Caregiver-Implemented Hanen Programs^®: A Narrative Review

Hanen programs^® have been used by clinicians to support caregivers of young children with communication needs to learn optimal ways to respond in everyday interactions and facilitate child-oriented strategies that promote interaction and language. This review aimed to evaluate peer-reviewed literature regarding Hanen programs^® for children with speech, language, and communication needs regarding the credibility, nature, quality, scope of the research, and outcomes of the research findings.

The Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol was used. Of 196 papers documenting Hanen interventions, 57 papers met inclusion criteria. Studies were synthesized and evaluated to rate (a) credibility/levels of evidence; (b) nature of existing research: efficacy, effectiveness, and perceived effectiveness; (c) quality of the studies; (d) scope of evidence; and (e) outcomes for each Hanen program^® for children with speech, language, and communication needs.

Credibility: Studies of Hanen programs^® were reviews (7%), randomized controlled trials (17.5%), nonrandomized controlled trials and mixed methods (31.6%), case-control or cohort studies (26.3%), qualitative reviews (1.8%), or employed qualitative methods (15.7%). Nature: The majority were efficacy studies (57.9%), others were perceived effectiveness (24.6%), and others were effectiveness studies (8.8%). Quality: Few studies were rated as high quality. Scope: Most studies related to two Hanen programs^® (It Takes Two to Talk^® and More Than Words^®) conducted across 11 countries (Canada, the United States, Spain, Turkey, Republic of Ireland, the Netherlands, the United Kingdom, Australia, Hong Kong, Singapore, and Malaysia), and a few studies evaluated adaptations of Hanen programs^® (e.g., telehealth). The studies reported on dyad interactions; child language, behavior, and autism; and caregiver perceptions, stress, and self-efficacy. Outcomes: Evidence supporting significant communication outcomes for different programs exists; however, mixed results demonstrate a variety of language, interaction, acceptability, feasibility, and maintenance outcomes.

A range of evidence supports the use of Hanen programs^® in its original format, with acceptability reported by families from target communities (e.g., middle-class families) and educators (e.g., Westernized countries). Effectiveness studies in real-world contexts conclude that future research could evaluate content flexibility and adaptations to meet a diversity of families and communities. A precision family initiative has been suggested to shift future research from "Does Hanen work?" to "How can Hanen-based intervention optimize outcomes for individual families?"