Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication

Abstract

Purpose This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice service delivery model. Method Four caregivers and children with language delays aged 18-27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver-child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach-Model-Coach-Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words. Results There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children. Conclusion Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies. Supplemental Material https://doi.org/10.23641/asha.14977605.

Figure 1.

Jessica and Jameson's number and percentage of correct EMT strategies. Closed circles represent caregiver responses during in-person sessions, and open circles represent responses during telepractice sessions. Line Graph B includes a double axis graph; the gray bars depict caregiver responses and correspond with the axis on the left side (scale = 0–30). EMT = enhanced milieu teaching; NAP = nonoverlap of all pairs; LRRi = Log response ratio increasing.

Figure 2.

Elena and Ira's number and percentage of correct EMT strategies. Closed circles represent caregiver responses during in-person sessions, and open circles represent responses during telepractice sessions. Line Graph B includes a double axis graph; the gray bars depict caregiver responses and correspond with the axis on the left side (scale = 0–30). EMT = enhanced milieu teaching; NAP = nonoverlap of all pairs; LRRi = Log response ratio increasing.

Figure 3.

Terry and Ambyr's number and percentage of correct EMT strategies. Closed circles represent caregiver responses during in-person sessions, and open circles represent responses during telepractice sessions. Line Graph B includes a double axis graph; the gray bars depict caregiver responses and correspond with the axis on the left side (scale = 0–30). EMT = enhanced milieu teaching; NAP = nonoverlap of all pairs; LRRi = Log response ratio increasing.

Figure 4.

Sydney and Nora's number and percentage of correct EMT strategies. Closed circles represent caregiver responses during in-person sessions, and open circles represent responses during telepractice sessions. Line Graph B includes a double axis graph; the gray bars depict caregiver responses and correspond with the axis on the left side (scale = 0–30). EMT = enhanced milieu teaching; NAP = nonoverlap of all pairs; LRRi = Log response ratio increasing.