EMT hybrid telepractice (Quinn et al., 2021)

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.

1. Detailed Description of Assessment Battery

2. Time Delay and Milieu Teaching Episode Scoring Procedures

3. Reliability of Dependent Variables for EMT Strategy Use Across Conditions, Tiers, and Participants

4. Reliability of Child Communication Outcomes

5. Procedural Fidelity Across All Phases and Participants

6. Tables Summarizing Visual Analysis by Caregiver-Child Dyad

7. Narrative Summary of Visual Analysis for Each Caregiver-Child Dyad

8. Non-overlap and Parametric Effect Size Metrics for Percentage of Correct EMT Strategies

9. Non-overlap and Parametric Effect Size Metrics for Number of Correct EMT Strategies

10. Child Communication Outcomes

11. Caregiver Assessment of Social Validity

12. Assessment Materials and Telepractice Equipment Expenses

13. Intervention Costs Per Caregiver-Child Dyad

Quinn, E. D., Kaiser, A. P., & Ledford, J. (2021). Hybrid telepractice delivery of enhanced milieu teaching: Effects on caregiver implementation and child communication. Journal of Speech, Language, and Hearing Research. Advanced online publication. https://doi.org/10.1044/2021_JSLHR-20-00430