Abstract
Dissemination efforts play an important role in bridging the gap between research and practice. Many evidence-based early intervention programs for young autistic children have yet to be widely disseminated to the early childhood workforce. The purpose of this letter is to discuss how packaging and branding early intervention approaches may facilitate or hinder widespread dissemination to community-based early childhood settings. To disseminate early interventions more effectively, we argue that it will be important to account for factors that are known to impact the widespread uptake within community settings.
Lay abstract
Dissemination, or the widespread sharing of information, is important for moving research evidence into community practice. Early intervention programs for young autistic children have not yet been widely disseminated to the early childhood workforce. This letter describes factors that may support or prevent dissemination to community-based settings, such as packaging and branding early intervention approaches. We argue that an increased focus on dissemination research is needed.
Keywords
Dissemination—or the widespread delivery of evidence-based information—is crucial for increasing the reach and uptake of interventions in the community. The early childhood workforce is vast and interdisciplinary, and includes those who deliver care, education, and intervention to young children with developmental delays, making this group of practitioners a crucial target for dissemination. Many of the intervention approaches available for implementation in early childhood settings are unknown or misunderstood among the early childhood workforce, indicating a dissemination gap. As the field accumulates more robust evidence supporting the effectiveness of early intervention approaches, we argue that there is a need for increased focus on dissemination efforts directed toward practitioners in the community.
Throughout this letter, we use naturalistic developmental behavioral interventions (NDBIs) as a case example, while acknowledging that much of what we discuss applies to a wide variety of interventions in the autism field. NDBIs, perhaps more so than other types of early intervention, exemplify the proliferation of branded programs which are increasingly well researched yet poorly disseminated to the early childhood workforce. Moreover, branded NDBI programs have substantial overlap in intervention components, which may represent a unique challenge to dissemination (Schreibman et al., 2015). Ultimately, if researchers wish to increase the uptake of interventions by the early childhood workforce, then it is critical that we consider whether packaging and branding facilitates or hinders that goal.
Our ultimate goal is to get evidence-based early intervention approaches into community-based practice, which requires that we intentionally consider the factors that drive their widespread dissemination to early childhood educational settings (Baumann et al., 2022). Of note, factors that support high-quality implementation at an individual level may be at odds with the factors that support widespread dissemination at a population level, and vice versa. While implementation-focused research in the field has increased, we argue that a complementary focus on dissemination is critical for advancing the field. This letter addresses key dissemination issues and determinants from Baumann and colleagues (2022) that likely drive the widespread dissemination of early intervention approaches to the early childhood workforce.
Dissemination factors to consider
Content of communication
The content of communication regarding early intervention approaches is predominantly disseminated by researchers in the form of manuals with specific target audiences and protocols. A well-branded, published manual may be appealing to the early childhood workforce as an accessible and affordable way to learn about intervention relative to other traditional outlets (e.g. journal articles, professional conferences, didactic trainings). Yet, ours and others’ research suggests that early childhood practitioners report low familiarity and competence with packaged NDBIs, while reporting use of a range of NDBI strategies when described in generic terms. Thus, in some cases, branding of packaged programs appears to hinder dissemination, perhaps by obscuring the content of the intervention, which prevents practitioners from understanding how the intervention might be similar to or different from their current practice. Indeed, the use of manualized programs is not commonplace within community early childhood settings where instead many practitioners deliver child-centered and family-centered care broadly speaking, using discipline-specific approaches and strategies. In addition, others have argued that an emphasis on specialized manual content (e.g. social communication) aimed toward young autistic children has hindered widespread dissemination to an early childhood workforce serving children with varied needs and goals who may or may not have an autism diagnosis. Thus, the extent to which published manuals support the widespread dissemination of evidence-based interventions in the absence of other active dissemination strategies is unclear.
Source of providers’ knowledge
Another factor that may be important to consider is the source of providers’ knowledge. Broadly, evidence-based early intervention approaches, like NDBIs, align with recommendations to improve early childhood development, such as those put forth by the World Health Organization (WHO). Although not formally referred to by their names, providers are likely exposed to the general components of branded early intervention programs in preservice training. On the other hand, information regarding manualized programs may not become available until after providers enter the workforce and interface with specific in-service trainings or implementation initiatives driven by grant funding or community-academic partnerships, which tend to be limited in scope. These findings underscore significant gaps and missed opportunities regarding how early intervention programs are disseminated to providers and our understanding of the determinant constructs that may differentially impact how the early childhood workforce learns about evidence-based early intervention approaches.
Accessibility of early intervention approaches
We must also consider how accessible it is for early childhood providers to learn about branded early intervention approaches. Although some interventions (e.g. Project ImPACT, Early Start Denver Model) have associated websites and manuals available for public purchase, others (e.g. Early Social Interaction, Early Achievements) do not have associated websites and are not available for public purchase. In addition, formal training and certification processes are generally quite costly and time intensive. Although formal training and certification processes may support high-quality implementation of intervention practices, this may come at a detriment to dissemination by restricting opportunities for early childhood providers to learn about these approaches.
Medium of communication
A well-branded and packaged intervention can appeal to the target audience as an effective medium of communication. Applying effective marketing principles may further advance the dissemination of early intervention approaches and make it easier for the early childhood workforce to make decisions about the relative value of different models. Yet, it is currently unclear how early interventions can be more effectively marketed given that early intervention researchers themselves rarely have the skill set needed to incorporate and evaluate marketing principles within dissemination efforts (Cook et al., 2013). Notably, some early interventions have been commercialized and disseminated widely with the support of intermediary and purveyor organizations (e.g. DIRFloortime®, as disseminated by The International Council on Development and Learning, Inc.; the Pyramid Model as disseminated by The Pyramid Model Consortium), but such practices are rare. This may be in part due to researchers’ (a) lack of skill, knowledge, or interest in business practices; (b) discomfort with marketing and advertising therapeutic services, likely stemming from historical tradition within the discipline of psychology; (c) concern with conflicts of interest that arise with the commercialization of early interventions; and, finally, (d) uncertainty with regard to striking a balance between ensuring intervention effectiveness/fidelity while also supporting intervention reach (Crane et al., 2023).
Conclusion
There are current limitations in our foundational knowledge that would inform how we disseminate the active ingredients of early autism interventions, so they are able to be widely known and taken up by the early childhood workforce. In addition to continued work on these gaps, we believe an increased focus on studying dissemination is needed to facilitate equitable and widespread access to early intervention approaches in community early childhood settings. Potential areas of focus for dissemination research include the following:
Examining the relative benefits of disseminating broad evidence-based early intervention concepts/strategies, branded programs, or both;
Measuring key determinants of dissemination within the early childhood context, including the source, content, compatibility, and accessibility of communication;
Evaluating methods to effectively embed training on core early intervention approaches within early childhood preservice training;
Exploring the utility of intermediary and purveyor organizations (IPOs) to support the widespread dissemination of empirically supported early intervention approaches.
Our field has made progress in advancing the science of early intervention and developing manuals and resources with the potential to support dissemination at a wider scale. Increased knowledge in the above areas is critical in supporting the development of tailored dissemination efforts necessary to increase use of early intervention approaches among a large and growing early childhood workforce to reduce the science-to-service gap.
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.
