Purpose: For children enrolled in Part C of the Individuals with Disabilities Education Act (early intervention services for children under 3), the role of the early intervention provider is to enhance a family's capacity to meet the developmental needs of the infant/toddler. A substantial gap exists, however, between recommended and actual practice in Part C service delivery, particularly related to interventions that facilitate the caregivers' ability to support their children's learning. Researchers consistently identify the child as the focus of home visits with the early intervention provider implementing "hands on" instruction directly to the child, rather than supporting and enhancing interactions between the parent and child. There is little research on evidence-based practices with caregivers (parents) as implementers of their children's interventions, and even less that is focused on the unique learning needs of infants and toddlers with significant disabilities.

The purpose of this project is to develop and pilot test a caregiver-implemented intervention approach called Embedded Practices and Intervention with Caregivers (EPIC). This intervention aims to increase the consistency and effectiveness with which caregivers embed learning opportunities in everyday routines so that their infants/toddlers with significant disabilities acquire and maintain critical functional skills. Once developed, the promise of the EPIC approach will be evaluated to examine whether it leads to increased caregiver use of embedded intervention and improved child outcomes.

Project Activities: The research will take place in three phases: (a) development, refinement, and feasibility testing of the intervention; (b) validation of the intervention components; and (c) pilot testing of the intervention. Data collected through focus groups of stakeholders (e.g., caregivers and early intervention professionals) will inform the manual and protocol development. In addition, four caregiver-child dyads will try out the intervention and provide the researchers with information regarding the initial acceptability, feasibility, utility, and fidelity of implementation. Next, a series of three single-subject studies will be conducted to examine contextual variation in the implementation of the intervention. Finally, the pilot study will examine the promise of the intervention on caregiver use of embedded instruction and child learning outcomes.

Products: Products include a fully developed version of the intervention, data on the feasibility of the use of the intervention with caregivers of infants and toddlers with disabilities, and evidence of the potential impact of the intervention on caregiver use of embedded instruction and child learning outcomes. Additional products include published reports and presentations on the project.

Structured Abstract

Setting: The research project will be conducted in homes in Illinois and Florida.

Population: Participants will include 20 multidisciplinary Part C early intervention providers and 50 infants/toddlers with significant disabilities and their primary caregivers.

Intervention: The EPIC intervention involves two components: (a) an early intervention provider protocol that will guide their instructional support (coaching) of caregivers; and (b) an intervention protocol for caregivers that includes a systematic five question (5-Q) process and visual model. The 5-Q process provides caregivers a script for increasing the use of embedded instruction through the use of five questions (Why, What, Where/When, How, and How do we know it is working). The provider-coaching protocol is grounded in adult learning research and practice. Providers will begin with 2-hour sessions, three times per week, to build caregiver knowledge and skill with embedded instruction and the 5-Q process. As caregivers demonstrate competence with the 5-Q intervention process, the frequency and duration of provider support will be faded. Caregivers will initially use the 5-Q process in one high-priority routine that serves as the context for teaching a caregiver identified motor or communication skill. As fidelity increases, the 5-Q process will expand to multiple routines and additional goals throughout the day.

Research Design and Methods: An iterative, mixed-methods research design will be used to develop the intervention. The iterative design process consists of focus groups and trial implementations followed by revisions. Data from focus groups will be used to identify issues regarding the intervention's feasibility, usability, and acceptability. This development process includes implementing the intervention, determining the potential impact of each component of the intervention, and refining the intervention based on feedback from stakeholders. In Year 1, four caregiver-child dyads and early intervention providers will try out the components of the intervention to examine the implementation protocol. A series of single-subject studies will be undertaken in Year 2 to further understand feasibility and potential impact of the intervention. For the pilot study, a small randomized trial with children/caregivers randomly assigned to the EPIC intervention or a business-as-usual condition will be used to evaluate potential impacts of the intervention on caregiver and child outcomes. Throughout all phases, social validity data will be collected through provider and caregiver study participants and a stakeholder panel.

Control Condition: Participants in this condition will receive Individuals with Disabilities Education Act Part C intervention services as stipulated on their individualized family service plan.

Key Measures: To confirm child eligibility for the study, the ABILITIES Index, a rating of child functional abilities and limitations, will be used. Key outcomes include provider measures of coaching strategies and social validity, as well as caregiver measures of parenting self-efficacy, social validity, ability to identify opportunities for the child to learn, and use of embedded instruction. Child measures include observational measures of communication and motor initiations and responses. Additional measures of child communication and motor skills include the Individual Growth and Development Indicators for Infants and Toddlers—Early Communication and Early Movement Indicators. The Mullen Scales of Early Learning will be used for child language, motor, and visual reception skills, and the Pediatric Evaluation of Disability Inventory will measure child functional skills in social functioning, mobility, and self-care.

Data Analytic Strategy: To determine feasibility, acceptability, and utility, data analysis techniques will include pre-post descriptive analysis on caregiver surveys, interval coding of videotapes using a structured protocol, thematic analysis of textual data, within- and across-site analysis of caregiver ratings on surveys, and visual inspection of single-subject data. For the pilot study, a mixed-model analysis of covariance will be used to examine interactions and main effects. Proportional change index analysis of child change on assessment data will be used to examine the impact of the intervention on child outcomes.

Products and Publications

Journal article, monograph, or newsletter

Salisbury, C., Woods, J., Snyder, P., Moddlemog, K., Mawdsley, H.P., Romano, M., & Windsor, K. (2017). Caregiver and Provider Experiences With Coaching and Embedded Intervention . Topics in Early Childhood Education. doi:10.1177/0271121417708036 Full text