Involving caregivers and teachers in the therapeutic process is a major component of successful therapy. However, social, familial, personal, and environmental factors can make caregiver and teacher involvement difficult. In this course we identify the benefits of family involvement and will then provide five research-based strategies for how to improve our interactions with families and teachers. We refer to the strategies as SMILE (Sign, Model, Imitate, Label, and Expand). These strategies have been found to improve communication skills in young children. We will define the SMILE strategies, provide the rationale behind them, and demonstrate how to implement the strategies when serving an early-childhood population.

1. 2012 American Community Survey (Kids Count Data Center)

2. Presentation Outline
1. Research supporting parent involvement
1. What have parents and researchers reported in
successful interactions?
2. How to apply the research to the field
1. 8 ways to improve therapeutic outcome
3. Case study
1. Looking at an example of how to make therapy
more successful by increasing parent and
teacher involvement

3. Background
• Development:
▫ Bilingual SLPs
▫ Home-based ECI Services
▫ Need for family involvement
 When families are involved in the intervention
process, language enrichment is ongoing rather than
during “therapy” only (Rosetti, 2001)
 Without family involvement, intervention is unlikely
to be successful (Bronfenbrebrenner, 1974)

4. Learner Objectives
Participants will list, identify, describe…
1. the importance of family involvement
2. factors affecting parent involvement
3. theoretical models of social systems
4. strategies to increase family involvement in
intervention

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7. 1. Importance of Family
Involvement
Research
a. Language enrichment
b. Empowerment
c. Self-Efficacy
d. Why family participation is critical

8. a. Language Enrichment
• Parents use of language-based strategies leads to
▫ Increased receptive language skills in the first year
(Baumwell, Tamis-LeMonda & Bornstein, 1997)
▫ Increased receptive and expressive language skills in
the second and third years of life (Olson, Bates &
Bayles, 1986)
▫ Greater receptive vocabulary at 12 years of age
(Beckwith & Cohen, 1989)

9. a. Language Enrichment (cont’d)
• Mother’s use of labeling and increased periods of
interaction lead to increases in receptive
vocabulary and greater expansion of expression
in older children (Tomasello & Farrar, 1986)
• Participation by fathers in early childhood
programs has been shown to be beneficial to the
child, father and other family members (Frey,
Fewell, & Vadasy, 1989; Krauss, 1993)

10. b. Empowerment
• Empowering parents increases their likelihood
of accessing information pertaining to their
child’s development

11. c. Self-efficacy
• Empowerment leads to self efficacy or the belief
that they can make a difference in their child’s
development (Dempsey & Dunst, 2004)

12. d. Why participation is critical
• When families are involved in the intervention
process, language enrichment is ongoing rather than
during “therapy” only (Rosetti, 2001)
• Without family involvement, intervention is unlikely
to be successful (Bronfenbrebrenner, 1974)

13. Models of Service Delivery:
Find a balance
Consultative
Model
Child Focused
Model

14. Not on the same page
Different Perspectives

15. Teacher and Family Perspective
The therapist
just plays with
my child.
They just sit
and talk with
me and do
nothing with
my child.This is all too
overwhelming.
I forget what
to do after the
therapist
leaves.
I don’t have
time in my day
to do this.

16. Speech Pathologist Perspective
Families don’t
always follow
through with
my suggestions.
I can’t get
families to
incorporate
ideas into daily
routines.
I don’t have
easily accessible
resources to
share with
families.
Many times
families don’t
keep
appointments.

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18. 2. Understanding families
• Demographics
• Theoretical models of social systems
• Factors affecting family involvement

19. Demographics – using Texas as a case
study

20. Demographics – using Texas as a case
study
Video Review

21. Demographics of Families
Enrolled in ECI in Texas
Research
a. Economics
b. Ethnicity
c. Language
d. Gender
e. Reason Eligible
f. Services on IFSP

22. a. Economics
• Percentage of ECI children receiving Medicaid
▫ 2006: 61%
▫ 2008: 60.3%
• Families at 250% of the poverty level or lower
▫ Approximately 84%

23. b. Ethnicity
Race/Ethnicity Percent
Hispanic/Latino 47
White 38
Black/African American 12
Asian/Pacific Islander 2
American Indian/Alaskan <1

24. c. Language
Primary Language Percent
English 81
Spanish 19
Other <1

25. d. Gender
Gender Percent
Males 63
Females 37

26. e. Reason Eligible
Reason Eligible Percent
Medical Diagnosis 11
Chromosomal Anomalies 35
Congenital Anomalies--Brain/Spinal Cord 16
Symptoms and Ill-Defined Conditions 14
Disorders of the Nervous System 12
Congenital Anomalies--Facial Clefts 9
Conditions Originating in Perinatal Period 7
Congenital Anomalies--Musculoskeletal 7
Developmental Delay 71
Atypical Development 18
Areas of Delay/Atypical Development
Speech/Communication 67
Physical/Motor 43
Cognitive 26
Adaptive/Self-Help 21
Social/Emotional 16
Vision 2
Hearing 2
Children with more than one qualifying diagnosis 22
Children with more than one area of delay 37

27. f. Services on IFSP
Percent of Children with Planned Service Types Percent
Service Coordination 100
Developmental Services 78
Speech Language Therapy 58
Occupational Therapy 32
Physical Therapy 25
Nutrition 12
Family Training/Counseling 5
Vision 3
Audiology 3
Psychological/Social Work 3
Medical/Nursing 1

28. Theoretical Models on Social
Systems
Research
a. Maslow’s Hierarchy of basic needs
b. Kubler-Ross’ 5 stages of grief

29. a. Maslow’s Hierarchy of basic needs

30. b. Kubler-Ross’ Five Stages of Grief
• Denial (this isn't happening to me!)
• Anger (why is this happening to me?)
• Bargaining (I promise I'll be a better person
if...)
• Depression (I don't care anymore)
• Acceptance (I’m ready for whatever comes)

31. Research Findings Pertaining to
Family Factors
• Mothers with limited family support tend to
withdraw from programs early (Luker & Chalmers, 1990)
• Mothers engaged in family conflict show
lower rates of involvement (Herzog, Cherniss, & Menzel,
1986)
• Mothers engaged in substance abuse showed
lower rates of involvement (Navaie-Waliser et al, 2000)
• Mothers who are anticipating a change in
residence also showed lower rates of
participation (National Committee to Prevent Child Abuse, 1996)

32. Factors Affecting Family Involvement
• Family Factors
▫ over which we have minimal influence but need to
understand
▫ over which we have more influence
• Minimal influence
▫ Social-emotional needs
▫ Economic needs
▫ Cultural parameters
• More influence
▫ Education about disability
▫ Attendance
▫ Engagement in the intervention process

33. Provider Factors Affecting
Parent Involvement
▫ Consistency and reliability
▫ Quantity (amount of
services)
▫ Recognizing your
assumptions
▫ Understanding family
needs
▫ Engaging all family
members
▫ Ability to adjust strategies
to match family style
▫ Communicating rationale
for intervention
techniques
▫ Clearly specifying what
families should do
between intervention
sessions
▫ Setting expectations
▫ Staff communication
▫ Staff education and
training
▫ Staff turnover rates

34. Research Findings Pertaining to Provider
Factors
• The more services a child/family receives, the more
progress the child makes
• High staff turnover rates reduce family involvement
▫ Gomby (2007)
• Quantity--There were some interesting studies that
showed that white families received more services
than others. Hispanics were rated as more engaged.
African Americans received less child-focused
activities.
▫ Wagner (2003)

35. Case Study #1: Understanding Kubler-
Ross’ stages of grief
How would you work with a family that is in denial?
Example
Interventionist: Lets work on the word “more”.
Parent: She says that.
Interventionist: Great, how about the words, mom or
dad?
Parent: She says that too.
Interventionist: She only says twenty words and she is
two years old
Parent: We understand what she wants

36. Case Study #2:
A client has been diagnosed with a receptive
and expressive language disorder. How
would you explain the rationale behind these
suggestions and strategies?
• Roll a ball back and forth with your child.
• Add a word to what your child says and
repeat the words back together.
• Give your child more time to form a response.

37. Routine‐Based Early Intervention
Guidebook
A Proven Program for Improving
Communication Skills with
Activities in English and Spanish
Click here to view on
Amazon.com

38. 3. Connecting Therapy
to Reality
Applying research to our family sessions

39. How do we improve outcomes?
We know it’s important,
how do we do it?
1. Provide specific instructions
2. Provide a rationale
3. Keep it simple and
consistent
4. Have it pertain to a family
event or routine
5. Set expectations
6. Have something written
7. In their native language
8. Follow through
• Make sure caregivers
understand:
▫ WHAT?
▫ HOW?
▫ WHY?
• Assess the caregivers
• Give positive reinforcement
• Take risks

40. Daily Routines

41. Daily Routines
• 12 daily routines
• Frequency and consistency
• More natural
• Extra time is not needed to implement strategies
• Use objects in their environment as therapy
materials

42. Daily Routines in the Schools
• 36 yearly units
▫ Colors
▫ Cowboys
▫ Zoo
▫ Etc.
• Once per week

43. Daily Routines
•Each routine includes:
• Speech/language focus
• Examples of each strategy
• Suggested target vocabulary and 6 pictures of signs
• Homework sheet
• Activity sheet
•The amount of time spent on each routine varies

44. Strategies:
Speech
Language

45. Language Development

46. Language Development

47. • Improved communication and bonding (Goodwyn,
Acredolo, & Brown, 2000; Tompson et al., 2007)
• Children stop using sign when able to
communicate orally (Pizer, Walters & Meier, 2007)
• Provide visual support during language learning
Language Development

48. • Frequency and consistency
• The more a child hears a phrase the more likely
they are to use it
• Use phrases that the child is able to imitate
Language Development

49. • Imitation is vital for speech and language
development (Rogers & Williams, 2006)
• Teach the child how to imitate, by imitating their
sounds and movements
Language Development

50. • Each routine focuses on different vocabulary
• Multisensory learning for language targets
• Label objects, actions and descriptors
• Repeat object labels – the more a child hears a
word, the more likely they are to use it
Language Development

51. • Expand the child's utterances by adding
semantic information or syntactic complexity
can help their language grow.
• It is important to keep phrases simple enough
that your child can repeat them.
Language Development

52. Speech Development

53. • Visual, tactile and motor cues
• Examples:
▫ Clap out syllables in words
▫ Put hand in front of mouth to feel air on plosives
Speech Development

54. • Auditory cues
▫ Emphasize specific sounds in words
▫ Melodic cues
• Model appropriate speech production
▫ Break consonant clusters apart
▫ Model target words slowly with emphasis
Speech Development

55. • Imitate sounds in the environment
• Repeat an incorrect production correctly,
repeating the correct production several times
Speech Development

56. • Have a scavenger hunt
• Label objects that begin with the same sound to
increase phonological awareness
Speech Development

57. • Follow the hierarchy of speech production
• Help parents measure small successes
Speech Development

58. Example by Brianne Ruhnke on www.speakingofspeech.com
Speech Development

59. A case study of practical
application
Script for sample session
1. Review the plan and any progress
2. Select the strategy and daily routine
3. Model the strategy
4. Give the family time to practice the strategy

60. SMILE Example

61. SMILE Example
Video Review

62. What strategies could you observe?
A. Sign
B. Model
C. Imitate
D. Label
E. Expand
F. All of the above

63. What strategies could you observe?
A. Sign
B. Model
C. Imitate
D. Label
E. Expand
F. All of the above

64. What was the language focus, or
targeted skill?
A. Turn-taking
B. Requests
C. Two-word Utterances
D. Describing
E. Contrasting – Yes/No Questions

65. What was the language focus, or
targeted skill?
A. Turn-taking
B. Requests
C. Two-word Utterances
D. Describing
E. Contrasting – Yes/No Questions

66. What daily routine was being used?
A. Bath time
B. Greetings
C. Bedtime
D. Getting Dressed
E. Story time

67. What daily routine was being used?
A. Bath time
B. Greetings
C. Bedtime
D. Getting Dressed
E. Story time

68. Sample session

69. Important Words
Practiquen estas palabras importantes y agreguen más:

70. Important Words
Practiquen estas palabras importantes y agreguen más:

71. Data Collection Sheet

72. Data Collection
• What words or gestures does your child use?
▫ Greetings/Saludos:
 Cuando saluda mueve la mano.
 Translation: To give a greeting, he waves his hand.
▫ Getting Dressed/Vestirse:
 Todavía no puede vestirse él solo. Le tengo que
ayudar.
 He still doesn’t get dressed on his own. I have to help
him.

73. Data Collection
• What words or gestures does your child
understand?
▫ Greetings/Saludos:
 Sí entiende pero no puede pronunciarlas.
 Translation: He does understand, but he can’t
pronounce them.
▫ Getting Dressed/Vestirse:
 No response

74. Homework at home

75. Homework in the schools

76. Homework

77. Homework

78. Homework

79. Homework

80. Activity page

81. Session Record Form

82. In Summary
Therapeutic improvements can be realized by
increasing parent and teacher involvement:
1. Provide specific instructions
2. Provide a rationale
3. Keep it simple and consistent
4. Have it pertain to a family event or routine
5. Set expectations
6. Have something written
7. In their native language
8. Follow through

83. References
• Goodwyn, Acredolo, & Brown (2000). Impact of symbolic gesturing on early language
development. Journal of Nonverbal Behavior, 24, 81-103.
• Kummerer, B., Lopez-Reyna, N.A., & Hughes, M.T. (2007). Mexican Immigrant Mothers’
Perceptions of Their Children’s Communication Disabilities, Emergent Literacy Development,
and Speech-Language Therapy Program. American Journal of Speech-Language Pathology,
16, 271-282.
• McWilliams, R. (2007). Early Intervention in Natural Environments. Retrieved February 5,
2008 from http://naturalenvironments.blogspot.com/2007/10/toy-bags.html
• Pizer, G., Walters, K., & Meier, R. P. (2007). Bringing up baby with baby signs: Language
ideologies and socialization in hearing families. Sign Language Studies, 7 (4), 387-430.
• Rogers, S. J., & Williams, J. H. G. (Eds.). (2006). Imitation and the Social Mind: Autism and
Typical Development. New York: The Guliford Press.
• Rogoff, B. (1990). Apprenticeship in Thinking. Oxford: Oxford University Press.
• Thompson, R.H., Cotnoir-Bichelman, N.M., McKerchar, P.M., Tate, T.L., & Dancho, K.A.
(2007). Enhancing early communication through infant sign training. Journal of Applied
Behavior Analysis, 40, 15-23.
• Vygotsky, L. S. (1967). Play and its role in the mental development of the child. Soviet
Psychology, 5, 6-18.

84. Click to visit www.bilinguistics.com