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Using the Mediator Model

MAY 4, 2023

As a caregiver, your participation in your child’s therapy can have a huge impact on their learning. A behaviour therapist spends limited hours with your child, but you are a consistent presence. For this reason, some Surrey Place services are structured so that you deliver the therapy directly to your child in your home. This is called the mediator model.

The goal of the mediator model is to teach skills to your child by providing training and support to a parent, caregiver or family member. We call this person the “mediator”. The mediator should be the person that spends the most time with your child and is available to attend training sessions.

Once you are registered in a service that uses the mediator model, a clinician called a “trainer” will teach you therapeutic and information-gathering methods to use at home. The trainer works closely with the parent, caregiver or family member to build their skills using behaviour skills training (BST).

What is Behaviour Skills Training?

The goal of BST is to encourage you to carry out the behaviour plan by yourself, without the help of the trainer. The idea is for your child to receive consistent treatment. This will help make the behaviour plan a success. The trainer will provide you with a checklist to help identify where you need to boost your skills training.

Behaviour skills training consists of four steps:

  • Explaining: During this step, the trainer will explain the skill. This includes why they are teaching that skill and the steps they will follow.
  • Modeling: During this step, the trainer will demonstrate the skill. They will either model the skill with your child (if they are present) or have you play the role of the child.
  • Rehearsing: After the trainer models the skill, you will rehearse the skill together. This might include “roleplay”. Roleplay is when the trainer pretends to be the child so you can practice the skill. After you have rehearsed the skill, the trainer will give you advice on things to work on. They’ll let you know what worked and what areas can be improved.
  • Mastery: The trainer will review the first three steps with you. Together, you will practice them until you feel confident you can do it on your own.

The mediator model is hugely beneficial for both the mediator and the child. Once you have finished behavioural skills training, you will be able to provide a consistent and structured environment for your child at home. If you are on the waitlist for services, BST will support you while you wait by setting you up with coping and behaviour management strategies.

Most importantly, BST helps children successfully learn and reinforce skills while empowering caregivers. For families with less urgent behaviour challenges, the aim of BST is to help you feel more confident in teaching your child skills while implementing their behaviour plan.

For families experiencing urgent behaviour challenges that are new or escalating, BST can help you introduce immediate changes into your child’s environment that can have a huge impact very rapidly.

What is data collection?

Data collection sounds intimidating, but it is actually quite simple. It involves taking notes throughout the day about your child’s behaviour and any changes that upset them. When you bring the data to your appointment, the information you collected helps your trainer better understand the circumstances surrounding your child’s behaviour. Here are some things you might be asked to write down:

  • How often your child’s challenging behaviour occurs
  • The intensity of the challenging behaviour
  • Whether anyone was injured when the behaviour occurred
  • If there are certain times of day when the behaviour occurs
  • Whether the behaviour is tied to a specific person, activity or transition

This information is important because:

  • It allows behaviour analysts to identify patterns and determine the function of challenging behaviours.
  • It helps behaviour analysts assess whether your child’s challenging behaviour is predictable or not. Predictable behaviour will be preceded by an event.
  • Understanding the function of behaviour helps the trainer figure out which socially appropriate skills your child must learn. The goal is for these skills to replace the challenging behaviour.
  • The information you gather helps your clinical team make informed decisions. These decisions are based on whether challenging behaviour is decreasing or increasing and whether new behaviours are appearing.

What time commitment is required?

The time commitment expected for a mediator model-based service will vary depending on your child’s needs. The Surrey Place team might meet with you once or twice a week for anywhere from one to three hours at a time.

As your training progresses and you master the skills being taught, you may require less frequent meetings with your clinical team. If at any point there is a change in your child’s behaviour, your team will meet with you to adjust the behaviour plan as needed to make sure it continues to support your child.

When determining your capacity to participate in the mediator model, Surrey Place’s clinical team will consider:

  • Your family situation (for example, how many children are in your household and the  demands you are managing)
  • The needs of your child 
  • Your work schedule and your family’s schedule

About Urgent Response Services

This resource was written with support from staff in Urgent Response Services. Urgent Response Services are part of the Ontario Autism Program. It was created to support children or youth with an emerging urgent need. Surrey Place leads Urgent Response Services for Toronto Region in partnership with 2-Spirited People of the 1st Nations, Community Living Toronto, Family Service Toronto, Geneva Centre, Holland Bloorview, Kerry’s Place, Lumenus, SAAAC, SMILE Canada and Strides Toronto.

How Surrey Place can help

If you’re a parent or caregiver whose child has new or escalating high-risk behaviours that require an urgent response, like self-injury, aggression, or property destruction, you may be eligible for Surrey Place’s Urgent Response Services. This program is accessed through the Ontario Autism Program (OAP). Urgent Response Services offer brief, rapid support from a multidisciplinary team to quickly address new behaviours that have been emerging in the last 14 days or less. Through Urgent Response Services, you can receive training in the mediator model approach.

Aside from Urgent Response Services, the following Surrey Place services also use the mediator model approach:

For support for a child with autism spectrum disorder whose needs are not urgent, please visit Surrey Place’s Autism Services page.

Resources for Parents and Caregivers

Along with the mediator model, another important tool for addressing challenging behaviours is learning to recognize triggers. These can include social, psychological and environmental factors. If you enjoyed this article, you may also find other behaviour resources useful including:

If you suspect your child’s behaviour is triggered by physical discomfort, you may find these resources useful:

If you suspect your child’s behaviour is triggered by anxiety, you may find How to Support an Anxious Child useful.

If you suspect your child’s behaviour is triggered by transitions, you may find these resources useful:

More on the Mediator Model

Urgent Response Services are funded by Ontario Autism Program to support children or youth with an emerging urgent need. Surrey Place leads Urgent Response Services for Toronto Region in partnership with 2-Spirited People of the 1st Nations, Community Living Toronto, Family Service Toronto, Geneva Centre, Holland Bloorview, Kerry’s Place, Lumenus, SAAAC, SMILE Canada and Strides Toronto.

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By 2 months

Has your baby had their hearing screened? YES NO

By 6 months

Does the child?

Startle in response to loud noises? YES NO
Turn to where a sound is coming from? YES NO
Make different cries for different needs (hungry, tired)? YES NO
Watch your face as you talk? YES NO
Smile/laugh in response to your smiles and laughs? YES NO
Imitate coughs or other sounds such as ah, eh, buh YES NO

By 9 months

Does the child?

Respond to their name? YES NO
Respond to the telephone ringing or a knock at the door? YES NO
Understand being told no? YES NO
Get what they want through using gestures (reaching to be picked up)? YES NO
Play social games with you (Peek-a-Boo)? YES NO
Enjoy being around people? YES NO
Babble and repeat sounds such as babababa or duhduhduh? YES NO

By 12 months

Does the child?

Follow simple one-step directions (sit down)? YES NO
Look across the room to a toy when adult points at it? YES NO
Consistently use three to five words? YES NO
Use gestures to communicate (waves hi/bye, shakes head for no)? YES NO
Get your attention using sounds, gestures and pointing while looking at your eyes? YES NO
Bring you toys to show you? YES NO
Perform for social attention and praise? YES NO
Combine lots of sounds together as though talking (abada baduh abee)? YES NO
Show an interest in simple picture books? YES NO

By 18 months

Does the child?

Understand the meaning of in and out, off and on? YES NO
Point to more than 2 body parts when asked? YES NO
Use at least 20 words consistently? YES NO
Respond with words or gestures to simple questions (Where's teddy? What's that?)? YES NO
Demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)? YES NO
Make at least four different consonant sounds (p ,b, m, n, d, g, w, h)? YES NO
Enjoy being read to and sharing simple books with you? YES NO
Point to pictures using one finger? YES NO

By 2 years

Does the child?

Follow two-step directions (Go find your teddy bear and show it to Grandma.)? YES NO
Use 100 to 150 words? YES NO
Use at least two pronouns (you, me, mine)? YES NO
Consistently combine two to four words in short phrases (Daddy hat. Truck go down.)? YES NO
Enjoy being around other children? YES NO
Begin to offer toys to other children and imitate other children's actions and words? YES NO
Use words that are understood by others 50 to 60 per cent of the time? YES NO
Form words or sounds easily and without effort? YES NO
Hold books the right way up and turn the pages? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 30 months

Does the child?

Understand the concepts of size (big/little) and quantity (a little/a lot, more)? YES NO
Use some adult grammar (two cookies, bird flying, I jumped)? YES NO
Use over 350 words? YES NO
Use action words such as run, spill, fall? YES NO
Participate in some turn-taking activities with peers, using both words and toys? YES NO
Demonstrate concern when another child is hurt or sad? YES NO
Combine several actions in play (puts blocks in the train and drives the train, drops the blocks off.)? YES NO
Put sounds at the beginning of most words? YES NO
Use words with two or more syllables or beats (ba-na-na, com-pu-ter, a-pple)? YES NO
Recognize familiar logos and signs involving print (Stop sign)? YES NO
Remember and understand familiar stories? YES NO

By 3 years

Does the child?

Understand who, what, where and why questions? YES NO
Create long sentences using five to eight words? YES NO
Talk about past events (trip to grandparents house, day at child care)? YES NO
Tell simple stories? YES NO
Show affection for favourite playmates? YES NO
Engage in multi-step pretend play (pretending to cook a meal, repair a car)? YES NO
Talk in a way that most people outside of the family understand what she/he is saying most of the time? YES NO
Have an understanding of the function of print (menus, lists, signs)? YES NO
Show interest in, and awareness of, rhyming words? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 4 years

Does the child?

Follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy)? YES NO
Use adult type grammar? YES NO
Tell stories with a beginning, middle and end? YES NO
Talk to try and solve problems with adults and with other children? YES NO
Show increasingly complex imaginary play? YES NO
Talk in a way that is understood by strangers almost all the time? YES NO
Generate simple rhymes (cat-bat)? YES NO
Match some letters with their sounds (letter b says buh, letter t says tuh)? YES NO