A multi-constituent qualitative examination of facilitators and barriers to caregiver coaching for autistic children in publicly funded early intervention.

BackgroundMost psycho-social interventions contain multiple components. Practitioners often vary in their implementation of different intervention components. Caregiver coaching is a multicomponent intervention for young autistic children that is highly effective but poorly implemented in community-based early intervention (EI). Previous research has shown that EI providers’ intentions, and the determinants of their intentions, to implement caregiver coaching vary across components. Organizational culture and climate likely influence these psychological determinants of intention by affecting beliefs that underlie attitudes, norms, and self-efficacy to implement an intervention. Research in this area is limited, which limits the development of theoretically driven, multilevel implementation strategies to support multi-component interventions. This mixed methods study evaluated the relationships among organizational leadership, culture and climate, attitudes, norms, self-efficacy, and EI providers’ intentions to implement the components of caregiver coaching.MethodsWe surveyed 264 EI providers from 37 agencies regarding their intentions and determinants of intentions to use caregiver coaching. We also asked questions about the organizational culture, climate, and leadership in their agencies related to caregiver coaching. We used multilevel structural equation models to estimate associations among intentions, psychological determinants of intentions (attitudes, descriptive norms, injunctive norms, and self-efficacy), and organizational factors (implementation climate and leadership). We conducted qualitative interviews with 36 providers, stratified by strength of intentions to use coaching. We used mixed-methods analysis to gain an in-depth understanding of the organization and individual-level factors.ResultsThe associations among intentions, psychological determinants of intentions, and organizational factors varied across core components of caregiver coaching. Qualitative interviews elucidated how providers describe the importance of each component. For example, providers’ attitudes toward coaching caregivers and their perceptions of caregivers’ expectations for service were particularly salient themes related to their use of caregiver coaching.ConclusionResults highlight the importance of multi-level strategies that strategically target individual intervention components as well as organization-level and individual-level constructs. This approach holds promise for improving the implementation of complex, multicomponent, psychosocial interventions in community-based service systems.Supplementary InformationThe online version contains supplementary material available at 10.1186/s43058-024-00552-5.

Caregiver coaching is an essential component of caregiver-mediated interventions for young autistic children. Previous research evaluating usual practice in early intervention (EI) has found that EI providers often do not use caregiver coaching. Increasing the use of caregiver coaching strategies is critical to improving the outcomes of EI. We used a community-partnered process to develop a toolkit of implementation strategies to improve the use of caregiver coaching in EI. This study presents findings from a preliminary evaluation of the toolkit using a non-concurrent multiple-baseline design across groups of providers and caregiver–child dyads. The results indicate that providers’ caregiver coaching fidelity improved following the introduction of the toolkit. Caregivers demonstrated moderate growth in their use of supportive parenting techniques. All providers rated the toolkit as acceptable, appropriate, and feasible. The findings suggest that a toolkit of implementation strategies tailored to support the needs of community-based providers shows promise for improving caregiver coaching in EI.

Purpose: The COVID-19 pandemic precipitated an abrupt transition to telepractice for many early intervention (EI) service providers; often, they had little previous experience with remote service provision. This study was designed to investigate their experiences with telepractice. Method: This qualitative study used interpretative phenomenological analysis to evaluate semistructured phone interviews with eight Illinois EI providers, recruited through EI agencies, social media, and word of mouth. In their interviews, they described the challenges and benefits of the transition to telepractice in 2020–2021. Results: These participants described a difficult adjustment period due to the unprecedented effects of the COVID-19 pandemic and a number of technological and interpersonal challenges. After this adjustment, they found telepractice offered a surprising and welcome degree of flexibility and spurred them to place new emphasis on caregiver coaching. Conclusions: Telepractice presents unique challenges and offers unique benefits to EI service providers due to the age of their clients and their emphasis on caregiver coaching. Clinical implications are discussed.

The practice of coaching caregivers requires early intervention (EI) providers to build relationships using compassionate care while implementing coaching practices to increase outcomes for caregivers and children. Coaching with compassion is highly valued and studied within other disciplines, yet investigations focused on interpersonal skills within the field of EI are just emerging. With the rise of families enrolled in Part C programs along with the increasing emphasis of caregiver coaching, it is critical to explore the approach of coaching with compassion. The aim of this study was to examine EI providers' perceptions and reported use of compassionate care competencies within caregiver coaching. We report findings from an online questionnaire that contained closed and open-ended questions. The results of this study indicate that most compassionate care competencies were ranked highly whereas some were not implemented as often and EI providers reported less confidence in using them. Early intervention providers also identified benefits and challenges to implementation. In addition, EI providers noted the importance of integrating compassionate care competencies into the practice of caregiver coaching. Results provide critical insights related to including compassionate care competencies into preparation for EI providers. Training recommendations and resources for EI providers are discussed.

Part C early intervention (EI) providers are expected to implement family-centered, capacity-building practices with the increasing number of caregivers of eligible infants and toddlers with or at risk of developmental delays or disabilities. There is a current knowledge to practice gap in service provision, establishing the need for evidence-informed professional development. The Coaching in Early Intervention Training and Mentorship Program (CEITMP) was developed to expand the professional knowledge and skills of Kentucky’s cross-disciplinary (i.e., developmental interventionists, occupational therapists, physical therapists, and speech-language pathologists) EI providers to coach caregivers to promote their increased confidence and competence to support their child’s development and learning. The CEITMP embedded adult learning principles and included professional development specialists’ supporting training and mentorship for EI providers over a 32-week period by introducing and illustrating strength-based caregiver coaching, offering performance feedback on providers’ video recorded EI visits and self-assessments, facilitating collaborative teaming, and providing follow-up to support sustained fidelity to caregiver coaching practices. Active Implementation Frameworks were applied to retrospectively investigate implementation and intervention data from the first four years of the statewide, multi-component training and mentorship program. Results indicated the CEITMP was implemented with good fidelity and was key in supporting EI providers to complete the program successfully; EI providers demonstrated the ability to use and sustain caregiver coaching with fidelity; and aggregate state data showed positive child and family outcomes. These results emphasize the significance of ensuring both intervention and implementation fidelity to promote intended outcomes.

Early intervention (EI) for infants and toddlers with disabilities relies on family-centered practices. Caregiver coaching, one family-centered practice used in EI, can lead to improved supports by caregivers and improved outcomes for children with disabilities. However, within the research literature, little is understood about the experiences, practices, and barriers EI providers face when coaching caregivers. To understand these issues, a mixed method design was used to collect quantitative and qualitative data using questionnaires, EI provider interviews, and coaching logs from EI providers. Results from all three data collection sources for 19 early interventionists provide insight into the perceptions, experiences, benefits, and barriers of caregiver coaching as shared by EI providers in one state. Implications for practice, future research directions, and limitations are discussed.

This study aimed to identify determinants influencing the utilization of early intervention services among young children with sickle cell disease (SCD) based on perspectives from medical and early intervention providers. Early intervention and medical providers from the catchment area surrounding St. Jude Children's Research Hospital and Washington University were recruited (20 total providers). Interviews were completed over the phone and audio recorded. All interviews were transcribed verbatim, coded, and analyzed using inductive thematic analysis. Three overarching themes were identified from both groups: Awareness (e.g., lack of awareness about the EI system and SCD), Access (e.g., difficulties accessing services), and Communication (e.g., limited communication between medical and early intervention providers, and between providers and families). Although these three themes were shared by medical and early intervention providers, the differing perspectives of each produced subthemes unique to the two professional fields. Early intervention services can limit the neurodevelopmental deficits experienced by young children with SCD; however, most children with SCD do not receive these services. The perspectives of early intervention and medical providers highlight several potential solutions to increase early intervention utilization among young children with SCD.

Providers' beliefs about an intervention's fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers' decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality of and access to early intervention services in the community. We looked at differences in providers' use of caregiver coaching, an evidence-based practice, with families from minority or vulnerable backgrounds, and the possible reasons for those differences. We did this to figure out what factors affect providers' use of caregiver coaching. We interviewed 36 early intervention providers from early intervention agencies in two different parts of the United States. Providers pointed out things like what they thought about a family's circumstances that affected their beliefs about how well coaching fits with minority and vulnerable families. Our findings bring attention to these beliefs that likely make accessing evidence-based practices for minority and vulnerable families harder and lessen the quality of care for these families of young autistic children. These findings highlight the need to come up with and use strategies to improve both access to and the quality of evidence-based practices for young autistic children from minority and vulnerable groups.

Purpose: The COVID-19 pandemic caused a rapid shift in service delivery; hence, many speech-language pathologists (SLPs) were delivering services to children and families via telepractice without advanced notice or preparation. This clinical focus article describes a caregiver coaching approach that can be implemented through telepractice and the results of a professional development training designed to assist early intervention (EI) providers in quickly implementing the caregiver coaching model. Method: Twenty-five EI providers participated in web-based professional development trainings describing the components of a caregiver coaching approach to be used in telepractice. Participants completed pre- and posttraining surveys to report on their current knowledge of caregiver coaching and self-reported changes in their provision of caregiver coaching through telepractice. Results: Most participants were able to list, describe, and identify caregiver coaching strategies following training. All providers also described changes in their implementation of the caregiver coaching practices during interactions with children and families in telehealth sessions after receiving training. Conclusions: This clinical focus article provides information for SLPs on the implementation of caregiver coaching approaches as applied in telepractice, as well as preliminary evidence of the effectiveness for web-based professional development training to expand SLPs' knowledge and skills related to caregiver coaching in EI. Future research, including ongoing professional development and coaching to ensure fidelity in the implementation of this approach, is discussed, as well as recommendations to expand practice and research in the area of caregiver coaching in telepractice.

Background:Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices.Objective:This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables.Methods:A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level.Key Results:Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 “Appraisal of health information” (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 “Navigating the healthcare system” (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience.Conclusions:EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128–e136.]Plain Language Summary:EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.

The purpose of this research was to investigate the relationship between early intervention providers’ backgrounds and their perceptions of caregiver coaching and auditory skill development. An explanatory sequential design was used with participants of varying backgrounds. In the first phase of the study, participants responded to a survey regarding their educational background, and their comfort with caregiver coaching and auditory skill development. Survey results were analysed using Spearman’s Ranked Correlational Coefficient (Spearman’s r s) to form groups of participants from extreme cases. The second phase of the study consisted of participant interviews from each of the groups. Interviews were coded to identify themes present within and between groups. The information from both phases was analysed to generate how professional preparation influences service delivery. Results were subsequently analysed to determine potential improvements in the Early Intervention system, professional development, and policy.

IntroductionThe translation and use of evidence-based practices (EBPs) within early intervention (EI) systems presents challenges. The Office of Special Education (OSEP) has emphasized results-driven accountability to expand state accountability from compliance to also include quality services that align with EBPs. OSEP’s results-driven accountability provided states the opportunity to design State Systemic Improvement Plans (SSIP) to strengthen the quality of EI services by increasing the capacity of EI systems to implement, scale-up, and sustain use of EBPs. Caregiver coaching is widely accepted as an EBP within EI settings, yet uptake and fidelity to coaching practices remains limited. Such widespread implementation of caregiver coaching is partially limited by a lack of measurement tools that operationalize behaviors consistent with coaching. In this study, we describe the development of the Kentucky Coaching Adherence Rubric-Revised (KCAR-R) and psychometric testing of the instrument.MethodsWe developed and tested the KCAR-R to measure fidelity of coaching practices within a state-wide professional development program, the Coaching in Early Intervention Training and Mentorship Program. We define operational elements of the KCAR-R and rubric design elements related to: creators; users and uses; specificity, judgment complexity; evaluative criteria; quality levels; quality definitions; scoring strategies; presentation; explanation; quality processes; accompanying feedback information; secrecy; and exemplars. With regard to psychometric validation of the KCAR-R, interrater reliability was analyzed using intraclass correlation coefficients across eight raters and 301 randomly selected video submissions. Internal consistency was evaluated using Cronbach’s alpha across 429 video submissions.ResultsResults showed 0.987 agreement, indicating excellent interrater reliability; item level internal consistency values ranged from 0.860 to 0.882. for scale if item deleted and 0.834 for the total scale.DiscussionFindings from this study showed that the KCAR-R operationalized behaviors that exemplify caregiver coaching and may serve as a resource for other states or programs to document the quality and fidelity of evidence-based EI services. To influence EI provider practices at a systems level, we used implementation science to guide our work and provide examples of how EI systems seeking ways to create sustainable quality services may build upon our approach.

Caregiver-mediated interventions for young autistic children are increasingly considered standard of care. These interventions share two sets of components: strategies to improve children’s communication, behavior, and development; and procedures to coach caregivers to implement those strategies. To date, no review has examined how caregiver coaching is described in caregiver-mediated intervention manuals. We assessed how caregiver coaching is described in caregiver-mediated intervention manuals for young autistic children. We conducted a scoping review to identify publicly available manuals that are designed to support providers in their practice; target core or co-occurring symptoms that affect young autistic children; and were tested as caregiver-mediated interventions in randomized controlled trials. We identified 11 publicly available manuals that met inclusion criteria. Manuals were coded using a summative content analysis to identify the presence and frequency of descriptions of caregiver coaching. The content analysis highlighted a wide range in the descriptions of caregiver coaching. Many intervention manuals did not include specific descriptions of caregiver coaching. Intervention developers should include explicit information about how to coach caregivers. Implementation strategies that specifically target caregiver coaching can serve as critical supports to increase the use of coaching in early intervention.

Caregiver coaching in early intervention (EI) can lead to positive outcomes for young children with delays and disabilities and their families. In response to the COVID-19 pandemic, some EI providers reported coaching caregivers more frequently. However, EI providers’ use of caregiver coaching is inconsistent, and there is a need for more effective personnel preparation in this area. In this qualitative study we explored EI providers’ beliefs about what factors contributed to their increased use of caregiver coaching during the pandemic. Participants reported two areas that contributed to their use of caregiver coaching: service delivery (e.g., telepractice, role changes, and caregiver expectations for services) and learning opportunities (e.g., personal growth and reflection, educational resources, and collaboration). Implications include the need for policies that allow and promote access to telepractice services and the importance of using a variety of adult learning strategies when delivering in-service and pre-service preparation related to caregiver coaching.

Newborn Hearing Intervention