Expectations and experiences of parents taking part in parent-child interaction programmes to promote child language: a qualitative interview study

Clinical practices in Swedish speech-language pathology for children with (developmental) language disorder

In Sweden, treatment for children with (developmental) language disorder ((D)LD) is traditionally carried out at a speech-language pathology (SLP) clinic, and based on formal language tests, which may not entirely represent the child's everyday language and communication skills. SLP services that include video recordings have shown positive outcomes in terms of providing information about children's linguistic and communicative abilities in everyday life, but little is known about the use of video in clinical practice. The aim of this study is therefore to investigate how Swedish SLPs link their clinical practices (assessment, treatment, and evaluation of treatment outcome) to the everyday language and communication abilities of children with (D)LD. A further aim is to explore SLPs' utilisation of video recordings as a part of their clinical practices with the target group. A web-based questionnaire was distributed to SLPs in Sweden, who work with children with (D)LD. Results demonstrate that Swedish SLPs perceive that their intervention is in alignment with children's everyday language and communication needs to a fairly high degree. However, an exception is assessment, which is considered to have a weaker alignment with children's everyday communication abilities. The use of video recordings for clinical purposes is very limited. It is suggested here that incorporating video recordings from children's everyday life would be an easy and time-efficient way to strengthen the ecological validity of SLP practices for children with (D)LD.

Swedish speech and language pathologists reflect on how their clinical practises align to everyday language and communication skills of children with developmental language disorder

This study aims to extend current knowledge about the possibilities and challenges encountered by Swedish speech and language pathologists (SLPs) in targeting everyday language and communication in children with developmental language disorder (DLD). To explore this matter, unstructured focus groups were conducted where 15 SLPs, working with children with DLD, shared their views on the alignment between their clinical practices and children's everyday lives. Thematic analysis was used to analyse the data, which resulted in five themes: It's everyday life that matters; As an SLP, you're not a part of the child's everyday life; How do we merge the different worlds?; Resources at home vary, and The employer sets the framework for clinical practices. The SLPs stressed the importance of targeting everyday skills and needs, but they experienced themselves as being detached from the children's daily context. Collaboration with caregivers and (pre)school staff was emphasised; however, the resources and capacity of the caregivers and staff varied, and this was experienced as a challenge for providing the most appropriate care. Some children and their families were situated in a multifaceted context and needed more extensive care, and this group was described as increasing. However, the services that the SLPs were able to offer varied and were largely regulated by organisational constraints. Individualised services are crucial for ensuring a positive development for children with DLD and for empowering caregivers to be effective collaborative partners in intervention. Therefore, it is essential for SLPs to have the time and resources to ensure high-quality care.

Treatment for Stuttering in Preschool-Age Children: A Qualitative Document Analysis of Treatment Programs

PURPOSE

The purpose of this study was to identify commonalities and differences between content components in stuttering treatment programs for preschool-age children.

METHOD

In this document analysis, a thematic analysis of the content was conducted of handbooks and manuals describing Early Childhood Stuttering Therapy, the Lidcombe Program, Mini-KIDS, Palin Parent-Child Interaction Therapy, RESTART Demands and Capacities Model Method, and the Westmead Program. First, a theoretical framework defining a content component in treatment was developed. Second, we coded and categorized the data following the procedure of reflexive thematic analysis. In addition, the first authors of the treatment documents have reviewed the findings in this study, and their feedback has been analyzed and taken into consideration.

RESULTS

Sixty-one content components within the seven themes-interaction, coping, reactions, everyday life, information, language, and speech-were identified across the treatment programs. The content component SLP providing information about the child's stuttering was identified across all treatment programs. All programs are multithematic, and no treatment program has a single focus on speech, language, or parent-child interaction. A comparison of the programs with equal treatment goals highlighted more commonalities in content components across the programs. The differences between the treatment programs were evident in both the number of content components that varied from seven to 39 and the content included in each treatment program.

CONCLUSIONS

Only one common content component was identified across programs, and the number and types of components vary widely. The role that the common content component plays in treatment effects is discussed, alongside implications for research and clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25457929.

"It doesn't matter if we're the most amazing professionals in the world…" A qualitative study of professionals' perspectives on parent-child interaction assessment with deaf infants

Introduction

Parent child interaction (PCI) is positively associated with deaf children's language development. However, there are no known, deaf-specific tools to observe how a parent interacts with their deaf child aged 0-3 years. Without a framework for professionals to use with families, it is unknown how professionals assess PCI, what they assess, why they assess, and how the assessment results relate to case management.

Methods

Eighteen hearing and deaf professionals, who work with deaf and hard of hearing infants aged 0-3 years and their families, attended online focus groups. The aim of the study was to gain insight into the professional assessment of PCI. Data were analyzed using thematic analysis.

Findings

Six themes were generated from the dataset. Professionals discussed how central parents were in the support offered to families in the home, the importance of knowing and understanding the individual family, and accounting for and supporting parental wellbeing. Descriptions on how to administer a best practice PCI assessment included which parent behaviors to assess and how to make adaptations for different populations. Professionals shared how the assessment and review process could be used to inform and upskill parents through video reflection and goal setting.

Discussion

This study provides insight into the mechanisms and motivations for professionals assessing the interactive behaviors of parents who have deaf children aged 0-3. Professionals acknowledged that family life is multi-faceted, and that support is most meaningful to families when professionals worked with these differences and incorporated them into assessment, goal setting, and intervention plans.

What do speech-language pathologists do to support families' active involvement in early intervention? Exploring moment-to-moment interactions in sessions

PURPOSE

There is growing emphasis on the importance of involving families in all aspects of the early speech-language pathology intervention process, however, both speech-language pathologists (SLPs) and families have reported that this can be challenging. To better understand how SLPs work together with families in intervention, this study aimed to (a) explore what SLPs do to support families to be actively involved in intervention, both inside and outside sessions, and (b) explore the perspectives of families regarding how SLPs supported their active involvement.

METHOD

Video-reflexive ethnography (VRE) was used to explore engagement with 21 matched SLP-family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants in individual semi-structured interviews where participants were invited to reflect on the interactions captured (i.e. "video-reflexive sessions"). Interview data were analysed using template analysis.

RESULT

Participants reported that SLPs supported families to be actively involved in sessions by (1) planning to involve families; (2) setting expectations; (3) modelling and teaching strategies; (4) inviting families to "have a go"; (5) providing feedback; and (6) problem solving together. Participants also reported that families were supported to be involved outside sessions when SLPs: (1) got them to practice in sessions; (2) made home practice achievable and provided resources; (3) asked about home practice; (4) linked home practice to progress; and (5) helped other family members get involved.

CONCLUSION

The results of this study provide an explicit understanding of how SLPs can support families to take an active role in early intervention, and support the importance of a reflective and individualised approach to supporting engagement.

‘Making the most of together time’: development of a Health Visitor–led intervention to support children’s early language and communication development at the 2–2½-year-old review

Background

Early interventions to support young children’s language development through responsive parent–child interaction have proven efficacy but are not currently delivered universally. A potential universal delivery platform is the Health Visitor (HV)–led 2–2½-year-old review in England’s Healthy Child Programme. It is unclear if it is feasible to offer such interventions through this platform. We report an intervention development process, including extensive stakeholder consultation and co-design which aimed to develop an acceptable, feasible and equitable early language intervention for delivery in this context.

Methods

The study involved five phases including 13 stakeholder co-design workshops with 7 parents and 39 practitioners (HVs, early years practitioners and speech and language therapists): (1) Identification of existing intervention evidence, (2) qualitative review of intervention studies extracting candidate target behaviours for intervention and intervention techniques, (3) co-design workshops with parents and practitioners examining acceptability, barriers and enablers to those behaviours and techniques (particular attention was paid to diverse family circumstances and the range of barriers which might exist), (4) findings were analysed using COM-B and theoretical domains frameworks and a prototype intervention model designed, and (5) co-design workshops iteratively refined the proposed model.

Results

Practitioners were committed to offering language intervention at the 2–2½-year-old review but were not sure precisely how to do so. Parents/caregivers wanted to be proactive and to have agency in supporting their own children and to do this as soon as possible. For equitable intervention, it must be proportionate, with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family. The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key, and so, strategies to engender successful collaborative partnership are also embedded in intervention design.

Conclusion

It is possible to develop a universal intervention which parents and practitioners judge would be acceptable, feasible and equitable for use at the 2–2½-year review to promote children’s language development. The result is one of the most explicitly developed universal interventions to promote children’s language development. Further development and piloting is required to develop materials to support successful widespread implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-00978-5.

A Qualitative Evidence Synthesis of Parental Experiences and Perceptions of Parent-Child Interaction Therapy for Preschool Children With Communication Difficulties

Purpose Parent-child interaction therapy refers to a number of interventions mediated by trained parents to treat developmental difficulties, including speech, language, and communication. Understanding the experiences of parents who take part in parent-child interaction therapy is a key aspect of determining how this intervention can be implemented successfully. However, to date, there has been limited work on synthesizing parental views of this intervention. Method We used qualitative evidence synthesis that involved searching the literature for qualitative studies addressing the experiences and perceptions of parent-child interaction therapy for parents of preschool children with communication difficulties. We identified 27 studies (from 32 publications) and synthesized the data using thematic synthesis. We appraised the quality of included studies using Critical Appraisal Skills Programme (CASP) and assessed our confidence in the review findings using GRADE Confidence in the Evidence from Reviews of Qualitative research (CERQual). Results At the beginning of this intervention, parents may have competing demands and varied expectations about the intervention. Their engagement is facilitated when the intervention is tailored to their individual family, their preferences for learning, and when they have a trusting relationship with the clinician. At the end of the intervention, although most parents perceive an improvement in their child's communication and feel empowered to facilitate this, they have concerns about their child's future needs. Conclusions It is important that clinicians explore parents' readiness for this intervention by discussing their needs and preferences openly, and that they facilitate their engagement through a supportive relationship. They also need to consider how parents will transition out of the intervention and continue to support their child's language development. Supplemental Material https://doi.org/10.23641/asha.14978454.