Parent/Caregiver Training Is One Piece of a Much Larger Goal. The Real Question… How Do You Make the Training Stick?
A curious lawyer working on a case involving a school district and a family with a child with autism once asked me the following question: Is parent training the key to the successsful education of children with autism? As I was about to respond with an emphatic “YES!” something held me back. I decided to take a few moments to think about the answer and then replied “no” because the question was misleading. It isn’t parent training that leads to the all-around successful education of children with autism, but the combination of a certain type of parent training plus parental adherence.
Experts can talk at parents, instruct them to read their books, join groups, and preach about the importance of “following through,” “keeping to a schedule,” or “offering lots of opportunities to engage with peers,” but without a clear and concise written and verbal explanation, a visual model of what they are supposed to do, and time to practice and receive feedback (the combination of which is called the behavior skills training model or BST), parents will have a difficult time putting that “expert advice” to good use.
On the other hand, I wouldn’t be the first professional to provide private hands-on parent training using the behavior skills training model only to find that the parents did not practice the skills we had worked on week-after-week because…(insert reason here).
Having dedicated my career to training parents (and staff) in applied behavior analysis, parental adherence is an area that I have had to address on numerous occasions. There are, at times, issues beyond our control, like cognitive impairment, little support from family or friends, and economic barriers that impact parental adherence (see Allen and Warzark, 2000* for a review), but when those issues do not exist, parental non-adherence can still be an issue.
5 Ways to Increase Parental Adherence
1. Develop clear goals and objectives for the parent, the child, and the trainer.
Who says, IEPs are just for kids? Having an “individualized education plan” with clear achievable goals for your parent training sessions, developed with the parent(s), sets expectations prior to the beginning of the training period. Not only will the parents have an idea of what is expected of them, they will also get a good idea of what the trainer is expected to do. Parents should agree to these goals and objectives prior to starting hands-on training.
2. Review your goals and objectives after every training session.
Are you achieving what you set out to do? If not, why? Are you spending time talking and not enough time modeling or practicing skills? Set aside a separate session to discuss other concerns. Are you running your initial training sessions with the child at home and finding mom or dad are having a difficult time focusing? Set up training sessions while the child is in school or in other therapy sessions so that the parent can practice with the trainer first, without distractions. Need a bit of help in this area? Check out our blog post on writing parent training goals.
3. Assign reasonable homework.
If you are not a parent, you have no idea what it is like to work, maintain a home, a relationship with a partner, attend to your kids, make sure everyone is fed healthy meals, and is able to participate in sports or other extra-curricular activities (never mind trying to take care of yourself!). And if you are not a parent of a child with autism or other special needs it is difficult, if not impossible, to know what it is like to do all of the things already mentioned, while trying to function as an advocate and a therapist and grapple with the emotional and social side effects of having a child with autism or special needs.
When parents sign up for parent training, they are taking a good step in the right direction. We need to reinforce their behavior by making it easy to practice when the trainer isn’t present. Want parents to take data? Ask them to do it two times a week, not five. Do they have the option to video their interactions and collect data later? If so, let them do it!. Want them to practice giving their child 1-step directions? Make sure the work is reinforcing for mom or dad as well as the child (Give mom a hug! Bounce on the ball!). Do you have 6 areas you are working on in training? Bring it down to 1 or 2 to increase the likelihood that everyone will be successful.
4. Work on parent skills outside of the training setting.
A parent has demonstrated successful implementation of a procedure in your office. Fantastic! But you are not finished. Now it is time to take make sure the parent can implement what you have taught them in the home. This doesn’t mean you have to physically visit weekly or even monthly. Video and web cameras increase our ability as trainers to take our instruction into the home while decreasing observer effects and session costs. I also find that parents appreciate not having to tidy up for your arrival or disrupt the entire family’s routine because the only time you can drive to their home, is say, during their older daughter’s flute practice. If your training occurs primarily in the home, make sure parents practice around the house and not just in the “therapy room” or designated area that you work in. You would be surprised how often parents find it difficult to generalize their skills to a less structured environment like the kitchen or backyard.
5. Be supportive of parents of children with autism. Allow them to share their successes and their not-so-successful moments.
Mistakes happen. Help parents recognize the times that it is harder for them to follow through with your recommendations and help them address those difficulties. Getting the combination of parent training and parent adherence right takes time and effort, but the end result is worth it.
References
Allen,K.D., & Warzak, W.J. (2000). The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough. Journal of Applied Behavior Analysis, 33, pp. 373-391.
