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

Autism is a neurodevelopmental disorder, which affects 1% of the population. Parents play a crucial role in the education of their children and due to substantial cuts in the provision for people with disabilities the need to train parents using technology in innovative ways is more pressing than ever. 

The need for such training is greater in rural areas where parents and children have to travel long distances to get the support they are entitled to. Professionals in these areas also spend many of their working hours travelling. This study will replicate a study conducted in the US. It will explore the extent to which training and coaching parents of children with autism in the county of Cumbria in the United Kingdom via telepractice can be an effective alternative or supplemental service. 

This research project is funded by BA/Leverhulme Small Research Grants and runs from 1 October 2019 to 30 September 2020.


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.

Aims and methodology of the project

  • 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.


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


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. 


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).


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.

Significance of the study

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.

Meet the team


Dr Lila Kossyvaki (Principal investigator)

Dr Lila Kossyvaki is a lecturer in Severe Profound and Multiple Learning Disabilities in the Department of Disability, Inclusion and Special Needs (DISN) at the University of Birmingham. She is also a member of the Autism Centre for Education and Research (ACER). Lila has worked on a number of research projects exploring Technology Enhanced Learning (TEL) in children with autism.


Dr lila kossyvaki

Professor Hedda Meadan-Kaplansky (Co-investigator)

Hedda Meadan is a professor at the Department of Special Education at the University of Illinois at Urbana-Champaign, a Goldstick Family Scholar, and a Board Certified Behavior Analyst. Hedda’s areas of interest include social-communication skills and challenging behavior of young children with autism and other developmental disabilities and intervention methods to enhance these spheres of functioning. 


Professor Hedda-Meadan-Kaplansky

Hadeel Alharbi (Researcher)

Hadeel is a lecturer in the special education department at AlQasim University in Saudi Arabia. She has worked as a special education teacher in autism centres in Saudi and as a teaching assistant at AlQasim University. She has participated in a research project examining the effect of antecedent based multi-sensory movement on attention and on-task time of children with autism. Hadeel is currently a PhD student at the University of Birmingham.


Hadeel Alharbi

Laura Cristescu (Researcher)

Laura Cristescu is a 3rd year PhD student at the University of Birmingham, researching the potential of using video as a tool for reflection to develop an approach aimed at promoting the self-determination of pupils with autism, in an all-age specialist school. Her professional background involves working with children, young people, and adults with a range of needs including autism, in a variety of settings including specialist schools, out-of-school and residential provisions, and individual work. Laura is also a trainee practitioner in Video Interaction Guidance. 


Laura Cristescu

Danielle Tuite (Researcher)

Danielle started her career over 25 years ago in residential and day services for adults with learning disabilities. She has been a teacher for 17 years, initially as a teacher of History, and then as the teacher in charge of an integrated resourced provision for pupils with communication and interaction difficulties including autism. For the past 5 years she has been an advisory teacher in Cumbria supporting mainstream schools with matters of inclusion for children with physical/medical difficulties or Severe Learning Disabilities (SLD). 


Danielle Tuite

James Halle (Advisor)

James Hale is a Professor Emeritus at the University of Illinois at Urbana-Champaign. He has been involved in research related to communication and language development of children with disabilities for more than 35 years. His research has focussed on examining both social communication of young children with significant intellectual disability, and the ecological factors that facilitate and discourage communicative growth. 


james halle

Rebecca Hacker (iPiCS trainer)

Rebecca Hacker is a Doctoral Student in the Department of Special Education at the University of Illinois at Urbana-Champaign. Her current research focuses on the social communication of young children who have complex communication needs and their typically developing peers.

Rebecca Hacker

Michelle Sands (iPiCS trainer)

Michelle Sands is a Doctoral Student in the Department of Special Education at the University of Illinois at Urbana-Champaign. She is researching the transition to kindergarten for children with Disabilities. She coordinated the Spanish i-PiCS project and the CoCare PD/i-PiCS Research Board project.  


Michelle Sands

Collaboration between the University of Birmingham and the University of Illinois

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. 

Find out more about the pilot study in the US: Internet-Based Parent-Implemented Intervention for Young Children With Autism: A Pilot Study