Pre-Professional Training for Serving Children With ASD

Abstract

Children with autism spectrum disorder (ASD) often present with varied skill profiles and levels of severity making development and implementation of specialized school services challenging. Research indicates that school professionals require and desire additional ASD-specific professional development, both at the pre- and in-service levels. Speech–language pathologists (SLPs) are one member of a school-based team who frequently serve children with ASD. Due to broad graduate training requirements (across the life span), SLPs receive limited ASD-specific clinical education, which may affect their contributions on school-based intervention teams. Given these issues, this article aims to briefly describe an apprenticeship model of clinical supervision, which may be well suited to preparing SLPs to significantly contribute to school teams serving children with ASD; present a case illustration of the use of this model within university graduate program; and briefly discuss implications for pre- and post-professional education and development.

Keywords

autism school services pre-professional training speech–language pathology

Autism is a complex neurodevelopmental disorder that can affect social, language, cognitive, play, and adaptive functioning across the course of an individual’s life span. With the rising prevalence of autism spectrum disorder (ASD; 1 in 68; Centers for Disease Control and Prevention, 2014), most school-based professionals will serve children with ASD and their families at some point in their careers. Indeed, according to the U.S. Department of Education, National Center for Education Statistics (2013), the number of children with autism ages 3 to 21 served under Part B of the Individuals With Disabilities Education Act (IDEA) has risen from 94,000 students during the 2000-2001 school year to 417,000 students during the 2010-2011 school year. This reflects the largest increase of any disability category served under IDEA during that time period.

Although the primary characteristics of ASD are social communication deficits and restrictive and/or repetitive behaviors and interests (American Psychiatric Association, 2013), many children with ASD present with complex needs that can affect multiple developmental domains (social, communication, adaptive, cognitive, motor; Hollander, Kolevzon, & Coyle, 2011). Given the heterogeneous nature of ASD and the wide range in severity of needs, interdisciplinary coordination and collaboration among school professionals with regard to development and implementation of services is key (National Autism Center, 2011).

In many school districts, teams serving children with ASD include special and general educators, speech–language pathologists (SLPs), occupational therapists, “autism specialists” (professionals with specific education and professional experience, often related to applied behavior analysis), school psychologists, instructional assistants, and others. According to the National Autism Center’s (2011) Evidence-Based Practice and Autism in the Schools’ report, “Schools now must prepare all staff to serve all children with ASD—including students with varying communication, social, cognitive, and adaptive skills” (p. 146). As such, graduate programs across multiple disciplines (not just education) must carefully assess their approach to pre-professional education specific to serving children with ASD to ensure that all professionals on a school-based team are well prepared to successfully collaborate and contribute to serving this population.

One central member of the school intervention team serving children with ASD is the SLP. According to the American Speech-Language-Hearing Association’s (ASHA; 2006b) position statement, SLPs “play a critical role in screening, diagnosing, and enhancing the social communication development and quality of life of children, adolescents and adults with ASD.” Ninety percent of school-based SLPs report serving children with ASD on their caseloads (ASHA, 2012). In addition, school-based SLPs report serving an average of eight students with ASD per month; this represents a 100% increase since 2000 (ASHA, 2012). The need for increased autism-specific training for SLPs has, however, been well documented and SLPs report the desire for increased opportunities to collaborate with other team members serving children with ASD within their school environments (Plumb & Plexico, 2013; Schwartz & Drager, 2008).

Barriers to ASD-Specific Training

Students with ASD often require specialized services in schools because of their unique social, behavioral, sensory, and communication needs (Barnhill, Polloway, & Sumutka, 2010). School teams, however, may struggle to develop and deliver these services due to shortage of personnel with appropriate and adequate training (LeBlanc, Gravina, & Carr, 2009; Maddox & Marvin, 2013). Teachers are expected to understand not only the characteristics of ASD but also the range of evidence-based practices (EBPs) and strategies for supporting their needs (Maddox & Marvin, 2013). “The dilemma has become one of an increased need for specialized training to work with students with ASD at the same time that training and licensure patterns are moving away from such specialized emphases” (Barnhill et al., 2010, p. 76).

This barrier to ASD-specific training is shared by speech-language pathology. While ASHA (2006a) clearly specifies the knowledge and skills necessary for SLPs working with children with ASD, graduate programs in speech-language pathology are inherently generalist in nature. To receive a master’s degree from an accredited university, a student must have met the knowledge and skills standards for understanding, evaluation, and intervention of communication and swallowing disorders and differences across the life span, including articulation, fluency, voice and resonance, receptive and expressive language, hearing, swallowing, cognitive aspects of communication, and augmentative and alternative communication modalities (Council for Clinical Certification in Audiology and Speech-Language Pathology of the ASHA, 2014). As such, students in these programs may have limited, if any, ASD-specific coursework and/or opportunities to receive hands-on clinical training in serving children with ASD; yet, they will be expected to actively collaborate (and even take a leading role with regard to social and communication targets) with other school intervention team members on development and implementation of Individualized Education Programs (IEPs) for children with ASD.

Such hands-on training is of particular importance for serving this population (LeBlanc et al., 2009). Barnhill and colleagues (2010) stated,

Depth of training [is] needed to ensure that individuals acquire the necessary skills to work with the heterogeneous group of individuals on the autism spectrum as well as have the opportunity to practice skills learned during preservice . . . training. (p. 84)

For pre-professionals, much like the students with ASD that they will soon serve, this means plentiful opportunities to actively participate in learning by observing and then performing specific skills under the guidance of an expert or mentor clinician.

Research also indicates the need for increased instruction on EBPs for serving children with ASD (Hess, Morrier, Heflin, & Ivey, 2008). The main steps to implementation of EBP include (a) critically analyzing the empirical evidence; (b) reviewing the evidence collected within one’s own professional experience (i.e., practice-based evidence; Lof, 2011); and (c) matching the intervention to the family’s values and beliefs (Dollaghan, 2007).

To address the first step of EBP, graduate programs must first teach student clinicians (and student educators) about the characteristics of ASD and the theoretical framework of the intervention (i.e., the theory of change associated with the intervention). They must then give them the tools to critically analyze the empirical evidence and draw conclusions about application. The second step is even more challenging within a pre-professional program, as the students have yet to gather their own practice-based evidence. Thus, training programs must give them the tools to do so. Students must learn how to collect their own evidence through detailed data collection and analysis procedures, and they must have opportunities to practice these skills with support and guidance. Actively collecting data while serving a child with social, communication, sensory, and/or behavioral challenges can be difficult for even seasoned professionals. Finally, students must hone their communication skills for engaging with families, identifying family values, beliefs, and priorities, and clearly articulating teaching methods and outcomes.

Given these factors, the purpose of this article is to (a) briefly describe an apprenticeship model of clinical supervision, which may be well suited to meeting these needs and preparing SLPs to significantly contribute to school teams serving children with ASD; (b) present a case illustration of the use of this model within a university graduate program; and (c) briefly discuss implications for use of this model in pre- and post-professional learning across school-based teams.

Clinical Supervision in SLP

Speech-language pathology is an applied discipline, as is teaching. Thus, a significant portion of an speech-language pathology graduate program is devoted to clinical education, and models of clinical supervision have the ability to dramatically shape the clinical education of pre-professionals. According to Anderson (1988) and ASHA (2008), supervisors should use a variety of methods to meet the needs, expectations, and competences of student clinicians across multiple contexts (specific to clinical tasks, service setting, client presentation). Much like the student teaching model, professional growth and development of both the supervisor and supervisee are the goals of the SLP supervisory process, which can be enhanced through clinical teaching that involves self-evaluation, and promotes critical thinking and problem solving.

Recently, increased graduate student enrollment and changing expectations for new graduates have motivated speech-language pathology programs to seek out clinical education models that follow these tenets in unique or “non-traditional” ways (Sheepway, Lincoln, & Togher, 2011). Such models may include group supervision or collaborative supervision, whereby the same clinical supervisor provides supervision to more than one student at a time. This might take the form of a weekly seminar where broad clinical topics are discussed amongst all student clinicians under the supervisor’s direction. Peer learning is another non-traditional approach during which two student clinicians share the same practicum experience and supervisor (Grundy, 2004) with the intent of working collaboratively with their partner and gaining experience that will be beneficial when they are later part of professional interdisciplinary teams (Baxter, 2004).

Speech-language pathology graduate programs in the United States, however, still most frequently use a “traditional” approach to clinical education (Sheepway et al., 2011). These most often involve one SLP supervisor overseeing the clinical experience of one student clinician (1:1 ratio), providing speech–language services to one client with a communication disorder (Sheepway et al., 2011). Within the traditional model, the continuum of supervision progresses from the supervisor taking a more directive role (with regard to feedback and supports in intervention planning) at the start of clinical training and moves toward the student clinician’s ability to self-monitor/self-supervise performance by the end (Anderson, 1988; Dowling, 2001; McCrea & Brasseur, 2003). Even when playing a more directive role, however, feedback (in the form of narratives on performance, rating scales, or competency-based assessments) is typically provided following the clinic session (Ho & Whitehill, 2009). That is, a graduate student clinician provides speech–language services to the client while a clinical supervisor observes (most often through a one-way mirror or live video feed) and the supervisor provides the student feedback regarding performance either immediately following the session or through delayed written feedback. Although the student may meet with the clinical supervisor to strategize the intervention plan, problem-solve clinical challenges, and brainstorm activities for targeting behavioral objectives, there is limited, if any, interaction between the student and supervisor during implementation of the intervention. A clinical supervisor might enter the room if the student requires assistance or to “fix” a challenging clinical situation, but these episodes are infrequent and most often in response to an emergent need. While this model may be effective for other clinical education situations, given the unique demands of serving children with ASD (particularly with concomitant behavior challenges), speech-language pathology graduate programs may need to look past these traditional models when teaching students to serve children with ASD.

The Apprenticeship Model of Supervision

In recent years, models of professional education and development have increasingly focused on reciprocity and social relationships within a community of learning (e.g., Feeney & Lamparelli, 2002; Glazer & Hannafin, 2006; Rueda & Monzo, 2002). The cognitive apprenticeship is one such model. Within this community, more competent learners assist other learners to move past their current skills and knowledge through participation in meaningful interactions (i.e., zone of proximal development; Vygotsky, 1934/1987). These roles are considered dynamic and both learners will have opportunities to contribute and co-construct the interaction (Rueda & Monzo, 2002).

Collins, Brown, and Holum (1991) differentiated a cognitive apprenticeship model from a traditional apprenticeship model in several ways. In a traditional model, an expert shows the apprentice how to complete a task and helps him or her complete it. The process is easily observable. Whereas in a cognitive apprenticeship model, the mentor must expose to the thinking behind the task and the protégé must also share his or her thinking about the intervention process. Thus, not only does a cognitive apprenticeship model include modeling, scaffolding, fading, and coaching, but mentors must also identify and make visible the underlying processes of the task, place the task within an authentic context, and then vary the situation and explain common aspects to ensure transfer of learning to new contexts (Collins et al., 1991).

Glazer and Hannafin (2006) described the use of such a model within school settings where teacher-leaders (mentors) and peer-teachers (protégés) learn through a collaborative partnership. Similar to the SLP supervision process described above, mentors take a more active and direct role at the beginning of learning and gradually decrease the intensity of their interactions as protégés become more independent and proficient. Glazer and Hannafin identified four phases of the apprenticeship model: (a) Introduction—Mentor teachers model use of intervention/teaching strategies, while protégés observe and participate in activities to support use of the strategies (e.g., role-playing); (b) Developmental—Mentors provide supports, scaffolding, and fading to protégés as they design and implement intervention activities; (c) Proficient—Protégés demonstrate autonomy in development and implementation of activities, while mentors identify areas for improvement and assist protégés in self-reflection and idea exploration; and (d) Mastery—Protégés become mentor teachers and are ready to model activities for new learners.

While this apprenticeship model has been frequently explored within the context of educator training, there has been limited discussion of its use within clinical settings. A notable exception is the use of this model within the speech-language pathology graduate program at the College of Saint Rose (Feeney & Lamparelli, 2002). Similar to Collins et al.’s (1991) description, they approach this model from the perspective of providing students with procedural support and intellectual support. Procedural support refers to use of a variety of teaching methods to assist student clinicians in learning target behaviors. These might include role-playing, modeling, cueing, imitating, shaping, fading, and modifying the task. “For students to fully understand and use intervention procedures, it is critical that supervisors model clinical procedures in order to promote success” (Feeney & Lamparelli, 2002; p. 26). With regard to intellectual support, they suggest the use of empirical readings and discussion of theoretical information to bridge academic knowledge to clinical application. In addition, they emphasize the need to support students in creation of behavioral objectives, clinical reports, and lesson plans. Critical features of the university’s apprenticeship model include the following: (a) The client is served effectively through sound planning and execution; (b) there is not extensive use of trial and error within the clinical practice itself; (c) supports are provided liberally as needed and faded when no longer needed; and (d) mentors and student clinicians both make explicit their thought processes and clinical decision-making processes (Feeney & Lamparelli, 2002).

The following case illustration describes the use of the apprenticeship model within the framework of serving a young child with ASD and her sibling. Our model represents a combination of those described above, with focus on intellectual and procedural supports (Collins et al., 1991; Feeney & Lamparelli, 2002) following the progression described by Glazer and Hannafin (2006).

A Case Illustration of the Apprenticeship Model in SLP Clinical Education

The apprenticeship model was used within the context of a study investigating the effects of a hybrid social communication intervention for children with ASD. The intervention combines two effective methods for targeting social communication—peer mediation (where the sibling of the child with ASD served as the “peer”) and video modeling, within the framework of Pivotal Response Training (PRT; see Ferraioli & Harris, 2011; R. L. Koegel & Koegel, 2012; Wang, Chui, & Parrila, 2011, for further information regarding these treatment methods).

Student Clinicians and Mentor

Two first-year graduate students completed one 10-week term of clinical practicum serving one child with ASD and her sibling (2 times per week for 50 minutes). Both students held a bachelor’s degree or post-baccalaureate degree in Speech & Hearing Sciences and were enrolled in the Master of Science program in speech-language pathology. Both students were in their third term of the graduate program and had completed two previous terms of on-campus clinical practicum under a traditional supervision framework serving individuals presenting with communication challenges other than ASD (e.g., child with speech–sound disorder, adult with acquired language disorder). Throughout the current practicum, the students were directly supervised using the apprenticeship model by a licensed and certified SLP with expertise in serving children with ASD (SLP mentor clinician). The mentor was either present in the clinic room or observing through the one-way mirror for 100% of all treatment sessions—This differs from traditional models of supervision, where direct observation is required 25% of the time by ASHA (2008) and typical programs average 50% to 60% across the course of the academic term.

Mentor Preparation

As indicated above, the mentor was a licensed and certified SLP with more than 8 years of experience serving children with ASD and their families. During this time, the mentor regularly trained caregivers to provide parent-implemented intervention targeting social communication skills for their children with ASD. The mentor further prepared for the current study by reading pertinent empirical literature related to the apprenticeship model (e.g., Glazer & Hannafin, 2006) and the intervention methods to be used in treatment (e.g., R. L. Koegel & Koegel, 2012). She and the first author discussed the readings and reviewed videos of previous implementation of the apprenticeship model (by the author); discussions focused on use of supervisor strategies, particularly related to provision of immediate, hands-on feedback, as well as overall principles related to PRT (how to facilitate student understanding of PRT implementation). In addition, the author modeled use of the strategies and discussed implementation with the mentor throughout the course of the intervention. The author also monitored the mentor’s performance through direct observation and regular meetings with both mentor and student clinicians.

Pre-Intervention Student Preparation

Prior to the start of the term, the students completed a 3-hour training with the mentor clinician and the author focusing on discussion of the intervention methods to be used during the treatment, creation of behavioral objectives, ongoing data collection, and review of video recordings of the child with ASD that were collected during her initial assessment with the author (e.g., Autism Diagnostic Observation Schedule–2; Lord et al., 2012) and a natural play interaction with her sibling. LeBlanc and colleagues (2009) indicated that use of videos for training personnel serving children with ASD is an effective tool. As the student clinicians had not yet met the children, this afforded them an opportunity to learn about the children’s social communication skills with guidance during the shared viewing from the mentor clinician. During viewing, special attention was given to showing the students how the environment (including communication partner, activity, physical space) can influence child performance—This is a key observational skill necessary to understanding behavior (Kearney, 2008) and is a training goal for professionals serving children with ASD (LeBlanc et al., 2009).

To address the first step in EBP (critically analyzing the empirical literature), the students then completed two independent study modules published to the university’s online learning management system (Desire2Learn). The aim of the study modules, which included empirical readings, online discussions, and review of already-available online resources related to ASD, was to provide intellectual support to increase the student clinicians’ knowledge related to the following: (a) core social and communication characteristics of children with ASD (American Psychiatric Association, 2013; Landa, 2005), (b) empirical evidence for (Reichow & Volkmar, 2010) and specific procedures for implementing video modeling (Banda, Matuszny, & Turkan, 2007; Charlop, Dennis, Carpenter, & Greenburg, 2010) and sibling mediation (Pierce & Schriebman, 1995, 1997), and (c) empirical evidence for and specific procedures for implementing PRT (L. K. Koegel, Koegel, Harrower, & Carter, 1999; R. L. Koegel et al., 1989)

Two online assessments using multiple-choice and true/false items were used to measure pre- and post-module knowledge of (a) key characteristics of ASD and (b) the tenets of PRT and the procedures for implementing video modeling and sibling mediation. At pre-module assessment for knowledge of key characteristics of ASD, both Students 1 and 2 demonstrated 80% accuracy. At post-module assessment, both demonstrated 100% accuracy. At pre-module assessment for knowledge of PRT tenets and intervention procedures, Student 1 demonstrated 75% accuracy and Student 2 demonstrated 80% accuracy. At post-module assessment, they demonstrated 95% and 100%, respectively.

Introduction Phase

Following completion of this pre-intervention training, the children began treatment. As a first step, the student clinicians and mentor met with the children’s parents and discussed the family’s priorities for intervention with the intent of establishing social communication targets that would be meaningful to the family at home and in the community (Step 3 in EBP: Matching intervention to family values and beliefs). The students co-led this meeting with the mentor and the author. To prepare, the mentor met with the students to share specific strategies for communicating with families, review the foundational principles of the intervention approach, and discuss the student clinicians’ ideas about potential target behaviors (and their rationale for identifying them). After determining with the family the initial skills to be targeted for each child, the students worked closely with the mentor to develop clear behavioral objectives that would allow for reliable data collection and analysis (intellectual support and Step 2 in EBP: a tool for collecting practice-based evidence).

Throughout the 10-week intervention, the mentor clinician guided the students’ development following the structure of the apprenticeship model described above. At the start of the term (Introduction phase), the mentor provided significant procedural support by actively modeling intervention methods within the treatment session, providing opportunities for the students to imitate the methods, as well as to demonstrate their own independent implementation with ongoing feedback. This kind of support may also be well suited to education teams, who might benefit from this level of guidance during the first stages of student teaching or when implementing use of a new curriculum for children with ASD. Following closely the procedures described by Feeney and Lamparelli (2002), the team ensured that the children received effective, high-quality intervention (either through modeling by the mentor or supported implementation by the students). Trial and error was limited due to the presence of the mentor in the treatment room to provide ongoing supports.

Immediately following sessions, the mentor also provided students with intellectual supports—clearly explaining her thinking behind her clinical decision making and drawing attention to features in the environment that influenced her performance (and that of the children). During weekly meetings with the students, the mentor offered further intellectual support by reflecting on the treatment sessions and encouraging the students to express their thoughts and perceptions about different aspects of the intervention (e.g., material selection, use of prompting, clarity of teaching, use of consistent and contingent reinforcement, etc.). The mentor supported development of lesson plans through brainstorming about intervention activities and guidance on clinical report writing by providing students with examples of previous reports. The students completed weekly written reflection exercises where they evaluated their performance and communicated about their experience within the team. Of note throughout the intervention was the use of peer learning opportunities. Students were encouraged and guided in their joint development of lesson plans, activity selection, review of intervention implementation (by co-viewing videos of intervention), and data collection. Finally, they also attended one of three group seminars with the author, the mentor, and other student clinicians also participating in the intervention (serving a different participant dyad). The hour and one-half seminars, spread across the course of the 10-week intervention, provided both intellectual and procedural supports through further exploration of the PRT intervention model and its application with the child participants, role-playing of teaching strategies, reflection on performance using video recordings of treatment sessions, and increased opportunities for peer learning across students.

Developmental Phase

During the Developmental phase, the students’ autonomy grew as they collaboratively developed lesson plans and discussed their ideas for teaching target behaviors within weekly meetings with the mentor. Students, the mentor, and the author determined the seminar topics cooperatively, incorporating an opportunity for discussion of foundation concepts (e.g., behavioral principles) that appeared to be more meaningful following opportunities to apply them within treatment, as well as student-generated topics related to problem solving and clinical decision making (e.g., identifying the function of challenging behavior, increasing motivation through activity selection, monitoring and modifying the environment, etc.). With regard to procedural support, the mentor’s scaffolding increased or decreased depending upon student performance. Students demonstrated increased independence in implementation of previously targeted skills, but required additional supports such as modeling, direct cueing, and reinforcement to teach new skills to the children. Students continued to complete weekly reflections on performance and bring ideas and questions to weekly mentor meetings.

Proficiency Phase

As the end of the term approached, students moved into the Proficiency phase during which they independently planned and executed treatment activities, collected data, and analyzed child performance culminating in a final clinical report for the family. Again, this progression may be similar to development of autonomy during the student teaching experience, or by a classroom teacher or educational assistant following ongoing coaching by a school or district mentor (e.g., “autism specialist”). The mentor, while still available and able to join the interaction when needed, stepped back and more frequently only observed student implementation of intervention. The mentor then asked students to critically analyze their performance and offered feedback to support further development of skills and to promote discussion of how skills might carryover to new contexts and serving different children. Within the final seminar of the intervention, the students led the discussion and a review of intervention video recordings. They identified successful and less successful methods of their own intervention implementation, and offered peers constructive feedback about their performance as well. The mentor and this author encouraged students to fully explore these topics with occasional feedback, reinforcement, and further reflection points.

Student Fidelity

As would not be expected following a 10-week intervention, students did not achieve the Mastery phase where they would be prepared to serve as the mentor to new students. They did, however, demonstrate strong fidelity of intervention implementation. Fidelity was measured by the author using 10-minute video recordings of independent student implementation of intervention at multiple time points (Weeks 1, 5, 10) throughout the course of the 10-week intervention. The fidelity measure was adapted from the Classroom Pivotal Response Training (CPRT) fidelity measure (Stahmer, Suhrheinrich, Reed, Schreibman, & Bolduc, 2011) and focuses on use of key principles of PRT, including motivation, shared control, use of clear instructions, use of contingent and immediate consequences, providing opportunities for response to multiple cues, and use of effective prompts. From the first training session, the mentor shared the fidelity form with the students to make explicit the student expectations and to guide discussions of student performance over the course of the term.

The author coded fidelity across all time points; she was blind to the chronological order of the videos. The mentor was trained in fidelity coding and also coded fidelity across all time points to assess measurement reliability. Cohen’s Kappa, a statistic that considers chance agreement within the total proportion of agreement (Hollenbeck, 1978), was used to determine interobserver agreement. A Cohen’s Kappa coefficient of .89 was achieved; Kappa values above .70 are considered good interobserver agreement (Cicchetti & Sparrow, 1981). Table 1 depicts each student’s mean fidelity score at each time point.

Table 1.

Mean Scores of Student Fidelity Across Intervention.

Student	Week 1	Week 5	Week 10
1	1.74	3.27	4.53
2	2.23	3.74	4.79

Note. Fidelity Scale: 1 = clinician uses the method <30% of the session; 2 = 30+% of the session; 3 = 50+% of the session; 4 = 80+% of the session; 5 = clinician implements across the session.

As indicated, both students achieved strong fidelity (more than 80%) by the third time point. Please note, however, the following: At no time over the course of the 10-week intervention did overall intervention implementation fall below fidelity of 80%, as the mentor ensured fidelity and effectiveness of intervention (Feeney & Lamparelli, 2002) through modeling and coaching.

The Apprenticeship Model and Clinical Education

The case above illustrates the successful use of the apprenticeship model of supervision in teaching graduate speech-language pathology student clinicians to serve children with ASD. Use of the model met the clinical education aims of increasing the student clinicians’ ASD-specific knowledge and skills, supporting internalization of such knowledge to promote generalization to new children with ASD, and teaching students the steps of EBP.

Indeed, the apprenticeship model seemed to be particularly well suited to this training, not only due to the varied presentation and level of severity represented by children with ASD but also due to the use of a naturalistic behavioral intervention for targeting social communication skills. LeBlanc et al. (2009) indicated, “Highly engaging incidental or naturalistic teaching may be more difficult to train than structured discrete-trail instructional procedure” (p. 226). To this end, the model provided an environment in which the mentor could readily assist student clinicians in identifying the relationship between instructional methods and environment and its subsequent impact on behavior in the moment—Understanding this relationship is an essential part of successful intervention for children with ASD (LeBlanc et al., 2009).

Another advantage of the apprenticeship model was to reduce (or, hopefully, eliminate) the “stigma” that may be associated with a supervisor entering into the intervention interaction. As indicated above, within traditional models, direct supervision involvement most frequently occurs only when a student requires assistance, leaving the impression that supervisor involvement equates with error on the student’s part. During the case described above, the mentor and author challenged the students to shift their thinking with regard to the mentor’s presence in treatment—to understand that the intent was promotion of a reciprocal relationship (a partnership in learning), rather than what might be perceived as solely a corrective presence.

Interviews with students following the intervention revealed that while this paradigm shift was at first challenging for the students, they highly preferred this method of supervision to the traditional model, particularly for serving children with ASD. This is significant. Because children with ASD may present with behavioral challenges or changes in response to treatment based on co-occurring and environmental factors, LeBlanc and colleagues emphasize the need for clear communication and use of praise within training. They state that service providers might be “reluctant to report [problem behavior] for fear of negative evaluation of performance” (LeBlanc et al., 2009, p. 230). The apprenticeship model provides students with hands-on experience in managing challenging behaviors through the mentor’s use of modeling, cueing, and reinforcement and it encourages frank discussion of such situations. The mentor openly identifies times when she has been challenged or when things did not proceed as expected or planned. The mentor and students can then brainstorm ideas for how to approach the situation again with new methods. Given these factors, this approach may be useful in the professional development of educational assistants or other team members who may encounter challenging behaviors when serving children with ASD.

Finally, “praise is most effective when it directly follows monitoring of performance and when it is directly contingent upon and descriptive of aspects of performance” (LeBlanc et al., 2009, p. 227). The apprenticeship model allows for such praise within training. Much like working with children with ASD, the potency of the reinforcer can be diminished when delayed (Kearney, 2008). Because the mentor can provide feedback and praise immediately within the treatment session, the behaviors of student clinicians can be directly shaped or reinforced, respectively.

Although use of the apprenticeship model has clear advantages for pre-professional ASD-specific training, there are also several challenges to adoption. First, this model (with 100% supervision) is resource intensive. Within the current higher education economic climate, this intensity of supervision may be prohibitive. Within the current case, however, the mentor was able to supervise two student clinicians at 1 time (equating in supervisory time to supervising two students at 50%). In addition, students were able to take advantage of peer learning within this highly supported framework. As such, a possible solution with regard to resources might be to provide peer or sibling dyad services to children with ASD, training two student clinicians at once within the apprenticeship model.

Another possible limitation of the model is reduced student clinician autonomy as they encounter a new clinical experience. A skilled mentor must know how to identify when students are transitioning through phases (particularly from Introduction to Development), to provide students with opportunities for growth and independence. While the reduced focus on trial and error learning ensures that the child receives effective and high-quality services, it can potentially affect the student clinician’s independent problem-solving skills and create some dependence on the mentor. As such, the role of the mentor in articulating her thoughts and internal decision-making processes and encouraging the same from students is of importance to counteract this potential challenge.

Conclusion

School professionals are faced with numerous challenges in designing and implementing specialized services for students with ASD. Given the unique and varied presentation of these students, team members must be able to collaborate and communicate effectively across disciplines to ensure continuity of services. Pre-professional training, for both educators and related service providers, has been identified as an area of growth for building such capacity. The apprenticeship model is one approach to teacher and clinical training that is worth further consideration. The model allows for intensive ASD-specific learning within a framework of reciprocity and social interaction that may help to prepare students from all disciplines for joining communities of learning within their work environments. As indicated, use of the model can also be extended to professional development within schools (Glazer & Hannafin, 2006), providing school teams with a framework for ongoing co-learning across members and creating an environment of reciprocity and engagement.

Footnotes

Acknowledgements

The author wishes to acknowledge the contributions of the participants and student clinicians who were described in the case illustration, as well as the mentor clinician, Tammi Bailey.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Autism Speaks (Treatment Research Grant—Pilot Level No. 8094).

Author Biography

Amy Donaldson is an Assistant Professor in the Department of Speech and Hearing Sciences at Portland State University. Her research focuses on examining the effects of intervention on the social communication skills of children with ASD and fidelity of intervention implementation by service providers.

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