Project Activities
In the first phase, the research team developed the PD approach and related intervention components based on user and expert feedback. Then the team implemented the suggested changes and field tested the revised model. Next, a single-case design study was conducted to identify relations between PD and coaching and provider implementation of PC TALK. Finally, a randomized controlled trial was conducted to determine the promise of the refined PC TALK intervention—with the new PD model, coaching, and tools—for improving provider implementation fidelity, parent fidelity of language strategies, and children's language outcomes.
Structured Abstract
Setting
This research took place in homes within home visiting and early intervention programs, funded by Part C of the Individuals with Disabilities Education Act (IDEA), in Kansas.
Sample
Participants included 15 early intervention providers and home visitors in the field-testing phase, and three early intervention providers and three caregiver-child dyads in the single-case design study. The team recruited 27 early intervention providers and home visitors and 47 caregiver-child dyads for a randomized controlled trial, though 12 providers and home visitors and 18 caregiver-child dyads (children 6 months to 3 years of age) completed data collection. These providers worked within home visiting and early intervention programs in rural, suburban, and urban settings.
A PD model, with associated coaching and tools was developed to support implementation of PC TALK within home visiting and early intervention programs. PC TALK is a manualized set of language-promoting strategies and tools that home visitors and interventionists use to guide caregivers in promoting children's communication skills through natural interactions in daily routines. In addition to the manual, PC TALK uses video demonstrations of strategies, poster reminders, activity cards, self-checklists, an observation system to measure fidelity, and use of text message reminders. During this project, the overall PD framework and coaching was developed along with refinement of the associated resources and materials. The preliminary model included group PD sessions, video tutorials, and group coaching with feedback on fidelity. The researchers also aimed to improve the technology-based resources to support implementation fidelity, including a new mobile app to enhance parent-child interaction measurement, and create graph reports representing parent fidelity of strategy use and child communication.
Research design and methods
The first 2 years of the project involved iterative intervention development, including expert and end-user feedback about the intervention's usability as well as field testing that incorporated formative feedback. More specifically, researchers gathered feedback on components of the PD model as well as the feasibility and usability of the critical PC TALK intervention and PD components through surveys and focus groups with expert researchers, early interventionists, and home visitors. The PC TALK intervention and associated PD training, coaching, and materials were then revised based on feedback from focus groups and user surveys, and the refined model was field tested by providers working with families to determine its acceptability and usability. Researchers also completed the development of a mobile app and secure online data dashboard to collect data on parent PC TALK strategy use and child communication interactions during naturalistic observations, the Promoting Communication Observation Tool (PC-Obs). Next, the research team conducted a multiple-baseline single-case design study to test the refined PD framework. Finally, the research team conducted a randomized controlled trial to pilot test the whole intervention and PD framework with home visitors and early intervention providers. Providers were randomly assigned to the intervention group or to a business-as-usual control group. Those in the intervention group received PC TALK PD and coaching and implemented PC TALK over a period of approximately 6 months. The research team collected data at baseline, 3 month, and 6 months following PD to determine implementation fidelity compared to the control group as well as impacts on parent fidelity of language strategies and growth in child language outcomes.
Control condition
For the pilot study, providers in the business-as-usual control group did not receive any PD or coaching related to PC TALK.
Key measures
For the initial iterative development process, data were collected through focus groups and questionnaires. For the field testing, the research team used a variety of measures to assess implementation fidelity, including the Intervention Delivery Checklist to assess provider intervention implementation, coded from audio recordings of home visits, and PC-Obs to assess caregiver strategy use and child communication. Focus groups and questionnaires were used to examine acceptability, feasibility, and clarity of training and coaching, and inform further refinements of the PD approach and PC TALK tools. Researchers used the revised implementation measures as well as a social validity questionnaire collected at the end of the single-case design study. Measures for the pilot study included the same implementation checklists, social validity scale, the PC-Obs: Parent Fidelity, and family and provider demographic questionnaires. Primary child language outcomes for the pilot study were measured through the Early Communication Indicator (observational progress monitoring tool) and PC-Obs: Child Communication (observations of parent-child communication interactions).
Data analytic strategy
Data from the focus groups were categorized, coded, and used to identify themes related to the intervention's acceptability, feasibility, and clarity. Questionnaire data were combined with the qualitative data to triangulate responses. Data from observations, surveys, and focus groups were compiled and summarized for the research team to use in making revisions. Survey data were also analyzed descriptively. The single-case design studies were analyzed using visual analyses and calculation of effect sizes. Multilevel growth curve analysis was used for the pilot study to examine the extent to which the PD and coaching framework improve providers' implementation fidelity, and the relationships between provider fidelity, parent fidelity, and children's language growth.
Cost analysis strategy
A cost analysis using the ingredients method to catalog all personnel, training, and material costs required to implement PC TALK was conducted. Costs were analyzed at the early intervention provider or home visitor (EIHV) level to provide cost data most relevant to those implementing and supporting the intervention in practice (i.e., home visiting and early intervention program staff and supervisors). All costs were calculated from the societal perspective to capture costs incurred across all participating parties (e.g., agencies, home visitors, families).
Key outcomes
The main findings of this project are described as follows. Given the limited number of participants who completed post-intervention data collection, these findings are considered exploratory.
- Providers who participated in PC TALK PD and coaching introduced more language promoting strategies and discussed daily routines during home visits than providers in the business-as-usual control condition.
- There were no significant effects for caregiver strategy use, although the main effect of group (intervention vs control) approached significance, with a trend toward higher communication scores in the intervention group compared to the control group.
- There were no significant effects for child communication during observations of caregiver-child communication and child expressive communication.
- Provider and caregiver satisfaction ratings were overall very positive, with providers strongly agreeing that the PD and coaching sessions were helpful in implementing PC TALK, and indicating that PC TALK is acceptable, usable, and feasible as an intervention delivered in the context of home-based interventions. Caregiver satisfaction responses indicated strong satisfaction and consistent use of the PC TALK strategies with their child.
- The total incremental cost of implementing the PC TALK program, involving 2 coaches supporting 12 EIHVs across 12 early intervention or home visiting programs serving 24 families, was $11,319.40, corresponding to an average cost of $782.01 per home visitor, $305.54 per coach, and approximately $55 per family served. If implemented by home visitors, the total cost was estimated at $7,631.81; if implemented by early interventionists, $15,007.00, reflecting wage rate differences.
People and institutions involved
IES program contact(s)
Project contributors
Products and publications
Project website:
Publications:
ERIC Citations: Find available citations in ERIC for this award here.
Additional project information
The PC-Obs data dashboard can be found at https://pcobs.ku.edu/, which houses the secure data dashboard for provider and family PC TALK graph reports and implementation reports.
Questions about this project?
To answer additional questions about this project or provide feedback, please contact the program officer.
