Caregiver-Mediated Enhanced Milieu Teaching with Shared Book Reading Using Telepractice-Based Coaching

Caregiver coaching is an established practice for training caregivers to implement interventions for young autistic children. Enhanced milieu teaching (EMT) and shared book reading are naturalistic interventions used to teach language to young autistic children. Telepractice as a training and coaching method provides an increased level of flexibility to caregivers and coaches in providing interventions. Using a non-concurrent multiple baseline design across caregivers, this study taught four caregiver-child dyads to implement an intervention package consisting of EMT with shared book reading. Caregivers were trained using a telepractice model using behavior skills training. Coaching was provided to the participating caregivers throughout the intervention until they reached mastery criteria. Due to attrition, only two caregivers reached final mastery criteria for intervention implementation. Target outcomes included caregiver fidelity of implementation and child unprompted target word use. Results indicated that training and coaching resulted in increases in caregivers' implementation fidelity, with evidence of generalization. Mixed results for child target word use were observed, with a greater effect observed on target word use during reading than during play. Findings indicate that while caregivers can be taught to improve their use of naturalistic strategies, the synchronous coaching model may need modifications for feasibility.