Adapting the JERI for PACE Coaching, a Community-Based Project for Children at Risk for Autism

• In Event: Placing Observations of Joint Engagement in Cultural Contexts

Abstract

The Parent and Child Early (PACE) Coaching Project was conducted in collaboration with Child Development Centres and Aboriginal service agencies across British Columbia, Canada, from 2017-2020. The project was aimed at parents of toddlers (age 15-36 months) at risk for autism spectrum disorder. One objective was to assess the impact of parent coaching on both child and parent/family outcomes by conducting a randomized controlled trial (RCT). In consultation with our partners, we also designed Parent-Child Connections (P-CC), a modified and highly individualized parent coaching intervention for Aboriginal families.

Sixty-four parents of children who screened positive for autism risk agreed to participate in an RCT that compared weekly parent coaching for up to 24 weeks (PC) to enhanced community services (assess and monitor, A&M). Of these, 49 families (24 PC and 25 A&M) completed the study; withdrawals were primarily due to a wide range of adverse family circumstances that hampered participation.

In order to include an ecologically-valid measure of change among our primary child and caregiver outcome variables, we adapted four tasks from the Communication Play Protocol (CPP; Adamson & Bakeman, 2016) and seven ratings from the Joint Engagement Rating Inventory (JERI; Adamson, Bakeman, & Suma, 2018; Adamson, Bakeman, Suma, & Robins, 2019).

The PACE project was unique in many ways. First, we applied very few exclusion criteria for parent eligibility. This resulted in a diverse sample of families with respect to socio-economic status; in fact, many families experienced multiple stressors in addition to having a child at risk of autism. Moreover, per the intent-to-treat approach, we did not dismiss any family from the study for any reason.

Second, we trained graduate-level clinicians in our partner agencies with limited research experience to collect the parent-child interaction videos that would later be coded by the research team using the JERI system. They learned to apply the protocol with fidelity while also allowing for flexibility (for example, respecting family preferences by going to their homes instead of requiring that they come to the clinic). Procedures were even more flexible for P-CC families with regard to play partners and toys.

For the combined PC and A&M groups, we found that parent change in behaviours that are known to support social-communication development (scaffolding and following in) predicted child change in joint engagement and in the fluency and connectedness of parent-child interactions. Overall, we deemed the JERI ratings to be sufficiently adaptable to be applied to i) children with varied developmental profiles, ii) parents from diverse SES backgrounds and with individual interactional styles, and iii) dyads who engaged in unique ways.
Only four of the ten families who agreed to participate in P-CC completed the study. Although the data from Aboriginal families are limited, the JERI shows promise to be further adapted with this population. This might include working more closely with someone from the same community as the families during the coding in order to maximally capture how caregivers foster engagement with their children.

Authors

• Paola Colozzo, University of British Columbia (UBC)
  Presenting Author

• Pat Mirenda, University of British Columbia (UBC)
  Non-Presenting Author

• Veronica Smith, University of Alberta
  Non-Presenting Author

• Karen Kalynchuk, University of British Columbia
  Non-Presenting Author