The Effects of Virtual Caregiver Coaching in Antigua & Barbuda on the Implementation of EMT Language Support Strategies in Naturalistic Environments


  • Sensemillah Z. Peters Rocky Mountain University of Health Professionals
  • Klaire Mann Brumbaugh Fontbonne University, Clayton, MO
  • Amanda Blackwell Minot State University, Minot, North Dakota, USA



Caregiver coaching, Communication strategies, Early intervention, Telepractice


This single-case multiple baseline design investigation set out to determine the effectiveness of using a telepractice service delivery model to coach caregivers in Antigua & Barbuda in the use of Enhanced Milieu Teaching (EMT) language support strategies with a child with language impairment. A slightly modified version of the Teach-Model-Coach-Review (TMCR) method was used during virtual instruction to train a caregiver on the language support strategies of environmental arrangement, matched turns, expansions, and time delay with milieu prompting. The caregiver attended sessions three times a week for up to 45 minutes for four weeks. The results of this study indicated a positive relationship between the intervention and caregiver use of strategies. The caregiver demonstrated increased responsiveness to the child’s communication attempts and exhibited the use of language support strategies across activities. This study suggests that telepractice can be an effective service delivery model for providing coaching to caregivers.



Akemoğlu, Y., Muharib, R., & Meadan, H. (2020). A systematic and quality review of parent-implemented language and communication interventions conducted via telepractice. Journal of Behavioral Education, 29(2), 282-316.

Alberto, P. A., & Troutman, A. C. (1982) Applied behavior analysis for teachers. Merrill.

Ambrose, T. (2020, August 11). Public health spotlight with Mona Gardner. All about the scrublife.

American Speech-Language-Hearing Association. (n.d.-b). Telepractice. (Practice Portal).

Bellom-Harn, M. L., Morris, L. R., Manchaiah, V., & Harn, W. E. (2020). Use of videos and digital media in parent-implemented interventions for parents of children with primary speech sound and/or language disorders: A scoping review. Journal of Child and Family Studies, 1–13. Advance online publication.

Brown, V. L., Bzoch, K. R., & League, R. (2020). Receptive-Expressive Emergent Language Test – 4th Edition. PRO-ED Inc.

Daczewitz, M., Meadan-Kaplansky, H., & Borders, C. (2020). PiCs: Telepractice coaching for a parent of a child who is hard-of-hearing. Deafness & Education International, 22(2), 113-138.

DeVeney, S. L., Hagaman, J. L., & Bjornsen, A. L. (2017). Parent-implemented versus clinician-directed interventions for late-talking toddlers: A systematic review of the literature. Communication Disorders Quarterly, 39(1), 293–302.

Economic Commission for Latin America and the Caribbean [ECLAC]. Disability, human rights and public policy in the Caribbean. LC/TS.2017/151, LC/CAR/TS.2017/12, 2018.

Ellis, E. M., & Thal, D. J. (2008). Early language delay and risk for language impairment. Perspective on Language Learning and Education, 15(3), 93-100.

Evans, J., & Brown, T. (2016). Specific language impairment. In G. Hickok & S. L. Small, Neurobiology of Language (1st ed., pp. 899-912).

Fairweather, G. C., Lincoln, M., & Ramsden, R. (2016). Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities. International Journal of Speech-Language Pathology, 18(6), 592-602.

Guðmundsdóttir, K., Sigurðardóttir, Z., & Ala’i-Rosales, S. (2019). Extending caregiver training via telecommunication for rural Icelandic children with autism. Rural Special Education Quarterly, 38(1), 26-42.

Hamren, K., & Quigley, S. (2012). Implementing coaching in a natural environment through distance technologies. The Volta Review, 112(3), 403-407.

Hatcher, C. A. (2018). Parent-implemented language intervention with young children from low-SES environments who have language impairment. Theses and Dissertations--Rehabilitation Sciences, 45.

Hatcher, C. A., Grisham-Brown, J., & Sese, K. (2019). Teaching and coaching caregivers in Guatemala to promote language in young children. Journal of International Special Needs Education, 22(1), 1-13.

Kaiser, A.P., & Hancock, T.B. (2003). Teaching parents new skills to support their young children’s development. Infants & Young Children, 16(1), 9-21.

Kaiser, A. P., & Roberts, M. Y. (2013). Parents as communication partners: an evidence-based strategy for improving parent support for language and communication in everyday settings. Perspectives on Language Learning and Education, 20(3), 96-111.

Kashinath, S., Woods, J., & Goldstein, H. (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Language, and Hearing Research, 49(3), 466-485.

Ledford, J. R., & Gast, D. L. (2018). Single case research methodology: Applications in special education and behavioral sciences (3rd ed.). Routledge.

Lindsay G., & Strand S. (2016). Children with language impairment: Prevalence, associated difficulties, and ethnic disproportionality in an English population. Frontiers in Education, 1(2).

McDuffie, A., Machalicek, W., Oakes, A., Haebig, E., Weismer, S.E., & Abbeduto, L. (2013). Distance video-teleconferencing in early intervention: Pilot study of a naturalistic parent-implemented language intervention. Topics in Early Childhood Special Education, 33(3), 172-185.

Meadan, H., Angell, M. E., Stoner, J. B., & Daczewitz, M. E. (2014). Parent-implemented social-pragmatic communication intervention: A pilot study. Focus on Autism and Other Developmental Disabilities, 29(2), 95-110.

Meadan, H., & Daczewitz, M. E. (2014). Internet-based intervention training for parents of young children with disabilities: A promising service-delivery model. Early Child Development and Care 185(1), 155-169.

Meadan, H., Meyer, L. E., Snodgrass, M. R., & Halle, J. W. (2013). Coaching parents of young children with autism in rural areas using internet-based technologies: A pilot program. Rural Special Education Quarterly, 32(3), 3–10.

Meadan, H., Snodgrass, M., Meyer, L. E., Fisher, K. W., Chung, M. Y., & Halle, J. W. (2016). Internet-based parent-implemented intervention for young children with autism: A pilot study. Journal of Early Intervention, 38(1), 3-23.

Oosterling, I., Visser, J., Sophie, S., Rommelse, N., Donders, R., Woudenberg, T., Roos, S., Jan van der Gaag, R., Buitelaar, J. (2010). Randomized controlled trial of the focus parent training for toddlers with autism: 1-year outcome. Journal of Autism and Developmental Disorders 40, 1447-1458.

Othman, B., & Aziz, N. (2019). Piloting teletherapy for children with hearing loss in Malaysia. Jurnal Pendidkan Bitara UPSI 12, 35-46

Pan American Health Organization. (2012). Antigua & Barbuda. Health in the Americas: Country Volume.

Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta-analysis. American Journal of Speech-Language Pathology, 20(3), 180-199.

Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., & Spidalieri, A. M. (2014). Effects of the Teach-Model-Coach-Review instructional approach on caregiver use of language support strategies and children’s expressive language skills. Journal of Speech, Language, and Hearing Research, 57(5), 1851-1869.

Roberts, M. Y., & Kaiser, A. P. (2015). Early intervention for toddlers with language delays: A randomized controlled trial. Pediatrics, 135(4), 686–693.

Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model curriculum checklist for young children with Autism. Guilford.

Romski, M., Sevcik, R. A., Adamson, L. B., Smith, A., Cheslock, M., & Bakeman, R. (2011). Parent perceptions of the language development of toddlers with developmental delays before and after participation in parent-coached language interventions. American Journal of Speech-Language Pathology, 20(2), 111–118.

Sheldon, M., & Rush, D., (2001). The ten myths about providing early intervention services in natural environments. Infants and Young Children, 14(1), 1-13.

Siller, M., Hutman, T., and Sigman, M. (2013). A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: A randomized clinical trial. Journal of Autism and Developmental Disorders 43(3), 540-555.

Simacek, J., Elmquist, M., Dimian, A., & Reichle, J. (2020). Current trends in telehealth applications to deliver social communication interventions for young children with or at risk for autism spectrum disorder. Current Developmental Disorders Reports 8, 15-23.

Snodgrass, M. R., Chung, M. Y., Biller, M. F., Appel, K. E., Meadan, H., & Halle, J. W. (2017). Telepractice in speech-language therapy: The use of online technologies for parent training and coaching. Communication Disorders Quarterly, 38(4), 242-254.

SpeakEZ Theracare (n.d.). Home [Facebook Page]. Retrieved July 29, 2021 from

Stredler-Brown, A. S. (2017). Examination of early intervention delivered via telepractice with families of children who are deaf or hard of hearing. Perspectives of the ASHA Special Interest Groups, 2(9), 25-42.

Stoner, J. B., Meadan, H., & Angell, M. E. (2013). A model for coaching parents to implement teaching strategies with their young children with language delay or developmental disabilities. Perspectives in Language Learning and Education, 20(3), 112-119.

Sussman, F. (1999). More than words: Helping parents promote communication and social skills in children with autism spectrum disorder. The Hanen Centre.

Van Balkom, H., Verhoeven, L., Van Weerdenburg, M., & Stoep, J. (2010). Effects of parent-based video home training in children with developmental language delay. Child Language Teaching and Therapy, 26(3), 221-237.

Vismara, L. A., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment, 2012, 121878.

Wright, C. A., & Kaiser, A. P. (2017). Teaching parents enhanced milieu teaching with words and signs using the Teach-Model-Coach-Review model. Topics in Early Childhood Special Education, 36(4), 192–204.

Weitzman, E. (2013). More than words – The Hanen program for parents of children with autism spectrum disorder: A teaching model for parent-implemented language intervention. Perspectives in Language Learning and Education, 20(3), 96-111.




How to Cite

Peters, S., Brumbaugh, K., & Blackwell, A. (2023). The Effects of Virtual Caregiver Coaching in Antigua & Barbuda on the Implementation of EMT Language Support Strategies in Naturalistic Environments. International Journal of Telerehabilitation, 15(2).



Clinical Research