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IES Grant

Title: An Intervention for Infants and Toddlers with Visual Impairment: Independence through the Mealtime Routines Model
Center: NCSER Year: 2016
Principal Investigator: Ferrell, Kay Awardee: University of Northern Colorado
Program: Early Intervention and Early Learning      [Program Details]
Award Period: 3 years (7/1/2016-6/30/2019) Award Amount: $1,291,048
Type: Development and Innovation Award Number: R324A160139

Co-Principal Investigator: Jamie Erskine

Purpose: The purpose of this project is to develop an intervention that trains providers to work with families on positive mealtime routines for infants and toddlers with severe visual impairment. Mealtime routines encourage children to develop behaviors that foster independence, a critical skill for success in classroom settings. However, most infants and toddlers with visual impairment require assistance at mealtime due to their inability to observe and imitate mealtime skills and engage in positive social interactions through eye contact. To address this need, this study will develop a family-centered intervention, the Mealtime Routines for Visual Impairment (MRVI) Intervention, to support infants and toddlers with visual impairment in gaining independent mealtime skills.

Project Activities: The intervention will be developed and pilot tested iteratively through a series of studies. In Study 1, the research team will survey Early Interventionists and Teachers of Students with Visual Impairment — Early Intervention (TSVI-EI) providers to learn their current knowledge about independent mealtime skill development for infants with visual impairment. Across Studies 2–4, the team will develop the intervention, including a professional development training for TSVI-EI providers, and collect provider and family data to inform intervention refinement. Study 5, the pilot study, will use a small randomized controlled trial to investigate the promise of the MRVI Intervention for increasing family confidence and positive mealtime interactions and promoting a variety of child outcomes related to mealtime independence (e.g., age-appropriate mealtime behaviors and food selectivity).

Products: The product of this project will be a fully developed intervention to support positive mealtime skills in infants and toddlers with visual impairment, peer-reviewed publications, and presentations.

Structured Abstract

Setting: This research will take place in family homes and other natural environments of infants and toddlers with visual impairments across seven states — Illinois, Kentucky, Maryland, Missouri, New Mexico, Utah, and Washington.

Sample: There will be approximately 400–500 TSVI-EI providers and other Early Interventionists working with children with visual impairment across the country participating in the initial survey. For the next series of three studies, 12 TSVI-EI providers with 12 infants/toddlers and their families will participate. For the pilot study, a new group of 14 TSVI-EI provider/family pairs will participate. Participating infants must be diagnosed by a pediatric ophthalmologist as having a severe visual impairment.

Intervention: For the MRVI Intervention, TSVI-EI providers will use a family-centered approach for helping families with children with severe visual impairment during mealtime routines to develop the child's independent eating and other mealtime skills. The provider training will include face-to-face professional development, online learning resources, and possible distance coaching. Providers will use guided decision-making tools in partnership with parents (or other caregivers) to develop individualized family mealtime routines (e.g., making tactile adaptations, encouraging the use of utensils) that address measurable family and child outcomes.

Research Design and Methods: The intervention will be developed in a series of iterative steps. In Study 1, TSVI-EI providers and other Early Interventionists working with children with visual impairment will complete an online survey about their current knowledge of independent mealtime developmental skills. Data from this survey will be used to help develop the intervention. Studies 2 — 4 will be conducted with a sample of 12 TSVI-EI provider/family pairs across the three studies. Study 2 will include only the providers, focused on developing provider training using evidence-based professional development practices. They will be trained on the initial version of the intervention, and feedback during this phase will be used to make improvements. Study 3 will examine whether there is a substantial benefit of adding distance coaching after training, with half the providers assigned to receive online coaching and the other half assigned to receive no coaching as they work with their participating family. Feedback from this stage will guide revisions to the intervention as well as establish implementation fidelity guidelines for the pilot study. Study 4, conducted simultaneously with Study 3, will examine the preliminary outcomes for families receiving the MRVI Intervention from the 12 participating providers. Families will identify individualized goals and strategies, and change in family and child outcomes will be measured. For Study 5, the pilot study, researchers will conduct a small randomized controlled trial with a new sample of 14 TSVI-EI provider/family pairs to examine whether there is evidence of promise for family outcomes (i.e., parent-child interaction, parent confidence in working with child on mealtime skills) and child acquisition of independent mealtime skills (i.e., age-appropriate mealtime developmental skills, food selectivity, and behavioral responsiveness to family members during mealtime).

Control Condition: During the pilot study, the families in the control condition will receive their usual early intervention services for their visually impaired child.

Key Measures: Family and child outcome measures include the Nursing Child Assessments Feeding and Teaching scales, the Behavioral Pediatric Feeding Assessment, anthropometric measures to assess growth (e.g., length, weight), the Early Intervention Development Profile, the Ehrhardt Developmental Prehension Assessment (i.e., fine motor development), scales of parent confidence and efficacy, checklist of foods the child eats, samples of observed mealtime parent-child communications, and parent surveys. Usability for the provider will be measured through a researcher-developed survey, online mastery quizzes, and journals of their impressions. Feasibility and fidelity of implementation will be measured through monthly video recordings of provider sessions with families and of coaching sessions with providers.

Data Analytic Strategy: Survey and feasibility rating data will be examined through descriptive statistics and correlation matrices. Qualitative data (e.g., impression journals) will be analyzed for thematic content. Video recorded sessions for fidelity will be coded for practitioner behavior in the home and the parent's ability to implement the intervention in a routine setting, with chi-square analyses of expected and observed criteria. To analyze the child and family outcomes in the pilot study (parent report measures and observational scoring), the research team will use repeated measures analysis of variance.