Juliann Woods

Florida State University, School of Communication Science and Disorders, Faculty Member

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An Exploration of Reflective Conversations in Early Intervention Caregiver Coaching Sessions

Journal of Early Intervention, Feb 12, 2021

This descriptive study included a systematic examination of provider and caregiver reflective con... more This descriptive study included a systematic examination of provider and caregiver reflective conversations during caregiver coaching sessions focused on embedded intervention. Transcribed videos from 31 provider–caregiver dyads in two groups (Embedded Practices and Interventions with Caregivers [EPIC] vs. business-as-usual [BAU]) were used for data collection, resulting in a total of 93 transcripts across three different time points. Using methods of directed content analysis, a coding scheme describing various components of shared reflection was developed and used to code transcripts. Coding data were used to explore the rate per minute and relative frequency of types, topics, and spontaneity of reflection. Although there were no statistically significant differences in the frequency and rate of reflective versus nonreflective conversational turns, there were group differences in the reflective topics and specific types of reflective comments and questions posed by participants. Results from this study and others can help the field further define reflection as a coaching strategy and consider the potential utility of different reflective comment and question types to increase caregiver capacity to embed interventions in home routines. Further research is recommended to explicate further definitions and processes for reflection specific to caregiver coaching, including methods used to code reflective conversations and evaluate how reflection impacts caregivers’ intervention implementation.

Early Social Communication Milestones and Autism Spectrum Disorder: Using Social Media to Engage Families

The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum

Autism, Mar 15, 2023

Robust evidence supports the efficacy of early autism intervention. Despite broad consensus that ... more Robust evidence supports the efficacy of early autism intervention. Despite broad consensus that earlier intervention leads to better outcomes, evidence for this has been limited to correlational studies. This study examined timing effects of the Early Social Interaction (ESI) model, a parent-implemented intervention, using a complete crossover randomized controlled trial (RCT). Effects of Individual-ESI were compared when initiated at 18 or 27 months of age, and also contrasted with effects of the less intensive Group-ESI as an active control condition. Participants included 82 autistic toddlers who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order randomized. Blinded clinicians completed assessments at baseline (18 months of age), end of Condition 1 (27 months), and end of Condition 2 (36 months). Toddlers randomized to Individual-ESI at 18 months showed greater gains during treatment than those starting Individual-ESI at 27 months in receptive/expressive language, social communication, and daily living skills. This pattern was not observed for Group-ESI, demonstrating that timing effects were specific to Individual-ESI and ruling out maturation effects. This RCT demonstrated that earlier intensive, individualized intervention led to greater improvements, and suggests that even a narrow window of 18 versus 27 months may impact child outcomes. Lay abstract Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.

Digital Platforms and Supervisory Feedback to Graduate Student Clinicians

Perspectives of the ASHA Special Interest Groups, Mar 31, 2016

Portable electronic devices are becoming more prevalent in the field of speech-language pathology... more Portable electronic devices are becoming more prevalent in the field of speech-language pathology, from assessment and intervention to supervision. This study examined the use of various forms of supervisory feedback provided through digital platforms on a detailed fidelity checklist to five first-year graduate student clinicians participating in a community-based practicum. Three feedback conditions were compared: (a) e-mails sent after intervention sessions, (b) text messaging during intervention sessions, and (c) no e-mails or text messaging feedback. All forms of feedback were supplemented by an e-mail graph depicting progress on the fidelity checklist. Graduate student clinicians found all forms of digital feedback to be beneficial, with specific, immediate feedback being preferred. The fidelity checklist supported the graduate student clinicians&amp;amp;amp;amp;amp;amp;amp;amp;#39; implementation of intervention techniques as well as the supervisors&amp;amp;amp;amp;amp;amp;amp;amp;#39; ability to provide detailed feedback. Implications for future research and suggestions for supervision of graduate student clinicians are discussed.

Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder

Autism, 2020

Early intervention has been established as efficacious in addressing developmental delays in youn... more Early intervention has been established as efficacious in addressing developmental delays in young children with autism spectrum disorder. Evidence that caregiver-implemented interventions are feasible and effective for young children with autism spectrum disorder is emerging, yet research suggests there are barriers to enrollment in clinical trials of these interventions for infants at risk for autism. This study identifies factors associated with enrollment in a clinical trial of a caregiver-implemented intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, fifty-seven infants were deemed eligible for intervention based on several converging indicators of autism risk. Of these eligible infants, 44% declined enrollment in the intervention study. Examination of factors associated with families who declined enrollment compared to those who agreed to enroll revealed maternal full-time work status, household income, and distan...

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Interprofessional Collaborative Practice in Early Intervention

Pediatric Clinics of North America, 2018

Professionals in pediatric practice encounter infants and toddlers with developmental delays, dis... more Professionals in pediatric practice encounter infants and toddlers with developmental delays, disabilities, or complex chronic health conditions eligible for Part C early intervention (EI) services. The most frequently identified concern by families is communication emphasizing the importance of the role of the speech language pathologist (SLP). This article provides a conceptual framework for SLP services in early intervention, based on the principles of interprofessional collaboration. The history of collaboration, EI, and the role of SLPs as members of the EI team are summarized. The competencies mandated for interprofessional education and practice are juxtaposed with the principles of EI and guidelines for SLPs.

Multi-component professional development for educators in an Early Head Start: Explicit vocabulary instruction during interactive shared book reading

Early Childhood Research Quarterly, 2018

This multiple-baseline, single case design study investigated the effects of a multi-component pr... more This multiple-baseline, single case design study investigated the effects of a multi-component professional development program to increase educators' use of explicit vocabulary instruction during small group interactive shared book reading sessions in Early Head Start classrooms. The effects of the program were examined across four educators and 2-3 of their students (n = 9 students). Educators were provided with a professional development program, which included an introduction to content through direct teaching, opportunities for practice during classroom routines, and individualized coaching with feedback. Baseline book reading sessions resulted in consistently low levels of educator intervention fidelity based on fidelity checklists, followed by immediate increases in fidelity upon introduction to the program. Students showed receptive vocabulary gains for words targeted during intervention and maintenance sessions. Educators found the program to be feasible for classroom use, and they planned to continue using the targeted strategies in the future. Implications and directions for future research are discussed.

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A Review of Problem Solving and Reflection as Caregiver Coaching Strategies in Early Intervention

Infants & Young Children, 2020

An increasing number of researchers are examining the benefits and outcomes of caregiverimplement... more An increasing number of researchers are examining the benefits and outcomes of caregiverimplemented interventions for young children with delays or disabilities. Most report the incorporation of multiple coaching strategies within their approach; however, definitions and descriptions of coaching strategies and processes continue to be limited. This scoping review examined the use of various coaching strategies across models of caregiver coaching in early intervention, with a specific focus on problem solving and reflection coaching strategies occurring in the literature between 2011 and 2018. Problem solving and reflection are 2 coaching strategies incorporated into coaching approaches to build caregiver competency, confidence, and independence within intervention implementation. The results of this review may guide the field in further defining caregiver coaching as well as specific coaching strategies, such as problem solving and reflection.

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Exploring message framing to engage parents in early screening for autism spectrum disorder

Patient Education and Counseling, 2020

With the average age of diagnosis of autism hovering between 4 and 5 years of age, many children ... more With the average age of diagnosis of autism hovering between 4 and 5 years of age, many children do not receive critical early intervention. Health information messages may be useful for increasing parents' understanding of the importance of early autism screening. Methods: Messages promoting autism screening were presented to 282 parents in a 2 (message frame: gain, loss) x 3 (evidence type: narrative, statistical, and hybrid), online, between-participants factorial design. Participants' involvement, affective responses, perceived threat to behavioral freedom, attitudes, and intentions to discuss screening with a healthcare provider were analyzed. Results: Loss-framed messages that included a hybrid of first-person narrative and statistical evidence were related to favorable ratings for most outcomes. Levels of perceived threat to behavioral freedom partially mediated involvement and attitudes, in a negative direction, for loss-framed narrative messages. Conclusion: Results of this preliminary study supported the inclusion of both evidence types in messages developed to encourage parents to engage in early screening for autism, and partially supported focusing these messages on the potential costs of not screening. Practice implications: Effective use of messaging with parents could help to increase knowledge and facilitate shared decision-making with health care providers to engage in early screening for autism.

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Encouraging Connections Between Parents and Children With Autism

ASHA Leader, 2014

Technology

Perspectives on Administration and Supervision, 2006

Technology

Perspectives on Administration and Supervision, 2007

Technology

Perspectives on Administration and Supervision, 2006

Technology-Supported Performance-Based Feedback for Early Intervention Home Visiting

Topics in Early Childhood Special Education, 2012

This study was conducted to evaluate the effects of a Distance Mentoring Model (DMM), including p... more This study was conducted to evaluate the effects of a Distance Mentoring Model (DMM), including performance-based feedback and technology support, on expanding the use of recommended home visiting practices by early interventionists. Data from 18 early interventionists indicated that participation in the DMM approach was associated with increased use of various caregiver coaching strategies and routine contexts. Specifically, participants spent significantly less time in child-focused intervention and more time using specific coaching interactions with the caregiver and child as a dyad after participating in technology-supported, performance-based feedback. All participants reported that they would participate in technology-supported, professional development opportunities again in the future.

An Activity Based Approach to Early Intervention

Pediatric Physical Therapy, 1992

... Login to save citations to My List. Citation. Database: PsycINFO. [Book; Authored Book]. An a... more

Participation as a Basis for Developing Early Intervention Outcomes

Language, Speech, and Hearing Services in Schools, 2011

Purpose This article describes how participation in activities/routines can be used as a basis fo... more Purpose This article describes how participation in activities/routines can be used as a basis for understanding children’s communication and language skills and how that knowledge can be extended to collaborate with families and caregivers to develop meaningful early intervention outcomes. Method The approach is centered on children’s use of communication and language skills to participate in typical activities/routines. Implementation of the approach is based on an understanding of children’s performance abilities/disabilities and their use of those abilities to participate in family-identified activities/routines in their natural environments. Discussion and case examples illustrate how communication and language skills can enhance or enable participation in such activities. Family-centered procedures for gathering information about activities/routines from caregivers are described, and strategies for developing outcomes in collaboration with caregivers are presented. Implication...

format_quoteRecent reviews show that EI outcomes often lack a connection to participation in natural contexts, undermining their effectiveness.format_quote

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Early Identification of and Intervention for Infants and Toddlers Who Are at Risk for Autism Spectrum Disorder

Language, Speech, and Hearing Services in Schools, 2003

Providing intensive early intervention is critical to maximizing outcomes for children with autis... more Providing intensive early intervention is critical to maximizing outcomes for children with autism spectrum disorder (ASD), and evidence suggests that the earlier intervention can begin, the better the outcome. The first purpose of this article is to review the earliest indicators of ASD in very young children—social and communication impairments—which have important implications for early identification. The second purpose is to review evidence-based intervention practices for children with ASD and to develop a set of guiding principles for providing intervention for infants and toddlers who are at risk for ASD. Issues that are delineated include providing intervention in natural environments, supporting families in early intervention, and embedding intervention in daily routines.

format_quoteGestural joint attention at initial testing predicted language development one year later in preschoolers with ASD, unlike other nonverbal measures.format_quote

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Enhancing Generalized Teaching Strategy Use in Daily Routines by Parents of Children With Autism

Journal of Speech, Language, and Hearing Research, 2006

Purpose The purpose of this study was to examine the effects of facilitating generalized use of t... more Purpose The purpose of this study was to examine the effects of facilitating generalized use of teaching strategies by parents of children with autism within daily routines. Method Five preschool children with autism participated in intervention with a parent within daily routines in the family’s home. Parents learned to include 2 teaching strategies in target routines to address their child’s communication objectives. Parent–child interactions in routines were videotaped for data coding and analysis. Proactive programming of generalization occurred by systematic selection of intervention routines and by embedding intervention in multiple routines. Generalization data were collected by measuring strategy use in untrained routines. A multiple baseline design across teaching strategies was used to assess experimental effects. Results All parents demonstrated proficient use of teaching strategies and generalized their use across routines. The intervention had positive effects on child ...

Working in the Classroom

Communication Disorders Quarterly, 2012

Idioms occur frequently in classroom language. Students with literacy or language weaknesses are ... more Idioms occur frequently in classroom language. Students with literacy or language weaknesses are often challenged by idioms; therefore, the failure to comprehend idioms can impact academic performance. Four 7th-grade female students (mean age: 12 years, 6 months) participated in a multiple baseline single subject study during their general education intensive reading class. Three sets of idioms were taught to examine the effects of classwide peer tutoring (CWPT) intervention on idiom comprehension. Following implementation of CWPT, comprehension of most idiomatic phrases increased and remained largely stable as indicated through visual analysis. Teaching idioms with CWPT was flexible, effective, and time-efficient in a general education classroom setting. Speech language pathologists collaborating with educators should provide evidence-based interventions as guided by educational standards and curriculum. Response to intervention provides a framework to implement a classroom interve...

Descriptive Analyses of Pediatric Food Refusal: The Structure of Parental Attention

Behavior Modification, 2010

Mealtime observations were conducted and occurrences of appropriate and inappropriate mealtime be... more Mealtime observations were conducted and occurrences of appropriate and inappropriate mealtime behavior and various forms of parental attention (e.g., coaxing, reprimands) were recorded for 25 children admitted to an intensive feeding program and their parents. Using the data from the observations, lag sequential analyses were conducted to identify changes in the probability of child appropriate and inappropriate mealtime behavior before and after various forms of parental attention. A combination of univariate and repeated measures ANOVAs using frequency of child behavior were also conducted to corroborate conclusions drawn from the visual analysis of individual participant data. Results showed that parental attention was frequently followed by temporary decreases in inappropriate mealtime behavior and increases in bite acceptance. Moreover, various forms of parental attention resulted in statistically significant changes in child behavior, which supports the clinical utility of th...

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