Coaching Bilingual Speech-Language Student Clinicians and Spanish-Speaking Caregivers to Use Culturally Adapted NDBI Techniques with Autistic Preschoolers

A cascading coaching model was used to teach bilingual speech-language pathology (SLP) graduate student clinicians and Spanish-speaking caregivers to implement naturalistic developmental behavioral intervention (NDBI) techniques with autistic preschoolers. Two triads (each consisting of a graduate student clinician, a minimally vocal child diagnosed with autism, and a caregiver) participated in the study. Following the cascading approach, a lead instructor (with limited Spanish conversational skills) coached bilingual student clinicians (in English) to apply culturally adapted NDBI with child participants. Following additional instruction in coaching, student clinicians coached caregivers in Spanish. Effects were evaluated using a multiple methods approach consisting of multiple probes across participants single case experimental design and a qualitative analysis of semi-structured interviews with adult participants. All adult participants increased their use of targeted NDBI skills including elicitation techniques (creating communication temptations, using wait time, and prompting) and response techniques (reinforcing children's communication with natural consequences and providing a contextually relevant vocal model), demonstrating large to very large effect sizes. Although qualitative findings indicated areas for improvement (e.g., additional Spanish supports for clinicians), thematic analysis revealed additional benefits in terms of positive changes across adult learning, behavior, and perspectives; child communication; and child-caregiver relationships.