Using telepractice to train and coach parents of children with autism in rural areas in North England

Autism is a neurodevelopmental disorder characterised by difficulties in social interaction and communication, repetitive and stereotyped interests and behaviours affecting 1% of the population worldwide. Social-communication skills have been reported to have a positive impact on a number of areas such as academic achievement, social success and quality of life outcomes.

Training and coaching practices have been suggested as essential for teaching adults new skills. More specifically, training adults to adjust their interactive style has been reported to promote communication skills in children with autism and video feedback has been proved an effective and empowering tool in the training process.

Telepractice is a promising service delivery approach which has been widely used in health but also to a certain extent in other disciplines including education. Its main advantages include reduced money and time spent on travel as well as reduced intrusion into the family home. Digital delivery methods to engage parents in training have been increasingly used as an alternative to traditional face-to-face training and coaching. The Internet-Based Parent-Implemented Communication Strategies (i-PiCS) program  is designed to train and coach parents how to use evidence-based teaching strategies to improve the social communication skills of their children with autism in the comfort of their home. As young children spend most of their waking hours with parents, parent-implemented interventions are likely to ensure that these strategies are used frequently and throughout daily routines.

Children in rural areas are likely to be living in poorer conditions than children in urban areas and be receiving interventions of less intensity (i.e. fewer sessions and of shorter duration) due to increased travel time and cost. The Financial Crisis of 2008 incurred substantial cuts in health, social care and education in many western economies  and people with disabilities were impacted to a great extent by these cuts.

Cumbria is a large mountainous county in North West England with 54% of its residents living in rural areas (compared to 18% across England and Wales). The Children's Health Therapists Team (consisting of Speech and Language Therapists, Occupational Therapists and Physiotherapists) and the Special Educational Needs and Disabilities (SEND) Teaching Support Team (consisting of Specialist Advisory Teachers and Educational Psychologists) are in charge of children with SEND in Cumbria. These teams often have to travel long distances to meet parents and children adding extra stress to their increased due to cuts workload. The situation is even more problematic in winter when travelling is not always possible due to bad weather conditions.

i-PiCS program has the potential to be an effective tool in counties like Cumbria considerably reducing Education and Health Care professionals' and parents' stress levels, enhancing parenting skills and family quality of life as well as children's social-communication skills.

• To explore the relation between i-PiCS and parents’ fidelity of implementation of the newly acquired evidence-based strategies.
• To examine the impact of i-PiCS on families' quality of life, parents' stress levels and parenting self-efficacy skills.
• To research how parents perceive the social validity of the goals, procedures and outcomes of i-PiCS.
• To investigate the relation between i-PiCS and the children’s social-communication skills.

Setting

All sessions will be conducted in the families’ homes or other locations of their choice over the internet using online teleconferencing. 

Sample

Four parent–child dyads will participate in the study. Inclusion criteria for children will be: (1) to have an autism diagnosis and (2) limited expressive language and (3) to be 7 years or younger. There will be no inclusion criteria for parents. Families will be selected by a process of purposive sampling (Denscombe, 2010); they will vary within a range of demographic features such as socio-educational and financial background, geographical spread within the county and ethnic origin. 

Methodology

A multiple-baseline design across strategies within each parent-child dyad will be used to examine the effects of i-PiCS on the parents' application of the teaching strategies and their child’s communication. In multiple-baseline designs, which are often employed to check the effectiveness of interventions, the intervention starts at different time points for each evidence-based strategy. Each family will act as their own control (i.e. four different multiple baseline studies).

Ethics

This study will be undertaken within the ethical guidelines and framework of the Universities of Birmingham and Illinois and the British Educational Research Association (BERA) Ethical Guidelines for Educational Research (2018).  University of Birmingham application for Ethical Review: ERN_19-1312.

This is a replication of the original i-PiCS study conducted by Meadan et al. (2016). In contrast to medical studies, educational studies are rarely replicated; however, more replication studies are needed in educational research to shape education policy and practice. Given that the original study was conducted in the US, the transferability of the findings to a rural population in the UK should be tested. In case i-PiCS is found to be effective, the study has the potential to immensely influence government policy; telepractice can result in great improvements to resource management and financial savings as a viable alternative or supplement to the face-to-face education and health care services. Research projects with more participants across areas of similar characteristics in the UK will then need to follow. Additionally, professionals will need to act as training and coaching providers in these studies to produce a version of i-PiCS directly applicable to the demands of real world environments.

The collaboration between the School of Education at University of Birmingham and the College of Education at the University of Illinois is a continuation of a BRIDGE Birmingham-Illinois partnership. Birmingham and Illinois’ School/College of Education have rich research traditions and teaching portfolios in the field of inclusion, disability and teacher preparation. The Department of Disability, Inclusion and Special Needs (DISN) at the University of Birmingham is the biggest of its kind in Europe whereas the Department of Special Education (SPED) at the University of Illinois has a similarly rich tradition, ranked among the top 10 best programs in the US. The 'family role and understanding of disability' is one of the main themes of the BRIDGE Birmingham-Illinois partnership and this research project will further extend this work.