based video models on,
[00:42:19.770]as Jamie was talking about
[00:42:21.000]the Early Start Denver Model,
[00:42:22.370]it's really on connecting and communication
[00:42:26.550]and joint attention and really developing a relationship
[00:42:31.760]with your young child or your, you know,
[00:42:35.490]child that's in your daycare and developing that rapport
[00:42:38.600]and relationship with your young child with autism,
[00:42:41.160]and then being able to teach critical skills
[00:42:43.600]throughout the daily routine.
[00:42:45.170]This is fabulous,
[00:42:46.360]like if you're struggling with what, you know,
[00:42:49.350]how do I teach these skills that seem, you know,
[00:42:52.810]maybe the parent just, or the provider
[00:42:54.870]just doesn't have any background
[00:42:56.770]or familiarity with these things?
[00:42:58.710]You could go in and show a little video,
[00:43:01.230]and then there, it's basically a really scripted resource
[00:43:05.890]for you to coach the parent or provider in acquiring,
[00:43:09.340]you know, really critical skills
[00:43:10.670]for young children with autism,
[00:43:13.050]with social communication problems.
[00:43:15.300]So that's one resource,
[00:43:16.370]I just encourage you to check it out,
[00:43:18.510]and the other one is a resource called the balance program.
[00:43:22.310]This is actually, it's a web-based training
[00:43:26.720]that you could sign up for intake,
[00:43:28.470]look for more on the balance program
[00:43:30.830]from the ASD network in the future,
[00:43:33.070]we're gonna try to sponsor some of this,
[00:43:35.060]but this actually trains providers
[00:43:37.990]on 10 lessons that you can take
[00:43:40.820]into the home setting, or again
[00:43:42.620]to daycare settings and teach parents
[00:43:47.080]how to prevent problem emerging problem behavior, right?
[00:43:51.640]And so this is rooted in behavioral
[00:43:54.880]and early childhood research,
[00:43:56.750]and it's teaching some critical skills to parents,
[00:44:00.470]to teach their young child
[00:44:01.844]to be a better more effective communicator
[00:44:04.830]and can actually reduce the chance of, you know,
[00:44:08.220]really significant problem behaviors from emerging.
[00:44:11.350]So those are just two resources that we encourage you
[00:44:14.000]to check out as you
[00:44:15.284]work on your coaching of families and providers.
[00:44:22.264]I think those resources
[00:44:23.577]are really useful and helpful,
[00:44:25.100]particularly if you're a provider and you're busy
[00:44:27.400]and you're trying to find the most efficient way
[00:44:29.940]to deliver and coach parents, and also be able to show them
[00:44:34.080]as you develop your skills and they develop their.
[00:44:36.470]So I know there can be some
[00:44:38.680]common misunderstandings or perceptions
[00:44:41.590]about primary service and autism intervention.
[00:44:44.610]Can you speak to that a little bit Annette?
[00:44:47.960]Absolutely, so in addition to our coaching
[00:44:50.980]and us wanting to be effective in our coaching,
[00:44:53.510]we also, you know, one of our priorities in Nebraska
[00:44:58.440]or approaches that we use
[00:44:59.580]is this primary service provider approach.
[00:45:02.250]And so some of the misunderstandings that have, you know,
[00:45:06.480]kind of emerged over the years
[00:45:08.700]is that sometimes there's an assumption,
[00:45:12.120]either from the family or from the team,
[00:45:14.230]that when using a PSP model,
[00:45:16.950]the child will receive less services than if, you know,
[00:45:19.700]a variety of providers were doing home visits.
[00:45:23.130]However, you know, this is actually
[00:45:27.520]a quote from Dathan Rush from 2020,
[00:45:33.720]and ASHA interview that he did.
[00:45:36.070]It basically says that
[00:45:37.550]you know, "Primary service provider approach
[00:45:39.720]should support the family as frequently as necessary".
[00:45:42.770]So we're gonna determine how much, you know,
[00:45:45.730]what those services look like and how often
[00:45:48.320]we're going to the home and who's going to the home
[00:45:51.150]based on the child's needs, right?
[00:45:53.210]So the PSP team needs to base decisions
[00:45:55.370]about frequency and intensity of services
[00:45:57.840]on the amount of support that the team
[00:46:00.980]and the family determines as needed and helpful.
[00:46:04.940]And I think that's really important.
[00:46:06.700]Dathan has done a lot of the training for Nebraska
[00:46:11.570]on both coaching and the PSP approach,
[00:46:14.770]and he's, you know, reiterating the fact
[00:46:18.100]that this should be individualized, not a set schedule of
[00:46:21.270]you know, one person from the team,
[00:46:23.380]comes out once a month and, and provide services,
[00:46:26.140]it's really determined on child needs and family need.
[00:46:31.100]So another common misunderstanding
[00:46:33.050]is that services are really watered down,
[00:46:35.910]because there's only access to one team member.
[00:46:38.260]So if the early childhood teacher
[00:46:40.010]is assigned as the primary service provider,
[00:46:43.230]then other, you know,
[00:46:44.580]there's not access to other team members,
[00:46:46.740]and that really is not how
[00:46:49.350]the primary service provider approach was designed.
[00:46:52.960]And to the contrary that again, Dathan is quoted
[00:46:56.670]as saying "Caregivers may still access all team members".
[00:47:00.780]And so we need to introduce
[00:47:02.820]those other team members as needed.
[00:47:04.810]And one example, I will tell you that it's concerning to me,
[00:47:07.580]and I think we wanna be careful of is,
[00:47:11.210]if we have a young child with autism,
[00:47:13.310]who's one of their greatest needs
[00:47:15.450]is represented in the IFSP or IEP,
[00:47:18.580]is communication or lack of,
[00:47:21.290]they need access to the speech language pathologist, okay.
[00:47:24.720]So that person may not be
[00:47:26.040]the primary service provider for that team,
[00:47:28.990]but they can be brought in and they should be brought in
[00:47:32.080]to be working with the child and the family
[00:47:34.830]on acquiring those much needed communication skills.
[00:47:40.070]Thank you for the sharing those.
[00:47:42.140]I know there's one other common misunderstanding
[00:47:44.710]and that's that the primary service provider
[00:47:48.450]or the primary service approach may prevent providers
[00:47:51.640]from providing those direct services
[00:47:54.360]to young children with autism,
[00:47:56.140]but what we know about the kind of getting ready strategies
[00:47:59.320]as well as the home visitor practices
[00:48:02.660]are really around being able to coach and model.
[00:48:05.950]And some of that requires direct teaching,
[00:48:10.030]direct intervention and direct interaction
[00:48:12.200]with the young children,
[00:48:13.660]and you've talked a lot about
[00:48:14.840]how those natural developmental behavior interventions
[00:48:18.330]can be embedded right there
[00:48:19.740]and modeled and coached and given feedback to the families.
[00:48:23.000]So we're gonna take a moment
[00:48:24.600]and have those of you that have been with us and are still
[00:48:27.820]with us to put in the chat box
[00:48:29.840]when direct services with more intensity
[00:48:32.150]might be beneficial when utilizing their primary coaching
[00:48:36.380]or primary service provider model.
[00:48:38.370]And we'll give you a little bit of time to put in the chat
[00:48:41.969]and we may keep moving to (indistinct),
[00:48:44.540]you can keep putting those answers in the chat for us.
[00:48:58.559]Thank you everyone for taking the time to put that in
[00:49:01.160]and to give it some consideration.
[00:49:03.910]And I know Teri, when we're trying, we've been talking
[00:49:06.580]about a lot of resources and some manualized programs,
[00:49:10.160]but they're not always available, right?
[00:49:12.650]Maybe the team hasn't been quite trained in those,
[00:49:15.781]or maybe the resources aren't available right now,
[00:49:20.090]but that doesn't prevent us from teaching
[00:49:22.830]those critical skills in the natural environment.
[00:49:25.770]Can you talk with us about those critical skills
[00:49:28.770]and what needs to be embedded
[00:49:30.027]in those programs when we're working with young learners?
[00:49:34.050]Absolutely, so we're gonna talk
[00:49:37.020]just for a little bit about four areas
[00:49:40.040]that we need to be intentional about
[00:49:41.757]when working with our young kids with autism.
[00:49:44.960]And we're gonna talk about those learning targets
[00:49:48.510]and also embedding some of those opportunities
[00:49:51.170]throughout the day when you're working with
[00:49:53.740]some of our real little kids,
[00:49:55.400]those areas are joined attention,
[00:49:57.170]intentional communication, imitation, and play.
[00:50:00.950]We consider these four critical areas
[00:50:03.930]for our students, with autism, especially those little ones.
[00:50:10.720]So the first area that we're gonna talk about
[00:50:12.550]is joint attention and joint attention is necessary.
[00:50:18.230]We can't teach our kids unless we can get them
[00:50:21.350]to attend to us and approach us and come around us.
[00:50:25.320]So we really really have to be on this area.
[00:50:31.795]Joint attention deficits are pervasive
[00:50:34.710]in most all of our children with autism.
[00:50:37.510]And I like to talk about joint attention
[00:50:39.450]as lots and lots of looking.
[00:50:42.270]They're just very engaged in the environment around them,
[00:50:45.360]very engaged with those who they're in their environment,
[00:50:48.770]and so that's kind of an easy way
[00:50:50.290]to think about what joint attention is.
[00:50:52.720]There are a couple of different purposes to joint attention,
[00:50:55.470]one is communication and one is socialization,
[00:50:58.490]and they're just a little bit different,
[00:51:01.227]but communication is used to require
[00:51:03.310]the behavior of someone else,
[00:51:05.190]in order maybe to get them to do something
[00:51:07.900]or get something for you or even maybe stop doing something,
[00:51:11.470]so they may be protesting something.
[00:51:13.440]And then socialization is used
[00:51:15.240]to draw another person's attention
[00:51:16.740]to an object or event out of interest.
[00:51:19.100]So they're really commenting or sharing with someone else
[00:51:21.950]what's going on in their environment.
[00:51:27.290]The goal of joint attention is really to get this nice triad
[00:51:30.480]between yourself, the child and the object.
[00:51:33.190]And this is just a nice little picture,
[00:51:36.300]a diagram to kind of show what we're talking about,
[00:51:38.400]you have an activity or a toy,
[00:51:41.300]you have the little one that you're working with
[00:51:43.330]and the teacher or the parent.
[00:51:44.950]And we really just want there to be just
[00:51:46.940]a nice sort of back and forth going on
[00:51:49.260]between all three of those corners of that triangle.
[00:51:53.050]So we're gonna look and see what that looks like
[00:51:55.890]with one of our kiddos, with one of our little ones.
[00:52:19.845](both talking)
[00:52:23.775]So you saw Danny looking at the truck there, the activity
[00:52:27.320]so that remote control truck looking at mom
[00:52:29.850]and then going back
[00:52:31.300]and actually pointing to make sure
[00:52:33.020]mom knows what it is that Danny wants her to see.
[00:52:36.770]And that's where we wanna head with our kids.
[00:52:38.700]And if you watch a lot of our little ones with autism
[00:52:41.090]you don't often see that triad happening.
[00:52:47.279](indistinct) Dr. Teri.
[00:52:53.070]Thanks Jamie.
[00:52:54.598]So when we talk about joint attention
[00:52:56.930]and just in some of the information that Annette shared,
[00:53:00.240]we do wanna take a look at,
[00:53:01.770]making sure we assess in that area
[00:53:03.650]and kind of know which skills we need to be working on.
[00:53:06.880]And so on the next slide,
[00:53:08.840]it's gonna show you
[00:53:09.850]some different levels of joint attention.
[00:53:12.080]And one thing we want you to know
[00:53:13.950]is that in your resource list
[00:53:15.720]at the end of the presentation, in your handouts,
[00:53:19.060]is a link to a one hour joint attention webinar
[00:53:23.410]that I did recently.
[00:53:25.090]And it goes over each of these areas
[00:53:27.480]and sort of how to teach them.
[00:53:30.310]And along with that Berenice de LA Cruz
[00:53:32.860]has a really nice sort of assessment and teaching guide
[00:53:37.120]that we will have in your handouts
[00:53:38.470]that you can take a look at.
[00:53:39.640]So I really recommend that you take a look at that webinar,
[00:53:43.610]take a look at that assessment in teaching guide,
[00:53:46.030]and this will help you in doing those
[00:53:48.810]really important pieces of breaking down these skills
[00:53:51.290]and being able to teach each of them
[00:53:53.680]and making sure we're not missing anything.
[00:53:55.770]One of the things we noticed when we saw this teaching guide
[00:53:59.310]was that the first three levels of this
[00:54:01.610]are not about eye contact.
[00:54:03.710]They're actually about the little one
[00:54:05.580]shifting in their environment.
[00:54:07.310]And so lots of times where people start
[00:54:09.540]and I was just as guilty of that
[00:54:11.270]in my early childhood special ed classroom,
[00:54:13.640]as I started at level four.
[00:54:15.350]And that's why these types of resources
[00:54:18.960]are really important for us,
[00:54:20.110]we make sure we don't miss anything along
[00:54:22.870]when we're going along and teaching these pieces.
[00:54:28.980]So we wanna make sure that we are embedding these trails
[00:54:31.690]into the natural environment.
[00:54:33.630]And so lots and lots of different things that you can do
[00:54:37.680]when you are working with joint attention,
[00:54:39.860]but one of a couple tricks of the trade that I say
[00:54:43.390]is looking at using time delay and spotlighting
[00:54:46.170]to increase joint control.
[00:54:48.020]So we wanna be sure a spotlighting is simply doing something
[00:54:51.550]that child isn't going to expect,
[00:54:53.100]so they look towards you.
[00:54:54.380]And then you can reinforce
[00:54:55.870]that you have that eye contact from them.
[00:54:58.470]So it could be something as simple as huh!
[00:55:00.503]And when you do that, people look okay,
[00:55:04.050]and actually in trainings when I do that in person training
[00:55:07.990]everybody turns and looks, same for our little ones.
[00:55:10.830]And so the second they turn and look
[00:55:12.530]and you get that eye contact,
[00:55:13.950]you reinforce that eye contact.
[00:55:15.910]And time delay is something we can use
[00:55:17.860]when we're talking about kids using that joint attention
[00:55:20.910]for socialization or to comment or get what they need.
[00:55:25.280]So if they bring you something, then you wanna be sure
[00:55:28.350]that you, you know, pause and say, oh gosh!
[00:55:31.610]You know, you hang onto that,
[00:55:32.920]they pause, they look at you, like,
[00:55:34.390]why isn't she opening the bubbles?
[00:55:35.900]Why isn't she blowing the bubbles?
[00:55:37.140]They look towards you, you get that eye contact,
[00:55:39.970]and then you reinforce that eye contact
[00:55:42.260]as you're blowing those bubbles.
[00:55:43.720]So doing that really purposeful pause,
[00:55:47.160]so that kids will look towards you.
[00:55:48.520]That's also something you can do,
[00:55:49.830]if they are, you know, wanting a cookie
[00:55:52.720]or wanting a specific toy,
[00:55:53.980]you kind of get those in your hands and pause,
[00:55:56.694]and see if you can get them to look towards you
[00:55:58.500]so you can reinforce that eye contact.
[00:56:00.770]Creating opportunities to interact with a child
[00:56:02.940]in a way that makes that interaction more reinforcing,
[00:56:06.110]so they need you.
[00:56:07.130]So the windup toy stops and they can't wind it up.
[00:56:10.130]You've got their favorite little item
[00:56:11.690]in a Tupperware container that they can't get open.
[00:56:15.640]Those are things that will help you to be able
[00:56:17.820]to get that joint attention.
[00:56:20.500]Using, the use of naturalistic motivational procedures,
[00:56:23.579]making sure that what you're using with that kiddo
[00:56:26.950]is reinforcing and is motivating for that kiddo.
[00:56:31.660]And so we oftentimes will start
[00:56:34.060]with those highly preferred activities,
[00:56:36.520]because those are the things
[00:56:37.353]they're gonna look towards and look for.
[00:56:43.000]These are some examples
[00:56:44.170]of some joint attention learning targets.
[00:56:46.160]Now you have a handout in your folder
[00:56:49.690]that has a variety of examples, for all of these areas,
[00:56:55.070]for some learning targets
[00:56:56.670]or some goals or objectives for an IEP.
[00:57:04.870]Okay, so now we're gonna talk a little bit
[00:57:06.740]about intentional communication
[00:57:08.380]or functional communication with our little ones.
[00:57:15.270]So in order to work on communication,
[00:57:18.010]intentional communication,
[00:57:19.220]we have to facilitate opportunities
[00:57:20.780]for the child to want and need to communicate.
[00:57:24.340]So this goes back to the same thing
[00:57:25.780]as I just said about joint attention,
[00:57:27.310]we need to use those motivating activities
[00:57:29.500]and objects to help increase that communication.
[00:57:37.280]So some of our early communication skills
[00:57:39.450]we might be working on with our little ones, Echoics,
[00:57:41.790]which is simply them repeating sounds or words,
[00:57:45.040]today I'm gonna show you a couple of examples of Manding
[00:57:47.410]or what we would call requesting, which is really the place.
[00:57:51.280]I mean, we're gonna be doing a lot of those Echoics
[00:57:53.260]as our kids are starting to babble
[00:57:54.750]and do those kinds of things.
[00:57:56.210]But then we're gonna move into that requesting.
[00:57:58.370]And we're gonna have our kids request
[00:58:00.280]those highly preferred items.
[00:58:02.070]So there's really motivational activities
[00:58:04.800]that they want to do.
[00:58:06.470]And we do that by having them request
[00:58:09.900]or ask for those items.
[00:58:11.900]Tacting and labeling objects in their environment,
[00:58:14.160]you see this a lot with little ones,
[00:58:15.740]they're either pointing to things and saying what's that,
[00:58:18.550]or looking towards you to get that,
[00:58:20.640]some of our kids with autism might not do that,
[00:58:22.540]we might have to help them point and then label that,
[00:58:24.650]so they learn those tasks.
[00:58:26.420]And then receptive following directions
[00:58:28.666]throughout the day and in those natural environments.
[00:58:35.310]So example of Manding, I was, wanna point out here quickly
[00:58:38.220]that Manding can be vocal language,
[00:58:40.730]sign language, handing a picture, usually with our littles
[00:58:44.720]they're not using a device
[00:58:45.790]but it might be a big Mac switch,
[00:58:47.260]so something really really simple.
[00:58:49.320]And then also for our real real early learners
[00:58:51.731]some adjusters might, we might use as Manding initially,
[00:58:56.250]and then shape that into, you know,
[00:58:59.060]something closer to the approximation
[00:59:01.430]that they want, of the item they want.
[00:59:06.433]Ball.
[00:59:09.161]Ball.
[00:59:11.321](indistinct)
[00:59:18.260]Okay, so Danny requested balls after prompted him,
[00:59:22.060]and then his second, the second thing he said was more
[00:59:25.210]and we held out there because Danny could say more balls,
[00:59:29.410]and so we wanna be sure that
[00:59:30.360]he doesn't just use that generalized manner
[00:59:31.980]more that he uses the more specific language
[00:59:34.230]of using actually asking for the ball.
[00:59:39.228](indistinct)
[00:59:42.649](laughing)
[00:59:44.530]Then there's some, just looking at (indistinct)
[00:59:46.370]getting some of this requesting.
[00:59:49.160]So go ahead Jamie, sorry about that.
[00:59:53.975]Are you all done or swing?
[00:59:55.951]More swing.
[00:59:56.991]More swing.
[00:59:59.930]And here's a receptive activity.
[01:00:02.150]Can you find the (indistinct)
[01:00:04.690]Super motivational,
[01:00:06.590]'cause Joey loves toys in the back of the boat.
[01:00:09.620](indistinct)
[01:00:18.370]So just a really fun way
[01:00:19.650]to work on those receptive following directions
[01:00:22.100]in a motivational activity
[01:00:24.060]that's actually embedded into the day.
[01:00:30.800]So you have a handout also in your folder
[01:00:34.470]that gives you a variety of strategies or ideas
[01:00:37.080]for embedding some of these activities into daily routines.
[01:00:42.149]And they're just some things
[01:00:43.560]like you forget some things,
[01:00:44.870]so kids have to ask things are visible
[01:00:47.210]but they can't quite reach it
[01:00:48.440]or they can't get it out of that container.
[01:00:50.740]It really requires us for our kids with autism
[01:00:53.650]to set up those opportunities.
[01:00:56.720]I always say to teams I'm working with,
[01:00:58.410]if you don't set up the opportunities
[01:00:59.900]for them to use their language,
[01:01:01.030]they probably won't use it.
[01:01:02.620]Because it can be hard work for a lot of our young kids.
[01:01:05.130]So, and then there's a few other examples on the next slide
[01:01:09.010]but all of those are on your handout.
[01:01:11.920]So, and then also remember that
[01:01:13.940]you have a handout with some ideas,
[01:01:15.580]for some intentional communication learning targets
[01:01:18.030]for some of your kids.
[01:01:21.660]And then imitation is the next critical area
[01:01:24.070]that we're gonna talk about,
[01:01:25.617]and that kind of alluded to this earlier,
[01:01:27.470]if you have kids that can imitate,
[01:01:29.010]they can learn a lot of skills on their own,
[01:01:31.090]and that's so important.
[01:01:32.850]Children on the autism spectrum display
[01:01:34.650]significant impairments and invitation,
[01:01:36.750]including imitation of facial expressions, body movements
[01:01:40.560]and then imitation of actions and objects on objects.
[01:01:45.710]So simply when we talk about in imitation
[01:01:48.150]it's so important for learning in so many areas.
[01:01:51.820]And so play, motor, social, communication,
[01:01:56.630]but most importantly is that whole idea
[01:01:59.530]that if kids can imitate, they can learn from other peers
[01:02:04.280]from watching others in their environment,
[01:02:06.200]and they can acquire those new skills
[01:02:08.020]without direct teaching.
[01:02:09.450]And there's just too many skills to teach.
[01:02:12.010]We need our kids to be able to watch others
[01:02:14.230]and learn from others in their environment.
[01:02:20.660]So we talk about imitation in the natural environment.
[01:02:24.100]This is mom working with Emma on some imitation
[01:02:26.550]and she's embedded that into some and getting dressed
[01:02:31.124]Emma, do this, (clapping) good job.
[01:02:34.857]Emma do this, good job.
[01:02:37.534]Emma do this.
[01:02:41.140]Arms are up, so we can practice
[01:02:42.840]putting on our sweater,
[01:02:45.270]and so when you and Rachel mom was also
[01:02:49.330]doing some behavioral momentum,
[01:02:50.720]shoot a couple of easies first,
[01:02:51.960]and then she worked in to getting her to put her hands up,
[01:02:54.550]to put her sweater on,
[01:02:55.550]which is not a preferred activity for this little one.
[01:03:01.430]And then again, examples of some of those learning targets
[01:03:04.340]in the area of imitation,
[01:03:05.580]which are also on your handout.
[01:03:09.890]And then last theory that we're gonna talk about is play,
[01:03:12.300]which is such an important area,
[01:03:14.080]and it really follows up nicely with the imitation
[01:03:16.550]that we just talked about,
[01:03:17.880]because one of the ways that we teach play
[01:03:19.720]to our young kids with autism is by using imitation.
[01:03:26.370]So play can oftentimes be difficult for kids with autism
[01:03:29.380]for a variety of reasons.
[01:03:30.720]There's deficits in social communication
[01:03:32.930]and imitation are definitely gonna impact play.
[01:03:36.220]And oftentimes our kids with autism really tend to focus
[01:03:39.430]on activities that are based on rote skills.
[01:03:41.910]So colors, shapes, numbers, letters
[01:03:44.020]seem to be highly preferred
[01:03:45.270]for many of our young kids on the autism spectrum.
[01:03:48.380]So children with ASD have kind of that need for sameness
[01:03:52.360]which is part of their autism,
[01:03:53.732]and then that becomes pretty evident
[01:03:55.670]in the fact that they like to use toys
[01:03:57.720]in those rigid and set patterns.
[01:03:59.790]So play oftentimes does have to be directly taught
[01:04:02.710]to our little ones with autism.
[01:04:09.340]So we know is important, and there's a couple reasons.
[01:04:12.170]I mean, Emily Iland did a little informal kind of study
[01:04:15.240]on looking at the importance of play,
[01:04:17.410]and it really is the vehicle for two important things.
[01:04:20.870]One is cognitive skills, which I'm speaking, you know,
[01:04:23.944]teaching the play
[01:04:24.777]'cause if you're working with little ones,
[01:04:25.640]you know that they're learning from their play.
[01:04:27.750]But also problem solving skills,
[01:04:29.480]and what I really like about this
[01:04:30.880]are these two areas of being able
[01:04:32.220]to negotiate and be flexible.
[01:04:34.230]Because those are two really difficult areas
[01:04:36.498]for our kids with autism.
[01:04:38.070]We wanna start working on those
[01:04:39.480]when they're really young through play.
[01:04:45.070]So there's a couple of videos here,
[01:04:46.410]and I think one thing you'll notice about this
[01:04:48.030]is there is some direct teaching going on here.
[01:04:50.410]And for our little one on the left,
[01:04:52.890]we had to do a little bit of direct teaching with her
[01:04:55.200]because she was very distracted in the classroom
[01:04:58.030]with lots of kids and lots of action going on,
[01:05:01.250]but we did a really nice,
[01:05:02.710]and her teacher did a really nice job
[01:05:04.130]of doing really a little quick direct sessions
[01:05:06.390]and then right into the Playhouse,
[01:05:08.290]and also did an interest inventory and took data
[01:05:11.740]on the things that Hayden
[01:05:13.630]was most interested in in the classroom,
[01:05:15.387]and those are the things we worked on for teaching
[01:05:17.510]to make sure that there was motivation behind that for her.
[01:05:20.390]So these are really quick fast videos
[01:05:23.670]Do this.
[01:05:25.057](kissing)
[01:05:27.709]So teaching her with imitation to do kiss the baby,
[01:05:31.360]and then also hear Joey's already learned two skills,
[01:05:35.520]and so we're using just some receptive directions
[01:05:38.070]and some gesture to get them put together,
[01:05:41.590]so that we can get a little longer play scheme.
[01:05:44.800]Joey, put the cow in.
[01:05:48.953]Move, can you say move.
[01:05:51.498]Move.
[01:05:52.331](indistinct)
[01:05:54.170]Okay, push truck.
[01:05:57.570]So putting the cow in and pushing the track.
[01:05:59.530]And then of course, and this is at a home, but, you know
[01:06:02.830]we might pull that farm out
[01:06:04.480]and pull out all the other kinds of things.
[01:06:06.130]Again, this was something that Joey was interested in.
[01:06:12.930]And again here's some examples
[01:06:14.370]of some of those learning targets.
[01:06:19.330]And so those are just a quick, fast
[01:06:21.210]little kind of summary of some of those four critical areas
[01:06:26.520]that if you don't have a manualized program,
[01:06:28.440]you can get started right now,
[01:06:30.230]while either you're purchasing one
[01:06:32.240]or you're actually getting trained
[01:06:35.070]in using one of those manualized programs,
[01:06:37.800]but don't hesitate to get busy
[01:06:39.410]doing some of these really critical pieces with your kids.
[01:06:43.080]So what we'd like you to do here at the very end
[01:06:45.210]is to share in the chat box,
[01:06:46.820]which of the critical learning targets
[01:06:48.550]you have directly taught or coach families to implement?
[01:06:51.860]So joint attention, imitation,
[01:06:54.180]functional communication and/or play.
[01:06:56.930]And so if you're doing any of those right now,
[01:06:59.320]go ahead and put that in the chat box.
[01:07:11.120]Alright, thank you so much for adding those to the chat box.
[01:07:18.660]Now, we have some time
[01:07:20.250]to answer any questions that you might have.

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Best Practices in Early Intervention Services (0-5)

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