Abstract
Teaching caregivers to support their young children’s language development is recommended as an effective early language intervention, and caregiver-implemented interventions are recognized as evidence-based. However, as the natural change agents for training and coaching caregivers, early intervention (EI) service providers are in need of professional development to effectively coach caregivers to use interventions with their child. The purpose of this study was to examine the Coaching Caregivers Professional Development program (CoCare PD) in which researchers train and coach EI service providers via telepractice in caregiver coaching, a set of skills useful in nurturing partnerships with families to support caregivers’ use of evidence-based practices with their young children with disabilities. A single-case research study across four EI service providers was conducted and findings support a functional relation between training and coaching EI service providers via telepractice and providers’ use of coaching practices with families on their caseload.
Social-communication skills affect academic achievement, emotional and behavioral development, and the development of relationships with others (Warren, 2000). Social-communication skills, the skills to express wants and needs and to interact with others, affect individuals’ quality of life (Kaczmarek, 2002). Therefore, early intervention (EI) that supports and promotes the development of these skills is needed for young children with disabilities who are perceived as having delays or deficits in their communication skills. Naturalistic developmental behavioral interventions (NDBIs) are evidence-based practices that are often of particular use when teaching social-communication skills to young children with diagnoses of autism spectrum disorders (ASD) and other developmental disabilities (DD; Schreibman et al., 2015). NDBIs can be integrated within everyday routines at home and other natural settings, and communication partners can embed these strategies within many learning opportunities to allow for repeated practice that leads to skill acquisition and generalization (Schreibman et al., 2015).
Teaching caregivers and parents strategies to support their young children’s language development is an effective early language intervention (Roberts & Kaiser, 2011), and caregiver-implemented interventions are evidence-based (i.e., there are sufficient studies of high quality demonstrating effectiveness; Biggs & Meadan, 2018; Meadan et al., 2016; Wong et al., 2015). Because parents and caregivers are with their child regularly, they are natural change agents and can support intervention implementation (Barton & Fettig, 2013; Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007). Combining naturalistic strategies and caregiver-implemented interventions can nurture the development of social-communication skills in young children receiving services under the categories of ASD or DD. The caregiver–child relationship and opportunities for naturalistic learning at home create optimal conditions for developing those early skills and opportunities for caregivers to be natural facilitators (Schertz, Odom, Baggett, & Sideris, 2018).
Many early childhood organizations have emphasized the critical role EI service providers play in empowering families to support the development of young children with delay and disability labels (e.g., Division for Early Childhood, 2014). Researchers examining how best to promote skill development for adults emphasize the importance of both training and coaching in such efforts (Dunst & Trivette, 2009; Fixsen, Naoom, Blase, Friedman, & Wallace, 2005). However, in most caregiver-implemented intervention research, researchers have trained and/or coached caregivers on the use of the intervention strategies even though providers are the natural change agents working directly with caregivers. Thus, providers need to use skills for coaching caregivers within family-centered practices to ensure that caregivers develop new skills to support their children’s development (Branson, 2015; Bruder, Mogro-Wilson, Stayton, & Dietrich, 2009; Hebbeler, Spiker, & Kahn, 2012).
Providers need professional development (PD) related to coaching and partnering with adults (Campbell & Sawyer, 2009; Salisbury, Woods, & Copeland, 2010; Snyder et al., 2012). According to adult learning theory, adults benefit from training (i.e., overview, description, and demonstration of the skill) that is followed by embedded coaching (i.e., observation and feedback of their application of the skill in its intended context; Knowles, Holton, & Swanson, 2015; Merriam, 2001). In addition, key features of evidence-based PD include explicit training and embedded coaching (Dunst, 2015). For providers to make meaningful changes in their behavior, providing both training and coaching is most beneficial (Joyce & Showers, 2002). Another advantage to providing them with both training and coaching is that it can serve as a model for teaching and supporting caregivers. For providers, the most likely PD opportunities available are topic-based trainings, webinars, or workshops with a limited description of consultation or coaching (Bruder et al., 2009). Additional investigation into EI PD programs that use approaches based on adult learning theory and family-centered, capacity-building practices is needed (Brown & Woods, 2012; Bruder et al., 2009; Meadan, Douglas, Kammes, Schraml-Block, 2018).
Many states have a shortage of EI service providers that provide support to children with a variety of disability labels, including ASD (Wise, Little, Holliman, Wise, & Wang, 2010). Providers are also often limited in how many children they serve due to the amount of travel time necessary between visits (Cason, Behl, & Ringwalt, 2012). Telepractice is one way of addressing the barriers related to providing an increased level of support to both providers and caregivers. Telepractice, or using online and telecommunication technology to deliver supports and services, can be accessible, cost-efficient, flexible, and useful in achieving treatment integrity for both providers and caregivers (Baggett et al., 2010; Ferguson, Craig, & Dounavi, 2019; Kyzar et al., 2014). However, demonstrations of effective methods for training providers in how to coach caregivers to use naturalistic teaching strategies with fidelity via telepractice are still needed.
The Coaching Caregivers Professional Development program (CoCare PD) is a cascading intervention model developed to address the mentioned gaps in the field. The program was developed by using the materials and procedures from the Internet-based Parent-implemented Communication Strategies (i-PiCS) program, a training and coaching program that nurtured caregiver implementation of naturalistic teaching strategies using telepractice (Meadan, Angell, Stoner, & Daczewitz, 2014; Meadan et al., 2016; Stoner, Meadan, Angell, & Daczewitz, 2012). In CoCare PD, researchers train and coach EI service providers via telepractice in caregiver coaching, a set of skills that providers can use to nurture partnerships with families and support caregivers’ use of evidence-based practices. Providers then train and coach caregivers in how to implement the evidence-based strategies with their children, and, in turn, caregivers use the strategies with their children. This type of a cascading intervention model includes four levels: (a) a researcher who trains and coaches (b) a provider who supports (c) a caregiver to use communication strategies (d) with their child who has communication support needs. Although two levels in the cascading model include coaching (coaching providers and coaching caregivers) that is based on adult learning theory, the interactions between researchers and providers and between providers and caregivers within the coaching process are different due to the targeted purposes; the end goal for coaching providers is to increase competency and proficiency in coaching practices, whereas the end goal for coaching caregivers is to increase provider–caregiver partnership, increase proficiency in specific strategies to support their child, and promote both caregivers’ and children’s quality of life.
The purpose of this study was to evaluate the CoCare PD program, specifically providing PD for EI service providers, via telepractice, and answer the following research questions.
Method
Participants
Four 3-person units participated in this study. Each unit included an EI service provider, a caregiver, and a child. To be included in this study, a unit had to be formed of (a) a provider who was working with (b) a family on their caseload with (c) a child who was 3 years old or younger, was receiving EI services, and had limited communication skills. The interactions (e.g., between provider and caregiver; between caregiver and child) had to be in English, and both the provider and the family had to have access to the Internet. Following Institutional Review Board approval, recruitment flyers were sent via listserv of an EI training program in a Midwestern state. Providers contacted the researchers and shared the information with families on their caseload.
Demographic information for participants is provided in Tables 1 and 2. The provider’s educational background was either early childhood education or special education and each had more than 10 years of experience in EI providing therapy that focused on global development skills (i.e., developmental therapist). None of the providers had experience with telepractice, but two had completed some PD related to coaching prior to the start of the study. Caregivers were all married, but differed in educational level, income status, and race/ethnicity. Each child received EI services under the category of developmental delays or other health impairment (e.g., vision, seizure disorder) and had had limited communication skills, determined through the MacArthur–Bates Communicative Development Inventories (Fenson et al., 2007).
Demographic Information of Early Intervention Service Providers and Caregivers.
Note. EI = early intervention; HS = high school; GED = general educational development.
Demographic Information of Children.
Note. ASQ = Ages & Stages Questionnaires; CDI = MacArthur-Bates Communicative Development Inventories; EI = early intervention; DD = developmental delay; S/L = speech/language; OT = occupational therapy; DT = developmental therapy; VI = vision impairment; PT = physical therapy; OHI = other health impairment.
Setting and Technology
All coaching sessions between a researcher and a provider were conducted via online videoconferencing. Providers were in locations of their choice (e.g., office, home), but the researchers were never physically present. The sessions between providers and caregivers were conducted in the families’ homes in person during home visits or via online videoconferencing using Polycom RealPresence® software, which complied with the Health Insurance Portability and Accountability Act (HIPAA). Providers and caregivers used a tablet or a smartphone for the videoconferencing sessions. Observations of provider–caregiver and caregiver–child interactions were recorded through Polycom RealPresence® or using an internal smartphone camera and uploaded to Box® (i.e., secure cloud file-sharing service). The online training was hosted by Moodle®, an online learning platform. All participants also had access to the project website.
Research Design
We used a single-case, multiple-baseline design across four providers (Kazdin, 2011). This design allowed for an evaluation of the effects of the CoCare PD intervention (i.e., training and coaching providers) on providers’ fidelity of coaching practices. The study consisted of four phases: (a) baseline, (b) training and posttraining, (c) coaching providers, and (d) maintenance. During the baseline phase, providers conducted home visits with the caregiver and child as they usually would, without receiving any instruction or feedback from the researcher. The providers video recorded the visit and shared it with the researchers. Next, after the providers completed the self-paced, self-directed online training modules (described subsequently), they video recorded two additional home visits and shared them with the researchers. The third phase of the study consisted of coaching sessions with the researchers (described subsequently). Coaching sessions continued until the provider achieved 80% on the coaching fidelity checklist in two consecutive sessions. In the maintenance phase, baseline procedures were used. To address quality indicators and meet design standards of single-case experimental research (Horner et al., 2005; Kratochwill et al., 2010), the design provided opportunities for four demonstrations of a basic effect (i.e., one basic effect for each unit). We also collected data on caregivers’ use of the targeted strategies and children’s communication behavior; due to space limitations, these are reported elsewhere.
Intervention
The independent variable in this study was a two-phased intervention (first training, then coaching). See Figure 1 for a representation of how this two-phased intervention was applied with providers (CoCare PD) and with caregivers (i-PiCS; reported elsewhere).
Depiction of the two-phase training and coaching intervention.
Training EI service providers
Online training included self-paced, self-directed activities. To receive training on the coaching practices, they (a) completed pre- and posttraining Check for Understanding questions; (b) viewed two, 1-hr videos that focused on adult learning theory, family-centered practices, and practices for coaching caregivers; and (c) had access to additional materials resources (e.g., coaching flowchart). To train providers on the targeted naturalistic teaching strategies, they completed four online modules. Each module consisted of (a) pre- and posttraining Check for Understanding questions, (b) a 10- to 14-min video with information and video examples of the strategy’s implementation, and (c) additional resources (e.g., flowchart of strategy steps). The materials in the online modules were those developed by Meadan and colleagues (i-PiCS program; Meadan et al., 2014; Meadan et al., 2016). Finally, to receive training on the coding and decision-making process, providers (a) reviewed the coding procedures, (b) practiced coding using example videos, (c) practiced coding with one of their baseline videos and received feedback from the researcher, and (d) discussed with the researcher how to make data-based decisions about coaching the caregiver. For this project, a new communication strategy was coached when data indicated that (a) the caregiver used a strategy with high fidelity on 80% of attempts for two consecutive sessions, and (b) the caregiver reported high levels of confidence in using the strategy.
Coaching EI service providers
Coaching included individual meetings with a researcher via online videoconferencing. Researchers had a doctoral degree or were enrolled in a doctoral program in special education and had experience in teaching and coaching professionals or caregivers (see Table 3). Coaching sessions consisted of three components: (a) a preobservation conference to discuss the targeted coaching practices and teaching strategies and developed a plan for implementation; (b) a video-recorded home visit with the provider, the caregiver, and the child that was shared with the researcher; and (c) a postobservation conference in which the researcher and the provider discussed the home visit, the provider reflected on their use of coaching practices, and the researcher provided supportive and corrective feedback. The researcher and provider scheduled preobservation conferences based on the home visiting schedule. The provider then video recorded the home visit and uploaded it to Box. After the researcher viewed the recording, they scheduled the postobservation conference within 48 hr of the visit. The same coaching flowchart used in the training modules was used when coaching providers (see Figure 2).
Demographic Information of Researchers.
Note. SPED = special education.
Service provider coaching flowchart.
The providers coached caregivers on the target strategies in a specific order (modeling, mand-model, and time delay; environmental arrangement was discussed with each of these strategies). Mand-model is built on the modeling strategy and, therefore, coaching on modeling was provided first. Time delay focuses on increasing initiation and was thus addressed last (Meadan et al., 2016). To support providers’ decision making, the researcher graphed the coded data and shared with the providers as a way to visualize caregivers’ strategy use and to determine when the caregiver met the first criterion for mastering the communication teaching strategy (i.e., 80% of high-fidelity strategy use for two consecutive sessions).
Fidelity of training and coaching sessions
To evaluate the fidelity of the training procedures, researchers monitored the completion of all components (e.g., coding practice videos, submission of Checks for Understanding questionnaires) and the providers received continuing education credits from the state education agency at the end of each training. Fidelity of coaching by the researcher was evaluated using a checklist that contained 10 steps (see Figure 2). The researcher completed an online form indicating the completion (not quality) of each step in the process for coaching a provider. Another researcher viewed at least 33% of the videos of the coaching sessions of each unit and completed the same form to evaluate interobserver agreement (IOA). For Unit 1, the average coaching fidelity was 98% (range = 80%–100%); for Unit 2, 92.5% (range = 80%–100%); for Unit 3, 95% (range = 80%–100%); and for Unit 4, 96% (range = 90%–100%). IOA across all units averaged 94% (range = 80%–100%).
Data Collection and Data Analysis
Data were collected on providers’ use of coaching practices during home visits, on providers’ knowledge of both coaching practices and communication strategies, and on the perceptions of providers related to the social validity of the program.
EI service providers’ use of coaching practices
The fidelity with which the providers coached the caregivers was the primary dependent variable and was evaluated using the Global Coaching Fidelity Scale (GCFS). The GCFS is a researcher-developed measure with 10 items to determine whether the providers followed the steps specified by the coaching model. The GCFS was used to code all video recordings of the providers’ in-home and telepractice visits with caregivers and children. A primary researcher coded all sessions using the GCFS and a secondary researcher coded to check reliability for 33% to 63% of the sessions (33%–40% of baseline sessions; 36%–63% of coaching sessions; 33%–40% of maintenance sessions). The overall IOA of GCFS was 93.8% (see Table 4). The GCFS was graphed, with data for each provider in its own tier, and visual analysis of the level, trend, variability, and immediacy of change of the GCFS (within phases, across phases, vertical analysis) was conducted to evaluate the functional relation between the intervention (CoCare PD) and the provider’s fidelity of coaching practices (GCFS).
Service Provider GCFS Interobserver Agreement.
Note. GCFS = Global Coaching Fidelity Scale.
Knowledge of coaching practices and communication strategies
Two pre- and posttraining Check for Understanding questionnaires were completed to assess providers’ knowledge of (a) the targeted communication strategies (i.e., environmental arrangement, modeling, mand-model, time delay) they would teach caregivers, and (b) the coaching practices they would use to do so. They completed an initial 34-item questionnaire on the targeted communication strategies. Following completion of the online module for each strategy, providers completed an eight- to 10-item questionnaire composed of the identical items from the initial questionnaire related to that module’s focus. Providers also completed a 10-item Check for Understanding questionnaire about coaching practices before and after completing the online module about coaching.
Interviews and questionnaires
To examine the third research question about the social validity of CoCare PD, we used subjective evaluation methods (Kazdin, 1979) by administering in-depth interviews with providers. The interviewer posed questions, adapted from the ones used in Meadan et al. (2016) regarding the goals, procedures, and outcomes of the CoCare PD program. To reduce potential response bias, the interviews were conducted with a research team member who had no prior contact with the participants. The interviews were conducted via online videoconference at a time that was convenient for each participant. Each interview lasted approximately 30 min and was transcribed and analyzed line by line by two members of the research team. Two team members first independently coded the interviews then and met to reach consensus. The data analysis process included development of codes, grouping codes into categories, and, finally, the development of themes (Creswell, 2012). The themes were based on Wolf’s (1978) framework (i.e., goals, procedures, and outcomes). Quality indicators (e.g., development of appropriate interview questions, use of adequate mechanism to record and transcribe interviews) and credibility measures (e.g., collaborative work) for qualitative research were used to promote trustworthiness of the findings (Brantlinger, Jimenez, Klingner, Pugach, & Richardson, 2005). We also collected social validity data via online questionnaires. Providers were asked about (a) the online training on coaching (e.g., Do you feel you received enough information about coaching?), the online training on communication strategies (e.g., Would you change anything about the online training?), and the program website (e.g., Would you change anything on the project website?); and (b) their perceptions of the goals, procedures, and outcomes of the program (i.e., 23 items).
Results
The results are described in three sections based on the guiding research questions, including the data on EI service providers’ use of the coaching practices, their knowledge outcomes, and their perception of the social validity of the program.
EI Service Providers’ Use of Coaching Practices
A single-case, multiple-baseline design across four providers was used to answer the first research question: Is there a functional relation between the CoCare PD program and providers’ use of coaching practices? The data are presented in Figure 3. Each tier of this figure represents a provider’s GCFS for all in-home and telepractice visits with the child and caregiver on their caseload (i.e., unit). An arrow indicates when a provider started coaching the caregiver to use the communication strategy labeled. Data collection lasted about 10 months across the four providers. In the baseline phase, Kelly initially used some of the coaching practices during the baseline phase (between 33% and 42%). However, her use of these practices did not happen consistently within that phase. The three other providers showed either consistently low GCFS or did not use the coaching practices at all.
Global Coaching Fidelity Score of service provider use of coaching practices.
After the self-paced online training, all four providers demonstrated either minimal or no improvement of coaching practices during their home visits. During the coaching phase, Kelly and Margaret showed immediate increase in their use of coaching practices (i.e., during the first coaching session, after the flowchart of coaching practices was discussed during the preobservation conference, both Kelly and Margaret used most of the practices correctly). Kelly consistently maintained a high GCFS, with the exception of the first session of coaching the caregiver on the mand-model strategy. Margaret showed immediate improvement of her coaching practices, although, at the beginning of the coaching phase, there was variability and she never reached the performance criterion (e.g., 80% high fidelity). However, from the fifth coaching session, Margaret’s GCFS shows an increasing trend and she maintained a high level with stability until the end of the coaching phase. Although Jenny did not show immediate effects after coaching was implemented, her GCFS clearly shows an increasing trend and the last two consecutive sessions maintained a high GCFS. Similar to Kelly and Margaret, Jean also showed immediate effects. However, she could not continue to provide services due to the child’s health problems and the family’s relocation.
Vertical analysis revealed an immediate effect for Kelly during the coaching phase, while other providers maintained a low GCFS in their baseline or posttraining phases. A similar pattern occurred between Margaret and the last two providers. Based on the vertical data analysis, we concluded that, for three providers, online training followed by embedded coaching coincided with an increase in the GCFS. In other words, there is a functional relation between CoCare PD and an increased use of coaching practices by providers when supporting caregivers on their caseloads. All three providers maintained high GCFS after coaching ended.
Knowledge Outcomes for EI Service Providers
Providers were asked to complete pre- and posttraining Check for Understanding questionnaires about coaching practices as part of their completion of the online training modules. Figure 4 (left) indicates the result of pre- and posttraining scores for the four providers. Prior to the online training, all four providers demonstrated some knowledge of coaching practices (above 75%, 15 correct answers of 20). After completion of the online training modules on coaching, all four providers had improved their scores to over 90% (18 correct answers of 20). In addition to the Check for Understanding for coaching practices, providers were also asked to complete pre- and posttraining questionnaires on communication strategies (see Figure 4, right). Similar patterns occur within these results. Prior to the training on the strategies (i.e., environmental arrangement, modeling, mand-model, time delay), providers’ scores were between 65% and 76% (22–26 correct answers of 34). After completing the online training, provider scores increased to 84% to 94% (28–32 correct answers of 34).
Service provider pre- and postintervention knowledge of coaching practices.
Social Validity
Overall, all providers indicated high satisfaction with the goals and outcomes of the programs. The providers indicated that, at the end of the program, they already were or were planning to use the naturalistic communication strategies with other families on their caseload and apply the coaching practices they learned from CoCare PD. However, they also suggested changes to improve the program.
Goals
All providers agreed that the content of the program (i.e., naturalistic communication strategies) aligned with each family’s priorities and expressed interest in learning coaching practices prior to the intervention. Kelly mentioned, I tried doing it [coaching] without all the knowledge yet and I just did a little bit. It’s something new for me. I could see the benefit, but it was really hard to just spur of the moment, just change my thought process without some support.
Jenny also emphasized the importance of coaching parents to use the strategies with their children: “It’s all about parents taking the lead because ultimately they’re with their child all the time and I’m just there to provide other ways for them to work with their own child. I’m not the expert, they are.”
Procedures
All providers reported that the procedures of the program, including online training and coaching on how to coach caregivers, were feasible to complete. Considering the overall time commitment for participating in CoCare PD, providers stated that the program was worth the amount of time they invested. All providers mentioned that the success of the program might depend on the providers’ skills in coaching and on the caregivers’ willingness, motivation, and capacity to learn the strategies.
Structured coaching procedures
Providers reported that the caregiver coaching procedures helped caregivers to engage in their EI sessions. For example, Kelly said, “They [caregivers] are really focusing and paying attention and we really have to go back and forth with each other pretty much the whole session, which is nice.” Also, providers reported that the materials for supporting their coaching of caregivers (e.g., coaching and strategy flowcharts) were very helpful as they coached and for increasing caregivers’ involvement during sessions (e.g., encouraging caregivers to reflect on interactions with their child).
Benefit of researcher’s supports
All providers reported that being coached by the researcher helped them stay on track when coaching caregivers to use communication strategies. For example, Margaret described that training alone did not prepare her to coach families in practice, but that the researcher’s coaching helped her to get ready for coaching caregivers. Kelly described that the structured coaching procedures from the researcher helped her to understand the expectations of her as a coach: “I tried to kind of base [coaching] on the way she [researcher] was coaching me how I coach the parent, so it gave me an example.”
Pros and cons of using telepractice
All providers agreed telepractice was a feasible way to enhance their PD and their service delivery. However, they suggested that spending some time practicing and adjusting to using the technology at the beginning was necessary. As Jenny explained, “It’s always a little nerve wracking because I don’t use technology all the time. . . . once I figured it out then I was completely fine.”
Outcomes
According to the results of the postintervention questionnaire, all providers reported that coaching caregivers and the caregiver-implemented communication strategies were both effective practices to use with caregivers and their children (i.e., cascading model). They also agreed that the intervention helped caregivers promote their children’s communication skills. Margaret described, It was like this lightbulb, like oh, you’re right I was saying too many words . . . and then we built on that . . . it was a good strategy for her and him (caregiver and child) in this context.
Providers explained that, after participating in the CoCare PD program, their practices while working with caregivers changed and that they felt more confident in coaching caregivers. Kelly talked about the importance of coaching: Having someone coach me on how to coach was really helpful instead of just going to you know seeing a webinar and then going out there . . . Because I don’t know if I’m doing it right you know? . . . It was really nice to get feedback.
Impact on provider–caregiver interactions
The providers mentioned that, as a result of participating in the CoCare PD program, the way they interacted with caregivers changed. Jenny stated the biggest change was understanding that she needed to take a step back and give the caregiver opportunity to reflect. Kelly described how the coaching practices helped encourage collaboration with the caregiver in structured and effective ways: “It really was nice to see, not Mom doing all the work, but Mom kind of running through the session and I could add comments to it.” In addition, providers reported that the program helped empower caregivers: I think once she [mother] started to understand and use the techniques and saw some progress, it really brought us closer because we were both excited. You know, and I kept saying, “I’m so proud of you,” because she’s the one doing this and, I’m like, “I’m just coaching you. You’re the one working with him all day long and putting these things into effect so it’s fantastic.”
Discussion
The purpose of this study was to evaluate one level of a cascading intervention model, the CoCare PD program in which researchers coached EI service providers via telepractice in how to coach caregivers. Overall, the GCFS for the providers improved only after receiving the CoCare PD program, demonstrating a functional relation between the CoCare PD program and the primary dependent variable (GCFS; providers’ fidelity of coaching practices). Specifically, there were no clear changes demonstrated after the training (i.e., online modules), but there were clear increases in the use of coaching practices after the researcher began to coach the provider. It appears that training alone was not enough to change providers’ coaching practices. It is possible that the combination of both training and coaching caused the changes in behavior, but because we did not evaluate the impact of only coaching, we cannot definitively determine this. Other researchers have emphasized the need for both training and coaching to produce changes in professional practice (Meadan et al., 2016; Trivette et al., 2009).
The second research question focused on the changes in providers’ knowledge about coaching and communication teaching strategies. Based on the data from the pre- and posttraining Checks for Understanding, the providers increased their knowledge about both the communication strategies and the coaching practices, but their increase was minimal. Interestingly, all four providers scored high on the coaching practices Check for Understanding before online training, but did not use many of the practices during their home visits (see GCFS baseline data in Figure 3). Finally, the providers found the intervention socially valid and were, overall, satisfied with the goals, procedures, and outcomes of the CoCare PD program.
Parent- or caregiver-implemented interventions are recognized as evidence-based practice (Wong et al., 2015) and researchers have reported that caregivers can learn new communication strategies and implement them with fidelity (Biggs & Meadan, 2018). In addition, positive outcomes from caregiver-implemented interventions for both the caregivers and children have been identified. However, one of the limitations of many research studies in this area is that researchers are the ones who train and coach caregivers instead of natural change agents, such as EI service providers (Meadan, Snodgrass, Palomo, Amenta, & Halle, 2017). The CoCare PD program uses the cascading intervention model in which researchers train and coach providers (natural change agents) who, in turn, train and coach caregivers to use evidence-based practices with their children. Although the cascading model includes four levels (researcher, provider, caregiver, and child), in this report, we focused on data on the first two levels (e.g., researcher fidelity of implementation and providers’ fidelity of intervention). Data on the effectiveness of the cascading model with three levels (researcher, caregiver, and child) have been reported elsewhere (Meadan et al., 2014; Meadan et al., 2016). This study extends previous research by demonstrating the effectiveness of the first two levels of the four-level cascading intervention model. This model allows for scaling up the intervention (e.g., training a few providers who can, in turn, train and coach many families on their caseloads and reach many children receiving EI services). In addition, this study complements other research that had evaluated the use of telepractice and technologies in interventions and PD.
Limitations
The study has a few limitations which must be considered. First, the fidelity of coaching practices (GCFS), the primary dependent variable measurement, had only 10 items which might not be sensitive enough to capture the quality of providers’ use of coaching practices. We developed this 10-item coaching measure based on existing coaching frameworks (e.g., Rush & Shelden, 2011) and checked whether providers completed each item during home visits. However, we did not evaluate how well (i.e., quality) the providers delivered each of the coaching practices (e.g., joint planning, reflection, feedback). The quality of the coaching practices can be evaluated by using qualitative methods, such as interviewing the providers after each coaching session or conducting case study research and taking detailed field notes during observations of home visits. Second, we did not conduct a component analysis of the independent variable (i.e., online training, coaching, telepractice). Therefore, we could not evaluate which component(s) in the intervention package were essential for increasing providers’ use of coaching practices. Other researchers have emphasized the importance of both training and coaching, but additional studies on the role of each component in such an intervention package are needed. Finally, in this report, we did not include caregiver and child data due to page limits. The caregivers’ and children’s behaviors are the ultimate outcomes of this cascading intervention model. Thus, limited information on caregiver and child outcomes can hinder the evaluation of the overall effectiveness of the program. However, the effectiveness of the three level cascading model already has shown promise in previous studies (e.g., Chung et al., 2016; Meadan et al., 2016).
Implications
The study also has implications for PD. All four providers scored high on Check for Understanding about coaching practices (see Figure 4) before training, but they did not use many of the practices during their home visits (see GCFS baseline data in Figure 3). The findings from this study support the implementation of PD activities that include both training and coaching delivered via telepractice to advance providers’ knowledge and coaching practices. Based on these findings and the principles of adult learning theory (Knowles et al., 2015; Merriam, 2001), it appears that one-time workshops or online modules are not sufficient for changing practice. Rather, providers need to practice, reflect, and receive supportive and corrective feedback to change their practices and these coaching activities should be included in any PD activity (e.g., Campbell & Sawyer, 2009).
Enhancing providers’ use of family-centered caregiver coaching practices could lead to caregiver empowerment and child growth and development. By using a cascading model in which researchers train and coach providers, the providers then act as direct change agents by demonstrating and supporting parent/caregiver use of evidence-based communication strategies with their child. The cascading model has the potential to not only support one family, but all families on the provider’s caseload. After participating in the CoCare PD program, providers described having an interest in using the coaching practices to support other caregivers they serve. Additional research is needed to determine whether these results can be replicated and to further examine the extent to which providers generalize the use of coaching skills with other caregivers on their caseloads following formal training and coaching. Overall, the cascading coaching model has the capacity to expand the impact of an intervention beyond formal participants.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
