Caregiver Training to Support Children With Social Communication Challenges

Changes from baseline in Child Communicative Participation at post-program and follow-up

The FOCUS-34 is a reliable and validated criterion-referenced measure of real-world changes in children's communicative participation in response to speech-language intervention. The FOCUS-34 includes 34 items based on the Activities and Participation components of the ICF. It includes 23 items focused on the child's capacity for communication and 11 items on the child's ability to engage independently, both of which parents rate on a 7-point Likert scale. The total score on the FOCUS-34 ranges from 34-238 points, although the primary clinical outcome is the pre-post-program change scores. A change score of 11 points or more is considered a meaningful clinical change, 7-10 is possibly a meaningful clinical change, and 6 or less is not likely a meaningful clinical change. The FOCUS-34 is used in the Ontario PSL as a provincial outcome monitoring tool and thus is part of the existing standard of care for participants in this study.

Changes from baseline in global social communication challenges at post-program and follow-up

The Clinical Global Impression (CGI) is a tool designed to quickly and sensitively monitor patient progress within clinical trials and has been adopted for the purpose of evaluating social communication behaviors following delivery of brief clinical interventions. The CGI-Severity will be coded at each timepoint in response to the prompt, "How impacted is the participant by social communication challenges at this time?" using a 7-point severity scale (1-normal, 2-borderline, and 3-mildly, 4-moderately, 5-markedly, 6-severely, 7-extremely impacted). Post-program, CGS-Improvement will be coded to assess changes in social communication challenges relative to pre-program on a 7-point scale (1-very much improved, 2-much improved, 3-minimally improved, 4-no change, 5-minimally worse, 6-much worse, 7-very much worse), with higher Improvement ratings meaning worse outcomes.

Changes from baseline in joint engagement at post-program and follow-up

The Joint Engagement Rating Inventory (JERI) is an observational measure designed to capture various features of joint engagement that occur between young children and their parents. The 2020 version of the JERI has 32 items, but as recommended in the manual, the investigators will use a subset of social engagement behaviors aligned with the specific research questions, namely, 11 items aligned with skills targeted by the MTW program. This includes five child behavioural outcomes (initiation of communication, responsiveness to partner's communication, expressive language level and use, quality of behaviour patterns, affect), four parent behavioural outcomes (affect, following in on the child's focus, symbol highlighting, scaffolding) and two dyadic interaction items (fluency and connectedness, routines and rituals). Each behavior item is scored on a 7-point rating scale (ranging from being 1-minimally to 7-highly present, with higher scores meaning better outcomes).

Changes from baseline in parent evaluation of self-efficacy and services at post-program and follow-up

The Parent Self-Efficacy and Services Evaluation survey incorporates two self-efficacy questions from the Early Intervention Parenting Self-Efficacy Scale: (a) "I feel confident that I can help my child to communicate their thoughts and ideas" and (b) "I feel confident that I can help my child develop their play skills". Each question will be rated on a 7-point Likert scale (from 1-strongly agree to 7-strongly disagree, with higher scores meaning a worse outcome). The remaining questions ask parents to report on and evaluate the perceived effectiveness of any services or developmental supported received over the last 3 months (including the MTW program after they receive it).