Telepractice presents challenges for engaging with children – for example, getting them to focus on the screen of the device, maintaining their attention on the device, difficulty prompting the child effectively through the screen, need for an adult to be present on the other end to manage the technology, children being uncomfortable with equipment, e.g. wearing headphones (Arefadib & Moore 2017).
This resource explains how practitioners who would traditionally deliver services directly to children can adapt their practices to a parent-mediated approach, via telepractice. It is relevant to practitioners across family services, early intervention and allied health.
Parent-mediated interventions refers to when a practitioner seeks to support a child by teaching the child’s parent(s) or other caregiver(s) how to act as the child’s intervention provider. The parent can act as the practitioner’s local ‘accomplice’ carrying out elements of the intervention with the coaching and supervision of the remote practitioner.
Advantages of a parent-mediated approach:
- It helps manage issues such as the practitioner not being physically present and child engagement.
- It drives practitioners to help parents build skills that they can use to support their child in the long term, rather than applying the skill themselves and expecting the parent to learn it just by watching.
The parent-mediated approach is more naturalistic – the child need not be taken out of their natural environment to deliver the intervention.
Parent-mediated interventions are well-supported by a significant scientific evidence base.
Practitioners could consider using this approach when working to support a wide range of issues, such as:
- behavioural issues, including Oppositional-Defiant Disorder
- speech and language
- early childhood intervention
- Autism Spectrum Disorder
- child mental health
- Attention Deficit Hyperactivity Disorder.
- select practices that work well as parent-mediated interventions
- consider whether there are practices you can adapt to be parent-mediated rather than delivered directly to the child.
We have adopted a framework for parent-mediated intervention developed by Snodgrass et al. (2017):
These examples are simplified to concisely reflect the parent-mediated approach. We acknowledge that practitioners working with families are generally juggling many more variables than those presented here.
These examples don’t cover the essential practices required for setting up telepractice sessions with families. Practitioners who would benefit from this may wish to view other resources on this website. Alternatively, the NSW Agency for Clinical Innovation has produced a useful guide.
Louis is a ten-year-old with additional needs whose family is experiencing disadvantage. Louis has been displaying significant behavioural issues at home and at school. Social worker Irma has been working with Louis to help him understand and process his emotions, which she has identified as contributing to his behavioural outbursts. She has been doing this face-to-face, however, recently Louis and his mother, Dominica, have moved residence to live with a relative due to financial issues, and they are now too far away for Irma to provide services face-to-face.
Irma has tried continuing her sessions with Louis via videocall, but found that he quickly becomes distracted and even leaves the room partway through the session. Because of this, Irma decides it may be appropriate to switch her approach to a parent-mediated intervention for Louis’s behaviour issues. After reviewing the case notes and consulting with her supervisor, Irma has a discussion with Dominica about the parent-mediated approach. Dominica is very willing to try the approach, but notes that financial stress may impact her ability to apply strategies. They agree to undertake the approach on a trial basis.
An early intervention Key Worker, Jo, has taken on a newly enrolled family – Mari and her parents Elle and Robin. Mari has a developmental delay and her family is keen to support her cognitive, language and social development. The family has expressed a strong preference for telepractice due to busy work schedules and the need to care for two other children with additional needs. Because Mari is only three, Jo believes that a parent-mediated intervention is the best approach in this case. She discusses this option with Elle and Robin over the phone and they agree that this would be beneficial.