When I got my first job working with children through early intervention I was really excited. Early intervention refers to services and supports provided to children with developmental delays and disabilities age birth -3 years old and their families. During these first 3 years of life it’s a critical time for speech and language development because children have growing and developing brains. If there is a delay or problem with development during this time, supports and therapeutic services should be started as soon as possible. So being able to help children during their prime developmental years was something I was looking forward to.

In my previous jobs I worked with adults and school age children (kindergarten – high school). I was used to providing direct instruction. Preparing therapy activities in advance, then delivering those during therapy sessions. Parents or caregivers were educated after the sessions on what they could do to help with generalization of skills. With about 7 years of experience as a speech language pathologist I felt like I was well experienced. So I thought it wouldn’t be that difficult to transition into working with a new age group.  

Oh, was I wrong. I would later find out that I did not have experience delivering the type of service recommended for children in early intervention.  Everything I read and heard about the SLPs role in early intervention was about parent coaching and less direct instruction.  Working with children and families in their daily routine activities. Helping parents learn language facilitation strategies and how to use them during their daily routines. I didn’t really know what parent coaching was or how to do it. My excitement turned into nervousness. I didn’t know where to start.

I came across an article that referenced a study where 68% of SLPs reported having low skill levels in working with infants and toddlers and that 60% of graduate programs provide little to no training in early intervention (Brooks, Hensale, Roberts, 2016). I know I surely felt unprepared when I first started in early intervention. But I jumped right in and gave it my best shot.  I spent hours researching intervention strategies and parent coaching techniques. As my caseload got bigger and I worked with more and more families, I started to feel more comfortable in my role as an early intervention SLP. I am going to share with you some things I learned along the way. Tips to help you get started during your first couple of sessions with families.
 
1. Get to know the child and the family and what goals the family has for the child. During your first visit with the family ask the parent/caregiver to tell you a about the child. Ask what are their goals for the child’s communications are. Have them prioritize the goals so you can focus on what’s most important to the family. Review the goals in the child’s current IFSP with the family. Ask questions about the child’s current level of communication skills. Examples of questions to ask:
 
“Is child currently imitating sounds or words?”
 “What sounds or words is the child using independently?”
“Is the child currently using any gestures or sign language?”
“How does child let you know what he/she wants?”
 
2. Explain to the family what therapy will look like. Let the parent/caregiver know that therapy is a team-based approach including you and them. Discuss your role as the speech language pathologist. Explain that you will coach them on ways to facilitate vocabulary growth and language use in their child. You will educate them on strategies to help address their child’s needs and coach them on using those strategies with their child during structured activities and daily routines, especially when you are not there Discuss with the parent/caregiver their role. Explain to them how they will be expected to be an active participant during sessions. Discuss the intervention model that will be used. The intervention model I was taught is the “I Do, We Do, You Do” model (see below) Explain the benefits for their child of them learning and using language strategies on a daily basis. Review that your there to help them meet their goals they have for their child.
 
Intervention Model
I Do: Explain the strategies and model doing the strategy with the child in activities.
We Do: Help the parent/caregiver use the strategy with their child. Coach them during the process with suggestions on words to use things to try.
 You Do: Allow the parent/caregiver to practice using the strategy with their child independently. Watch and provide feedback and allow for reflections at the end.
 
3. Observe interactions between the parent/caregiver and child. Take notes (mental or written) on how the child plays with toys, interacts with people, make requests, protest, and more. Ask the parent to engage with the child, if they haven’t been already to see what that looks like. Try to focus on activities that are important to the family and activities that are part of their routines. Example of some things to say to lead into this may be:
 
“Can you show me some activities you do together”?
“I see he/she likes playing with cars (or whatever the child is playing with), how does he/she respond when you join in to play too?”
“Can you show me” or Let’s see what he/she will do”
“What are you usually doing at this time?”
 
4. Introduce language strategies and educate the parent/caregiver with information supporting the strategies being introduced.  As you are watching the interaction between parent/caregiver and child you will notice where the parent or child needs support to help make the interaction more successful. This is when you can introduce language strategies. Explain what the strategy is and how it can help with speech and language development. Go through the intervention model.
 
5. Review and reflect what you and the family practiced. To begin ask the parent/caregiver to reflect on what worked and what didn’t work (and why). Remember the your role as SLP is to help the parent/caregiver help their child to learn. Ask them for their input on new ideas to try. Provide feedback on how things went. Share your ideas for things to try.
 
6. Plan for the next visit. Have the parent/caregiver discuss what they’re going to work on until the next visit. Explain that you would like them to share what worked and didn’t work during the next session. Then discuss what the goals will be for the next visit. Talk about what activities or materials to have ready for the next visit.
 
The biggest thing I learned from my experience working in early intervention is how important parent/caregiver participation is in the process. In the same article by Brooks, Hensale, Roberts, 2016 the authors referenced a study that reported how parent’s behavior subsequently affects their child’s behavior and how changing the behavior of one inherently changes the behavior of the other. They referenced another study that found parents feel less competent as a parent when they see others successful at getting their child do something they have not been able to do. As SLPs we don’t want a child to create dependence on us nor do we want parent/caregivers to feel like they cannot help their child learn.
 
I hope this information is helpful. I also hope it helps SLPs feel more confident starting out in early intervention. I didn’t discuss different language strategies to use. Maybe that will come in another post. I wanted to focus more on how to move into the role of coaching as a SLP.  Good Luck!!
 

​Brooks, M Hensale, T,  & Robers, M. (2016), More Than “Try This at Home” –Including Parents in Early Intervention. Perspective of the ASHA Special Interest Groups, SIG 1 Vol 1(Part 4). 130-140.

 April 2 was World Autism Awareness Day. A day when people from around the world took part in spreading awareness about autism and showing support for those living with autism. But the support doesn't stop on that one day. The whole month of April is recognized around the world as Autism Awareness Month. All month long organizations and people share information, stories, and hold events to continue to educate others about autism, to foster support for individuals living with autism and their families, and to help raise money for autism research related initiatives.

 Autism, also referred to as Autism Spectrum Disorder (ASD), is a developmental disability characterized by persistent differences in communication development and social skills accompanied with restrictive and repetitive behaviors, patterns, interests, and activities (1). Some of the communication challenges seen in children with ASD include: difficulty understanding what others say, repetitive language patterns, difficulties understanding nonverbal communication, and delayed speech development The Center for Disease Control and Prevention (CDC) estimated in 2016 that 1 in 54 children were diagnosed with autism. 
 
Autism awareness month was first started in 1970 by The Autism Society to increase public awareness about autism and the day-to-day issues faced by individuals with autism, their families and the professionals who work with them. Since then many more organizations around the world have been created to join those efforts. 
        
In this post I wanted to do my part to spread awareness and highlight some organizations that are working to support autism awareness. These organizations  are dedicated to helping families, and communities gain proper education, training, treatment, and support for individuals living with autism from culturally and linguistically diverse backgrounds. While there are many organizations around who are dedicated to helping people from all walks of life, a lot of times families from different cultures and underserved communities are seeking education and support that is sensitive to their communication barriers and cultural values. As well as increased access to education, proper diagnosis, and support. 

https://www.globalautismproject.org/
1. The Global Autism Project was founded in 2003.  They are involved in providing training services for staff and families who work with people in their communities living with autism from underserved countries around the world. 

https://gruposalto.org/
2. Grupo-Salto was founded in 2003 by Latino parents of children with autism and Hispanic program staff from The University of Illinois at Chicago (UIC) Developmental Disabilities Family Clinics (DDFC). Their goal is to provide support for Latino families that have children with ASD by providing culturally and linguistically appropriate training, education and services.
 
https://thecolorofautism.org/
3. The color of Autism is a nonprofit organization founded in 2009 working to educate and support African American children diagnosed with Autism and their families. They aim to help families with early identification and diagnosis of autism to provide them with information to advocate for services for their children.
 
http://www.naaacn.com/
4. The National African American Autism Community Network (NAAACN) is a nationwide coalition of organizations who support and educate African American families affected by autism. They advocate on behalf of underserved African American communities for increase awareness, screening, and access to early intervention and treatment for members of their communities with autism.
 
https://autisticadvocacy.org/
5. Autistic Self Advocacy Network (ASAN) is a nonprofit organization founded in 2006 by individuals living with Autism. Members include individuals with autism, cross-disability advocates, family members and friends, of individuals with autism, professionals, and educators who work to make sure the voices of individuals with autism are heard and included at all levels of dialogue related to autism advocacy. 
 
https://www.autismspeaks.org/international-autism-organizations
6. International Autism Organizations is a page listed on the Autism Speaks website that provides a lengthy list of autism organizations in different countries around the world.
 
https://www.ihs.gov/icp/autism/
7. The Indian Health Service (IHS) is an agency within the Department of Health and Human Services that provides culturally appropriate health services and to increase access to accurate Autism Spectrum Disorder diagnosis to American Indians and Alaska Natives. The IHS division of Behavioral Health Indian Children’s Program (ICP) provides education, training, and consultation on issues affecting American Indian/Alaska native youth via IHS's Tele behavioral Health Center of Excellence (TBHCE).
 
https://www.multiculturalfamilies.org/
8. Open Door for multicultural families
This nonprofit organization was founded in June 2009 by a group of parents of family members with intellectual disabilities, professionals, and community members to provide culturally and linguistically relevant information, services, and programming to families with family members with developmental intellectual disabilities and special health care needs. Their bilingual/bicultural family support specialist come from the same cultures and speak the same language as the families they serve. They currently provide services in English, Spanish, African (Amharic, Oromo, Tigrinya, Somali), Asian (Cambodian, Chinese, Cantonese, Mandarin, Taiwanese, Korean, Japanese, Laotian, Vietnamese, Tamil, Hindi), European (French, German, Italian), Eurasian (Russian, Ukrainian), and Middle Eastern (Arabic, Kurdish). On their resources page they have information about Autism in 15 different languages.

This list is just a few of the organizations out here making a difference. There are plenty more promoting acceptance and igniting change for the autism community! Throughout this month I will share with you some of my personal experiences working with kids with autism and some of the strategies that I seen be effective time and time again to support speech and language development. Stay tuned!

​Kynisha