A Proposed Framework for Enhancing Collaboration in Early Intervention/Early Childhood Special Education

Abstract

Collaboration with caregivers and between disciplines and agencies is a recommended practice in the field of early intervention and early childhood special education (EI/ECSE) as well as required by federal legislation for young children with disabilities. Review of relevant literature suggests that collaboration entails a complex set of principles and practices that are essential for teams and programs to employ if they are to ensure effective and sustained change. Despite the recognized complexity of collaboration in EI/ECSE, few systems frameworks have been proposed that organize the essential components of effective collaboration. We offer a framework that defines the core components of collaboration in EI/ECSE. The proposed system further identifies and operationalizes the infrastructure and practices associated with the components and the levels of action at which these practices operate.

Keywords

collaboration early education programs children with disabilities IDEA systems change

The Education for All Handicapped Children Act (Public Law 94-142) enacted in 1975 emphasized the importance of multidisciplinary collaboration as a guiding principle (Shonkoff & Meisels, 2000). However, the law offered little practical guidance to states for the creation and maintenance of collaborative practices (Cook & Friend, 2010; Friend & Cook, 1996). Most health-related professions joined the move to introduce and expand collaborative practices in the 1970–1980s (Leathard, 2003). For example, professional organizations such as the American Speech-Language-Hearing Association began encouraging the use of multiple-disciplinary or transdisciplinary collaborative practice when serving clients (Paul et al., 2006). The call for more and better collaboration across and between disciplines has continued to grow over time. The World Health Organization (WHO) encourages clinical and nonclinical health workers from various professional backgrounds to adopt and employ collaborative practices (Gilbert et al., 2010). The Division for Early Childhood (DEC), American Occupational Therapy Association (AOTA), and the American Physical Therapy Association (APTA) have championed the use of teams and collaboration as a mechanism for developing and maintaining ongoing partnerships, relationships, and interactions between caregivers and professionals across disciplines and services to improve child and family outcomes (e.g., APTA, 2019; Division for Early Childhood, 2014; Nardella et al., 2018).

Since its inception in the 1970s, collaboration in early intervention and early childhood special education (EI/ECSE) has been a critical feature of how contemporary services are conceptualized and delivered (Bricker et al., 2018). The field has evolved from single disciplines or entities providing services to the understanding that no one person, field, or resource is sufficient to address the array of needs presented by infants, toddlers, and preschool-age children and their families (Adams et al., 2013; Administration for Children & Families, Office of Planning, Research & Evaluation, 2010; Kochhar-Bryant, 2008; Reeves et al., 2017; Summers et al., 2001). As noted by others, “collaboration is not the intended outcome; it is a means to an end” (Administration for Children & Families, Office of Planning, Research & Evaluation, 2010, p. 9). For our purposes, that “end” is ongoing comprehensive and effective intervention with children and families designed to address important goals that will enhance their lives.

Collaboration becomes increasingly important as children experience genetic, physical, learning, or environmental challenges. Thus, the need for collaborative efforts for children with identified disabilities is substantially greater than for children without disabilities. As children experience problems or deficits, the need for services to address their needs generally expands. The EI/ECSE literature addresses the need for collaboration, explicates its complexity, and offers examples of how to proceed (Dinnebeil et al., 1999; Friend et al., 2011; Goffin et al., 2011; Rush, Sheldon, & Hanft, 2003; Young, 2010). However, discussions of systems frameworks that can accommodate the complexities associated with collaborative practices are missing from this literature.

The lack of attention to developing testable systems focused on collaboration is troubling given the assumed importance of collaboration to the delivery of quality services to young children and their families. Some researchers who have studied collaboration in K–12 systems have acknowledged measurement challenges associated with the practice. These recognitions have led to further work and research focused on collaboration in educational systems designed for children age 5 years and older (Cook & Friend, 2010). However, despite these advances, the development of systems to examine and study collaborative practices and their impact in EI/ECSE settings remains limited. We address this deficit by offering a systems framework to develop, implement, and evaluate collaboration in EI/ECSE in this manuscript. First, critical terms are defined to ensure clarity across readers. Second, challenges to collaboration already identified in the literature are reviewed. Next, the framework is described with accompanying implementation considerations. Finally, general approaches are offered for beginning to examine the impact of collaborative practices. These approaches are not meant to be an exhaustive set of solutions to this multifaceted issue but rather a means for moving the field forward.

Definitions

Key terms used in this article include collaboration, team, and system. Collaboration in EI/ECSE is defined as a broad construct composed of core premises and assumptions, and the components of infrastructure, collaborative practices, and action levels. For our purposes, collaboration involves joining, pooling, or coordinating resources and entities to meet goals, overcome problems, and improved service delivery. This framework makes our definition broader than what others often call “service coordination and collaboration” (Bruder & Dunst, 2005) or how others from related fields focus on interdisciplinary or multidisciplinary collaboration efforts (Reeves et al., 2017). In addition, collaboration in EI/ECSE currently lacks an empirical base. Much as we would like to build our proposed systems framework on sound empirical work, little research currently exists that examines collaboration in EI/ECSE.

The term team refers to the array of individuals who can and do work together (i.e., collaborate) to plan, design, and execute assessments, interventions, and/or evaluations of young children. For our purposes, team members include professionals (teachers, health care providers, interventionists), paraprofessionals (aides, assistants), and caregivers (parents, relatives, foster parents). Effective teams are those that include individuals who have a major impact on a child’s well-being and development and whose members work as a coordinated unit. Finally, system is defined as a set of parts or components designed to create a complex interconnected network with the goal of operating efficiently and sustainably over time. The system described in this article is a framework for organizing the many components of collaboration.

Challenges of Collaboration

Collaboration is essential to the delivery of quality EI/ECSE services; however, the collaborative process faces many challenges at the team, program, state, and federal levels. From our experience (as EI/ECSE instructors, program administrators, a physical therapist, an occupational therapist [OT], a speech-language pathologist, a behavior analyst, and an early childhood educator) and review of pertinent literature, five major challenges to effective and sustainable collaboration were identified. These challenges can be categorized as follows: conceptual, policy-related, leadership, operational, and training-related.

Conceptual Challenges

Conceptual positions (i.e., how one thinks about a subject) can influence behavior. How people perceive collaboration will affect their verbal and behavioral responses to collaborative practices. Those who believe collaboration is essential to delivering quality services are more likely to ensure collaboration at the team, program, state, and federal levels than those who do not see value in sharing ideas and expertise and working in a coordinated fashion. The conceptual acceptance of a stance, idea, philosophy, or strategy associated with collaboration among team members and across programs is highly dependent on one’s acceptance of collaboration as an important goal (Dinnebeil et al., 1999; Foster-Fishman et al., 2001; Utley & Rapport, 2002; Wiggins & Damore, 2006). Recognizing and respecting each team member’s skills and potential contributions is important to building collaborative efforts (Bruder et al., 2019; Chapman & Ware, 1999; G. King et al., 2009; Rapport et al., 2004).

For example, if a toddler in a child care setting has difficulty with grasping objects, OTs who believe in collaborative practices will seek help in gathering information about the child’s grasping skills from other team members, such as childcare workers or parents, and will share intervention strategies with other team members. This mutual information gathering and sharing will help ensure the child receives the necessary supports to improve his grasp throughout the day and across settings. Contrarily, OTs who do not value collaboration may believe that only their expertise can assist the child in improving his grasp. These OTs may not gather input from other team members nor share strategies to improve the toddler’s grasp; rather, the focus will be one-on-one “treatment” with a child that is provided by the “expert.” Team members who hold a conceptual position that one person, discipline, program, or service has more expertise than another hamper collaborative efforts (Cumming & Wong, 2012; Hanna & Rodger, 2002). Team members or organizations that do not value collaboration will likely behave in ways that maintain positions and practices that are not shared or coordinated with other team members or services.

Policy-Related Challenges

Policy refers to the principles, guidelines, structure, and related actions that govern and provide the structure for decision-making for a program, state, or larger entity such as the federal government. Policy challenges to collaborative practice can occur at all levels and can interfere with effective and cost-effective delivery of services. Administrative legislation outlines the need for collaborative practices in EI/ECSE (Division for Early Childhood, 2014; Individuals with Disabilities Education Improvement Act, 2004), but as noted elsewhere, implementing practices that require change is often challenging (Summers et al., 2001).

At the local or program level, participating children and families may require a broad range of services and supports if intervention is to be successful. For example, intervention to improve a child’s motor skills may be ineffective if the child has increased medical needs; hence, the reasoning for the mandated role of “service coordination” in the Individuals with Disabilities Education Improvement Act (IDEA) Part C regulations (IDEA, 2004). EI/ECSE program staff may have to work with professionals associated with other programs or services that can assist the family to obtain needed social or medical services. Such collaboration may be hindered because of policy differences between education, social service, and health agencies (Adams et al., 2013; Flynn & Harbin, 1987; T. King et al., 2010; Pedonti et al., 2019; Summers et al., 2001).

Policy differences at the state and region levels are often more complex and thus potentially more challenging. Programs in the same region may vary in terms of services offered, costs, family involvement, and intervention approach. Collaboration at the state level may entail coordination of programs within a state or coordination at the federal level. State laws, regulations, credential/licensing requirements, and data systems may differ within and across states because of policy variations. For example, health agencies may use data systems that are different from those used by social service and EI/ECSE programs, making it difficult to share information and track progress across time. Such policy inconsistencies contribute to both redundancy and gaps in services that often result in the ineffective use of limited resources.

Leadership Challenges

Collaboration requires an authentic commitment and accompanying resources (e.g., staff time, training) to be successful. In addition, successful collaboration needs a vision or goal, cultivation of staff strengths and relationships, and alignment of purposes and values. Effective leadership is essential to ensuring collaborative practices and high-quality programs (Bruder, 2000). Although clearly essential for successful collaboration, often leadership in EI/ECSE programs has focused on management-related skills rather than on leadership-based skills in spite of the latter being linked to higher quality programs and services (Bruder, 2000). Therefore, it becomes imperative for leaders to receive pre- and in-service related training on core leadership related skills including understanding values, vision, effectiveness, and results instead of focusing on structures, funding, and procedure, when working to foster complex practices such as collaboration between providers and across systems (Covey, 1991).

Once leaders have foundational skills and support high-quality collaborative practices, they are better able to foster team actions and facilitate motivation and commitment for collaboration across staff, programs, and services. Specifically, well-equipped leaders have the potential to create an open and supportive environment, establish a system to transfer expertise, arrange a reasonable caseload for each staff member, provide professional development on teaming and collaboration regularly, offer multiple ways to communicate, and encourage self-reflection on collaboration (G. King et al., 2009). Overall, although leadership is foundational to all high-quality programs and services in EI/ECSE, it becomes an essential component when fostering complex practices such as collaboration.

Operational Challenges

Operational challenges refer to those associated with the activities that are necessary to deliver services to young children and their families. Operational activities for programs may include intake routines, intervention, assessment, and progress monitoring. Programs and professionals have operational requirements guided by their policy, funding agency, administrative leadership, staff, and available resources. Frequently the operational requirements across services and disciplines vary and consequently offer a range of challenges (Cumming & Wong, 2012; Hong & Shaffer, 2014; G. King et al., 2009). For example, when beginning a new intervention for addressing a language delay, parents are asked to provide an array of information about the child that mirrors the information provided to the child’s intervention program. Other professions or agencies often request the same information when children are receiving services from multiple professionals or agencies. Families are often required to participate in similar assessments or parallel assessments. For example, the intervention program may ask a child’s mother to note her verbalizations when reading a book while the intervention program asks the same parent to complete a form on the child’s verbalizations.

The operational challenge of requesting and collecting redundant information and data is a waste of limited resources. There is a significant need for agreed-upon information gathering and assessment/progress-monitoring measures. Information and test results gathered at one site or time should be shared and used by subsequent agencies and staff. The use of agreed-upon measures helps create a common language and builds aligned data system among programs, regions, and states. Information and data that can be shared will benefit practitioners and families by saving time, linking services, and creating a common language to communicate that will result in improving consistency and accountability of services.

Training-Related Challenges

One goal of EI/ECSE is the delivery of comprehensive services to infants, toddlers, preschool-age children, and their families. This goal requires sharing and integrating the expertise of team members to meet children’s and families’ needs. However, an examination of training programs in higher education across disciplines suggests that most of them have a strong disciplinary focus: Curriculum content and practicum experiences are centered on a specific discipline. For example, speech-language pathology students are prepared with other speech-language pathology students, and their curriculum is almost entirely focused on content relevant to communication science. Similar disciplinary training occurs for students in the fields of psychology, education, social work, and health. Limited attention and time are given to interdisciplinary or cross-disciplinary collaborative practices in pre- and in-service training (Campbell et al., 2009; Gilbert et al., 2010; Hamilton-Jones & Vail, 2014). Consequently, in their first job, many beginning practitioners are poorly equipped to participate in collaborative practices with other team members (Bruder & Dunst, 2005).

As noted, most disciplinary training programs do not provide effective models for collaboration or sufficient practice opportunities to permit students in training to obtain the necessary perspectives, content, and skills for effective collaboration. Although interprofessional preparation of students in health care arenas has occurred in recent years (Reeves et al., 2017), it is uncommon in EI/ECSE (Applequist, McLellan, & McGrath, 2010). Professionals and paraprofessionals whose preparation lacks adequate experience and attention to collaboration will require subsequent formal or informal pre- and in-service training (Ebersöhn et al., 2007; G. King et al., 2009).

Summary of Challenges

The described challenges (by no means an exhaustive list) clearly pose hurdles to the development of collaborative practices in EI/ECSE programs (Cumming & Wong, 2012; T. King et al., 2010; Utley & Rapport, 2002). The proposed systems framework offered in this article is designed to recognize these challenges and more importantly offer a conceptual, structural, and operational approach to address these challenges in constructive ways.

Proposed Systems Framework

The proposed systems framework is founded on core premises, developmental assumptions, and collaboration assumptions that are listed in Table 1. Based on these premises and assumptions, the proposed framework has three major components: infrastructure, collaborative practices, and action levels. These components were derived from reviewing the literature associated with collaborative practices in human services and from the authors’ personal knowledge and expertise gained from working in early childhood programs as therapists, administrators, and instructors.

Table 1.

Framework Foundations: Core Premises and the Developmental and Collaboration Assumptions.

Framework Foundations	Premises and Assumptions
Core premises	The less able the child, the less supportive the environment, the greater the need for collaboration. The more comprehensive and sustained the collaboration, the more effective the outcomes for children and families.
Developmental assumptions	Child characteristics and the integration of developmental processes affect development and learning. The immediate environment and the larger historical and contemporary social/cultural context significantly influence development and learning.
Collaboration assumptions	Collaboration is foundational to all human service practices and systems. Collaboration requires commitment, planning, coordination, and follow-through. Collaboration must be flexible to accommodate a range of expertise, values, goals, and strategies. Collaboration must be sustained and generalized to be effective. Collaboration assumes partnership and recognition of unique skills and abilities of all team members.

Note. Premises and assumptions are based upon common principles in EI/ECSE and nearly 100 combined years of experience of the interdisciplinary author group focused on practice, teaching, and research in EI/ECSE. EI/ECSE = early intervention and early childhood special education.

Figure 1 offers a schematic of the proposed framework and includes the following: (a) core premises, including developmental and collaboration assumptions, (b) collaboration components, and (c) implementation strategies. The proposed components of infrastructure, collaborative practices, and action levels were derived from the premises and assumptions listed in Table 1 and theoretically can be combined and coordinated to improve outcomes for target children and families. The implementation strategies offer a structure for translating selected components into effective collaborative practice and evaluating the impact of those components. The three components (infrastructure, collaborative practices, and action levels) of the proposed systems framework, based on the core premises and assumptions, are described next.

Figure 1.

The proposed systems framework.

Component 1: Infrastructure

Infrastructure is defined as the underlying foundation or basic framework of a system. Infrastructure provides the parts, pieces, or elements that permit a system, organization, or enterprise to operate, function, or run. In regard to collaboration, infrastructure refers to the elements that allow or enhance sharing and working toward an agreed-upon goal or outcome. In the proposed framework, the collaborative infrastructure for EI/ECSE is composed of the following major areas: policy, professional standards, administrative leadership, disciplinary training, resources, and assessment and evaluation (Romano et al., 2019).

Policy

Policy is defined as the collections of rules, guidelines, or parameters that set the standards or govern the operation of a system, agency, or other enterprise. Other writers have referred to this component as governance (Goffin et al., 2011; Goodman et al., 1997; Regenstein & Lipper, 2013). Most training institutions, government agencies, or service delivery units have policies in place that govern their operations. In the proposed framework, policy that addresses how these various entities define and pursue collaboration is a fundamental component of infrastructure.

Professional standards

Professional standards are defined as the guidelines, rules, or requirements that set parameters for expected knowledge and behavior for a profession or work environment. Professional standards are often used as indexes or indicators by which professional practice is evaluated (National Policy Board for Educational Administration [NPBEA], 2015). In the proposed framework, professional standards refer to those discipline-related guidelines that establish the acceptable information and skill base to receive accreditation, licensure, or certification. More specifically, this component of infrastructure governs, at least partially, the standards of knowledge and performance for individuals delivering services to young children and their families.

Administrative leadership

Administrative leadership is defined as providing the vision, inspiration, motivation, and behavioral examples that move staff toward fulfilling organizational goals (Green, 2017; NPBEA, 2015). Establishing and maintaining collaborative practices and agreements in EI/ECSE depends greatly on the administrative support and leadership. In the proposed framework, administrative leadership is an essential component of infrastructure that underlies collaboration across teams, programs, and larger entities.

Disciplinary training

Disciplinary training is defined as the formal and informal preparation of personnel who will be delivering EI/ECSE services, which includes early childhood educators, early interventionists, special educators, health professionals (e.g., occupational therapists [OTs], physical therapists [PTs], speech-language pathologists [SLPs], nutritionists, physicians, specialists), psychologists, social-welfare workers, child care workers, and support personnel such as teaching aides. In the proposed framework, disciplinary training refers to offering a broad range of conceptual and practical information on collaboration as well as opportunities to acquire skills that permit, promote, and enhance collaboration (G. King et al., 2009).

Resources

Resources is defined as an entity or supply of money, materials, staff, or other assets that can be used by a person or organization to function or operate (Essa, 2013). Training, government, and service delivery organizations cannot operate without resources. The quality and quantity of available resources often determines, at least partially, the breadth and effectiveness of delivered services. In the proposed framework, resources refer to materials or personnel used to engage in collaborative efforts for young children and their families.

Assessment and evaluation

Assessment and evaluation are defined as activities, processes, or strategies that permit the gathering of baseline information and subsequent follow-up data needed to monitor program effectiveness over time. Effective collaborative efforts across teams or programs depend on using resources wisely and determining if goals are being met. Meeting such an essential standard requires that personnel engage in defensible assessment and progress-monitoring procedures over time. In the proposed framework, use of common or agreed-upon procedures for initial evaluation and subsequent progress monitoring are an essential area needed for effective collaboration (Ebersöhn et al., 2007; Nijhuis et al., 2007).

Component 2: Collaborative Practices

Collaborative practices are defined as the range of clinical, educational, or personal actions, interactions, or reactions used by professionals and paraprofessionals to assist in meeting agreed-upon goals at the team, program, state, and federal levels. In the proposed framework, collaborative practices in EI/ECSE encompass those behaviors, skills, actions, and reactions as well as formal or informal policy that build capacity, use resources wisely, and effect positive outcomes in children and families. In the proposed framework, seven practices have been identified as essential: communicating, sharing, joint planning, contributing, compromising, modeling, and acknowledging. Examples presented in this section are focused at the team level; however, these practices are also essential to effective and sustained collaboration at program, state, and federal levels.

Communicating. This means the sending or exchanging of verbal and nonverbal information to enhance understanding, show agreement or disagreement, resolve problems, formulate plans of action, conduct agreed-upon actions, and evaluate outcomes. For teams, effective communication allows participants to arrive at common understandings, discuss alternatives, and take coordinated actions (Ebersöhn et al., 2007). To attain effective communication, team members need to convey positive and accepting attitudes, be willing to discuss alternatives, and compromise to develop and execute joint action plans.

Sharing

Sharing is the ability and willingness of team members to make information, resources, and skills accessible and usable within the team. A team member may offer specific information, explain terminology, teach others how to apply a skill, or provide materials. Effective sharing between team members requires that information, resources, or skills are offered in the spirit of enabling overall team improvement and received in the spirit of becoming more competent (Cook & Friend, 2010; Hamilton-Jones & Vail, 2014; Lieberman-Betz et al., 2019; Wiggins & Damore, 2006).

Joint planning

Joint planning refers to team members working cooperatively to examine and integrate all collected information into a unified plan that is guided by specific goals, intervention strategies, and progress-monitoring activities. Effective joint planning requires team members to be accountable and responsible for their joint decisions, actions, and outcomes (Friend & Cook, 2010).

Contributing

From the perspective of the proposed collaborative framework, contributing refers to actions that assist, enhance, improve, or help team members move toward agreed-upon accomplishments either for the team or for families served by the team (Nijhuis et al., 2007). Effective contribution requires team members to offer information, skills, and time that accurately address the agreed-upon need.

Compromising. This refers to team members’ willingness to consider alternatives or options and make reasonable adjustments or concessions with other team members to arrive at cohesive plans and subsequent actions (Nijhuis et al., 2007).

Modeling. This is demonstrating actions or providing an example to assist other team members in imitating, replicating, learning, and adopting a skill or strategy. It is a useful practice for explicitly showing and teaching a variety of skills to other team members. Modeling is a particularly relevant practical skill used by more knowledgeable, experienced professionals to assist other team members (Shelden & Rush, 2013).

Acknowledging. This means offering feedback and appreciation to someone for an action. In EI/ECSE, an important collaborative practice is to provide positive feedback (Chen et al., 2007; Morgan et al., 2015). The practical skill of acknowledging in the proposed framework is the offering of constructive feedback to team members.

Component 3: Action Levels

The collaborative infrastructure and practices components identified earlier are relevant for the hierarchy of services available in the United States. These levels usually include the following: team, program, region/state, and federal.

Team level

The first action level, team, is focused on the staff delivering services to children and caregivers. Having a team implies that two or more individuals are involved in the planning and delivery of EI/ECSE services that require some form of interaction between these individuals. In cases where teams are composed of many individuals, interactions are likely to become more varied and more complex. To offer effective and sustainable services, whatever the team size, team members need to use some or all of the collaborative practices noted above. For example, if a child has a communication goal, the SLP may share developmental information with the caregiver and early interventionist as well as model appropriate language interventions to address the goal. The caregiver may, in turn, inform the SLP about times that are most appropriate for intervention in the home setting.

Program level

The second action level, program, refers to local community entities that offer EI/ECSE and other services to identified children and families. At the program level, the delivery of effective services relies on collaboration among team members as well as different service programs working in collaboration. For example, children and families being served in an EI/ECSE program may also require medical and social services to address all their needs. Consequently, the need for team collaboration at this level also requires collaboration among programs or services. The involved program staff must exceed actions that facilitate team collaboration to also discuss how different programs or services can coordinate their efforts. Such coordination and collaboration may require discussions and decisions about infrastructure areas such as policy, resources, and assessment/evaluation. These discussions and subsequent agreements are necessary to ensure that personnel across programs are collaborating to the extent possible to better meet child and family needs.

State level

The state action level refers to those programs or services that operate beyond the local program level but still within a particular state. For example, public kindergarten programs have state departments of education personnel who provide direction and evaluation. State departments of education, along with federal and state legislatures, also develop policies to provide guidelines for operations and requirements at the program level; in some cases, these guidelines extend to nonpublic entities. Collaboration is largely focused on the interface between other state-sponsored services (e.g., public health or welfare services) or privately funded entities (e.g., community childcare operated primarily through fees). Effective collaboration between state services and public-private services often requires serious examination of infrastructure and practice components across programs. Cross-systems collaboration requires shared and well-coordinated policies (Herrenkohl, 2019). Effective collaboration is dependent upon the freedom to loosen restrictions, share resources, and compromise. Such actions may be facilitated through participation in state-level councils, collaborative agreements or memorandums of understanding at the state level, or formal state rules, regulations, and state plans that promote collaboration across entities.

Federal level

This action level refers to national programs that affect more than one state. For example, Parts B and C of IDEA are programs at the federal level enacted for children with disabilities (IDEA, 2004). These federal programs are designed for implementation in individual states and are usually accompanied by funds with a set of regulations for how those funds are to be used. In addition, federal agencies also create “specialty” research, demonstration, and training programs that are available on a competitive base. These programs may or may not require collaboration across entities. Action at the federal level can greatly encourage and enhance collaboration at the team, program, and state levels by establishing guidelines, requirements, and policy that mandate collaborative efforts. For example, early childhood technical assistance (ECTA) entities can bolster the development of collaborative efforts in EI/ECSE and early childhood systems throughout the nation (e.g., Early Childhood Technical Assistance, Infant Toddler Coordinators Association [ITCA]). This coordination may involve sharing information or resources across states or cross-agency coordination at the national level for guidance to states on provisions of EI/ECSE services.

Summary of Action Levels

This section offered a systems framework that highlights the complexity of collaboration and delineates how to operationalize that complexity into meaningful components of infrastructure, practices, and levels. The usefulness and effectiveness of the proposed systems framework is dependent in large part upon its implementation. Once implemented, evaluation of its effectiveness becomes essential. The next section addresses the need for systematic implementation of a framework and offers a multistage strategy. The final section proposes next steps to examine the effectiveness of the implemented systems framework.

Implementation Strategies

Limited research on systems approaches to collaboration in EI/ECSE parallels a similar lack of attention to the implementation and sustainability of collaborative practice—or more broadly, the translation of conceptual/research findings into practice (Odom, 2009). Therefore, we have found it useful to think about the creation and adoption of a conceptual framework and/or research outcome as a three-step process: (a) the development of a model or framework and the collection of data, (b) the implementation of the model or research finding/examination of the actual rates of use and feasibility in real-world settings, and (c) the evaluation of the impact following implementation.

We began by developing a systems framework; consequentially, the next step, implementation, is designed to move the proposed systems frameworks into practice. Many strategies and models for moving from concept to practice are described in the implementation science literature. From this array, we adopted a model proposed by Halle et al. (2013). The model is conceptualized as a bridge between research and practice involving a five-stage process: exploration, installation, initial implementation, full implementation, and sustainability (Halle et al., 2013).

Exploration Stage

In the exploration stage, preliminary information is gathered on infrastructure and practice components. Organizational, cultural, and behavioral determinants (supports and barriers) to collaborative practices identified in the systems framework are noted. These practices might include questions to determine how well components of the systems framework fit within the organization, which levels of collaboration are feasible, and which supports and barriers exist for collaborative practices proposed by the systems framework. For example, do organizational privacy laws allow sharing of information? Do the organizational mission and values align with and promote collaboration or create barriers to collaboration? In the exploration stage, organizations must examine whether they have the necessary infrastructure (i.e., policy, professional standards, administrative leadership, disciplinary training, resources, and assessment/evaluation) that support collaborative practices.

Installation Stage

After feasibility and readiness are determined in the exploration stage, teams and organizations need to ensure structural changes are made that support the core components (i.e., infrastructure, practices, and levels) of the proposed systems framework. This process may require alterations in infrastructure elements such as policy, training, or administrative leadership as well as shifts in practices (i.e., communicating, sharing, contributing, joint planning, compromising, modeling, and acknowledging). Teams or organizations should identify goals or outcomes specific to collaboration, which may include plans for data collection, storage, and use. For example, on the team level, to enhance sharing and communicating, members might ensure that documentation includes neutral language without discipline-specific jargon. On the program level, an organization might adopt program-wide policies for collaborative practices. On the state level, two service organizations might adopt a goal to better align policies to permit sharing of information and data, or a service might have a goal to increase the frequency and efficiency of collaboration to improve shared outcomes.

Initial Implementation Stage

In the initial implementation stage, agreed-upon changes in infrastructure and practice components are adopted at the appropriate action level (i.e., team, program, state, or federal). This stage does not permit changes to the systems framework but rather allows adjustments in how various components are employed to improve fit with each unique environment, enhance adoption and use in real-world settings, and gauge their potential impact. For example, initial implementation may highlight where personnel require further training and leadership to ensure buy-in from staff or where adjustments in policy are needed to more optimally promote collaborative practices. During the initial implementation stage, personnel can practice the agreed-upon changes with the understanding that adjustments are possible and supports for embedding new practices are available. These supports, also known as implementation strategies or implementation drivers, may include follow-up coaching, additional time for learning new teaming and collaboration processes, and additional training or resources in areas of need that emerge (Powell et al., 2015).

Full Implementation Stage

Feedback gathered during the initial implementation stage permits fine-tuning necessary for the full implementation stage. Examination of fidelity of the collaborative treatment should occur at this stage, permitting evaluation of outcomes or the impact of the adopted systems framework. For fidelity of framework application, ongoing monitoring is necessary to ensure that all personnel adhere to the critical components of the systems framework.

Sustainability Stage

The sustainability stage addresses the maintenance of the systems framework over time. This maintenance will require ongoing structural supports such as funding and policies that include components of the systems framework. During this stage, adopters may ask some of the following questions: Is the framework sustainable in the face of leadership, staff, or funding changes? Are there built-in processes for training new staff to understand and use the components of the systems framework? Are administrators able to locate and involve new agency partners when there are changes in the community that may affect collaboration? The sustainability stage ensures sufficient engagement over time, which is critical to understanding whether the collaboration has lasting impact on outcomes. Overall, careful attention to ensuring the framework has been fully implemented through the sustainability stage lays the groundwork necessary for scientifically valid measurement on the effectiveness of the collaboration, which we discuss next.

Next Steps

Not all decisions can be based on empirical determinations, particularly as we grapple with the complexity of human behavior and intervention efforts (Baer, 1981). Significant challenges face those attempting to create an empirical base to evaluate collaboration efforts, including (a) the number of factors associated with comprehensive intervention efforts, (b) our limited methodological/analytical base, and (c) the lack of funding to sort through the myriad of variables that affect, interact, and change young children and their families.

Nevertheless, we believe that the field of EI/ECSE must begin to find strategies to expand the limited data associated with collaboration. This brief section offers three potential strategies (there are likely many more) that investigators might undertake to gather data on facets of the collaborative process, which may in turn lead to better practice.

Strategy 1: National Consortium

The first strategy requires the development of a national consortium of EI/ECSE programs equated on selected variables (e.g., type of children and families served, available resources to deliver services). However, programs would need to use different approaches or models to allow for comparison of selected collaboration components. The adoption and use of common-outcome measures would permit relevant comparisons (e.g., parent satisfaction, child progress) across programs (Coulton et al., 2015). The alignment of measures and terminology is especially relevant when gathering and examining data across linked or integrated data systems (Administration for Children & Families, Office of Planning, Research & Evaluation, 2010; Jordan et al., 2018). For example, the National Center for Educational Statistics (NCES) has completed work on the integration of data systems through the Center for Educational Data Systems (CEDS) and may be a helpful resource for states working on data alignment across services and programs. In addition, the Early Childhood Data Collaborative provides a number of resources related to data alignment as well as publications highlighting examples of data alignment and integration within early childhood systems (Jordan et al., 2018).

In addition to work on combining and aligning data systems, the formulation of a data repository to house data that addresses common areas of research is underway. Such repositories could allow for more broad-based analyses of the components of collaboration. For example, in a recent systematic review of big data practices in EI/ECSE, Stegenga et al. (2018) noted that data repositories for autism and early speech development research were successfully created to analyze large data set assembled from multiple studies (e.g., Beckman et al., 2017; Brundage et al., 2016; Payakachat et al., 2016).

Strategy 2: Sequential Research Design

The second strategy requires the participation of several comparable EI/ECSE programs to examine the effect of each collaborative component using sequential key component addition. Programs would need to use a similar approach to intervention. Once a baseline was established (e.g., child progress), a selected component of a collaboration approach would be implemented. The effect of each component addition could then be evaluated. In addition, the order of component addition could vary across programs to evaluate the effects of an introduced component. Factorial, sequential multiple assignment randomization trials (SMART) and multiphase optimization strategy (MOST) designs could be considered for examining the impact of the components. These designs are increasingly employed in implementation and real-world research due to their ability to maximize power while allowing examination of multiple components of an intervention or practice (Baker et al., 2017; Collins et al., 2007, 2009). In addition to using the aforementioned designs to examine the impact of each key component of collaboration, we suggest increasing the use of hybrid effectiveness-implementation research designs that intentionally examine the effect of both implementation factors on collaborative practices as well as examine the effect of the collaborative practices.

Strategy 3: Comparative Collaboration Training

The third strategy requires examining the effects of training programs on collaboration skills of professionals. For example, comparison across higher education training sites could be conducted. These sites would differ in that some would offer training programs that use models in which students are trained on collaborative teams, and others would use traditional disciplinary training approaches (e.g., PT students are trained with other PT students). Common metrics could be used to evaluate trainees’ subsequent on the job performance of collaborative skills.

In addition, higher education personnel preparation and professional development programs could gather information on interprofessional education (Kilgo et al., 2019) and foundational knowledge of early intervention (EI) across different disciplines (Weglarz-Ward, 2019). Programs could adopt and build upon strategies currently being utilized in the medical community for pre-service training related to cross-disciplinary collaboration (Bridges et al., 2011; Bruder & Dunst, 2005; Miller & Stayton, 1998; Wise et al., 2015).

For smaller institutions that may have fewer resources to accommodate collaborative training programs, other exploratory strategies might involve the use of distance programs (e.g., online classes) or telehealth. Institutions of higher education could partner with EI programs to evaluate collaborative performances of staff and to adjust professional development offerings as needed (Newton et al., 2019).

Summary

The inspiration for this article was the need to improve collaborative practice in EI/ECSE programs throughout the United States. Before offering a systems framework, challenges to effective collaborative practice were discussed. To improve both the understanding and practice of collaborative efforts, a comprehensive systems framework was proposed that includes premises, components, and implementation strategies. To be effective, conceptual frameworks require carefully planned and documented strategies and processes to ensure fidelity to the framework. We concluded by suggesting three general strategies to expand the empirical underpinnings of effective collaborative practice.

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

This research was supported in part by a grant from H325D150082.

ORCID iDs

Sondra M. Stegenga

Sloan O’Malley Storie

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