This mixed-methods study examined real-world implementation of the primary service provider (PSP) teaming model in early intervention (EI) programs and identified individual- and program-level factors influencing implementation. Guided by implementation science frameworks, quantitative and qualitative data were collected from 30 practitioners across 11 EI programs using a fidelity checklist, scales, questionnaires, and interviews. Practitioners demonstrated moderate to high implementation fidelity, supported by statewide mandates, systematic training, and technical assistance. Leadership, cross-disciplinary knowledge and skills, ongoing training and colleague coaching, self-efficacy, and attitudinal openness among providers, particularly those with medical backgrounds, emerged as the most influential facilitators, whereas workforce shortages and limited funding constrained team formation and sustainability. Findings suggest that individual-level factors are interrelated with program-level conditions and can be strengthened through organizational supports. They highlight multilevel, context-responsive strategies that engage families and health care providers and address program-specific challenges to strengthen PSP implementation in EI programs.
Early Intervention (EI) is a crucial first-step service for young children with developmental delays and disabilities and their families. With the increased use of EI through telehealth, interest-holders’ perspectives and experiences with telehealth-delivered EI remain critical. Incorporating their voices can enhance the effectiveness of telehealth in EI and ensure high-quality service delivery. This review synthesized research on interest-holders’ experiences with telehealth EI in the United States. Thirteen studies were included and analyzed based on participant characteristics, study designs, and reported perspectives and experiences with EI. Implications for research and practices are discussed.
The joint position statement, Service Coordination in Early Intervention , from the Division for Early Childhood and IDEA Infant and Toddler Coordinators Association, included calls to action and recommendations that the early intervention (EI) field address the workload and compensation challenges faced by service coordinators. This cross-sectional, mixed-methods study used a national survey and focus groups to understand the perspectives of service coordinators regarding these challenges. Data pertaining to the number of families served, pay, greatest needs, and perceptions of professional value are presented. Participants recommended caseloads of 40 to 50 families, but any caseload number is complicated by level of family needs and required frequency of contacts. In all, 61% of participants felt they were inadequately compensated, with comments suggesting that poor pay was a reflection of their professional value in the field. Consistently, participants emphasized that addressing caseloads and compensation were their greatest needs. Implications for the calls to action in the joint position statement are discussed.
Background: Up to half of autistic children experience disruptive behaviors (DBs) that hinder daily functioning and caregiver well-being. Early intensive intervention can effectively address these challenges. This study examines the feasibility and acceptability of implementing the RUBI parent training protocol, an evidence-based intervention for reducing DBs, in diverse community settings across Israel. Objectives: This study aimed to assess the challenges and facilitators of implementing RUBI in community settings and evaluate its impact on DBs. Methods: A convergent mixed-methods approach was used, integrating quantitative and qualitative data. A total of 53 families across six sites received the RUBI protocol, delivered over 12 weekly sessions. The Aberrant Behavior Checklist (ABC) assessed DB changes pre- and post-intervention, complemented by qualitative interviews and site-specific observations. Results: RUBI was well received by parents and clinicians, with sustained implementation at sites with strong managerial involvement. Barriers included clinician time constraints, variability in cultural and professional backgrounds, and usability issues with the RUBI companion website. Reductions in DBs were observed across all sites: 27% of children showed significant improvement on the ABC Irritability subscale, 35% on Hyperactivity, and 38% on the ABC Total scale. Conclusions: RUBI effectively reduced DBs in community settings. Key recommendations for implementation include ensuring protected clinician time, developing materials for non-applied behavioral analysis (ABA) therapists, and culturally adapting parent-facing materials.
Interventions to enhance interactions between children with disabilities (CWD) and typically developing children (TDC) in inclusive preschool classrooms are crucial for the development of young children. This systematic scoping literature review describes peer interaction interventions in inclusive preschool classrooms. Sixteen studies met the inclusion criteria and were categorized according to a peer interaction intervention framework. Explicit social skills interventions, such as peer-mediated interventions, were the most common type of intervention. Most interventions were delivered to 4-year-old White children with Autism. Studies generally focused on increasing language and social skills for CWD and positioned TDC as intervention agents. The results suggest that future research intending to support peer interactions in inclusive classrooms should (a) include CWD other than autism and improve the reporting of race and language background; (b) clearly report what supports were in place before individualized interventions were implemented and expand research on less-intensive, naturalistic, or class-wide approaches; and (c) broaden the types of dependent variables measured.
The purpose of this qualitative study was to understand themes of parent-identified benefits and barriers to using math activities in the home setting. Specifically, parents of seven 4- to 5-year-old children with disabilities implemented math activities with their child for 3 weeks and provided feedback via logs and interviews. This served as an initial step toward identifying barriers to existing materials and iteratively developing a new, inclusive home math intervention. We used open coding to identify themes. Two benefit themes ((a) Improvements to the Child’s Behavior and Content Knowledge, (b) Increased Math Talk), three barrier themes ((a) Behavior Management Impedes Content Learning, (b) Lack of Confidence in Content and Teaching, (c) Factors Outside of the Study Impacts Capacity to Engage) and three recommendation themes were identified ((a) Prioritize Child Engagement, (b) Provide Explicit Instruction During Training, and (c) Prioritize Convenience and Ease). These themes offer insight into challenges with existing commercially available materials for families of children with disabilities, and future directions for the development of inclusive mathematics interventions.
The aim of this study is to adapt the Families in Early Intervention Quality of Life Scale (FEIQoL) into Turkish and determine its psychometric properties. Family members of 351 children with different types of disabilities participated in this study. During the adaptation process, confirmatory factor analysis determined that the factor structure was consistent with the original form. It was found that the criterion validity of the scale contained meaningful relationships with external criteria, and Cronbach’s alpha coefficient was calculated as .956 for the entire scale. Guttman’s split-half reliability supported the overall reliability of the scale, and item-total correlations indicated that the items adequately represented the scale as a whole. Significant differences between the mean scores of the lower and upper 27% groups revealed that the scale items had high discriminative power. In conclusion, the Turkish version of FEIQoL has been found to be a valid and reliable measurement tool.
This study presents the development, validation, and reliability of the Natural Environment Using Scale (NEUS), which is a parent-report evaluation of the natural environment (NE), in Turkey, in children aged 0 to 6 with disabilities. The NEUS measures the frequency of parents' use of NEs in early intervention and special education services. The first stage includes a pilot study, which involved 26 items generated from the current literature. Three items were removed based on calculated content validity indices and expert opinions in the pilot study. The main study form utilized comprised 23 items. The analysis yielded the following fit indices for the scale: RMSEA = 0.010, GFI = 0.93, CFI = 1.00. The Cronbach's alpha was .79. Based on findings in the current study, we developed a valid and reliable scale comprising 22 items and three factors related to the daily life of children with disability (Physical Environment and Materials, Parenting Skills- Social Interaction, and Support Services). In the future, the NEUS can serve as a valuable scale for more targeted and effective family-centered interventions.
Quality early childhood (EC) programs for infants and toddlers with disabilities are difficult to access, yet research examining families' perspectives on this issue remains limited. This qualitative study investigated barriers faced and supports needed by families of infants and toddlers with special needs in accessing quality EC programs. This study highlights family perspectives on policy and practice improvements for this underserved population. Semi-structured interviews were conducted with 10 families participating in early intervention services in a southeastern state. Thematic analysis revealed three primary barriers: program availability, knowledge of available programs, and financial constraints. Three essential supports were identified: staff understanding of special needs, funding of programs, and parent support and education. Findings highlight the interconnected nature of these barriers and supports, suggesting that comprehensive approaches are needed to address challenges simultaneously. Recommendations include implementing systematic information sharing in health care settings, enhancing staff training for medical accommodations, and developing parent support networks.
Naturalistic developmental behavior interventions (NDBIs) are commonly taught to caregivers to target social communication in autistic children. In addition to social communication challenges, 50% of autistic children engage in disruptive behaviors. This study aims to evaluate the impact of responsive and directive NDBI social communication strategies on autistic children's disruptive behavior. At baseline, mother-child dyads were randomized to receive 8 weeks of a caregiver-mediated intervention focused on either responsive or directive NDBI communication strategies (n = 73, Mage = 33.49, standard deviation [SD] = 6.37, directive n = 36, responsive n = 37). Before and after intervention, 10-min mother-child interactions were video-recorded and coded using an event-based disruptive behavior code. A linear model revealed that children in the directive condition were more likely to display disruptive behavior as compared to the responsive condition. This study's findings can be used by providers and caregivers when engaging in shared decision-making to identify NDBI strategies that best fit the family's priorities. Additional research is needed to examine (a) disruptive behavior over time and across contexts and (b) the effects of directive and responsive strategies implemented in tandem on disruptive behavior. The original clinical trial was prospectively registered in a publicly accessible database (NCT02632773, clinicaltrials.gov).
The development of children's emergent literacy skills in kindergarten must be supported, given the significance of these skills for their future educational success. However, without further training, it may be challenging for educators to provide this support effectively. The current study aims to evaluate the impact of a relatively brief professional development program with several components on the number of emergent literacy learning opportunities offered to children. A multiple baseline design was employed with three educators of inclusive kindergarten classes for 4-year-olds. Data collection involved between 6 and 12 observation time points during the baseline phase and 18 time points for the intervention phase. Visual and statistical analyses indicated that professional development led to an increase in learning opportunities presented to children. Consequently, even if the professional development program provided was brief, it represents a promising option to support emergent literacy skills in kindergarten.
Early intervention (EI) is federally mandated under Part C of the Individuals with Disabilities Education Act. It is a critical system supporting young children with developmental delays and their families; however, the use of evidence-based practices (EBPs) remains under-implemented across EI systems. Implementation climate is a key driver of successful EBP implementation, yet no validated tools exist to assess this within EI settings. This study adapted and validated the Implementation Climate Scale for Early Intervention (ICS-EI) using data from 183 EI providers across 33 states and Washington, D.C. The data indicated excellent internal consistency, and exploratory and confirmatory factor analyses supported a seven-factor structure with excellent model fit. The ICS-EI offers a psychometrically strong, contextually appropriate tool for assessing implementation climate in EI. Findings provide preliminary support for the ICS-EI as a tool to assess implementation climate in EI settings, which may inform future efforts to enhance EBP use.
This study examined the functional relation between the Teach-Model-Coach-Review (TMCR) instructional approach and Brazilian parents use of Enhanced Milieu Teaching with Phonological Emphasis (EMT-PE) strategies with their child with nonsyndromic cleft palate. A single-case multiple baseline across behaviors experimental design replicated across three parents was utilized. The Teach-Model-Coach-Review approach was applied to teach EMT-PE strategies (use of speech and language targets within balanced turns, use of speech recasting and/or language expansions, and use of communication elicitation procedures). The intervention was short term (2-3 months) and delivered in an in-person and hybrid in-person + telehealth model. Children's expressive language outcomes were measured, and social validity data were collected. A functional relation between the TMCR intervention and parent's use of EMT-PE strategies was found for the three dyads. All children showed improvement in their expressive language. Parents reported that the intervention approach was effective. Brazilian clinicians rated the approach as culturally valid.
Children with medical complexities (MC) are one population of infants and toddlers served under Part C Early Intervention (EI) of the Individuals with Disabilities Education Act (2004). Children with MC and their families have unique characteristics, such as requiring frequent medical appointments, needing extensive medical equipment, and incurring significant financial and social impacts. The literature on children with MC in EI is scant. The purpose of this qualitative study was to understand what practices EI providers believe are important for children with MC and their families, using interview data from 19 EI providers across the United States. We constructed four themes that represent the findings: (a) capacity-building practices, (b) individualizing and slowing down, (3) collaborating with professionals, and (c) intentionality around intersectionality. More research is needed that focuses on this population of infants and toddlers, so that we ensure that EI providers are well prepared to address their unique needs, and that families and children with MC receive the best care possible.
Reflection and feedback are commonly considered to be essential components in early intervention (EI) caregiver coaching frameworks. However, there is limited research demonstrating how EI practitioners (EIPs) and caregivers engage in reflective coaching conversations during sessions. The purpose of this study is to identify how these strategies support ongoing interactions between the caregiver, child, and EIP, and work to build caregivers' competence and confidence. This study uses a qualitative approach to investigate reflective coaching conversations among four matched triads during their EI sessions and explores both EIP coaching strategies and caregivers' responses. Findings suggest that EIPs use a variety of strategies to promote caregiver reflection and deliver supportive reflective feedback during EI sessions. Correspondingly, caregivers provided varied responses matching EIP strategies. Implications highlight the need for EIP training in various reflection and feedback caregiver coaching strategies for working with caregivers.
Previous research has highlighted the need for trauma-informed care (TIC) to be used in Early Intervention (EI). However, little is known about how EI providers use TIC in their practice. Therefore, the purpose of this study was to explore how EI providers think about and use TIC. We conducted semi-structured interviews with fourteen EI providers in Illinois. We organized our findings using the Substance Abuse and Mental Health Services Administration's framework of TIC, highlighting how EI providers realize the impact of trauma, recognize the signs and symptoms of trauma, respond by using trauma-informed practices, and resist re-traumatization. The findings from this study have implications for research, practice, and policy related to the provision of EI services.
Dual language learners are often underidentified for having language delays and may not receive services in their caregiver's primary language. This study explored how the language used during evaluations influenced the effectiveness of a brief intervention for children with mild language delays. By examining whether evaluation language impacts intervention outcomes, the study provides insight into optimizing strategies for supporting children with early language challenges. Participants were 433 children (Mage = 31.12 months), who spoke English, Spanish, or are dual language English-Spanish learners who completed a brief speech-language intervention and pre- and post-intervention evaluations. We determined language "match" if the caregiver's primary language used in the home was the same as the language in which the child received the pre-intervention baseline evaluation. Dyads were a "non-match" if the caregiver's primary language used in the home was not the same as the language in which the child received the pre-intervention baseline evaluation. Children who had their evaluation conducted in the language that matched their caregiver's primary language showed more improvements than children whose evaluations did not match their primary language. This study builds on previous findings on the importance of providing dual language evaluations and interventions for children with early language delays.
This study validates the Traditional Chinese Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2), referred to as the ASQ:SE-2-TC, for children in Taiwan. A sample of 3,954 children aged 1-72 months was used to assess seven age intervals of the ASQ:SE-2-TC. Convergent validity was tested with the Child Behavior Checklist (CBCL 1.5-5) in a subset of 208 children. Results showed acceptable internal consistency for most intervals (Cronbach's alpha = .66-.85), with lower reliability at 2 months (alpha = .40). Test-retest reliability was strong (r = .86). Multiple methods were used to determine the cutoff scores. Across age intervals, sensitivity ranged from 87.5% to 100% and specificity from 64.3% to 85.7%. In addition, statistically significant correlations were found between the scores of ASQ:SE-2-TC and CBCL 1.5-5. In terms of instrument utility, caregivers reported the questionnaire as time-efficient and helpful for understanding child development. Overall, the ASQ:SE-2-TC demonstrated good psychometric properties for use in Taiwan.
Provider-based leadership is essential in early intervention (EI) and early childhood special education (ECSE), where providers play a pivotal role in supporting children with disabilities and their families through collaboration and evidence-based practices. This study explores the experiences and perceptions of 30 EI/ECSE providers, examining leadership characteristics; informal expressions of leadership through mentoring, coaching, and collaboration; and the systemic barriers and supports shaping leadership opportunities. Findings reveal the critical importance of interpersonal skills and content knowledge in fostering leadership and emphasize leadership’s organic, adaptive nature in this context. However, systemic challenges, such as time constraints and undervaluation of the profession, hinder leadership development. The study highlights disparities in leadership accessibility and the need for collaborative frameworks to address these barriers. These findings inform actionable strategies to strengthen leadership capacity, enhance systemic support, and advance equity in leadership opportunities within EI/ECSE.
Transitions comprise a substantial portion of the school day in early childhood classrooms. A unique aspect of these transitions, when compared with transitions occurring throughout grade-school classrooms, is the emphasis on restoring toys and materials to their original place prior to moving to a new activity or area of the classroom. To support young children who are struggling with the “cleaning-up” aspect of transitions, we used a series of single-case multiple probe designs to evaluate the effectiveness of video models with teacher narration presented during center-based transitions in an inclusive preschool classroom. In addition, to understand the extent to which the intervention yielded evidence of generalized learning, we evaluated children’s behavior across untrained centers within the context of an experimental single-case design. Results indicated that children acquired, maintained, and generalized cleaning behaviors across centers. Replications of this research are warranted to validate the utility of video models with teacher narration to address cleaning and transition-related behaviors in early childhood classrooms.
