Josh Feder, MD
Director of Training,
Disclosures 2103
Clinical SymPlay, ICDL Grad School, Early Years COC and BRIDGE Circlestretch, CAPTN, Cherry Crisp FTE = 2.5 (cloned)
Growing numbers of people with ASDs Diminishing resources Need to catch cases earlier Diverse views on best intervention: strict behavioral, PRT, Developmental (DIR) Little research on intervention in toddlers Community Based Participatory Research: collaborative, shared decision making that supports Evidence Based Practice.
Settling on an Intervention:
2008 - 2010, pre-funding Concrete problem solving Process oriented evolution
Diverse group: researchers, clinicians (MH, SL, OT, Ed), parents, funders (SDRC,Harbor RC, Kaiser ); most from the behavioral world, some from the smaller developmental world (M. Burgeson, M. Culligan, HOPE Infant, L. Jenkinson J. Feder, et. al.) Meeting monthly with FOOD! gradual coalescing trust deciding on a name and logo Reviewed multiple programs for: parent-focus, evidence in ASD, developmental breadth, crossdisciplinary breadth
Settling on an Intervention
2010 2012 grant (250k) Concrete problem solving Process oriented evolution
3 picked for community presentation: P.L.A.Y. Project, Enhanced Milieu Training, and Project ImPACT Focus groups from community Mediated final decision-making & process of acceptance: Picked Project ImPACT with plan to enhance and modify
Communicative temptations
Follow your child's lead Imitate your child Animation Modeling & expanding language
Participants
13 children (with 12 moms and one dad) , 7 to 21 months, at-risk for ASD, 85% Male, 77% Caucasian
Mullen Scales of Early Learning, Early Learning Composite: M = 89.9; SD = 20.9; Range = 67-119
Measures Child: MacArthur/Bates Communicative Development Inventory Communication and Symbolic Behavior Scales Parent: Fidelity of implementation of the intervention strategies Intervention content knowledge quiz Treatment Satisfaction.
Procedures
Context: 4 clinics, multidisciplinary, training days, setting reflective precess Recruitment: referred by local agencies or the Regional Center. Consent, intake assessments assigned to provider based on funding / geographic location. Intervention: 1.5 hour sessions, twice per week for 12 weeks (approx. 29 hours total). Parents received manual and learned 1-2 strategies per week. Sessions: reviewing strategies, modeling techniques with child, coaching parent with child Homework: times to practice, questions on success and difficulty Missed sessions were rescheduled. Assessments: The research team conducted assessments before and after intervention.
BRIDGE Outcomes:
Training: feels too compressed; examples arent for toddler ( ImPACT for older kids ) Clinicians: floortimers do floortime, behaviorally oriented people often focused on specific goals (ball!) Parents: good fidelity, master 70 -80% of strategies, Parents like it, but not the HW Kids: McArthur-Bates improve Saying 30 more words, understanding 85 more words, using 15 more gestures; Kids: % Prelinguistic dropped from 40 to 30%, Early 1 Word rose from 15 to 45 %, Late 1 Word fell from 30% to 0; Multiword rose from 15 to 35% Researchers: got talks, posters, and papers out of it
BRIDGE Challenges
Recruitment: Finding families For many clinicians: Embracing engagement Utilizing reflective process Giving control over to parents Helping clinicians and parents learn to wait Helping clinicians and parents to be empathic For some clinicians: Accepting formal goals for sessions Taking data For Parents: need to retool manual for younger children and better respect for principles of adult learning (change homework)
Rewriting Clinician Manual: e.g. what not to say clinician- parent cartoons (I cant meet at 5, I have to take my daughter to violin lessons)
The Future
More meetings more food! More training and more clinics More research - and more publications! More families helped, we hope And gradual shifting toward a culture of true evidence based practice