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Parent-Implemented Intervention (PII)

Parent delivery of an intervention to their child that promotes their social communication or other skills or decreases their challenging behavior.

Evidence Based
Ages: Skip to Evidence

Steps for Implementation

Step 1. Determining Family Needs

  1. Gather information about individual family and child needs by:
    1. conducting parental and caregiver interviews and
    2. observing child, caregiver–child interactions, and daily routines.
  2. When gathering information, identify:
    1. strengths of the child and family;
    2. areas of concerns/needs of family regarding the child;
    3. child behaviors that impact family functioning;
    4. parent–child interactions that include type, frequency, nature, and reciprocity of interactions;
    5. family activities, routine, and physical layout of the home; and
    6. supports/resources in immediate, extended family and community.

Step 2. Selecting Goals

  1. Select goals that:
    1. address areas of concern and priority for the child, parents, and/or family members;
    2. will have a positive impact on family functioning and will not cause additional stress to the parents or family;
    3. can be implemented by parents with consistency; and
    4. are appropriate for parents to implement in home and/or community settings.
  2. Assure that goals:
    1. are written in observable and measurable terms,
    2. were selected in partnership with parents, and
    3. are shared with all team members in written format.
  3. Consider the following when selecting goals for the child:
    1. Individualized Education Plan (IEP) or (IFSP) goals are appropriate for parents to implement in home and/or community settings
    2. Goals will increase positive behavior and reduce interfering behavior
    3. Goals will increase communication/language skills
  4. Prioritize goals that:
    1. concern safety,
    2. ease disruptions in the home,
    3. increase interactions (frequency, quality, turn‐taking, etc.),
    4. would increase access to the community, and
    5. require instruction in the home or community for generalization.
  5. Consider the following when determining parent goals:
    1. Parent–child interactions (e.g., shared attention, turn‐taking)
    2. Parents’ knowledge of autism
    3. Parents’ knowledge/skills of strategies that promote development and learning
    4. Parents’ knowledge of behavior management strategies
  6. Identify goals for family members who may be involved in implementing the intervention plan.

Step 3. Developing the Intervention Plan

  1. Develop an individualized intervention plan that:
    1. targets the identified child, parent, and/or family goals;
    2. is consistent with the parents’ ongoing practices, routines, values, and interactions;
    3. incorporates intervention within the context where target behavior occurs;
    4. incorporates intervention into naturally occurring daily routines to the maximum extent possible;
    5. includes practices that have an evidence base and have been shown to be effective when implemented by parents; and
    6. includes practices that are compatible with parent knowledge, characteristics, and preferences and will not cause added stress.
  2. Develop step‐by‐step instructions for individual practices that include the following information:
    1. The target skill or behavior
    2. Who will implement the intervention
    3. Where the intervention will be implemented
    4. When the intervention will be implemented (minimum amount of intervention, frequency, duration)
    5. How long the intervention will be implemented (define how parents know when the intervention session or instructional trial is completed)
    6. Materials required
    7. Any steps needed to prepare the intervention
    8. Strategies to be used
    9. Prompting hierarchy to be used
    10. Reinforcement schedule
  3. Design a data collection system that parents can use to monitor their child’s progress toward goal attainment that:
    1. takes family characteristics into account,
    2. is simple and succinct,
    3. is quick and easy to implement,
    4. can be implemented in the context natural routines, and
    5. can be analyzed quickly.

Step 4. Training Parents

  1. Prior to parent training, choose at least one of the following formats for instruction:
    1. Individual
    2. Group
    3. Combination
  2. Choose one or more of the following locations for training parents to implement the intervention:
    1. Home (child’s primary residence)
    2. Community (any setting outside of the home)
    3. Clinic (any laboratory, university, or treatment center)
    4. School (any educational setting)
  3. Provide individualized training programs that incorporate an assortment of components including didactic instruction and one or more of the following:
    1. Feedback and coaching
    2. Modeling
    3. Role playing and/or behavioral rehearsing
    4. Documentation of implementation using log book or other data collection tools
    5. Video analogies
    6. Video analysis
  4. Determine an appropriate amount and duration of training based on:
    1. child characteristics,
    2. parent characteristics,
    3. family characteristics, and
    4. peer‐reviewed articles that have demonstrated the minimum amount of intervention needed to achieve goals.

Step 5. Implementing the Intervention

  1. Parents implement intervention with their child daily.
  2. To the greatest extent possible, parents implement intervention within naturally occurring routines and interactions.
  3. For instructional components that cannot be completed in a natural context, parents implement intervention at the same time each day in a relatively quiet area that is free from distractions.

Step 6. Monitoring Progress

  1. Use progress monitoring data to determine if the intervention is working.
  2. Use progress monitoring data to adjust intervention if needed.
  3. Monitor parents’ implementation of the intervention using fidelity checklists and adapt training/support as needed.
  4. As parents demonstrate mastery over training content, the frequency of parent training sessions is systematically reduced based on:
    1. child performance as reflected on data collection sheets and
    2. parent implementation of intervention as reflected on parent fidelity implementation checklists.
  5. Provide parents with additional opportunities to learn how to implement intervention, improve intervention, ask questions, and solve problems.
  6. Promote ongoing supervision and collaboration by providing at least one of the following:
    1. Continued contact with the trainer
    2. Parent training booster sessions
    3. Documentation
    4. Video analysis
    5. Observation
    6. Email and phone correspondence

Research and Outcomes

Research Summary

Age Range: 0-18

Skills: Communication, social, joint attention, play, cognitive, school readiness, academic/pre-academic, adaptive/self-help, challenging/interfering behavior, motor, mental health

Settings: Home, community

Evidence Rating: Evidence Based

The information found in the Research Summary table is updated following a literature review of new research and these ages, skills, and settings reflects information from this review.

Outcomes Matrix

The Outcomes Matrix shows outcome areas by age for which this evidence based practice is effective
Age: 0-5 6-14 15-22
Academic/Pre-academic Yes
Challenging/Interfering Behavior Yes Yes Yes
Cognitive Yes
Communication Yes Yes Yes
Joint Attention Yes
Mental Health Yes Yes
Motor Yes
Play Yes Yes
School Readiness Yes Yes
Social Yes Yes Yes
More about Intervention Outcomes

In Parent-Implemented Intervention (PII), parents are the primary person using an intervention practice with their own child. Practitioners teach parents in individual or in group formats in home or community settings. Methods for teaching parents vary, but may include didactic instruction, discussions, modeling, coaching, or performance feedback. The parent’s role is to use the intervention practice to teach their child new skills, such as communication, play or self-help, engage their child in social communication and interactions, and/or to decrease challenging behavior. Once parents are trained, they implement all or part of the intervention(s) with their child. Parents are often implementing other EBPs included in this report including naturalistic interventions, video modeling, or social narratives (Steinbrenner, et al., 2020).

• Manualized Interventions Meeting Criteria: Project ImPACT (Improving Parents as Communication Teachers); Stepping Stones Triple P (SSTP)/Primary Care SSTP.