Parent-Implemented Interventions (PII) in Autism

Autism spectrum disorder or “autism” is a qualitative impairment affecting the functions in the following three areas: 

(1) Social interaction, 

(2) Communication, and 

(3) Restricted, repetitive, and stereotyped patterns of activities, interests, and behavior 

Each person with autism is unique. The severity in the spectrum differs from person to person.

Poor eye contact, trouble in developing peer relationships, poor speech development and conversation, obsessive motor mannerisms, and strict adherence to routines are the common symptoms of ASD.

Parents need skills and practices that they can implement with their children to reduce their discomfort in daily activities.

The medical field has developed many interventions, which have the support of scientific research for their effectiveness. These interventions help to improve the quality of life in people with ASD.

One of the most crucial evidence-based interventions is Parent-Implemented Intervention (PII). It enables parents to help their kids with ABA Parent Training. The National Professional Development Center on Autism Spectrum Disorder supports the implementation of PII.

What is Parent-Implemented Intervention (PII)?

Parent-implemented intervention is an evidence-based approach that involves parents using individualized practices with their kids to help them learn positive skills. The structured training program at home or in the community teaches the parents’ intervention methods and techniques.

PII helps the child get more learning opportunities as parents themselves can address the symptoms in their autistic child. The coaching in applied behavior analysis (ABA) helps parents develop appropriate and functional skills in their children to improve their quality of life.

Parent-implemented intervention (PII) helps people with ASD improve their social and conversation skills, learn the language, and use alternative communication, action, attention, and play skills. PII also helps children with ASD become more compliant and enhance functional living skills. The research has shown encouraging results in minimizing disruptive or aggressive behavior.

The applied behavior analysis (ABA) provider should include parents in the treatment to make PII more effective.

Why use PII

Most of the time, the children are with their parents. Parents are the first teachers. Playing and interacting with parents is the most common way toddlers learn their skills. Therefore the child gets more opportunities when parents know how to implement an intervention in everyday routines and activities.

PII- Effectiveness and Targeted Areas 

Parents can directly implement the customized parent-implemented intervention with their children. It will help a child get more opportunities to learn and acquire functional skills.

The parent-implemented intervention for children with ASD has numerous techniques and practices. These techniques are designed to improve various skills associated with ASD.  

PII Targeted areas include:

• Communication, both verbal and nonverbal
• Cognitive performance
• Playing abilities,
• Social skills, and
• Reduce interfering behaviors like repetitive, stereotypical, and disruptive behaviors

PII effectively improves communication and conversational skills and helps learn and use language. It improves compliance and reduces aggression and disruptive behaviors.  

The multiple steps of implementing parent-implemented intervention include:

• Determining the needs of the Family
• Selection of goals
• Development of the intervention plan
• Imparting training to parents
• Implementation the intervention
• Monitoring the progress

Steps of Parent-Implemented Intervention

The cooperation between practitioners and parents is critical to making parent-implemented intervention successful. For effective partnership, family-centered planning is necessary. The development and implementation of PII include identifying needs of the parent and child, deciding goals, formulating intervention plans, parent training, and intervention delivery.

The collaborations among parents, caregivers, and professionals facilitate the optimal development of skills in the child. It addresses the concerns and priorities of families. When using family-centered practices, the involvement of parents empowers them and helps them make meaningful decisions.

Step 1. Determine the Needs of the Family  

Each child with ASD is unique. Moreover, each family has its own needs and circumstances.

For an effective intervention plan, the practitioner must acquire knowledge of the child with ASD. The practitioner should understand the family attributes, including the unique cultural context of the family.  

Practitioners can learn the needs of individual families through:  

• Interviews of parents and caregivers
• Observing child with ASD, daily routines, and interaction between caregiver and child 

Through this activity, the practitioner can identify:

• strengths and weaknesses of the family and child
• needs areas of concern about the child
• behaviors of the child that impact family functioning
• Type and nature of child-parent interactions and reciprocity of interactions
• Routines and family activities of the child
• Resources within the family and community to assist in carrying out interventions.

The practitioners must be responsive and sensitive to the cultural aspects of each family. The practitioner should consider ongoing practices, routines, values, and interactions occurring in the family.

The home setting is ideal for observing parent-child interactions.

Step 2. Selecting Goals  

It is essential to identify the goals family wants to achieve through intervention. Step 2 involves the identification of goals and helping parents implement the intervention. The practitioner involves parents and other members to decide the goals and objectives of the intervention. Individualized Education Programs (IEPs) or Individualized Family Service Plans (IFSPs) should form the basis of finalizing objectives.

 The goals and objectives of parent-implemented intervention should address the followings: 

• Focus on the priority of the child and areas of concern
• The completion of goals should leave a positive impact on family functioning and not cause additional stress
• The parents should be able to implement the plans with consistency
• Objectives should be appropriate for parents to implement at home or in community settings

The parent-implemented intervention can achieve several goals. Most interventions focus on child improvement, but the practitioner should consider a broader orientation that covers the parents and family.

The finalization of goals should emphasize not only the design of the intervention plan but also its success. It is critical to the success of intervention to document the goals and monitor their implementation.

Practitioners must assure that parent-implemented intervention goals are: 

• measurable and observable
• selected in partnership with parents, and
• shared with parents and others in written format

Goals vary for each member. The goals are separated into three separate categories.

1.Child Goals 

Promoting child progress is the prime aim of the parent-implemented intervention. Goals for children may focus on a broad range or can be specific.

The parents and practitioners should consider the following when deciding on goals for the child: 

• Goals (IEP or IFSP) that are suitable for parents to implement in home and community settings
• that focus on developing positive behavior and reducing interfering behaviors
• that increase communication/language skills

Moreover, the goals decided for a child should prioritize behaviors that:

• causes safety concern
• causes disruptions
• increases and improves interactions like type, frequency, and nature
• increase access to the community; and

Practitioners should also finalize goals to positively impact the performance of the child, parents, and family members. They should identify realistic goals which do not put additional stress on the family.

2.Parent Goals 

Besides deciding goals for the child, it is helpful to identify goals for parents to achieve with parent-implemented intervention. The parents should assume the role of an instructor and the learner in PII.

Through parent goals, the child will acquire skills that will have a profound effect on the progress of the child’s progress as well as the mental health of the parents.  

While determining the goals for parents, the practitioners and parents should consider the followings:

• level of parent-child interactions
• knowledge of parents about ASD
• knowledge and skills of the parents regarding instructional strategies that promote development and learning
• The information of parents about behavior management strategies.

3.Family Goals 

Parents who have a child with ASD need the meaningful involvement of family members and other people to offer help.

Family members have a powerful and enduring influence on a child with ASD. Daily functioning and the lives of all family members have a demoralizing impact due to the presence of a child with ASD. Therefore, it may be helpful to outline goals for family members focusing on augmenting their knowledge and skills on ASD. However, the objectives must be implementable and measurable. 

Step 3. Developing the Intervention Plan

After determining the child and family goals, the practitioner creates the intervention plan. The intervention plan involves specific steps for the parents to implement.

The intervention plan includes

• Step-by-step instructional strategy  
• the time limit and time intervals to implement the intervention
• where and when to provide intervention  

Each intervention plan focuses on the need of the individual child, parent, and family goals.

The priority of the parents, family characteristics, and daily routines help develop the intervention and strategies. When deciding on the intervention plans, the practitioner should consider the economic status and abilities of the parents. 

The intervention team can target a particular behavior or skill to individualize the plan.

To develop a customized intervention plan for the child and family, it should:

• focus on the goals identified for the child, parent, and family
• be consistent with the practices, routines, and values of the parents
• incorporates the target behaviors
• incorporates the intervention into daily routines
• include evidence-based approaches that are effective when implemented by parents
• consider the instructional practices compatible with parent’s knowledge and preferences

Step-by-step guidelines in the intervention plan will help the parents to implement the intervention plan.

The instruction plan for individual practices should include the following information:

• target behavior/skill
• the person responsible for the implementation of the intervention
• Place of implementation of the intervention  
• Frequency, duration, time for implementation of the intervention
• For how long to implement the intervention
• Input material and strategies needed  
• reinforcement schedule

Checkout our blog – Functional Communication Training (FCT) in Autism

Step 4. Training Parents 

After developing the intervention, the practitioner teaches parents how to implement the intervention. Through structured parent training programs, the parents receive the training. 

Practitioners with parents develop an individualized training program. The program helps parents to implement the intervention. 

Practitioners consider the following when creating the training program: 

• The format of the training 
• The location of the training 
• The training components 
• The amount involved and duration of training

Monitoring the progress of the parents is critical during the training. The duration varies depending on the progress and the situation. Parents become more independent over time and master targeted skills and strategies. The collection of data is thus critical as it helps to determine whether parents are implementing interventions with constancy.

Step 5. Implementing the Intervention

Parents implement the intervention plan as per guidelines. The intervention plan should indicate when and where to implement instruction. However, sometimes you may need revisions after implementation begins. 

Sometimes parents learn skills in professional development settings and implement intervention within naturally occurring routines.  

• Parents implement the intervention with the children as per plan.  
• Parents implement the intervention in natural routines. 

Having a fixed and consistent time and place for the intervention will help the parents implement the intervention with greater frequency. The children will also know what their parents expect from them.

Step 6. Progress Monitoring 

To assure consistency in implementing this evidence-based intervention, the practitioners advise parents to monitor implementation and the development of skills of the child with ASD.

Practitioners present this component to parents or family members in a positive manner. Monitoring the progress refines implementation and helps to achieve the goals more efficiently.

Conclusion

Components and programs in the parent-implemented intervention (PII) make the parents more responsible in carrying out intervention with their child. The professionals train the parents one-on-one or in group formats in the community or home settings. When sufficiently trained, the parents implement the intervention with their children effectively.

PII is an effective behavioral treatment for ASD based on a solid foundation of scientific evidence. It is effective in developing skills in people with ASD. PII also helps minimize the difficulties people with ASD experience in performing daily functions.