Michelle Catao (presenting author)
Duquesne University, United States
Michelle Catao is a sophomore at Duquesne University. She is majoring in Speech-Language Pathology and minoring in Spanish and Public Health.

Financial Disclosure(s): No, I do not have financial relationships relevant to the content of the session.
Nonfinancial Disclosure(s): No, I do not have nonfinancial relationships relevant to the content of the session.

Kelsey O'Connor (presenting author)
Duquesne University, United States
Kelsey O'Connor is a third year student at Duquesne University studying speech language pathology with a minor in special education. She is also an active member of Best Buddies International.

Financial Disclosure(s): No, I do not have financial relationships relevant to the content of the session.
Nonfinancial Disclosure(s): No, I do not have nonfinancial relationships relevant to the content of the session.

Marisa Ricciardi (presenting author)
Duquesne University, United States
Marisa Ricciardi is a senior at Duquesne University majoring in Speech-Language Pathology. She is currently serving as the Vice President of DU's NSSLHA chapter.

Financial Disclosure(s): No, I do not have financial relationships relevant to the content of the session.
Nonfinancial Disclosure(s): No, I do not have nonfinancial relationships relevant to the content of the session.

Lori Marra (presenting author)
Duquesne University, United States
Lori Marra, MA, CCC-SLP is a Clinical Assistant Professor in the Department of Speech-Language Pathology at Duquesne. She has worked in both inpatient and outpatient facilities treating adults with neurological impairments and children with speech and language impairments for over 30 years. At Duquesne, she supervises graduate students in the evaluation and treatment of children and young adults with language disorders. She teaches Language Development to undergraduate students.

Financial Disclosure(s): Yes, Salaried, full or part time employee

• Employed as a full-time faculty member at Duquesne University since 2006.

Nonfinancial Disclosure(s): No, I do not have nonfinancial relationships relevant to the content of the session.

Abigail Delehanty (presenting author)
Duquesne University, United States
Abigail Delehanty, Ph.D., CCC-SLP is an Assistant Professor in the Department of Speech-Language Pathology at Duquesne University. She has extensive clinical experience serving preschoolers, school-age children, and adolescents with communication disorders and autism in school settings. Her research interests include studying and promoting social communication development in young children, lowering the age of early detection of communication delays and autism, and expanding the role of technology to engage families and enhance screening, assessment, and intervention.

Financial Disclosure(s): Yes, Salaried, full or part time employee, Grant Funds

• Abigail Delehanty is a full time employee of Duquesne University. She has received grant funds from NIDCD to support her work.

Nonfinancial Disclosure(s): No, I do not have nonfinancial relationships relevant to the content of the session.

Thank you for stopping by to learn more about our study entitled "Student Family Navigators Promoting Social Communication Outcomes for Infants and Toddlers from Lower-Income Families". We would like to begin with our disclosures. This project was supported by the Charles Henry Leach II Fund for Duquesne University and we were selected to participate in ASHA's 2022 Progeny program, which seeks to promote the next generation of researchers. Michelle Catao, Kelsey O'Connor, and Marissa Ricciardi, are students at Duquesne University and have no additional disclosures. Abigail Delehanty and Lori Marra are employed by Duquesne University. This study was approved by the Institutional Review Board at Duquesne University.

Some background to our study. Early social communication and language skills are strong predictors of school readiness and later school success. However, a great deal of research has documented gaps in language skills at school entry between children from lower and higher income families. When children begin school with low or below average language skills, it becomes more difficult to change their developmental trajectories.

A recent study by List and colleagues found that parents beliefs about their ability to influence a child's development differ by socioeconomic status. With lower income families less inclined to believe that parenting makes a difference for promoting child development. However, when families from lower income backgrounds participated in a randomized controlled trial of home visiting program that focused on infant development and offered parenting tips, results indicated that participation in this study was related to significant changes in parents beliefs, improved parent-child interactions, and stronger child vocabulary, math, and social-emotional skills. From this study, it seems that increasing parents knowledge about early development and responsive parenting, may be one strategy that can make a big difference for child outcomes.

A second consideration for promoting positive outcomes in children from lower-income families is the need for earlier identification of developmental delays that may warrant early intervention. Rates of universal screening in primary care for very young children are rising. But screening alone may not be sufficient for catching children who need early intervention. Following a positive screen, many families do not receive a diagnostic evaluation even if their provider makes a referral. Including developmental screening and monitoring as complimentary strategies has been shown to improve linkage from screening to receipt of early intervention services.

Finally, a third strategy is the coordination of care across providers and services through family navigation, a promising approach for lowering the ages of identification of autism and promoting access to care for children from lower-income families. It is possible that family navigators could support children at risk for language delays as well.

The purpose of this session is to describe the feasibility of a fully mobile brief engagement prevention intervention for nine lower-income families of infants and toddlers to promote social communication and language development.

Our feasibility study captured information about satisfaction, acceptability, and preliminary responses to the intervention. The study was guided by five objectives. One, to evaluate recruitment capability and our resulting sample, two, evaluate and refine our data collection procedures and outcome measures. Three, evaluate the acceptability and suitability of our study procedures four, evaluate resources to implement the study and intervention. And five, evaluate preliminary participant responses to intervention.

This study is grounded in the transactional theory of language development that emphasizes the importance of ongoing social interactions with communication partners and everyday contexts and a measurement paradigm that is based on constructs of family-centered individualized intervention.

So for our methods, the program included three components that have been found to support positive outcomes. We provided one, social communication and language screenings two, seven individualized education sessions via mobile technology to monitor development and share evidence-based resources in early child development and responsive parenting using a modified FGRBI framework. And three, family navigation to early intervention services as needed. We collected all data online via surveys and teleconferencing.

Three Duquesne University students studying Speech Language Pathology, the authors of this poster presentation, served as family navigators. In this study, we were trained and responsible content, responsible conduct of research (the CITI online courses) social communication and language development in infants and toddlers, 9-24 months of age (SC-DIT online courses offered by Autism Navigator) and family-centered practices for early intervention. Family guided routines based intervention or FGRBI online materials were adapted and used as a framework for our sessions. Here are some examples of materials that we shared with families during our sessions. We used evidence-based resources from organizations like baby navigator, Vroom and Zero to Three. Finally, we were trained on developmental screening processes. We learned about three different parent report questionnaires. The Communication and Symbolic Behavior Scales Caregiver Questionnaire, the Infant Toddler Checklist, and the MacArthur-Bates Communicative Development Inventories. We use the Piccolo (Parenting Interactions with Children Checklist of Observations) Linked to Outcomes to observe parent-child interactions. Parent measures included demographics, satisfaction/accessibility, and attendance. Data on implementation fidelity was collected for each session using a modified FGRBI key indicators manual.

Next in the lower left of our poster, the families who participated. So we recruited nine families through community partnerships in early childhood education and healthcare. Participants varied in age at birth, and race, ethnicity, although six identified as white. Mothers have completed at least some college and seven were employed at the time of the study. Four reported reported speaking more than one language at home. Infants and toddlers are 8-17 months at the study entry, and were mostly boys. Almost all were born prior to their due date, but this ranged from three days early to five weeks premature. Five were attending child care during the study. Mothers reported concerns about language development in three of the nine children and one mother reported concerns about motor development.

For our results, all student family navigators passed the required CITI online courses. We also successfully completed all 15 social communication development in infants and toddlers self-guided lessons across five developmental domains, including language, play, social interaction, emotional regulation, and self-directed learning, and achieved 80% or higher on each ten question learning assessment. As of now, 31 videos (54% of all sessions) have been reviewed by an undergraduate student who is not affiliated with this study. So far, this data resulted in a 96.66% intervention fidelity. Updated values will be presented during the in-person poster presentation at the ASHA Convention.

For family and attendance, seven families completed the program and two left this study after completing two sessions. Family feedback to our surveys was primarily positive. Families felt like we maintained contact with them, presented material in different ways, offered opportunities to ask questions and provided additional referrals and resources. Families also mentioned that the resources helped to increase their confidence about communication and language and it was worth their time and effort. They also recommended this project to others who want to learn more about their child's development.

For student perceptions, we thought that the program helped us to connect with families, other students, faculty, and learn more about the Speech Language Pathology field. Our feedback also showed that we gained confidence while talking with parents as the sessions went on. Some things that went well included having an outline for each session that could be personalized, sessions on Zoom that allowed us to be respectful of families time and preparation and support by supervisors. Some students challenges included time-management, balancing graduate school with research and students also express that practice sessions may have been helpful during the study to better prepare. Another challenge was varying levels of parent participation with their overall engagement and responses to e-mail, parents expressed concerns or ask questions that students had to defer to faculty supervisors. Additionally, some children had already achieved the milestones we shared.

Our takeaways are that this was a rewarding learning experience beneficial to both students and families. This was a great way to get to know families, watch their child grow and give resources to support them all over the computer. This experience taught researchers about analyzing social communication and young children.

Preliminary responses to the program baseline indicated that eight of nine children scored within the average range on parent reported measures of communication and language development confirmed through interview and observation of parent-child interaction. For outcome, of the six families who completed the study, four, maintain typical social communication and language development. We supported two families through the process of pursuing additional evaluation and subsequent receipt of early intervention services.

For our takeaways, results of this feasibility studies suggests that the mobile technology platform was feasible and the screenings and resources we provided were perceived as acceptable and useful for our families. Throughout, parents shared that they felt isolated during the COVID-19 pandemic, concerned about their child's development and relieved to access the online support and resources we shared. Results also suggests that using student family navigators to deliver the prevention intervention program offers a creative solution to expanding the workforce needed to improve available services, promote education, and adjust health disparities.

Reflecting on our study as it relates to the theme of the 2022 ASHA Convention "Reframe your thinking: Resilience reinvented" ongoing income related disparities in language development and COVID-19 encouraged us to reframe our thinking and develop a new way to support the resilience of at-risk infants and toddlers and their families in our community.

Ultimately, we hope to make a significant contribution to reducing income related disparities in children's language development so that they increasingly benefit from the curriculum when they begin school.

Thank you again for listening and we appreciate your time!

About
Children from lower-income families often start school without robust communication and language skills. This session describes the feasibility of a fully mobile, brief-engagement prevention intervention for 9 lower-income families of infants and toddlers to promote social communication and language development. Three students studying speech-language pathology were trained in early social communication development, developmental screening processes, and family-centered practice. The program included three components that have been found to support positive outcomes: 1) frequent social communication and language screenings, 2) monthly, individualized education sessions to monitor development and share evidence-based resources in early child development and responsive parenting, and 3) family navigation to early intervention as needed. Preliminary results suggest that families found the program accessible and the information valuable.

Learning Outcome(s):

• Describe income-related disparities in child language development
• Identify three potential strategies for promoting social communication and language development for infants and toddlers from lower-income families
• Evaluate the feasibility of utilizing mobile technology and student family navigators to support the early social communication and language development for infants and toddlers from lower-income families

Instructional Level: Intermediate
Session Focus: Research

References

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2. Fernald, A., Marchman, V. A., & Weisleder, A. (2013). SES differences in language processing skill and vocabulary are evident at 18 months. Developmental Science, 16(2), 234-248.
3. Ginsborg, J. (2006). The effects of socio-economic status on children’s language acquisition and use. Language and social disadvantage: Theory into practice, 9-27.
4. Pace, A., Luo, R., Hirsh-Pasek, K., & Golinkoff, R. M. (2017). Identifying pathways between socioeconomic status and language development. Annual Review of Linguistics, 3, 285-308.
5. List, J. A., Pernaudet, J., & Suskind, D. L. (2021). Shifting parental beliefs about child development to foster parental investments and improve school readiness outcomes. Nature communications, 12(1), 1-10.
6. Barger, B., Rice, C., Wolf, R., & Roach, A. (2018). Better together: Developmental screening and monitoring best identify children who need early intervention. Disability and health journal, 11(3), 420-426.

7. Feinberg, E., Abufhele, M., Sandler, J., Augustyn, M., Cabral, H., Chen, N., ... & Silverstein, M. (2016). Reducing disparities in timely autism diagnosis through family navigation: results from a randomized pilot trial. Psychiatric Services, 67(8), 912-915.

8. Feinberg, E., Augustyn, M., Broder-Fingert, S., Bennett, A., Weitzman, C., Kuhn, J., ... & Blum, N. J. (2021). Effect of family navigation on diagnostic ascertainment among children at risk for autism: A randomized clinical trial from DBPNet. JAMA pediatrics, 175(3), 243-250.

9. Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of child and family studies, 19(5), 629-645.

10. Fey, M. E., & Finestack, L. H. (2009) Research and development in child language intervention: A five-phase model. In Schwartz, R. G. (Ed.), Handbook of child language disorders (pp. 513–529). New York: Psychology Press.

11. Orsmond, G. I., & Cohn, E. S. (2015). The distinctive features of a feasibility study: objectives and guiding questions. OTJR: occupation, participation and health, 35(3), 169-177.

12. Eshel, N., Daelmans, B., Mello, M. C. D., & Martines, J. (2006). Responsive parenting: interventions and outcomes. Bulletin of the World Health Organization, 84, 991-998.

Additional References

Fenson, L. (2007). MacArthur-Bates communicative development inventories. Baltimore, MD: Paul H. Brookes Publishing Company.

Roggman, L. A., Cook, G. A., Innocenti, M. S., Jump Norman, V., & Christiansen, K. (2013). Parenting interactions with children: Checklist of observations linked to outcomes (PICCOLO) in diverse ethnic groups. Infant Mental Health Journal, 34(4), 290-306.

Wetherby et al. (2020). Social Communication Development in Infants and Toddlers (SC-DIT). Autism Navigator. https://autismnavigator.learnercommunity.com/SCDIT-Resources 

Wetherby, A. M., & Prizant, B. M. (2002). Communication and symbolic behavior scales: Developmental profile. Paul H Brookes Publishing Co.

Woods et al., (2022). Family Guided Routines Based Intervention (FGRBI). http://www.fgrbi.com

Vroom (2022). https://vroom.org

Zero-to-three (2022). https://zerotothree.org

Image credits:

Cerquiera Thiago, Unsplash.com

Markus Spiske, Unsplash.com