ASHA journals
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Just-in-time EMT (Bailey et al., 2024)

online resource
posted on 2024-02-12, 19:25 authored by Kathryn M. Bailey, Mary E. Rodgers, Emily D. Quinn, Suzanne Thompson, Jennifer Nietfeld, Ann P. Kaiser

Purpose: We investigated effects of an adaptive telehealth coaching model on caregiver implementation of enhanced milieu teaching (EMT) with newly diagnosed toddlers with autism.

Method: Three caregiver–child dyads participated in a multiple-baseline-across-behaviors, single-case design. Caregivers were taught EMT via telehealth using the teach–model–coach–review approach. EMT strategies were taught sequentially in four components corresponding to design tiers. Caregivers reported their needs for support and adaptation via weekly surveys. Primary outcomes were measures of caregiver’s implementation, including (a) a fidelity checklist for wholistic use of EMT and (b) a percentage of correct use of a subset of key EMT strategies (e.g., matched turns, target talk, expansions, play actions, milieu episodes). Generalization and maintenance of caregiver strategy use in uncoached home activities were measured. The number of different words used by children was measured as a secondary, descriptive outcome. Social validity data were collected through ratings and interviews at the end of the study.

Results: There was a functional relation between the intervention and caregiver’s implementation of EMT for all dyads. Caregiver’s use of EMT strategies often generalized and maintained post-intervention. Child response to intervention was variable. Social validity data indicated that the model was beneficial to caregivers and children.

Conclusions: An adaptive telehealth coaching model is effective for teaching caregivers of toddlers with autism to implement EMT and potentially helps to bridge the gap between diagnosis and comprehensive intervention. Further exploration of the relation between caregiver fidelity and dosage of active ingredients and child spoken language outcomes is needed.

Supplemental Material S1. Coding manual for timed event sampling via Datavyu.

Supplemental Material S2. Caregiver EMT fidelity checklist measure.

Supplemental Material S3. Family story interview protocol.

Supplemental Material S4. MyCap survey.

Supplemental Material S5. Social validity interview protocol.

Supplemental Material S6. Social validity follow-up survey.

Supplemental Material S7. Supplemental effect sizes for timed-event sampled key EMT strategy data.

Supplemental Material S8. Supplemental effect sizes for EMT fidelity checklist data.

Supplemental Material S9. Supplemental effect sizes for number of different words child outcome data.

Supplemental Material S10. Toy sets provided to participants.

Bailey, K. M., Rodgers, M. E., Quinn, E. D., Thompson, S., Nietfeld, J., & Kaiser, A. P. (2024). Just-in-time: A caregiver-mediated intervention for toddlers with autism. American Journal of Speech-Language Pathology, 33(3), 1209–1225.


Funding sources, including the Agency for Healthcare Research and Quality Grant HS026370 (awarded to Emily D. Quinn), OSEP Doctoral Training Grants H325H190004 (awarded to Kathryn M. Bailey) and H325D180095 (awarded to Mary E. Rodgers), and a Vanderbilt University Hobbs COVID-19 Discovery grant (awarded to Ann P. Kaiser), supported this work.