Integrating the little talks intervention into Early Head Start: An experimental examination of implementation supports involving fidelity monitoring and performance feedback

Abstract

Enriching home visiting services by incorporating scientifically-supported interventions is a means for improving their effectiveness in promoting child development. However, deliberate efforts to ensure that home visitors are fully knowledgeable and supported to implement interventions with parents of young children are necessary. In this experimental study, a randomly-assigned group of Early Head Start home visitors monitored the fidelity of their provision of a scientifically-based intervention, Little Talks, and the program's general child development services. On a bi-weekly basis, home visitors received performance feedback specific to their implementation of Little Talks and based upon the fidelity data. Findings demonstrated that home visitors showed immediate and consistent mastery of the Little Talks content, while the quality of their implementation, including their clinical decision-making and collaborative processes, improved to adequate levels over time. The Little Talks home visitors showed generalized improvements in their ability to obtain Parent Input while providing the program's typical child development services were detected. In fact, Little Talks home visitors' were superior in obtaining Parent Input relative to comparison home visitors. Further, parents for whom low-quality intervention implementation was observed discontinued their enrollment in home visiting prematurely, while high-quality implementation was associated with sustained enrollment. Limitations for this study are identified, leading to future directions for advancing home visitors' incorporation of evidence-based practices.