Original Research Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines

Chevonne D. du Plessis, Lauren H. Hampton, Michal Harty

South African Journal of Communication Disorders | Vol 71, No 1 | a989 | DOI: https://doi.org/10.4102/sajcd.v71i1.989 | © 2024 Chevonne D. du Plessis, Lauren H. Hampton, Michal Harty | This work is licensed under CC Attribution 4.0
Submitted: 21 April 2023 | Published: 21 February 2024

About the author(s) Chevonne D. du Plessis, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Lauren H. Hampton, Department of Special Education, The University of Texas at Austin, Austin, United States
Michal Harty, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Centre for Autism Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT’s fit or what adaptations might be needed to improve its applicability within a resource-constrained setting.

Objectives: To explore stakeholders’ perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT’s contextual fit.

Method: We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components.

Results: Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families’ available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa.

Conclusion: Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.

Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

Keywords

adaptations; contextual fit; developmental disabilities; Enhanced Milieu Teaching; implementation science; naturalistic developmental behavioural interventions; resource-constrained settings; stakeholder perceptions

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