Enhanced Milieu Teaching

Enhanced Milieu Teaching

Alejandra Hernandez

Elisa Palomo

Ambar Castro

Desirae Medrano

Andrea Oseguera

SPED 431 FALL 2020

Introduction

Who is EMT for?

• Children with autism
• Children with down syndrome
• Children with a repaired cleft

( Kaiser, Hampton, Fuller. 2016, slides.25-47)

• Children with a language delay
• Children with intellectual disabilities
• Children at-risk due to poverty

(Kaiser. n.p, slide 19)

What is the intervention?

Enhanced milieu teaching a systematic, instructional practice defined as, “a naturalistic, conversation-based intervention that uses child interests, and initiations as opportunities to model and prompt language in everyday context.” ( Kaiser, Hampton, Fuller. 2016, slide 7)

This intervention can be used in the child's natural environment, throughout daily interactions, and to help children generalize language skills.

In the past years, EMT has been practiced by several groups of research, and has provided many examples with different participants. According to an intervention report by Works Clearinghouse, the only approved study was by Kaiser, Hendrickson, and Albert.

(US Department of Education, 2012. p.2)

What are the benefits of using it?

Some of the benefits include:

• Increased child use of language targets.
• Increased child frequency of communication.
• Generalization of the

child's natural

environment.

• Maintenance of newly

learned targets.

• Helps facilitate communication growth.
• More effective than drill-practice methods.

( Kaiser, Hampton, Fuller. 2016, slide 8)

Enhanced Milieu main components

Three main components that make Enhanced Milieu Teaching possible are environmental arrangement, responsive interaction and prompting strategies (Hancock, & Nietfeld,2000).

Truck!

Yes, blue truck!

Responsive interaction: We follow the child's lead, we respond to children's verbal and nonverbal actions, and we expand their communicative acts.

Environmental arrangement: We use the child's environment to help create communication opportunities. We do so by minimizing access to preferred toys, modifying a play routine or limiting a specific material that is essential for a given activity. (Grisham, 2017, p.147)

We use Enhanced Milieu prompting strategies such as modeling, mand-modeling, naturalistic time delay and incidental teaching. All while considering developmental levels when using any of the strategy procedures.

Say, "Give apple."

"Give, apple."

Modeling

Modeling: Used to promote verbal responses and teach new communication skills .

• We wait for the child to interact with an object or in play.
• We prompt the child to imitate new words or label objects.
• We might use “say” then the desired word. As the child imitates, we can expand describe his actions or needs more elaborately.

(Grisham, 2017, Table 7.2, p.146)

Mand Modeling

Mand modeling: Used to teach new forms of communication. Essentially giving the child the language skills to better communicate with peers or adults.

• We use wh questions to help prompt a response.
• We give an instruction to encourage communication.
• We may also ask wh questions that relate to label objects to help guide a child's response.

“What do you want?" (While holding item in hand)

• If there is no response, we then model the expected response.
• Dont forget to reinforce if it witholding access.

(Grisham, 2017, Table 7.2, p.p147-148)

Naturalistic Time Delay

Naturalistic time delay: Used to encourage spontaneous use of a learned language skill, or when teaching the child to make a request.

(Noonan & McCormick, 2014)

• We may withhold objects to promote a communication request, and wait 5 seconds. “What do you want?”
• We wait expectantly for a short period.
• If no response, model the expectant response.
• Reinforce the child with the desired item.

(Grisham, 2017, Table 7.2, p.148)

Incidental teaching

Incidental Teaching:Used to help extend the child's communicative skills by making language attempts.

(Grisham, 2017, Table 7.2, p.148)

• We use a mix of model, mand model, and naturalistic time delay.
• We challenge the response using any of the three prompting procedures for extension.
• We make sure to avoid frustration and provide items immediately after desired response.

(Grisham, 2017,p.148)

• Child is eating cereal, and it finished
• Teacher: what do you want? <--- Mand model
• Child: Looks to the side showing bowl but with no emphasis on bowl.
• Teacher: “Say, cereal” <-- Model
• Child: "Cereal”
• Teacher: “More cereal” <-- Expansion
• Teacher: Gives her more cereal

Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children's expressive language skills

Participants:

• Four child-caregiver pairs
• Children have to meet a specific set of criteria
• Children had to be between 24-42 months of age
• Recruited through emails to the university staff and community

Method

• Total of five interventionists
• Used Teach-Model-Coach-Review as an instructional approach
• Baseline session and 24 individualized sessions
• Took place in a clinic room with age-appropriate materials and toys

Results

• Led to changes in the use of EMT strategies
• The caregiver generalized EMT strategies to play at home with the child
• Resulted in a positive change in the child’s use of communication targets
• Showed “substantial gains in standardized measures of receptive and expressive skills” (pg. 1866).

Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., &amp; Spidalieri, A. M. (2014). Effects of the Teach-Model-Coach-Review Instructional Approach on Caregiver Use of Language Support Strategies and Children's Expressive Language Skills. Journal of Speech, Language, and Hearing Research, 57, 1851-1869.

Parent-Implemented Enhanced Milieu Teaching with Preschool Children with Intellectual Disabilities

Participants:

• 77 children were chosen, at random to participate in one of the two treatments.

• The children were assessed before, after, 6 months after and 12 months after the intervention.

• Majority of the children received regular community-based

speech-language therapy.

Methods

• This study was made up of two different groups.

Parent + Therapist:

• Identical to first intervention, only difference is the added parent training.
• One therapist intervened with the child, and the other with the parent.

Therapist only EMT:

• Children received 36 intervention sessions

- Each session lasted 20 minutes (10 minutes with each therapist).

- Parents were not present during these sessions.

• During the sessions, therapists implemented EMT in the child's home during 4 routines:

- Play for 10 minutes

- Clean up

- Snack for 5 minutes

- Book for 5 minutes

Results

• Suggest that there are numerous benefits from training parents with EMT strategies.

• "The effects of parent-implemented EMT were evident in children’s use of targets, length of utterances, and NDW in play activities at home in which parents received training at both 6 and 12 months following intervention." (Kaiser, Roberts 2013)

Research autism to improve the quality of life

The main purpose for this website is to provide a general overview on

autism.

The key focus is to give information on the important features of EMT/MT as an intervention for children with autism.

• Characteristics of teaching EMT/MT.
• Teaching Procedures.
• Specific Forms of Milieu Teaching

(MT) Pre-linguistic vs. (EMT) Enhancing responses

• Cost & Time
• Risk & Safety
• History Overview of EMT/MT (Researchers & Year)
• Current research (EMT/MT is identified as the main intervention)
• Ongoing research by Vanderbilt University.

Future Research in EMT (Existing research & recommendations for future research)

• Related Studies & Trials (Links to journal articles)

http://www.researchautism.net/interventions/91/milieu-teaching-and-autism/keyfeatures

vanderbilt kidtalk

The main purpose of the website is to provide research information that emphasizes on language growth in young children with disabilities using EMT/MT intervention.

The key focus is to provide information on program "KidTalk" as an EMT/MT intervention in minimally verbal preschool children.

Resources

• Research- journal articles
• Teachers- supporting classroom material
• Professionals-Manuals, Play Protocol, Intervention Fidelity Worksheets & Checklist,etc..
• Graduate Students- Thesis presentations
• Parent Resources- handouts for language level target.
• Links We Love- Informational websites

Current Projects

• "KidTalk For Preschoolers With Language Delay"

Completed Projects

• KidTalk For Toddlers With Autism
• KidTalk For Preschoolers With Autism
• Kidtalk for Preschoolers With Down Syndrome

Parent Information

• Teaching Communication (Instructional Strategies)
• Everyday Talk: Watch Lennox's Story (video)
• What Parents Say (Parent Testimony)

https://kidtalk.vkcsites.org/

Institute of Education Science-What works Clearing House(WWC)

The main purpose of the website is to review existing research on different programs, products, practices, and policies in education.

The key focus is to provide educators a trusted database with the information they need to make evidence-based decisions on EMT/MT intervention programs that work.

• Intervention Reports (Eligible intervention programs)

-Summaries of EMT/MT (Reviewed programs included details)

-Snapshots of EMT/MT (1- page Quick View)

• Practice guides (Research & Practices)
• Summary of key findings.
• Instructional tips (Implement recommendations)
• Summary of the instructional tips.
• Reviews of individuals studies (Intervention key criteria & WWC standards)
• Resources for researcher (Handbooks with standards & Procedures).
• Related Interventions & Studies

https://ies.ed.gov/ncee/wwc/FWW