Co-Principal Investigators: Romano, Mollie; Gurka, Matthew; Woods, Juliann

Purpose: The purpose of this project is to examine the efficacy of Florida Embedded Practices and Intervention with Caregivers (FL-EPIC) on improving outcomes for infants and toddlers with disabilities and their caregivers. FL-EPIC is a fully developed, caregiver-implemented intervention for infants and toddlers receiving Individuals with Disabilities Education Act (IDEA) Part C services implemented within community-based early intervention (EI) programs. This evaluation is timely because Florida has installed FL-EPIC as part of the state's Part C system and is currently in the process of rolling out implementation throughout the state. The study aims to demonstrate whether the FL-EPIC intervention can be delivered with fidelity by trained EI providers and examine whether it has an impact on caregiver and child outcomes across developmental and learning domains (adaptive, social, motor, cognitive, and communication). The project will also examine whether implementation may mediate the impact of the intervention on outcomes and whether provider, caregiver, or child characteristics may moderate its impact.

Project Activities: The researchers will randomize EI providers to the FL-EPIC intervention condition or a control group with children and families across three sites and three cohorts. The research team will measure differences in EI provider self-efficacy, caregiver delivery of embedded learning opportunities and self-efficacy, and child developmental and learning outcomes. A cost-effectiveness analysis will also be conducted to examine the ratio of costs to effects.

Products: This project will result in evidence about the efficacy of FL-EPIC for infants and toddlers with disabilities and their families as well as its cost-effectiveness. The project will also result in a final dataset to be shared, peer-reviewed publications and presentations, and additional dissemination products that reach education stakeholders, such as practitioners and policymakers.

Structured Abstract

Setting: This study will take place in family homes as part of Florida's Early Steps, the EI program in Florida funded through IDEA Part C.

Sample: Participants in the study will include 108 EI providers, 540 infants and toddlers with disabilities, and their families (in caregiver/child dyads) who are participating in one of three Local Early Steps programs. The sample will include linguistically and culturally diverse populations across urban, suburban, and rural communities.

Intervention: The FL-EPIC intervention is an adaptation of the IES-funded Embedded Practices and Intervention with Caregivers (EPIC) intervention. The adaptation for Florida included revised caregiver coaching practices, the addition of social-emotional intervention practices to the original focus on motor and communication practices, and adjustment of the intervention to fit the cultural and linguistic characteristics of the state's population. FL-EPICis characterized by a caregiver coaching approach called SOOPR (Setting the stage, Observation and Opportunities to embed, Problem solving and reflection, and Review). Providers coach caregivers in how to systematically provide meaningful learning opportunities to their child during everyday routines and activities as part of their Individualized Family Service Plan (IFSP) using a 5 Question framework. The questions include, for example, what the learning targets are, how caregivers can support learning, and how to know whether strategies are working. The intervention is designed to build the caregiver's capacity to embed instructional strategies within their everyday activities to support their children's meaningful learning across multiple domains.

Research Design and Methods: The study will use a cluster randomized efficacy trial to examine the efficacy of FL-EPIC. Twelve providers will be randomly assigned within each of the three cohorts within Local Early Steps programs. The EI providers will conduct weekly home visits with the families on their existing caseload, with intervention delivered according to their group assignment. After 6 months, differences in outcomes will be assessed, including EI providers' self-efficacy, caregivers' self-efficacy and delivery of embedded learning opportunities, and children's developmental and learning outcomes.

Control Condition:  Caregivers and children whose EI providers are randomly assigned to the business-as-usual waitlist control condition will continue to receive Part C services as described on their IFSP.

Key Measures:  Outcome measures include the Early Intervention Self-Efficacy Scale for providers and Embedded Instruction Observation System-Early Intervention and Family Self-Efficacy Scale for caregivers. Child outcomes will be measured with the Vineland Adaptive Behavior Scale (third edition), Battelle Developmental Inventory (third edition), Individual Growth and Development Indicators, and the Embedded Instruction Observation System-Early Intervention. Data on implementation and intervention fidelity will be collected using direct observational measures. Self-report surveys will be used to collect data on potential child (age), caregiver (education, socioeconomic status, and home language), and provider (field of expertise and years of experience) mediators as well as the ABILITIES Index to measure disability severity.

Data Analytic Strategy: The overall efficacy of FL-EPIC will be analyzed using generalized linear mixed models (GLMM) that account for clustering of families by provider and repeated measures over time for all outcomes. Moderator analyses within GLMM will examine whether certain factors related to provider, caregiver, or child characteristics impact the effects of the intervention. Mediation analysis will examine whether providers' fidelity of home visit practices and caregivers' implementation of embedded instruction learning opportunities mediate the relation between coaching practices and child outcomes.

Cost Analysis: The cost and cost-effectiveness analyses will use the ingredients method for estimating costs, estimating the economic value of all inputs, and then relating those costs on a per child basis to the estimated effects of the intervention. The resulting ratio of costs to effects will be compared to cost-effectiveness ratios for similar programs.

Related Projects: Embedded Practices and Intervention with Caregivers (EPIC) (R324A130121)