Early Intervention Providers Research Articles

Providers’ Perspectives About Selecting Materials for Early Intervention Sessions: Five Tensions That Influence Material Use

Early intervention (EI) sessions are intended to occur in a child’s natural environment. Part of a child’s natural environment includes the materials they typically can access. Recommended practices in the field suggest that EI providers should use materials in children’s homes rather than bringing a toy bag to address the child and family goals. However, the use of the toy bag is still prevalent in the field. The purpose of this qualitative study was to understand the perspectives of EI special instructors related to how they select materials for their EI sessions. Findings include five themes that represent tensions that EI providers experienced when selecting materials for EI sessions: (a) the journey of bagless intervention, (b) family-centered versus judgment-based views, (c) the natural environment versus the “ideal” environment, (d) professional responsibilities, and (e) addressing children’s needs. Implications include the need for high-quality preservice preparation and professional development related to this recommended practice and continued research related to bagless intervention.

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

Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers' attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.

Experiences of Service Coordinators Utilizing the Getting Ready Approach for Home Visits

Service coordinators (SCs) in Part C early intervention (EI) programs fulfill critical supportive roles assisting families in accessing and successfully navigating services needed for their infants/toddlers identified with delays or disabilities. However, evidence of effective training for SCs is limited. One state scaled up training in the Getting Ready approach to promoting family–professional partnerships and strengthening home visiting practices of dedicated SCs and their EI provider teammates. In this mixed method study, surveys were completed by 50 trained SCs, their 15 supervisors, and 81 trained EI providers working with the SCs. Forty-one participants were subsequently interviewed in focus groups. Findings indicated SCs’ abilities to fulfill key roles and responsibilities on EI teams were bolstered and family capacity in terms of ownership of their EI services and ability to self-advocate grew. Overall quality of EI services was positively impacted. Implications for SC training are discussed.

Risk Factors for Internal Jugular Vein Thrombosis 1 Month After Non-Cuffed Hemodialysis Catheter Removal.

Background: Complications, namely, catheter-related thrombosis (CRT) and venous stenosis, are associated with non-cuffed hemodialysis catheters used for emergency vascular access. However, only a few reports have demonstrated changes in the venous lumen and intravenous thrombosis after catheter removal. In this study, we comprehensively investigated the risk factors for residual thrombus 1 month after hemodialysis catheter removal. Methods: This prospective observational study was conducted from June 2021 to October 2022. We included patients with end-stage kidney disease who underwent hemodialysis catheter placement in the internal jugular vein (IJV). After catheter removal, we observed the IJV using vascular ultrasound and evaluated the thrombus and vein properties. Furthermore, we observed thrombosis 1 month after catheter removal, and investigated the risk factors for residual thrombus 1 month after catheter removal. Results: A thrombus was observed at the site of catheter removal in all the cases. Of the 37 patients who were followed up, 11 exhibited a residual thrombus 1 month after catheter removal. Patients with arteriovenous (AV) access dysfunction and enlarged lymph nodes during catheter removal were significantly more likely to have a residual thrombus 1 month after catheter removal. These associations remained significant even after adjusting for age, sex, and diabetes status. Conclusions: In 29.7% of the patients, CRT persisted even 1 month after the removal of the non-cuffed hemodialysis catheter. The provision of early intervention in patients with AV access dysfunction and enlarged lymph nodes during catheter removal may prevent CRT persistence.

Reimagining Preparation for Early Intervention Providers

Preparing highly qualified Part C early intervention providers to serve eligible infants and toddlers and their families is crucial. Currently, there is no licensure for early childhood special education in the state of New Mexico, leaving many Part C providers without the necessary preparation. Project RISE, Reimagining Intervention to Support Early Childhood, a grant funded through the Office of Special Education Programs, will create a Multicultural Early Intervention Concentration within the existing Early Childhood Education Birth-Four non-licensure program. The aim of this project is to reimagine the preparation of early intervention providers through the infusion of culturally sustaining practices, strengths-based practices, and Yosso's community cultural wealth model. This manuscript will describe Project RISE, including the relevant New Mexico context; the development of Project RISE competencies, courses, and practicum experiences; the development of and collaboration with our affiliated faculty team and advisory board; scholar recruitment; and lessons learned thus far.

What Supports and Barriers Influence Early Intervention Providers’ Practices? A Qualitative Study

Early intervention providers (EI) have a responsibility to enact recommended practices to best support young children with disabilities and their families. However, pre-service and in-service preparation of early intervention providers is complex and often lacking, leading to gaps in practice. In this qualitative study, we aimed to understand what supports and barriers EI providers experience that they believe influence their practices. Overall, we developed four themes that represent the data: (1) systemic barriers, (2) collaboration as a support and barrier, (3) key experiences as supports, and (4) the need for meaningful professional development. Implications include the need for policies that address financial concerns and collaborative teaming, as well as personnel development focused on effective teaming and responding to diverse family needs.

Simple but Not Easy: A Case Study of Caregivers and CVI Resources in Early Intervention

Introduction: This multiple case study research analyzed how caregivers find and use resources to understand how cerebral or cortical visual impairment (CVI) manifest in young children. Method: Data were analyzed from three caregivers who received services from a well-resourced early intervention program in the Southwest of the United States. The aim was to examine how each parent accessed, valued, and implemented CVI-specific resources to meet practical and meaningful outcomes for their child. Results: The findings from this study clarify the journey that caregivers take from first learning about CVI to engaging in collaborative conversations with service providers about how resources can improve outcomes for their child. The caregivers selected, valued, and implemented resources that were varied in format and content. The resources they found most useful changed over time, and the resources they used with early intervention providers were the most efficacious. Discussion: This study of caregivers and providers within early intervention services found that CVI-specific resources provided in a timely manner and within meaningful collaborative discussion were valued and enacted. The findings show the importance of socially mediated CVI resources within hopeful conversations that provide specificity in how CVI manifests and simple interventions embedded in family routines. Implications for Practitioners: Caregiver access to CVI-specific resources alone does not equate to an understanding of the condition that leads to relevant practices and care. Providers should pair resources with collaborative discussions and coaching with parents to help them develop interventions that are simple, effective, and meaningful to the family.

Development, field testing, and initial validation of an adherence rubric for caregiver coaching

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.

Examining the Relation Between Telehealth Experiences in Early Intervention and Rurality Among Families of Young Children With Developmental Disabilities

The Individuals with Disabilities Education Act (IDEA, 2004) governs the Early Intervention (EI) system for families of children aged zero to three with developmental delays and disabilities. As a result of the COVID-19 pandemic, many states offer telehealth as a way for families to receive their EI services. Given the limited EI providers in rural areas, it seems that telehealth may especially help rural families to access EI services. However, little research has been done in relation to family use and satisfaction with telehealth in relation to rurality. To this end, we conducted a statewide survey of 256 families of children in EI about their use of EI services via telehealth. There was a negative correlation between family satisfaction with telehealth and rurality, with rural families being more dissatisfied with telehealth. Implications for practice and research are discussed.

Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system.

Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention-based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.

Let’s Work Together: Elements to Strengthen Teaming and Collaboration Between Early Intervention Providers

Let’s Work Together: Elements to Strengthen Teaming and Collaboration Between Early Intervention Providers

We Must Consider Infrastructure when Attempting to Scale up Autism EBIs: A Case Example from Early Intervention Systems.

In the autism field, there is increasing interest in translating evidence-based interventions (EBIs) into systems that serve young autistic children and their families. Public Early Intervention systems have been a focal point of research-based implementation efforts given that these systems are federally mandated to provide services to children birth to three years of age with developmental delays under Part C of the Individuals with Disabilities Education Act. Although a growing number of research studies are now training Early Intervention providers to deliver autism EBIs, this work has been conducted on a relatively small scale and has only just begun to consider the alignment of these models with Early Intervention systems and whether sufficient infrastructure exists to scale up these training efforts and to sustain their public health impact. This commentary aims to address this gap by reviewing factors that have been found to uniformly impact the scale-up of EBIs across diverse public systems (Fagan 20, 1147-1168, 2019), and to extend this framework to the implementation of EBIs within public Early Intervention systems. These factors include developer and funder capacity, the public's awareness of and support for EBIs, the system's leadership support for EBI use, the capacity for community engagement in implementation efforts, the availability of a skilled workforce capable of delivering EBIs, and the capacity for data monitoring and quality improvement. This commentary discusses how these factors may specifically impact the scale-up of autism EBIs within EI systems to support toddlers and young, autistic children, and implications for autism researchers.

Using an evaluative lens to characterize the implementation outcomes of an NDBI within an early intervention system

A growing number of research studies are attempting to increase access to naturalistic developmental behavioral interventions (NDBIs) for autistic toddlers and their families by translating these approaches into Part C Early Intervention systems. As efforts to increase the use of NDBIs across EI systems grow, it is important to expand the scope of research to evaluate the implementation impact of this work. In order to address this gap, the current study was grounded in the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) to evaluate a broader range of implementation outcomes when a parent-mediated NDBI, Project ImPACT, was implemented within an Early Intervention system. Specific aims included examining: 1) the reach of Project ImPACT to children across the system; 2) the perceived effectiveness of Project ImPACT; 3) rates of provider participation in Project ImPACT training and consultation; 4) the delivery and adaptation of Project ImPACT by Early Intervention providers; and 5) providers’ intent to sustain their use of Project ImPACT. Forty-eight Early Intervention providers enrolled in Project ImPACT training, with a subsample participating in ongoing group consultation followed by an exit interview and a 6-month follow-up survey. Although there was a high level of interest in Project ImPACT training and good retention once enrolled, only half of EI providers who expressed interest in Project ImPACT training ultimately enrolled. Participating providers delivered Project ImPACT to families and children who were representative of state-level demographic information and perceived that Project ImPACT was effective for families and children on their caseload irrespective of whether children were autistic. Consistent with other research studies, providers’ fidelity to Project ImPACT was inconsistent, and providers reported a moderate level of adaptation to the program. At 6-month follow-up, providers reported high maintenance of Project ImPACT. The findings from this study have implications for how the RE-AIM framework could be used to more concisely characterize the impact of implementation efforts within public systems serving autistic toddlers and their families.

자폐 조기중재의 부모 코칭에 대한 사례 연구

This case study explores the factors that may influence the parent coaching fidelity and intervention fidelity in a parent-implemented intervention within the context of early intervention for autism. Drawing from Stahmer et al.’s (2020) research, the study involved one early intervention provider, two parents, and two toddlers either diagnosed with or at a high likelihood of autism. Video behavior coding was used as the primary method for data collection, focusing on (1) the duration spent on each coaching strategy, (2) the frequency of feedback types, and (3) the frequency of toddlers’ behaviors that were challenging to address. The study data, parent coaching fidelity, and intervention fidelity outcomes were analyzed and compared, and implications and recommendations for early intervention settings were summarized based on the results. The discussion focuses on the importance of adopting the implementation science framework for promoting effective parent coaching and parent-implemented intervention practices, the significance of support for early intervention providers and families, the need for factor analysis in studies with larger sample sizes to facilitate more statistically meaningful outcomes, and the importance of implementing cultural adaptation processes when introducing evidence-based parent-implemented intervention programs from other countries to South Korea.

The shared decision-making tool for caregivers of children with prenatal opioid exposure: A pilot and acceptability study.

This pilot and acceptability study sought to report provider acceptability and developmental concerns expressed by caregivers of children with prenatal opioid exposure using the Shared Decision-Making Tool (SDMT), an instrument created by study authors. Data were collected from five health care and early intervention providers and 83 caregivers from a medical clinic and early intervention service center. Descriptive statistics were used to identify frequency, mean level, and prioritization of developmental concerns using the SDMT, and to summarize provider acceptability about integrating the SDMT into their workflow. Communication was the most frequently cited concern in four consecutive age categories, followed by Inattention/impulsivity and Problem behavior. All providers "strongly agreed" or "agreed" with all statements on the provider feedback survey, except two instances. Results of this study support the SDMT as a potential tool to help engage caregivers and providers of children with prenatal opioid exposure in the shared decision-making process by standardizing communication related to areas of developmental concern and caregivers' priority needs. Findings from this pilot study will inform modifications to the SDMT and administration instructions before our next study, which will examine psychometric properties and caregiver acceptability of the scale.

발달지체 및 장애 영아 조기개입 서비스 제공에 대한 현장 전문가의 인식

This mixed methods analysis employed online surveys and semi-structured interviews to explore the perspectives of 60 early intervention service providers in South Korea regarding service delivery. This study aimed to comprehensively understand their perceptions of the barriers and facilitators in early intervention services. The online survey- consisting of 30 items related to participant characteristics, service information, and perspectives on barriers and facilitators- was conducted. Participants were intentionally categorized based on survey data, and six individuals were randomly selected for follow-up interviews to ensure a wide spectrum of perspectives. The results of the mixed-methods study indicated diverse experiences and perspectives among early intervention providers, with responses varying across each item. While there was relative consistency among respondents regarding facilitators, perspectives on barriers differed both among participants and across various variables. The significance of preservice educator preparation programs and in-service educators’ professional development opportunities in enhancing early intervention services was commonly emphasized. The study concludes with recommendations and implications aimed at enhancing the early intervention system in South Korea.

Awareness, access, and communication: provider perspectives on early intervention services for children with sickle cell disease.

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.

Using Causative Methods to Determine System-Level Factors Driving the Uptake and Use of Evidence-Based Practices in a Public Early Intervention System.

Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Call to Action.

This Call to Action is the eighth and final article in this special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. Collectively, these articles highlight evidence-informed actions to enhance family well-being and to optimize developmental outcomes among children who are DHH. This Call to Action outlines actionable steps to advance FCEI-DHH supports provided to children who are DHH and their families. It also urges specific actions to strengthen FCEI-DHH programs/services and systems across the globe, whether newly emerging or long-established. Internationally, supports for children who are DHH are often siloed, provided within various independent sectors such as health/medicine, education, early childhood, and social and disability services. With this Call to Action, we urge invested parties from across relevant sectors to join together to implement and improve FCEI-DHH programs/services and systems, build the capacity of early intervention (EI) Providers and other professionals, extend research regarding FCEI-DHH, and fund EI supports, systems, and research, all with the aim of advancing outcomes for families and their children who are DHH.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Guiding Values.

This article is the second of eight articles in this special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. Five foundational values that guide FCEI-DHH are described, providing an evidence-informed, conceptual context for the 10 FCEI-DHH Principles and other articles presented in this issue. These values are applicable for Early Intervention (EI) Providers and other professionals on FCEI teams, as well as for FCEI-DHH programs/services and systems. The five key values include (1) being family-centered, (2) responding to diversity, (3) involving invested parties, especially families and individuals who are DHH, (4) supporting holistic child development, and (5) ensuring fundamental human rights. These evidence-informed values are considered essential to the effective provision of FCEI-DHH supports.