Thanks to an NIH grant, Undivided has partnered with researchers at Stanford and the University of Oregon to provide the Family Advice and Support Text and Telephone line (FASTT), a text-based service available for caregivers to receive customized advice and support on questions about challenging behaviors and managing stress related to caregiving. Parents can text as little or as much as they want, and they can pause and come back when they have time. The most asked for topics include:
In March 2024, we sat down with Dr. Shannon Peake, one of the researchers behind FASTT, to talk about the program and its impact on parents. FASTT is still open to new parent signups, so watch the replay of our conversation to learn how to participate! (FASTT is available to all parents of children under age 10 in California — no Undivided membership required.)
Lindsay Crain
What is FASTT? And how does it work?
Dr. Peake
FASTT stands for family advice, support, text and telephone line. And that really gives the clue to what it is. It's a text and telephone service for families of neurodiverse children to get tips on building skills or behavioral topics for their child. Its partnership between Undivided and the University of Oregon. I work at the University of Oregon. I'm a research assistant professor, and we work on child development programs and research on child development.
Lindsay
Why did you why did you start FASTT? What was the need that you were seeing from families?
Dr. Peake
You know, we were talking to a lot of families working with families in different contexts. And I don't think it's a surprise to anyone that you know, raising a child is can be challenging. Any child and especially raising a child that's neurodiverse can have its own challenges. And parents had other services available to them, like occupational therapy, speech and language, autism specialists, for example. But those were more structured services, something you would make an appointment for, you would go to an office or a clinic, or sometimes they would come to your home, but it was more structured. And we were seeing, and this especially was prominent, during the pandemic, when parents had very limited availability to go out to places or have people come into their homes, they needed a more flexible way of getting tips and strategies that they could be working on. And so that's why we started FASTT so that we could offer something that was text based, very flexible, you can text in get the tips you need, you can pause conversations, you can read them when you have time, it just seemed like a more accessible way to get some help.
Lindsay
One of one of the silver linings of the pandemic, I guess, right, we were forced to sort of, you know, break out of the comfort zone, but also discovered, right, that there are other ways that we can get help. But I do want to talk specifically about how FASTT works. But first, I think that it's important to talk about the principles in which it's rooted. So it is strength based, child centered and evidence based. So which are all beautiful words, you know, that parents want to hear? So but if you could tell us about that, and how that really does root, what you're doing?
Dr. Peake
Yeah, let's walk through those. FASTT is strength based. And that means that we focus our perspective on the strengths of the child and build on those. Now, people use the term strength based a number of different ways. But for us, what that means is we're not so much looking, it's not a deficit based focus, we're not looking at what the child can't do. We're taking whatever the skill or the behavior is flipping it to the thing that we want to build. And then we look to see where's the child at on that skill. And that allows us and and here's the thing, they're never at zero. They're always somewhere, they always have some amount of that skill. That then helps us work with the parent to figure out okay, what are the steps that are closest to where they're at, that we can help support them in building the skill. So that is why we call it a strength based still skill, because it is based on what the child can already do. And then finding the next accessible steps that are able for them to manage to build the skill. The second part is about a child centered approach. So in this case, we don't just think about behavior and changing behavior. We view, as many others do, we view behavior as a form of communication. It's a way of understanding what does the child need? What do they want? What what is helpful for them in that moment? And sometimes it's more challenging than others. But but the idea that it's a communication means then that we we aren't just looking to fix a behavior, we're looking at what's the underlying message that's being sent? And can we address that? That is often more helpful. It sometimes means that we're not changing behavior, we're changing things that might trigger a behavior, or we might think of more acceptable ways for the child to get that need met. Sometimes it means there's a change to the environment or the demands on the child that would help them. So that's what we mean by a child centered approach as opposed to behavior approach. And then the last thing is we use evidence based approaches. So we work at a university, we do research ourselves. And we actually really adhere to using evidence to see what is really working. And that means programs or approaches that have been tested, they have been run in trials to see that they actually work, not just someone's idea of what might work. And we take that very seriously. So so we use evidence based approaches. Now, that said, evidence based approaches incorporates a wide range of things. And not all of those approaches fit with each child or parent. So part of our job is to understand what are the evidence based approaches, and help find the ones that fit best with for that child and that parent.
Lindsay
I love that, because it isn't just about "Yep, there's evidence that this works. So we're gonna fit your child into this mold." Because a lot of times I know a lot of parents feel like they're going into something. And it is about fitting their child into a certain mold doing something a certain way. And again, that would be the opposite of child centered. So I love that that is your approach, as it should be the approach and many things that are our family space. Yeah.
Dr. Peake
When we say is it a fit, it's really a fit for whom? And, and, and there are a lot of factors that go into that.
Lindsay
Yeah, definitely. And so how does the program work? Like, what can parents expect when they use it?
Dr. Peake
First of all, this is a research study. So this is a federally funded research study to test how is this working? And so because of that there's a consent process, the first thing a parent would do is they'll get a link to a consent where they read through, and that tells them about what the study is, what are we doing it, we'll talk about things like privacy, confidentiality, and we'll ask them to sign off that they agree for them to be in the study, then we'll ask them to do some online surveys. And these are pretty short, like most parents finished these in, I don't know, 10, maybe 15 minutes. Like, there's some questions about parenting stress things that are stressful for you as a parent. And then there's some questions about how you view yourself in your role as a parent. And then there's some demographic questions, you know, basic household size, status, things like that. And they'll do the questionnaires, then they'll get a text sent to their phone, and it will be a welcome text that'll say, Hey, welcome to the FASTT line. Here's how it works, text us when you've got a topic that you want to talk with a specialist about. And when they're ready, they text in and they'll say, oh, I want to talk about this topic. And as specialist support specialist will reengage with them. The hours of that study are the hours of the service are Monday through Friday, 9am to 6pm Pacific time. So within those hours, they'll get a text back, and the person will say, hey, and they'll ask a few questions about the topic about their child. And then they'll go back and forth with some strategies after they finish that, and that can be over a short period of time in a single day. Or it might be, if the parent's busy, they might pause and they might pick it up later, next day, two days later, a week. There's no set time on when the parent responds. But once they kind of have the strategies they feel like they are willing to try, then that topic will get closed down. And they'll receive another text in about two weeks after they've had time to try it. To do a follow up survey, same questions like parenting stress, parenting ideas, and some questions about their experience of using the program. So how was it for you? What worked well? Are there things that you think could be better? So that we learn about how the program is working. And then that's really that's, that's the program.
Lindsay
So would a parent do the survey after every question that they had? Is it every topic? Or how often are they responding to how those strategies worked for their family?
Dr. Peake
Yeah, good question. They, we, for the purposes of the research aspect of this, they only do the surveys once, you know, they'll do the pre survey, then they'll get some strategies, and then they'll do the what we call the post survey after they finished. They can still text in as many times as they want on other topics like there's no there's no limit on that. And we encourage them to do that. We love that. But we're not going to ask them for surveys for every single topic. And so it's just one time, it's just one time. I'll also say because you mentioned it earlier that as a thank you for taking the time to do these surveys, we'll give them a $25 Amazon gift card for each of the two surveys. That's not a ton, but you know, might be helpful for something.
Lindsay
Well, yes. And if you're like, some unnamed people that you know, you might be seeing on screen, Amazon might come to your door quite often. So we know that families, you know, every every bit counts. Absolutely. And I did have a follow up question. I really love this piece, so I want to make sure that parents hear it, that if when you said, they can come back to it. So it isn't like, Okay, I'm going to text and then maybe I'm going to, and maybe you are, or could you be on a session talking to somebody for an hour texting back and forth? Or if you're like, I need to, like ask this question. But then I'm going to need to go get my you know, son at school, I'm going to run out. So it might be five minutes, and you can continue later. I just wanted to follow up on that. Because I think that's a really, we know how busy parents lives are. And so that they really know that this is something within those working hours that they can send something to, but it doesn't have to be I need to set aside an hour for this.
Dr. Peake
Yeah, exactly. Yeah, that is totally the way it works. The whole idea of this is that it's flexible, that parents can do it when they've got time. They can text in, we sometimes will have a parent who will just engage and they want to do all the questions right at all, all in a block. And that is fine. But very often, I would say more often we have parents who will text in, they'll send us up some questions, we'll maybe ask them a couple of questions so that we're trying to understand what will work best for them. And then there'll be a pause, and we might get an answer back later that day, or sometimes the next day, sometimes it's a couple of days, sometimes it's a week, there's just no rule for it. And that's fine with us. The whole idea of this is to make it flexible, and accessible.
Lindsay
Wonderful. I think it would be great if you could maybe give us an example, and walk us through how that can be handled by a FASTT support specialist.
Dr. Peake
When the parent texts in for an issue and they'll say I'm working on this issue with my child. And they'll get a, first of all, they'll get a greeting back from a support specialist, an early childhood support specialist. And these specialists are trained in evidence based approaches, and trained in how to do this over text. Right. So they will get a text back saying Hi, my name is so and so, I'm, you know, a support specialist and I've been assigned to work with you. And they'll ask a few questions usually, because usually the parent will say something like, Oh, my, my child's having some issues with aggression, or my child's having problems with anxiety or whatever the issue is, the support specialist will start to ask a few questions about the background and and what the parents tried. And then they'll sort of establish this rapport. We usually will go through a series of steps that help us understand is there a challenging behavior? And then we'll move that to identify what is the corresponding skill, or that behavior? That's the strength based part. And then we'll do a little check to find out what are the some of the specific things for this child. Now, it's not an exhaustive list, or history of everything about that child, we're really trying to understand things that are relevant to this particular whatever the topic is for the parent, and, and also things that the parent may have tried, and the parents beliefs about a couple of things. So it will typically sound like this. I want to help my child with you know, my child says no all the time to me, and what would I ask? And that would be an example.
Lindsay
I can relate just this morning, I can relate.
Dr. Peake
We will say okay, that's pretty easy one to flip, we'll say. So what you want to do is build cooperation for your child. Yes. And we'll start to figure out where's the child at like, how often are they cooperating versus not cooperating? What are the what are some of the circumstances where we're finding that they're not cooperating? What might be triggers for those things? What does it look like? We'll ask the parent what they've tried so far. And if they have any, you know, values around that, like, hey, are there some things that you've tried? Are there particular approaches that you don't want to do? So we'll find some parents who are open to any evidence based approach, and they're very open about what are the options some parents have tried some things and feel like it's not for them and their child and they want to stay away from them. And that is totally fine with us. We can do that. help us give them strategies that are a better fit. Let's see what would be example so that in texting, what we'll do is we'll go through with the parent. And we're trying to do this as efficiently as possible through text. And that's not always easy. You know, texting is not always the simplest way. But we can ask key questions that will give us an idea of those directions relatively quickly, and will give the parents some choices. It's almost like playing a game of would you rather right? Would you rather this? Or would you rather this? It's a broad direction. And when the parent answers, we'll say, Okay, I see this direction. And then we'll say, Okay, let's talk about some strategies in this direction, we'll float a general idea of a strategy. If the parent says, That sounds interesting, then we'll send details on that. And the details can be lengthy. I'm not gonna lie, like they can be lengthy. But a lot of parents tell us that they want the details. They want the data, they just don't want a ton of things that are not relevant to what they're asking. But once we get to what they're asking, they do want the details. We've also heard from parents that having the details in a text is nice, because they can go back and read refer to it, periodically, they can reread it. So they don't just have to listen to it and remember it. And that's it. So we'll usually check with the parent after we give the details about how they feel about that strategy. Does it seem to fit with what they're thinking? Are they did they feel like it's something they can try? And once they say, Yep, I think that is I'm going to try that. Then that particular case is done in about two weeks, then they'll get a a text that says, Hey, do you want to do the follow up survey?
Lindsay
I think you already answered this. But just to reiterate, so how often can parents text for help?
Dr. Peake
It's unlimited. Yeah, I mean, well, while we're running the program, so the program is funded for a set length of time, and I think we're going to we're wrapping up in July of 2024, this coming July. And so through that period of time, as much as you want.
Lindsay
And I know families will want to know this, will they get to speak to the same person every time they text?
Dr. Peake
Yeah, we try to do that. When the support specialist goes on, they will, there's a way that they can so to speak claim that case, and then that just stays with them. And that's helpful, because then you don't have to re explain things. And that's the way we do it. Occasionally, there'll be a case where a parent needs an answer right away. And if that support specialist person is not in that day, someone else may step in to give some help. If the parent need is time sensitive, they'll step in. And the same thing is that if they text back and later on a new topic, we will try to keep the same support specialists person. So you don't have to start over.
Lindsay
Exactly. That's, again, time is golden, for families. And so when you can just sort of take off running with somebody that already has some backstory, that's always helpful. So that's, that's great. And I also wanted to ask, do you, do you suggest that FASTT, do you suggest it as a standalone behavior intervention or in addition to what families might already be using?
Dr. Peake
Definitely, in addition, we know that families will often have support services available to them. And those support services, FASTT is not a substitute, let's say for speech and language therapy, or occupational therapy, or even autism specialists like that. Those are in depth, you know, more intensive therapies, and they're often in person, which is very important. So it's not a replacement for those. This is really about, hey, I need some tips in between, or I need some tips that align with that. And our focus is really on support for building skills around especially around behaviors. Like that is our that is our focus. And sometimes those other services include that or some form of that, but we're really focused on it. Now, that said, I think that you can, you can get pretty good guidance from text. Just, there's sometimes when a behavior is really intense, right? You're really dealing with something tough. You're going to want you're going to want more intensive work on that. The text isn't going to do it.
Lindsay
It's really a great option as an extra support for parents, and like you said it's those skills and so if you're if you're getting any kind of, you know behavior intervention in whatever form that may be on the regular, we all know that lots of things happen in between or you might have follow up questions and you can't, you can't access, you know, your child's team, you know, in real time quite often. And so to have an extra gateway to learn those skills for parents, a direct support for parents is just, you know, really essential. There's, there's not, I don't think there can be too many, you know, places for parents to go for help, especially like, if it is in that moment, or even in that moment of like, hey, this has been going on, I gotta run out the door. But you know, help, right?
Dr. Peake
Yeah, yeah. I think, let's say you're in between visits with one of your specialists support programs, the, one of the options for a parent, well, they can go do an internet search. And then there's just like, a myriad of things, some of which are great, some of which are not great. There's forums and other groups of parents, which are super helpful, here's been my experience. What we're trying to add to that is a place where there are people who really think about what are evidence based approaches, and really try to think about what will work for that child and that parent. So that's the idea. And to be able to do it flexibly when you may not have time or availability. The other thing I'm hearing from parents is that when they're working on these strategies, sometimes they want to know the answer to something kind of while the behaviors happening. Like, right, very close to when the behaviors happening. And that just makes it so that they can begin trying things like right then, right, it's just faster. And you don't have to remember what happened last week. It just happened.
Lindsay
And, and so important. I think it's really exciting when parents can get involved with these research studies, because then they can really give you the feedback of, you know, this works, or this didn't, or, you know, this would be more effective, right? So you guys can really learn from families about did it work in the moment, you know, was it better when you know, you came back a week later, or, you know, getting that feedback, because every family is different. But I love the opportunity for things to be built, obviously, with parents, which is that's that's what this is all about. And I'm sorry, did you have something to say?
Dr. Peake
Well, I'll just say that, you know, we're learning through this, through this partnership, we are learning also, and we are adjusting the service to see how it fits better with parents and what they need. I'll say that the early on, we began understanding how important it was to understand the parents experience with different things, because that really guided a lot of the work. And so I think we're we are now starting to dial in a little bit better on it. Occasionally, we're hearing from parents, well, this worked or this didn't work. Plus one of the clearest things that we're seeing is that you can't just reliably pick any one strategy and know 100% that is going to work for you and your child in that moment. Not only are there different circumstances, but there's different timings, developmental timings of the kids, some things will work at one age, and they won't work at another. And so all of the strategies, and this is something we really try to work with parents on is that you should view them as a test and experiment. I wonder how this is gonna work and trying it out. And then you'll watch the result. And we'll tell them like, hey, if this is working, here's what you should see, you should see this behavior changing. And you should see this skill changing. And you should see it over the next two weeks. So that parents approach this with the idea of testing. And we really love it when parents will give us feedback later to go, Hey, that worked or No, no, I need a different one.
Lindsay
Yeah, and, and one of the hard and fast rules that I think parents know to rely on is that what works one day might not work the next but sometimes it does, sometimes. Well and on that, I love, obviously this is a passion project for you and your team and something again that anything giving access to parents for more skills and strategies and support is something we get excited about. But I would love, you know, is there anything that you want to say to parents who are struggling you know, with with best with how to best support their children?
Dr. Peake
First of all, we talked with a lot of parents and in the course of that we also hear about their kids and their circumstances, life circumstances and the behaviors that they're sometimes dealing with, we hear about what they want for their kids, what their hopes are for the future. And so the first thing I would just say to the parents is that I really wish that the world in general could see what we see what what we see parents doing to support their kids, like the effort, the challenges that they are willing to deal with. Like, I'm impressed by it every day, every day. So first, that second thing I'll say is that this sounds maybe trite, but hang in there. And because we are seeing the improvement for kids, I remember, a while back, there was we were doing a group implementation, it was a group of parents all had neurodiverse kids. And there was one mom, who had, and her child was three had just been diagnosed with autism, and had some very challenging behaviors. And, and she was struggling a little, like, that was hard. And the newness of it, and all the things that she was facing was hard. And there was another mom in the same group. And she had three kids, all of whom had autism. And they were like, 13, 9, and maybe 7. Anyway, they were a lot older. And that mom, I remember that mom telling the younger mom, hey, it gets better. Like, it's not easy. But I've been doing this a while now. And she had the benefit of seeing over time, literally over the years. And developmental stages, how it gets better. And so that's what I would say to parents: hang in there. It gets better, focus on the small wins, because they will be if you if you can see them. I think it's reassuring to know that you're on the path for it to get better.
Lindsay
Absolutely. And one of the big parts on that path is finding your partners and finding, you know, and taking the time. You know, for yourself, I guess some people might say this isn't exactly self care. But I would say that it could absolutely fit into that category. We all we all need our toolbox of ways that you know, we can really best reach and support our children, and, and ourselves. And I'm really excited that this is available for families. And that is a focus for for you and your team. So thank you.
Dr. Peake
Well, it's been great. We would we would welcome any families to come and if you've got questions, hit us up about it. And if not, you want to try it out. We'll give you a way to do that.
Lindsay
Thank you Dr. Peake.
