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IES Grant

Title: The Effects of Online Decision Making Support for Home Visitors Using an RTI Approach to Promote the Language Development of At-risk Infants and Toddlers
Center: NCSER Year: 2012
Principal Investigator: Buzhardt, Jay Awardee: University of Kansas
Program: Early Intervention and Early Learning      [Program Details]
Award Period: 7/1/12-6/30/16 Award Amount: $2,998,772
Type: Efficacy and Replication Award Number: R324A120365

Co-Principal Investigators: Charles Greenwood and Dale Walker

Purpose: Children who lack key early language and literacy experiences prior to kindergarten face significant challenges learning to read. Because of impoverished early language experiences, many children are not adequately prepared to benefit from the reading instruction they receive when they reach school. Home visitation is a viable model for improving the home language experiences that are known to promote children's growth in language and early communication. However, home visitors face challenges in promoting these outcomes including how to (a) identify children who are on a path toward language delay, and (b) provide the needed supports to parents/caregivers for changing that trajectory.

The long-term goal of this research is to reduce the number of children who are not ready for school because of delays and disabilities in language and early communication skills that have antecedents prior to preschool. The aim of this project is to test the efficacy of a web-based intervention decision support system for home visitors, MOD: Making Online Decisions. This intervention (a) identifies children at risk for early language delay in a Response to Intervention (RTI) approach, and (b) assists home visitors in the design, delivery, and maintenance of a parent-implemented intervention for promoting their child's early language development.

Project Activities: The researchers will conduct a waitlist randomized controlled trial to investigate the effects of the web-based MOD support system on home visitors' intervention decision making and children's communication outcomes. Home visitors serving infants and toddlers at risk for language delay will be randomly assigned to one of two conditions. Condition A consists of didactic training on data-based decision making, access to evidence-based language intervention, and use of the Early Communication Indicator (ECI) for progress monitoring. Condition B includes Condition A plus MOD decision-making support. The research team will recruit 80 home visitors and 160 children aged 6–34 months who are at risk for language delays. Children's early communication skills will be assessed before, during, and after the intervention to document intervention effectiveness.

Products: The products of this project include evidence of the efficacy of MOD as a decision support system for implementing the RTI approach for early communication interventions with infants and toddlers in a home-visiting context, published reports, and presentations.

Structured Abstract

Setting: This study will be conducted in participants' homes in Kansas, Iowa, Minnesota, and Ohio.

Sample: The sample will include 80 home visitors and 160 children (average of 2 per home visitor), aged 6–34 months, at risk for language delay. Children from both English- and Spanish-speaking homes will be included.

Intervention: The MOD is a fully developed online decision support system for implementing the RTI approach with early communication interventions for infants and toddlers in a home-visiting context. It follows a systematic set of steps that lead to the provision of a more intensive intervention (Tier 2) as necessary. These steps are identified by the following questions posed to home visitors through the online MOD system: (1) Is there a problem? Children whose score on the progress monitoring assessment, the Early Communication Indicator (ECI), is at least one standard deviation below their age-based norm are identified as not making adequate progress and the child's growth chart is examined. (2) What is causing the problem? A list of clinical issues linked to poor progress are considered and ruled in or out (e.g., hearing loss). (3) What intervention should be used? A planning process leads to an appropriate intervention selection. The MOD recommends language-promoting strategies based on the child's communication skills as measured by the ECI. (4) Is the intervention being implemented? The home visitor and caregiver document the fidelity and dosage of the caregiver intervention, and enter it into the MOD to help guide subsequent coaching of the caregivers. (5) Is the intervention working? The MOD monitors, analyzes, and reports to the home visitor the child's performance on the ECI before and after intervention. If there is a lack of improvement, the recommendation is to revise the intervention. If progress is being made, the intervention is updated based on the progress monitoring data with new strategies recommended as the child develops more advanced means of communicating.

The MOD also provides the home visitor with implementation support at each decision step. For example, home visitor and caregiver checklists supporting implementation of the language-promoting strategies are provided to document home visitor and parent intervention implementation activities.

Research Design and Methods: The research team will conduct a waitlist randomized controlled trial with random assignment of 80 home visitors to one of two conditions: (1) Condition A (Comparison), which includes didactic training on data-based decision making, access to evidence-based intervention (language promoting strategies for parents/caregivers to use during daily routines with their children), RTI data-based decision-making framework for changing and intensifying interventions (e.g., Tier 2), and data from the online ECI for frequent screening and progress monitoring of growth in early communication; or (2) Condition B (Treatment) which includes all that Condition A receives plus MOD support. After 18 months of no MOD in Phase I of the study, home visitors in the Condition A waitlist group will use the MOD for 18 months in Phase 2. An average of two children per home visitor will be included in the study for a total of 160 children. Child outcome measures will be collected pre-intervention and every 6 months until the child turns 36 months or until the end of the study.

Control Condition: As described above, the waitlist control group will receive all intervention components (training on decision making, language promotion strategies for parents, RTI framework, and progress monitoring with the ECI) but no MOD support for 18 months in Phase I of the study. In Phase 2, this group will receive MOD support along with the intervention for 18 months.

Key Measures: Multiple measures will be used to assess child communication outcomes, including the Preschool Language Scale-5 and MacArthur-Bates Communicative Development Inventory. Researchers will also conduct assessments of parent engagement in the intervention and relationship with the home visitor. The researchers will collect data on the fidelity of the intervention implementation by home visitors in both groups through review of an online information system, independent observation by assessors during home visits, and surveys of home visitors. Implementation fidelity will be assessed for parents through direct observations and a self-report fidelity checklist.

Data Analytic Strategy: The primary analytic techniques used to address the study research questions will be hierarchical linear modeling and structural equation modeling.

Related IES Projects: The Infancy to Preschool Early Literacy Connection: Validation Studies of the Early Communication (ECI) Indicator of Growth and Development (R324A070085)


Journal article, monograph, or newsletter

Greenwood, C.R., Walker, D., Buzhardt, J., Howard, W.J., McCune, L., and Anderson, R. (2013). Evidence of a Continuum in Foundational Expressive Communication Skills. Early Childhood Research Quarterly, 28(3): 540–554. doi:10.1016/j.ecresq.2013.02.006

Greenwood, C.R., Walker, D., Buzhardt, J., McCune, L., and Howard, W. (2013). Advancing the Construct Validity of the Early Communication Indicator (ECI) for Infants and Toddlers: Equivalence of Growth Trajectories Across Two Early Head Start Samples. Early Childhood Research Quarterly, 28(4): 743–758. doi:10.1016/j.ecresq.2013.07.002