The applicability of implementing Enhanced Milieu Teaching (EMT) with young children with developmental disabilities who reside in the Western Cape and speak Afrikaans or IsiXhosa at home: parent and professional perspectives

Master Thesis


Permanent link to this Item
Journal Title
Link to Journal
Journal ISSN
Volume Title
Background: Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) to improve expressive communication. EMT produces favourable long-term results in both vocabulary growth and linguistic structure after a relatively short intervention period. However, very little research has been conducted to prove its effectiveness in culturally and linguistically diverse populations. Furthermore, before interventions can be implemented in different contexts, there is a need to determine if any adaptations are needed to maximize the fit of the intervention to the novel context. Tension exists between the need for implementation fidelity and the flexibility or fit of an intervention into novel settings, populations and contexts. A single proof of concept study exists which indicates that a trained therapist can implement EMT to fidelity in a South African special school context with English-speaking children. However, very little research exists which documents stakeholder perspectives of the perceived fit of naturalistic developmental behavioural interventions in the South African context. This study adds to this important body of literature by documenting the perceptions of bilingual Speech and Language Therapists, as well as bilingual parents of children with developmental disabilities, regarding the applicability of EMT within the South African context. Aim: To determine bilingual parents’ and Speech and Language Therapists’ perceptions regarding the acceptability and appropriateness of implementing EMT with young children with developmental disabilities who reside in the Western Cape and speak Afrikaans or isiXhosa at home. Methods: A descriptive exploratory study was conducted using two qualitative methods. Five bilingual SLT’s were interviewed, and two focus groups with eleven bilingual parents of children with developmental disabilities was conducted thereafter. Data was transcribed and analysed using thematic analysis according to the approach suggested by Braun & Clarke, (2006). The findings of the thematic analysis were then merged as subthemes within the adaptome framework (Chambers & Norton, 2016) in order to present diverse parent and SLT perspectives adequately. The adaptome framework comprises four sources of adaptations, namely: service setting, mode of delivery, target audience and cultural adaptations. vi Results: The barriers and facilitators to implementing EMT, together with the areas for potential adaptation within a multilingual and/or multicultural context, were reported in this study. Both parent and professional stakeholders reported that the core components of EMT are appropriate within their contexts and would not require adaptations. The data obtained from both parent and professional participants pertaining to potential adaptations were grouped into ten subthemes which were assigned within the four sources of adaptation. Bilingual SLTs highlighted aspects such as limited resources and limited parent-professional collaborations as barriers to sustained implementation across diverse service settings. Parents expressed concerns regarding the resources and the mode of intervention delivery used during EMT implementation. The facilitators and barriers, together with the areas for potential adaptation identified by the participants, align with perceptions of parents and professionals as reported in previous literature. Implications: Bilingual parent and professional stakeholder participants found that the core components of EMT would be appropriate in the South African context. However, participants suggested that adaptations to the peripheral elements of EMT would be required, with the majority of the adaptations relating to preferred service delivery settings and the mode of intervention delivery. Conclusion: Bilingual parents and Speech and Language Therapists view EMT as an appropriate and potentially valuable intervention in the South African context.