Co-Principal Investigators: Carol Scheffner Hammer (Teachers College, Columbia University)

Purpose: The purpose of this project is to develop and pilot test an intervention aimed at improving the language outcomes of preschool children with language impairment (LI) by teaching parents to use evidence-based strategies with their children. LI is the most common disability during the preschool years. Although children with LI receive speech-language services in a preschool setting, speech-language pathologists (SLPs) do not have time to train parents to support their children's language abilities. Yet parents have the potential to be a valuable resource to help their children improve their language skills and prepare them for school success. The proposed intervention, Parents Plus: Language Coach (P+), is a web-based resource coupled with support from a certified SLP coach to teach parents to use focused stimulation strategies, an approach in which the adult engages the child in interactions that are constructed to enhance the likelihood that the child will express specific language forms through repeated modeling of targets and use of other responsive language techniques (e.g., following child's lead, establishing joint attention).

Project Activities: In Phase 1, the research team will develop a web-based resource for parents –consisting of training modules, exemplar videos, and other resources—with feedback from parents, educators, and an expert consultant. In Phase 2, P+ will be assessed for its feasibility of use by parents in authentic educational settings (e.g., home and community settings) and perceived sustainability for preschool programs. Findings from this phase will be used to inform revisions to P+. In Phase 3, the research team will conduct a pilot study to examine the promise of P+ for improving language outcomes for children with LI and parents' implementation of focused stimulation strategies.

Products: Researchers will produce a fully developed intervention, Parents Plus: Language Coach, for children with LI, peer-reviewed publications, and presentations.

Structured Abstract

Setting: The study will take place in family homes of preschoolers in Pennsylvania.

Sample: Initial development will include approximately six to eight parents and six to eight educators (e.g., speech language pathologists, early intervention supervisors, program directors) to form two advisory boards. The research team will recruit six additional parents to review the intervention and pilot test the fidelity measure. Phase 2 participants will include 10 3- to 5-year-old preschool children with LI and one of their parents. Phase 3 participants will include 30 parent-child dyads. All participating children will continue to receive their regular language services through their preschool SLPs, who will also participate in data collection.

Intervention: P+ is an intervention that teaches parents how to use focused stimulation strategies. The training takes place online and is supported by coaching from an SLP. The website is comprised of four components: (1) training modules, (2) exemplar video clips, (3) implementation plans and other written resources, and (4) a community chat room for parent peer support with coach facilitation of discussions. The primary responsibilities of the SLP coach are to develop individualized language goals for each child, which will complement the speech-language services children are receiving in their preschool settings, and aid parents' understanding and implementation of focused stimulation.

Research Design and Methods: The research team will conduct this project in three phases. In Phase 1, the research team will develop an initial version of P+ in partnership with parent and educator advisory boards and an expert consultant. After initial feedback, a small sample of additional parents will review the website and materials, and assist in pilot testing the P+ fidelity measure to be used in subsequent implementation phases. In Phase 2, the research team will assess usability, feasibility, and fidelity of implementation. Following an initial home visit by a coach, the parents will begin their training and partnership for implementing the intervention with the coach. Data will be collected from the website, coaching logs, parent logs, interviews, and coach-parent interactions through videoconferencing. Data collected during this phase, as well as additional feedback from the advisory boards and consultant, will lead to revisions in the intervention. In Phase 3, the research team will pilot test the intervention through a matched randomized design in which 30 parent-child dyads will be assigned to either the P+ or control condition. The research team will collect data at baseline, immediately post intervention, and 3 months following the intervention.

Control Condition: The control group will receive business-as-usual speech-language services according to their IEP. Following the conclusion of the pilot study, the control group will have access to the P+ website.

Key Measures: The Kaufman Assessment Battery for Children and the Clinical Evaluation of Language Fundamentals—Preschool (CELF—P) Core Language Index will be used as screening measures for participant eligibility. Primary child outcome measures include the Word Structure, Sentence Structure, and Expressive Vocabulary subtests of the CELF—P and natural language samples from structured interactions between the child and the parents and researcher. Parents' fidelity measures include coaching and parent logs, data collected from the website, and videos of parent-child interactions. Coach fidelity measures include videos of coach-parent interactions and the coaching log. Feasibility will be assessed through interviews with parents and their children's SLPs, including their perceived sustainability of the intervention. Quality of the classroom language environment will be assessed using a time-sample observational measure, Language Interaction Snapshot. SLPs will also complete a weekly log that will provide information on child experiences with speech-language services.

Data Analytic Strategy: Qualitative methods will be used to gather, transcribe, and code natural language samples, videos, and interviews. The research team will conduct descriptive analyses to examine the feasibility and fidelity of P+. The pilot study will use hierarchical regression analyses to determine the promise of P+ for improving parents' fidelity of implementation of focused stimulation strategies and child language outcomes.