Project ImPACT (Improving Parents as Communication Teachers)

Parents of young children with autism spectrum disorder (ASD) and related social communication delays and the children themselves

For children/adolescents ages: 3 - 8

For parents/caregivers of children ages: 3 - 8

Project ImPACT (Improving Parents As Communication Teachers) is a parent-mediated intervention for young children with autism spectrum disorder (ASD) and related social communication delays. Parent-mediated means that a Project ImPACT coach teaches the parent techniques to be used with their child. The Project ImPACT coach uses systematic instruction to increase the parent's responsiveness to the child's behavior and teaches the parent how to use prompting and reinforcement to teach the child to use new communication, imitation, and play skills within child-led interactions. It is a naturalistic developmental behavioral intervention (NDBI). An NDBI is a newer class of intervention that has been informed by the fields of developmental and communication sciences and applied behavior analysis (ABA). Project ImPACT can be implemented in an individual or group coaching model and can be adapted for telehealth.

Brooke Ingersoll, PhD

• Agency/Affiliation: Michigan State University
• Website: https://www.project-impact.org/
• Email: ingers19@msu.edu
• Phone: (517) 930-2275

Anna Dvortcsak, MS CCC-SLP

• Agency/Affiliation: DSLSI
• Website: https://dslsi.com/project-impact-workshops
• Email: anna@dslsi.com
• Phone: (503) 887-1130

The goals of Project ImPACT (Improving Parents As Communication Teachers) are:

For parents:

• Increase responsiveness to their child.
• Increase use of prompting and reinforcement during daily routines with their child.
• Increase feelings of empowerment and engagement in the treatment process.

For children:

• Improve social communication skills
• Improve social engagement
• Improve communication (receptive and expressive language)
• Improve imitation
• Improve play skills

The essential components of Project ImPACT (Improving Parents As Communication Teachers) include:

• Coach works with the parent to develop social communication goals using a defined collaborative goal setting process:
• Parent- and provider-completed social communication skills checklist
• Observation of a parent-child interaction
• Observation of a coach-child interaction
• The coach then teaches the parent one to two techniques per session which include:
• Setting up the home for success
• Following the child's lead
• Imitating the child
• Adjusting their communication
• Modeling and expanding communication
• Playful obstruction
• Balanced turns
• Communicative temptations
• Prompting and reinforcement – applied to teaching communication (expressive and receptive), imitation, and play
• Shaping the interaction
• The coach uses adult learning strategies to coach the parent which include:
• Setting the agenda
• Reviewing the practice plan
• Introducing the technique
• Demonstrating the technique
• Giving parent feedback while they practice the technique
• Reflecting on the experience
• Setting up a plan to practice the technique

Child/Adolescent Services

Project ImPACT (Improving Parents as Communication Teachers) directly provides services to children and addresses the following:

• Diagnosed on the autism spectrum, possesses undeveloped communication skills, poor social engagement, poor imitation skills, poor play skills

Parent/Caregiver Services

Project ImPACT (Improving Parents as Communication Teachers) directly provides services to parents/caregivers and addresses the following:

• Caring for a child on the autism spectrum, with undeveloped communication skills, and/or poor social skills; experiencing parental/caregiver stress

Recommended Intensity

The program is designed to be implemented as an individual coaching model or a group coaching model. In the individual coaching model, the parent and child attend 60- to 90-minute coaching sessions twice a week though it can be adapted to once weekly. In the group coaching model, the parent attends either a 2-hour group session (parents only) or a 60-minute coaching session (parent and child) every other week.

Recommended Duration

The intervention is 3 months for either group or individual sessions.

Delivery Settings

This program is typically conducted in a(n):

• Birth Family Home
• Community-based Agency / Organization / Provider
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

The coach works with the parent to complete a practice plan at the end of every session which describes the child's goal that the parent will target, an activity for practice, and the techniques that the parent will use. Parents are asked to practice and record what went well and what was hard on the practice plan.

Languages

Project ImPACT (Improving Parents as Communication Teachers) has materials available in the following languages other than English:

• Chinese
• Dutch
• Korean
• Spanish
• Turkish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Coach and parent manuals. Age-appropriate play materials (if providing coaching outside the home or there is a lack of them in the home). For the group coaching model, a computer and projector to show slides and video examples.

Prerequisite/Minimum Provider Qualifications

Coaches ideally have a Master's level degree, but a Bachelor's level degree plus significant experience and training is acceptable. Coaches can come a variety of disciplinary backgrounds as long as they have a background in child development and behavior management and experience with young children with social communication delays. These backgrounds can include employment as special educators, early intervention providers, speech-language pathologists, psychologists, and behavioral specialists (e.g., BCBA).

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Ingersoll, B. & Dvortcsak, A. (2010). Teaching social-communication to children with autism: A practitioner's guide to parent training and a manual for parents (2 book set). Guilford Press.

Ingersoll, B. & Dvortcsak, A. (2019). Teaching social communication to children with autism and other developmental delays: The Project ImPACT guide to coaching parents and the Project ImPACT manual for parents (2 book set; 2nd ed.). Guilford Press.

They can be purchased from the publisher or on Amazon.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Open workshops (in person and virtual) are offered periodically throughout the year. In-person workshops are usually offered in Portland, OR, and East Lansing, MI, USA. Closed workshops can be provided on-site or virtually to community organizations based on trainer availability.

Number of days/hours:

Online Tutorial: Providers complete a 6-hour, interactive online tutorial that introduces the intervention techniques and parent coaching strategies.

Introductory Training: Providers complete the 6-hour, interactive online tutorial followed by a 14-hour, multiday workshop. Workshops can be delivered over 2 full-days or 4 half-days; and may be delivered in person or virtually.

Certification. After completing Introductory Training, providers receive 6 months of consultation while using the program with families (individual OR group consultation option). Individual consultation: Provider attends 6, 1-hour consultation meetings with an ImPACT Trainer via phone or videoconferencing. Group consultation: Groups of 3 to 5 providers participate in 1-hour group consultation meetings twice a month to assist them in their implementation of Project ImPACT.

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Project ImPACT (Improving Parents as Communication Teachers).

Formal Support for Implementation

Consultation is provided to individual providers or small groups of providers within the same organization to check and help them meet fidelity (see above under certification). Consultation with organizational leaders around implementation and scaling up the program across the organization is also provided. All consultation is provided via teleconferencing.

Fidelity Measures

Fidelity is assessed through trained observations based on video review of recorded sessions using a checklist. Fidelity measures for the intervention and coaching are available in the manual. More detailed scoring procedures are available upon request from the authors.

Established Psychometrics

There are no established psychometrics for Project ImPACT (Improving Parents as Communication Teachers).

Fidelity Measures Required

No fidelity measures are required for Project ImPACT (Improving Parents as Communication Teachers).

Implementation Guides or Manuals

The coach manual includes some details on implementation and an implementation planning form though it is not as detailed as a full implementation guide.

Implementation Cost

There are no studies of the costs of Project ImPACT (Improving Parents as Communication Teachers).

Research on How to Implement the Program

Haine-Schlagel, R., Rieth, S., Dickson, K. S., Brookman-Frazee, L., & Stahmer, A. (2020). Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder. Journal of Community Psychology, 48(4), 1215–1237. https://doi.org/10.1002/jcop.22347

Hao, Y., Franco, J. H., Sundarrajan, M., & Chen, Y. (2021). A pilot study comparing tele-therapy and in-person therapy: Perspectives from parent-mediated intervention for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 51(1), 129–143. https://doi.org/10.1007/s10803-020-04439-x

Ingersoll, B., & Dvortcsak, A (2006). Including parent training in the early childhood special education curriculum for children with autism spectrum disorders. Journal of Positive Behavior Interventions, 8(2), 79–87. https://doi.org/10.1177/10983007060080020601

Ingersoll, B., Straiton, D., Casagrande, K., & Pickard, K. (2018). Community providers' intentions to use a parent-mediated intervention for children with ASD following training: An application of the theory of planned behavior. BMC Research Notes, 11, Article 777. https://doi.org/10.1186/s13104-018-3879-3

Pickard, K. E., Kilgore, A., & Ingersoll, B. (2016). Using community partnerships to better understand the barriers to using an evidence-based, parent-mediated intervention for ASD in a Medicaid system. American Journal of Community Psychology, 57(3–4), 391–403. https://doi.org/10.1002/ajcp.12050

Pickard, K., Rowles, S., & Ingersoll, B. (2019). Understanding the impact of adaptations to a parent-mediated intervention on parents' ratings of perceived barriers, program attributes, and intent to use. Autism, 23(2), 338–349. https://doi.org/10.1177/1362361317744078

Pickard, K. E., Wainer, A. L., Bailey, K., & Ingersoll, B. (2016). A mixed-method evaluation of the feasibility and acceptability of a telehealth-based parent-mediated intervention for children with autism spectrum disorder. Autism, 20(7), 845–855. https://doi.org/10.1177/1362361315614496

Stahmer, A. C., Brookman-Frazee, L., Rieth, S. R., Stoner, J. T., Feder, J. D., Searcy, K., & Wang, T. (2017). Parent perceptions of an adapted evidence-based practice for toddlers with autism in a community setting. Autism, 21(2), 217–230. https://doi.org/10.1177/1362361316637580

Sengupta, K., Mahadik, S., & Kapoor, G. (2020). Glocalizing project ImPACT: Feasibility, acceptability and preliminary outcomes of a parent-mediated social communication intervention for autism adapted to the Indian context. Research in Autism Spectrum Disorders, 76, Article 101585. https://doi.org/10.1016/j.rasd.2020.101585

Wainer, A., Pickard, K. E., & Ingersoll, B. (2017). Using web-based instruction, brief workshops, and remote consultation to teach community-based providers a parent-mediated intervention. Journal of Child and Family Studies, 26, 1592–1602. https://doi.org/10.1007/s10826-017-0671-2

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• Note: The following study was not included in rating Project ImPACT (Improving Parents as Communication Teachers) on the Scientific Rating Scale.

  Ingersoll, B., & Wainer, A. (2013). Pilot study of a school-based parent training program for preschoolers with ASD. Autism, 17(4), 434–448. https://doi.org/10.1177/1362361311427155

  Type of Study: One-group pretest–posttest study

  Number of participants: 24 students and their parents

  Population:

  • Age — Children: Mean=44.9 months; Parents: Not specified
  • Race/Ethnicity — Children: 20 White, 2 Hispanic, and 2 Bi/multi-racial; Parents: Not specified
  • Gender — Children: 21 Male and 3 Female; Parents: 20 Female and 3 Male
  • Status — Participants were children receiving services under an autism spectrum disorder (ASD) eligibility or another eligibility if the teacher strongly suspected an ASD diagnosis.

  Location/Institution: Three intermediate school districts (ISDs) serving children with ASD

  Summary:

  The purpose of the study was to investigate the feasibility and preliminary effectiveness of a parenting training program [now called Project ImPACT]. Participants and their parents all received the parenting program. Measures utilized include the Social-Communication Checklist (SCC), the Social Responsiveness Scale (SRS), the ImPACT Fidelity Rating Scale, the Parenting Stress Index, 3rd Edition (PSI), the Behavioral Intervention Rating Scale (BIRS), and a parent-child interaction. Results indicate that from preintervention to postintervention parents improved their use of the treatment strategies and children increased their rate of language during a parent-child interaction in their home. Parents and teachers reported significant gains in child mastery of social-communication skills and teachers, but not parents, reported a significant decrease in social impairment. Parents reported a significant decrease in parenting stress. Both groups rated the intervention highly regarding treatment acceptability, perceived effectiveness, and usability. Limitations include lack of standardized measures of child functioning, lack of control group, lack of randomization, the children had an educational diagnosis of ASD, and several of the children were receiving services under another eligibility.

  Length of controlled postintervention follow-up: None.

• Stadnick, N. A., Stahmer, A., & Brookman-Frazee, L. (2015). Preliminary effectiveness of Project ImPACT: A parent-mediated intervention for children with autism spectrum disorder delivered in a community program. Journal of Autism and Developmental Disorders, 45(7), 2092–2104. https://doi.org/10.1007/s10803-015-2376-y

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Number of participants: 30 parent-child dyads

  Population:

  • Age — Children: 1.5–8 years (Mean=3.9–5.34 years); Parents: Mean=34.80–36.50 years
  • Race/Ethnicity — Children: 47% Multiracial, 30% Caucasian/White, 10% Hispanic/Latino, 7% Asian/Pacific Islander, 3% African American, and 3% Other; Parents: Not specified
  • Gender — Children: 79–81% Male; Parents: 97% Female
  • Status — Participants were children with a documented autism spectrum disorder (ASD) diagnosis or considered "at risk" for ASD.

  Location/Institution: A community-based service center that routinely serves children with ASD and their families

  Summary:

  The purpose of the study was to compare child and parent outcomes between the intervention group [now called Project ImPACT] and a community comparison for young children with ASD at baseline and 12 weeks. Participants were either in the intervention group or services as usual comparison group. Measures utilized include the Social Communication Questionnaire (SCQ), the Social Responsiveness Scale (SRS), the Modified Checklist for Autism in Toddlers (M-CHAT), the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), the Center for Epidemiological Studies-Depression Scale (CES-D), the Parenting Stress Index-Short Form (PSI-SF), an evaluation report documenting ASD diagnosis, and video-taped parent intervention adherence. Results indicate that there was significant improvement in child communication skills and a strong trend for parent intervention adherence for the intervention group from baseline to 12 weeks. Higher baseline parenting stress was negatively related to child social gains from baseline to 12 weeks. Limitations include lack of randomization, lack of generalizability due to gender, small sample size, and a reliance mostly on parent-report.

  Length of controlled postintervention follow-up: None.

• Note: The following study was not included in rating Project ImPACT (Improving Parents as Communication Teachers) on the Scientific Rating Scale.

  Barber, A. B., Swineford, L., Cook, C., & Belew, A. (2020). Effects of Project ImPACT parent-mediated intervention on the spoken language of young children with autism spectrum disorder. Perspectives of the ASHA Special Interest Groups, 5(3), 573–581. https://doi.org/10.1044/2020_PERSP-20-10005

  Type of Study: One-group pretest–posttest study

  Number of participants: 22 children and their caregivers

  Population:

  • Age — Children: 22–53 months (Mean=32.5 months); Parents: Not specified
  • Race/Ethnicity — Children: 52% White, 45% Black, and 0.04% Hispanic; Parents: Not specified
  • Gender — Children: 19 Male; Parents: Not specified
  • Status — Participants were children at risk for autism spectrum disorder (ASD) or with diagnosed ASD.

  Location/Institution: A university training clinic

  Summary:

  The purpose of the study was to measure spoken language and social communication in young children with autism spectrum disorder (ASD) following their participation in Project ImPACT. Expressive vocabulary and social communication were measured pretreatment and posttreatment. Measures utilized include the Social Communication Checklist (SCC) and the Communicative Development Inventories (CDI) Gestures and Words Form. Results indicate expressive vocabulary significantly increased at the group level as measured by parent report. Expressive vocabulary for half of the sample grew by more than 25%, indicating good response to Project ImPACT. However, when a categorical approach was applied using total number of words, all but one of the participants who was minimally verbal pretreatment remained minimally verbal after treatment. Clinicians reported significant increases on all dimensions of social communication as measured by the SCC with the exception of imitation. Caregiver responses on the SCC suggested significant growth in only form of language and play functions. Greater change in spoken language between pretreatment and posttreatment was significantly related to higher posttreatment average scores of language form, language function, understanding, imitation, and play dimensions, as reported by caregivers. Limitations include lack of control group, lack of follow-up, cognitive measures were not collected, and the parents and clinicians who were actively involved in the intervention also completed the SCC preintervention and postintervention, which introduces possible instrument bias.

  Length of controlled postintervention follow-up: None.

• Akhani, A., Dehghani, M., Gharraee, B., & Shooshtari, M. H. (2021). Parent training intervention for autism symptoms, functional emotional development, and parental stress in children with autism disorder: A randomized clinical trial. Asian Journal of Psychiatry, 62, Article102735. https://doi.org/10.1016/j.ajp.2021.102735

  Type of Study: Randomized controlled trial

  Number of participants: 44

  Population:

  • Age — Children: 3–5 years; Parents: Mean=37.00 years
  • Race/Ethnicity — 100% Iranian
  • Gender — Children: 35 Male and 5 Female; Parents: Not specified
  • Status — Participants were children with ASD.

  Location/Institution: Tehran, Iran

  Summary:

  The purpose of the study was to examine the effectiveness of structured individual and group parent training sessions among Iranian families. Participants were randomized to either the intervention group, Project ImPACT, or to the control group that received pharmacotherapy, occupational therapy, or speech therapy. Measures utilized include Gilliam Autism Rating, Functional Emotional Assessment Scales, Parenting Stress Index, and Quality of Life Questionnaire. Results indicate that the treatment group manifested significant improvement regarding autism symptoms in both the posttest and follow-up as well as Functional Emotional Development. Comparing the means indicates that the experimental group's mean score is significantly higher in quality of life and lower in parenting stress than the control group’s. Limitations include length of follow-up, reliance on self-report measures, and COVID-19 impacting the study’s follow-up phase.

  Length of controlled postintervention follow-up: 3 months.

There are currently no references available for Project ImPACT (Improving Parents as Communication Teachers).