Reflections on TalkAbility: The Hanen program for verbal children on the Autism Spectrum
Parent training. In the early-intervention world, this word gets tossed around on a regular basis. As clinicians we are all taught that involving family in therapy is key to outcomes, both for children and for parents. Yet how many times do we really arrive at the place of empowering parents to make significant changes in the lives of their children outside of the therapy setting? How often do parents leave therapy sessions feeling like an observer instead of an active participant?
The truth is, parent training is hard work, both for parents and clinicians. Clinicians must be comfortable taking on the roles of teacher and coach, which require a different set of skills than being the therapist. Likewise, parents have to develop direct therapy skills, as well as the confidence to use them. Breaking out of the mindset that puts the clinician in a position of power and moving parents into that position isn't as simple as it might seem either. The challenges faced by parent training beg the question: Is it really worth it?
While your immediate reaction to this question might be something like "yes, of course, parent training is worth it. The research all indicates the importance of involving parents in therapy" or something of the like, I have found that many of us, parents and clinicians alike, don't have a personal connection to parent training that gives us a "hook" on which to hang those research findings. When we are in this position, I find we often pay lip service to parent training, rushing to teach parents a few strategies, showing parents a few videos and then quickly moving on to the more traditional, comfortable, clinician-directed therapy. And while clinician-directed therapy certainly has a place, I was reminded recently of just how powerful parent training can be. I hope my story inspires you to commit to parent training as a mindset, whether you are a parent or a clinician.
This fall, I had the privilege of teaching TalkAbility, the Hanen program for verbal children on the Autism Spectrum. For anyone who is unfamiliar, the Hanen Centre is a not-for-profit organization based in Toronto, ON, Canada. Their mission "is to provide parents, caregivers, early childhood educators and speech-language pathologists with the knowledge and training they need to help young children develop the best possible language, social and literacy skills." (www.hanen.org). They achieve this mission by developing research-based and supported programs which focus on empowering parents to play an active role in their children's language, social communication and literacy development. In general, programs consist of parent-only sessions, in which a Speech-Language Pathologist teaches parents strategies to use with their children and then parents make and practice plans for implementing these strategies. In addition, programs include video feedback sessions in which parents are recorded using their plans. The Speech-Language Pathologist then coaches parents to help them identify their areas of strength and weakness as well as the next steps for therapy. TalkAbility, the program I taught, focuses verbal social communication skills such as beginning, continuing and ending a conversation, theory of mind development (called "Tuning in" in the program), pretend play and play with peers.
Prior to teaching TalkAbility, I had participated in various parent training models. Most were adaptations of one or another of Hanen's programs, and all were approximately 6 weeks in length. I would have said that these programs were all moderately successful, but that I consistently walked away feeling as though things were left unfinished. Fast forward to TalkAbility, which was run as a full 12 week program. Nothing in my previous experience could have prepared me for the difference between my two experiences.
In 12 weeks, I watched parents who didn't know how to engage their child in play or conversation not only start to play and talk with their child, but do so with confidence, knowing they had the skills to adjust and modify as necessary. Parents who felt like they were constantly getting stuck with their child, not sure how to continue a conversation were able to identify and use specific strategies to gently guide their child back into conversation. Children who had never pretended in their lives started to offer creative ideas in made up play with their parents. Children who previously didn't know how to separate their own thoughts from those of others began to recognize that others thought and wanted different things than they did.
I could go on all day about the clinical growth we saw in 12 weeks. To say it was remarkable and life-changing would be an understatement. But some other things happened in 12 weeks that were not quite so predictable. Parents started talking. A LOT! By the last evening session it was all I could do to cover the curriculum material, these parents had so much to say to each other! Problem-solving, resource-sharing, play-group starting, you name it, these parents were keen to talk about it. Although the parents in my previous groups had been friendly and interactive, they were not comparable to the comrades I saw in this longer group. And as these parents started talking, we learned something. While I was able to offer them ideas, strategies and support, they were able to really fit them into their lives in a way no one outside of their family could ever plan or build. Without me needing to guide their every step.
As a therapist, this transition was a little unnerving. Had I really just equipped these families with skills to the point where they didn't need me anymore? What does that even mean? And just as these thoughts were starting to bubble up in my mind, I realized this was really what parent training was about. Achieving a place where we can let parents go and run with their kids, with the confidence and knowledge that they are truly able to move forward independent of a therapist. Maybe they will need more guidance in the future, maybe even direct therapy for specific skills, but these families knew they had something that they could be actively doing to improve their child's communication on their own.
To close this post, again, I hope you are encouraged by my experience. Encouraged as parents to persist, to take on active roles in your child's therapy, in whatever capacity you can. To see yourselves as vital elements to your child's success. Encouraged as clinicians to truly commit to parent-training and to seeing it through. To finding your own personal story to hang the research on.
For more information about the Hanen Centre or TalkAbility, please visit www.hanen.org.