Nurturing care, encompassing early learning, responsive caregiving, safety, security, good health, and adequate nutrition, is vital for optimal early child development. The World Health Organization (WHO) has developed the Nurturing Care Framework, which health workers are advised to translate into practice. However, their role in the aspects of early learning, responsive caregiving, and safety and security have not been adequately mapped. This review synthesizes evidence on delivery mechanisms, strategies to strengthen health worker support, and barriers and enablers influencing implementation. Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched peer-reviewed and grey literature published before 23 April 2025. Inclusion criteria involved literature pertaining to various domains of nurturing care delivered by health workers. Data extraction focused on delivery mechanisms, promotion strategies, and enabling or hindering factors. Analysis was guided by the Nurturing Care Framework and socio-ecological model, using combined inductive and deductive thematic strategies. From 29,997 records, 99 peer-reviewed articles and 14 grey literature reports from 48 countries were included. Common delivery mechanisms were community-based platforms (e.g., home visits, group sessions), facility-based counselling, and blended community-facility based supports or technology-enabled methods. Interventions were primarily delivered by community and primary health workers through task-sharing approaches. Key strategies to enhance support included training and supervision, integration of nurturing care into routine maternal, newborn, child health and nutrition services, and caregiver coaching. Less frequent but influential drivers of scale-up were supportive policies, multi-sectoral collaboration, and digital technologies. Barriers included time constraints, workloads, inadequate training, limited supervision, and restrictive cultural and gender norms affecting caregiver engagement. Health workers are central to advancing early learning and responsive caregiving within health systems, yet safety and security remains the least institutionalized component of nurturing care. Effective integration requires strengthening frontline worker capacity while embedding interventions into routine services supported by policies, financing, and intersectoral platforms. Without systemic commitments, efforts risk remaining fragmented and unsustainable, limiting their long-term impact on child development.

This study examined the characteristics and differences in the verbal and behavioral strategies employed by Chinese-speaking parents of children with Autism Spectrum Disorders (ASDs) and parents of typically developing (TD) children. Ten-minute video recordings of parent-child interactions were analyzed, involving 34 children with ASD (Mage = 4.77 years, SD = 1.46; 29 boys) and 31 TD children (Mage = 4.84 years, SD = 1.43; 15 boys) alongside their parents. Verbal and behavioral samples were transcribed, coded, and analyzed using EUDICOLinguisticAnnotator (ELAN) and Computerized Language Analysis (CLAN) software to evaluate grammatical, syntactic, pragmatic, semantic, and non-verbal functions. The Mann-Whitney U test was utilized to compare the interactive strategies between the two parental groups. Parents in the ASD group demonstrated a significantly shorter mean length of utterance (MLU), greater reliance on gestures and labeling, and a higher frequency of behavioral directives compared to parents in the TD group (all ps < 0.01). In contrast, parents of TD children exhibited a significantly higher frequency of expansions, general responses, and questions, facilitating richer language input and reciprocal conversational engagement. These findings suggest that parent-mediated interventions for Chinese-speaking children with ASD should prioritize balancing developmentally appropriate simplified input with responsive interaction strategies rather than merely increasing linguistic complexity to better support child-initiated communication and joint engagement. What is already known on this subject Previous research has established that parent-child interaction plays a central role in early language intervention for children with Autism Spectrum Disorder (ASD). Parents tend to adapt their communication to children's reduced responsiveness by using shorter utterances and more directive strategies. Responsive parental behaviors, such as expansions and contingent responses, are consistently associated with better language outcomes. However, most evidence comes from Western language contexts, and parental communication strategies in Chinese-speaking families remain under explored. What this study adds to existing knowledge This study extends existing evidence by characterising the structure of parental communication strategies in Chinese-speaking parent-child interactions involving children with ASD. It demonstrates that, despite comparable amounts of overall linguistic input, parents of children with ASD show a systematic imbalance between adaptive scaffolding (shorter utterances, gestures and labeling) and responsive strategies (expansions, questions and imitations). The findings further identify a culturally specific pattern of increased gesture use in Chinese-speaking ASD families, highlighting language- and culture-dependent adaptations not captured in Western-focused research. What are the potential or actual clinical implications of this work? The findings have direct implications for speech and language therapy practice with Chinese-speaking families. Intervention should focus on calibrating parental interaction patterns rather than increasing the quantity of language input. Speech-language therapists should support caregivers in maintaining developmentally appropriate scaffolding, such as simplified utterances, gestures, and labeling, while reducing excessive behavioral directives and strengthening responsive strategies, including expansions, imitations, and child-led questioning. These results inform culturally responsive caregiver coaching and support the integration of parent-mediated approaches into routine clinical service delivery.

To assess clinical outcomes and parental experiences following an intensive multidisciplinary intervention (IMI) for children with Avoidant Restrictive Food Intake Disorder (ARFID). A prospective cohort of 28 children (aged 2-8 years) with severe eating difficulties, all meeting ARFID diagnostic criteria at baseline, participated in a 3-day assessment and an 8-day IMI involving guided mealtimes, play-based exposures, nutritional counseling, and caregiver coaching. Clinical outcomes were assessed using the Pica, ARFID, and Rumination Disorder Interview (PARDI) at baseline and at 7-15 months post-intervention. Parental experience was evaluated using the Experience of Service Questionnaire (ESQ) and the study-specific Eating Intervention Experience Questionnaire (EIEQ). At follow-up, 27 of 28 children continued to meet ARFID criteria; however, overall symptom severity decreased significantly (M = 3.55 → 2.57, d = 0.80, p < 0.001), with reductions in both the sensory (M = 2.77 → 2.21, d = 0.63, p = 0.002) and low-interest profiles (M = 3.48 → 2.50, d = 0.93, p < 0.001), alongside improvements in nutritional status and growth-related criteria. Parents reported high satisfaction with the intervention, valuing the multidisciplinary approach, tailored support, and practical strategies. Findings suggest that intensive, multidisciplinary, nondirective interventions may yield clinically meaningful benefits for young children with severe ARFID, particularly those with combined sensory sensitivity and low interest in eating profiles. Although full remission was uncommon within the follow-up period, the intervention supported symptom reduction and caregiver competence. Larger controlled studies are needed to establish efficacy and guide development of sustainable models of care.

Childhood trauma is pervasive and can have widespread negative influences on language development. Children with disabilities, especially with communication disorders, are at elevated risk for, and have barriers to reporting, neglect and abuse. Protective factors, such as responsive caregivers and trauma-informed services, can buffer against the influence of trauma for individual children. Caregiver coaching is a common delivery method of early language intervention. Although principles of trauma-informed practice exist broadly in the field of mental health, there has been limited direct application to early language intervention. In this clinical tutorial, we aim to (a) describe how childhood trauma can impact language interaction, development, and caregiver coaching and (b) apply trauma-informed practice to caregiver coaching in early language intervention. We adapt the Substance Abuse and Mental Health Services Administration principles of trauma-informed care-realize, recognize, respond, and resist-to the context of early language development and intervention. In the first section, we use the ecobehavioral model of early language development as a framework for realizing the mechanisms by which trauma might impact children's development and their caregivers. We also describe how to apply an International Classification of Functioning, Disability and Health model of assessment to systematically and comprehensively recognize individual child and caregiver strengths and needs. In the second section, we present applied strategies for responding to trauma and resisting retraumatization. The pervasiveness of childhood trauma and the uniqueness of individual experiences necessitate trauma-informed practices within early language intervention. This tutorial provides background knowledge and applied strategies for clinicians to implement trauma-informed strategies.

Coaching is a relational approach used in early intervention and early childhood special education to empower families in supporting the development of their children with autism or other developmental disabilities (DD). While various individuals can coach caregivers, this flexibility underscores the importance of understanding the factors that influence the fidelity of coaching practices. This study examined how the coach’s role, shaped by their training and professional background, impacts their application of key coaching practices with caregivers of young children with autism or other DD. Data were collected from 12 coaches (Board Certified Behavior Analysts, early interventionists, and parent coaches), who collectively conducted 92 baseline and 110 intervention sessions with 15 caregivers of young children with autism or other DD. The fidelity of caregiver coaching was evaluated using the Coaching Fidelity Scale, which measures the extent to which professionals implement a set of coaching practices with fidelity. The findings indicated that the coach’s role significantly predicts coaching fidelity in the baseline phase, with varying effects based on role, but not in the intervention phase. Moreover, significant improvements in coaching fidelity were observed for all coaches from the baseline to the intervention phase, with different levels of improvement among roles.

Testing the effectiveness of a professional development program to support practitioners' ability to provide caregiver coaching for children younger than age 3 with sensory-based challenges is a professional responsibility. To evaluate the impact of the Sensory Approaches to Infant/Toddler Learning (SAIL) program on practitioners' knowledge of and confidence in caregiver coaching and its acceptability, appropriateness, and feasibility. Prospective cohort pilot study with data collected at three time points. Large midwestern pediatric hospital with established evidence-based practice, research, and professional development infrastructure. Occupational therapy practitioners with one or more children younger than age 3 on their caseload were eligible and invited via email. SAIL included five asynchronous webinars (sensory integration [SI] theory and intervention), 12 biweekly mentorship sessions over 6 mo, and 3 mo access to the Sensory Processing Measure-2 Sensory Professional Reasoning Kit to Promote Infant/Toddler Participation (SPM-2 SPARK). Practitioner knowledge of and confidence in SI and SI-based caregiver coaching were measured with an investigator-developed survey. Ratings of acceptability, appropriateness, and feasibility of SAIL components were completed using validated measures. Participants significantly improved in all knowledge and confidence domains from pretest to posttest and from pretest to follow-up; no significant change occurred from posttest to follow-up. Participants rated the webinar series and SPM-2 SPARK as highly acceptable, appropriate, and feasible. SAIL is a feasible and well-received approach to enhance capacity for SI-based caregiver coaching. Further research is needed with larger, diverse samples to confirm the results and assess long-term use. Plain-Language Summary: Sensory integration and processing challenges can disrupt infants' and toddlers' participation, yet the literature documents that occupational therapy practitioners feel underprepared to coach caregivers. Despite consensus on the need for postprofessional education and mentorship, evidence of effective approaches is limited. Some young children process and respond to sensory information differently. This includes what they see, feel, hear, taste, and smell, as well as their sense of movement and balance, their sense of body position, and how they use these senses together. Differences in processing and combining these senses can make daily activities such as eating, sleeping, or playing harder. Early intervention, which provides services for children from birth to age 3, often includes occupational therapy practitioners who work with caregivers to help children join in everyday routines. Yet there are reports that many practitioners do not feel confident coaching caregivers about sensory needs. This project tested the Sensory Approaches to Infant/Toddler Learning (SAIL) program, which included online training, mentoring, and practical resources. After the program, practitioners reported more knowledge and confidence in working with families. These results are a first step toward showing that SAIL is effective, but more research is needed.

Childhood apraxia of speech (CAS) is a pediatric speech sound disorder with genetic and neurological underpinnings, implying its presence at birth. While early identification and intervention offer clear benefits, clinicians' perspectives on early diagnosis of CAS remain unclear. This study examined speech-language pathologists' (SLPs') knowledge, beliefs, and clinical decision making regarding CAS in children under 3 years old. A novel survey was distributed to SLPs working with children under 3 years old (N = 298). Respondents shared demographic information, CAS training and knowledge, diagnostic opinions and practices, and, in a subset, clinical decision making. Data were analyzed using z tests for proportions, logistic regression, and descriptive statistics. Forty percent of early intervention SLPs believed CAS cannot be diagnosed before the age of 3 years, and 52% would not disclose a diagnosis to caregivers of children in this age group. Continuing education on CAS was the only significant predictor of accurate early diagnostic beliefs; years of experience, setting, and general CAS knowledge were not. Among SLPs who did diagnose and treat CAS in children under 3 years old, most used caregiver coaching and play-based models. Highly structured, clinician-directed interventions were relatively underused, despite strong evidence for them. Findings reveal gaps in early intervention SLPs' knowledge and practices related to CAS. Hesitation to diagnose or disclose CAS in young children may delay appropriate intervention. Results highlight the need for better alignment between research and clinical practice to support early identification and treatment of CAS. https://doi.org/10.23641/asha.30781640.

Limited caregiver-mediated naturalistic developmental behavioral interventions’ (NDBIs) research exists with the Latine community. To understand the effectiveness of caregiver-mediated NDBI, we must investigate feasibility and effectiveness with marginalized populations to assure family-centered and culturally sensitive care. This study examined the effects of a caregiver-mediated NDBI with three caregiver–child dyads using single-case design (SCD) research informed by a brief priori cultural adaptation. Caregivers demonstrated improved implementation fidelity of NDBI strategies with empowerment-based coaching. We discuss Latine caregiving practices and make recommendations for culturally congruent NDBI caregiver coaching.

Responsive feeding therapy for children with pediatric feeding disorder (PFD): A scoping review.

Pediatric cancer and its treatment can negatively affect nutritional status, impacting treatment tolerance, survival, and overall well-being. Poorly managed side effects often lead to lasting poor dietary habits. Caregivers, who bear the psychosocial burden of these effects, are also at risk for diminished health. Interventions that support caregivers' capacity to provide quality care while maintaining their own health are critically needed. Culinary medicine interventions have shown promise in improving cooking confidence, dietary quality, and symptom management. We developed an 8-week culinary medicine intervention, including caregiver coaching, to support pediatric cancer patients and their caregivers. Let's Cook Together is designed to increase caregivers' knowledge of a whole foods dietary approach, improve caregiving preparedness, and boost self-efficacy in managing treatment side effects. Caregivers with children undergoing cancer treatment will be recruited from the Children's Hospital of Philadelphia. The program includes four remote, biweekly cooking sessions led by a medical chef educator and a registered dietitian nutritionist, along with alternating coaching calls focused on caregiving goals and challenges. Participants will also receive written nutrition and cooking resources. This is a single-arm, explanatory sequential mixed-methods feasibility study. Quantitative assessments will be conducted at baseline, post-intervention, and 3-month post-intervention; qualitative interviews will follow the intervention. The primary objective is to assess feasibility and acceptability. Secondary objectives include collecting exploratory outcome data on caregiving preparedness, caregiver self-efficacy, pediatric feeding behaviors, and dietary intake to inform the design and sample size calculations for a future trial and to identify potential signals of intervention effect. Results will inform refinement of the intervention and study design and guide the development of a future trial. Findings may be relevant to oncology and allied health professionals involved in supportive care for families navigating pediatric cancer treatment. ClinicalTrials.gov, NCT06523322, Registered 22 July 2024, https://clinicaltrials.gov/study/NCT06523322 .

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.

ABSTRACT Research indicates that caregiver coaching has positive outcomes for both children and families. Children receiving early intervention services experience developmental differences that often impact regulation skills and occupational engagement. The purpose of this evidence-based occupational therapy project was to determine if a coaching service delivery model promoted co-regulation between toddlers and their caregivers in an early intervention program. This project was implemented with 10 caregiver-toddler dyads and took place over six early intervention occupational therapy sessions in a suburban area of the northeastern United States. Results showed an increase in caregiver self-efficacy as rated on a 5-point Likert scale. A decrease in toddler dysregulation indicators was observed from pre- to post-intervention, as well as a decrease in negatively impacted daily occupations and routines. Data from open-ended questions revealed positive outcomes for caregivers regarding the use of co-regulation strategies and perceptions of the coaching model. The results suggest that coaching can be an effective service delivery model to promote co-regulation between caregivers and their toddlers in early intervention. Further research is recommended to increase the generalizability of findings, as well as to explore the efficacy of specific co-regulation strategies.

Early-language skills vary and are among the best predictors of later social and academic outcomes. High-quality early interaction supports strong early-language skills. Identifying modifiable sources of variability in early interaction quality is critical to determining intervention need, developing effective caregiver coaching, and improving outcomes. The purpose of this study was to examine whether and how caregivers' parenting beliefs, locus-of-control (LoC) perceptions, and stress when the infant was 1 month old affect child language skills at 36 months via parent-child interaction quality at 24 months. Furthermore, we tested whether beliefs, LoC perceptions, and stress mediated the relationships between parent education level and interaction quality as well as child language. We designed and tested a structural equation model using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Our sample included data from 180 parent-child dyads evenly distributed across income groups and matched for child expressive language at 36 months. We used data from the 1-month, 24-month, and 36-month timepoints. Model fit was adequate (comparative fit index = .892, standardized root-mean-square residual = .078). We observed a significant, positive direct effect of collaboration-focused parenting beliefs on interaction quality and indirect effect on child language outcomes. Collaboration-focused parenting beliefs mediated the relationship between parent education and interaction quality significantly. Mothers' LoC perceptions and stress did not play a mediating role between parent education and child outcomes. Dyads in which parents have more collaboration-focused parenting beliefs tend to exhibit higher quality interaction and children tend to have stronger language skills. This has clinical implications for implementing strengths-based caregiver coaching and for improving intervention effectiveness.

Purpose: The purpose of the current study was to explore the use of a hybrid telehealth approach following a Teach-Model-Coach-Review intervention format as a means to increase caregivers' ability to use language facilitation techniques with their children diagnosed with expressive language delay (ELD) in need of early intervention (EI) services. Method: A modified, single-subject, multiple-baseline design across participants study was completed with five dyads of children with ELD and a primary caregiver. The intervention included teaching a series of three target language facilitation techniques (modeling, matched turns, communication temptations) to caregivers via a telehealth session, modeling the skills in a clinic environment, using telehealth to then coach caregivers in their home, and reviewing the skill again in the clinic environment. Data collected included the frequency of skills demonstrated by the caregivers and the number of new words produced by children in probe sessions. Results: Across the five dyads, four of five children demonstrated a statistically significant increase in the number of different words used per probe. In all five dyads, caregivers demonstrated increased use of language facilitation strategies after the intervention. Increases were noted across all language facilitation techniques taught. Conclusions: A hybrid telehealth approach targeting caregiver coaching may serve as a means to provide caregivers with skills to support their children's language development through the use of specific language facilitation techniques. Using this approach likely supported caregivers in their acquisition of skills and may be applied clinically to support children in need of EI services. Supplemental Material: https://doi.org/10.23641/asha.29109719

Developing Shared Understanding About Caregiver Coaching in Early Intervention: An Individualized Approach

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 most common way for children with social communication delays to receive intervention before age three in the United States is through Part C early intervention (EI). Part C was designed to take a multidisciplinary approach to address a range of developmental domains. The type of intervention delivered in Part C EI has rarely been examined through direct observation. Our team conducted a mixed-methods analysis to characterize EI sessions by 33 providers across four states. Specifically, we describe the quantity and quality of caregiver coaching based on provider report and researcher coding of EI session content. Eligible providers conducted weekly EI sessions with at least one child with social communication delays. Providers self-reported greater use of caregiver coaching relative to the video coding conducted by researchers. While there were similarities in session topics, presumed goals, and intervention strategies used across providers, differences were observed in session duration, session location, and caregiver engagement in session. This study begins to fill a substantial gap by illuminating the types of interventions children with social communication delays receive in federally mandated Part C. It also highlights the need for more specialized training and standardization in EI practices to ensure that children with social communication delays and their caregivers benefit from the most efficacious interventions during a critical time of increased brain plasticity.

The goal of this study was to develop a comprehensive Theory of Change of caregiver coaching processes for an early social communication intervention for young autistic children, with attention to the caregiver learning process and a full constellation of outcomes for the caregiver and family unit. We interviewed intervention experts (n = 10), community providers (n = 22), and caregivers (n = 12) about their knowledge and experiences with a parent-mediated intervention (Project ImPACT), guided by the Theory of Change Framework. Qualitative interviews were transcribed and coded using the Framework Method and causation coding. We developed a comprehensive causal model which describes how both learning and motivational processes contribute to caregivers' implementation of the intervention, as well as broader outcomes with regard to sustainment, quality of life, advocacy, and goals and expectations. We also identified aspects of service need and contextual fit which inform the broader context for our theory of change. This study identified two mechanistic processes by which caregiver coaching impacts relevant short- and long-term caregiver and family outcomes, informed by practice-based knowledge. In the future, these findings can be used to guide empirical research that directly tests the mechanistic processes underlying effective parent-mediated interventions for young autistic children.

There is a great demand for quality early intervention services for autistic children and their families. Caregiver-mediated interventions are critical components of evidence-based early intervention. However, their implementation in publicly funded systems is often done with poor fidelity. Qualitative evidence suggests that family characteristics impact clinicians’ use of caregiver-mediated intervention coaching strategies. We estimated associations between family characteristics and clinicians’ use of a caregiver-mediated intervention in a publicly funded early intervention system, leveraging data from a pilot randomized trial. Data were collected from 12 clinicians and 34 families. We used multiple linear regression models to estimate associations. The association between household income and clinicians’ overall coaching fidelity demonstrated a quadratic trend (b = −10.4, standard error = 4.1, p < 0.05) with low fidelity for low- and high-income families relative to middle-income families. Use of in vivo feedback, one component of coaching, was similarly associated with income (b = −0.5, standard error = 0.2, p < 0.05). Clinicians’ coaching fidelity was lower among families in exclusively English-speaking homes than for families who speak other languages (b = 18.4, standard error = 8.8, p < 0.05). Results suggest that associations between family characteristics and clinician behavior may be more nuanced than previously understood.Lay abstractThere is a high demand for quality early intervention services for autistic children and their families. A key part of effective early intervention is teaching caregivers how to support their child’s development through caregiver-mediated interventions. However, in publicly funded programs, these strategies are often not followed correctly. Some studies suggest that family characteristics may influence how well clinicians apply these coaching methods. In this study, we explored the connection between family factors, like household income and language spoken at home, and the way clinicians coached families. We found that clinicians used coaching strategies less consistently with both lower- and higher-income families compared to middle-income ones. In addition, families that spoke only English at home received less consistent coaching than those who spoke other languages. These findings highlight the complex relationship between family background and how early intervention services are delivered, suggesting a need for further research.

Parental involvement is essential in interventions aimed at enhancing communication outcomes for children with autism spectrum disorder (ASD). Research has shown that parents can effectively implement evidence-based strategies following professional coaching. However, there is a notable gap in research on the procedures of parent coaching provided to families of children with ASD in Taiwan. This study aims to evaluate a protocol for distance-delivered parent coaching focused on the implementation of evidence-based strategies for parents of children with ASD. This study employed a multiple-probe design across participants to assess both parent implementation of intervention strategies and the communication outcomes of the children involved. The results demonstrated that the online parent coaching program effectively increased parents' use of evidence-based intervention strategies, which corresponded to measurable improvements in the target communication behaviors of children with ASD. Also, this study highlighted potential challenges, such as the influence of children's challenging behaviors on the intensity and effectiveness of parent coaching. These findings contribute to the clinical significance of distance caregiver coaching as a possible approach to supporting families of children with ASD, particularly in underserved areas. The necessity of tailoring service intensity and incorporating culturally responsive practices for the diverse needs of families of children with ASD and effective intervention implementation is discussed in this study.