Caregiver-Implemented Hanen Programs ® : A Narrative Review

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Purpose: Hanen programs ® have been used by clinicians to support caregivers of young children with communication needs to learn optimal ways to respond in everyday interactions and facilitate child-oriented strategies that promote interaction and language. This review aimed to evaluate peer-reviewed literature regarding Hanen programs ® for children with speech, language, and communication needs regarding the credibility, nature, quality, scope of the research, and outcomes of the research findings. Method: The Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol was used. Of 196 papers documenting Hanen interventions, 57 papers met inclusion criteria. Studies were synthesized and evaluated to rate (a) credibility/levels of evidence; (b) nature of existing research: efficacy, effectiveness, and perceived effectiveness; (c) quality of the studies; (d) scope of evidence; and (e) outcomes for each Hanen program ® for children with speech, language, and communication needs. Results: Credibility: Studies of Hanen programs ® were reviews (7%), randomized controlled trials (17.5%), nonrandomized controlled trials and mixed methods (31.6%), case–control or cohort studies (26.3%), qualitative reviews (1.8%), or employed qualitative methods (15.7%). Nature: The majority were efficacy studies (57.9%), others were perceived effectiveness (24.6%), and others were effectiveness studies (8.8%). Quality: Few studies were rated as high quality. Scope: Most studies related to two Hanen programs ® (It Takes Two to Talk ® and More Than Words ® ) conducted across 11 countries (Canada, the United States, Spain, Turkey, Republic of Ireland, the Netherlands, the United Kingdom, Australia, Hong Kong, Singapore, and Malaysia), and a few studies evaluated adaptations of Hanen programs ® (e.g., telehealth). The studies reported on dyad interactions; child language, behavior, and autism; and caregiver perceptions, stress, and self-efficacy. Outcomes: Evidence supporting significant communication outcomes for different programs exists; however, mixed results demonstrate a variety of language, interaction, acceptability, feasibility, and maintenance outcomes. Conclusions: A range of evidence supports the use of Hanen programs ® in its original format, with acceptability reported by families from target communities (e.g., middle-class families) and educators (e.g., Westernized countries). Effectiveness studies in real-world contexts conclude that future research could evaluate content flexibility and adaptations to meet a diversity of families and communities. A precision family initiative has been suggested to shift future research from “Does Hanen work?” to “How can Hanen-based intervention optimize outcomes for individual families?”

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