Speech-language pathologists play an important role in neonatal teams by supporting small vulnerable neonate's developmental needs through collaborative care, parent education, early intervention, and discharge planning. Parents' needs of speech-language pathology services in private sector units may inform systemic change in neonatal care. This study explored parents' experiences and needs regarding such support during and after Neonatal Intensive Care Unit admission. An online survey was completed by 42 parents whose infants had been admitted to private sector Neonatal Intensive Care Units, most born moderate-severe preterm (28–33 weeks). Although most parents felt welcome and involved in care, many reported emotional distress, limited bonding opportunities, and inadequate support for feeding and communication interaction. A considerable proportion described stressful feeding experiences and minimal referral to speech-language pathologists. Information on parent-infant communication and developmental milestones was also insufficient. Findings highlight the need for stronger integration of speech-language pathology services within private Neonatal Intensive Care Units and improved continuity of care postdischarge to support parent-infant interaction, feeding, and developmental outcomes. Advocacy for systemic change and greater speech-language pathology involvement is important to optimize care for small vulnerable newborns and their families in South Africa's private health care sector.
This study examined the fidelity of implementing Family Guided Routines Based Intervention (FGRBI) by displaced Ukrainian early intervention (EI) professionals working with refugee families in Poland. These professionals, themselves forcibly displaced, were trained and simultaneously coached to deliver EI services to young children at risk for or experiencing developmental delays. The aim was to assess changes in fidelity over time and compare self-assessed and trainer-rated scores. Twenty participants engaged in practice-based training program on FGRBI and caregiver coaching. The program integrated live instruction, self-assignments, guided reflection, and video-based feedback with concurrent service delivery through weekly home visits. Fidelity was measured using the 12-item FGRBI Key Indicators Checklist through self-assessment at three points (pretraining, 6, 12 months) and through trainer ratings at 6 and 12 months. Analyses included repeated-measures analysis of variance and paired-sample t -tests. Self-assessed fidelity scores improved significantly across the three assessments ( p < .001, η 2 = 0.95). Trainer-rated scores showed similar gains and closely aligned with self-assessments, with no significant differences at either time point. Interrater reliability between trainers was substantial to almost perfect (κ = 0.76–0.82). Findings highlight the feasibility of refugee-led EI models and the value of practice-based training and coaching in building professional capacity within displaced communities.
Early intervention during infancy is critical for supporting developmental trajectories of infants at risk for developmental disabilities; however, few programs specifically target sensory–motor functioning through structured caregiver–infant interaction during the first year of life. This study examined the feasibility of the Developmental Intervention Program Based on Interaction with Sensory–Motor Functions (DUMFET), a novel, caregiver-implemented early intervention program designed for infants aged 0–12 months with developmental risk or disability. Guided by a Type 1 feasibility framework, the study evaluated development and design feasibility, implementation fidelity, demand and retention, measurement feasibility, and caregiver acceptability. Six infants and their caregivers participated in a 6-week hybrid intervention combining face-to-face and online sessions. Quantitative data were collected using the DUMFET Program Evaluation Form and the Test of Sensory Functions in Infants, while qualitative data were obtained through caregiver focus group interviews and social validity forms. Results indicated high feasibility across domains, including 100% retention, high procedural fidelity (90%), successful administration of assessment tools, and strong caregiver satisfaction. Exploratory descriptive trends suggested observable changes in sensory regulation, tactile processing, and adaptive motor functions, supporting measurement sensitivity. Qualitative findings highlighted parental empowerment, increased caregiver confidence, and perceived improvements in infant regulation and interaction. Findings support the feasibility and acceptability of the DUMFET program and provide a strong foundation for refinement and progression to pilot or controlled efficacy trials.
This study examined the relationship between effort-reward imbalance (ERI), burnout, and intention to leave (ITL) among 465 rehabilitation professionals providing early intervention (EI) services to children from birth to three years in one US state. Using a cross-sectional survey design, physical therapists, occupational therapists, and speech-language pathologists completed validated measures assessing ERI, overcommitment, burnout, and ITL across three domains: early intervention, pediatrics, and the profession. Multivariable ordinal logistic regression and mediation analyses revealed that ERI was the strongest predictor of ITL across all three domains, with effects 11–63% higher than overcommitment. Over 80% of providers reported moderate to high burnout levels, and nearly one-quarter considered leaving EI weekly. Burnout partially mediated the relationship between ERI and ITL EI and the profession, while the relationship between ERI and leaving pediatrics was direct and not mediated by burnout. Years of experience in EI provided protective effects against burnout-mediated turnover. Findings suggest that workforce retention in EI requires systemic interventions that address modifiable organizational factors, such as inadequate compensation, administrative burden, and insufficient mentorship, rather than solely focusing on individual burnout reduction. Evidence-informed policy and organizational changes are essential to stabilize the EI workforce and best support children during this critical developmental period.
Best practice in early childhood intervention (ECI) in Australia has been influenced by initiatives such as funding packages for specific disabilities and the National Disability Insurance Scheme, shaping the professionals sought and the expectations for practitioners within services that support young children with disabilities and their families. The purpose of this study was to identify the knowledge, skills, and experience required for current ECI roles and the extent to which these correspond with the Australian ECI best practice guidelines. Data extracted from 246 online advertisements, retrieved over a 5-month period, revealed a lack of consistency in what employers seek from candidates. Only 26% of advertisements included essential skills and knowledge aligned with the ECI best practice guidelines, whereas just 16.7% specified experience consistent with the guidelines. To ensure that high-quality early childhood intervention services are provided, it is paramount that professionals' competencies, experiences, and qualifications are leading considerations.
Utilizing the family-centered approach and providing interventions in natural environments are two common early intervention practices. One way to apply these two practices is to teach caregivers to deliver naturalistic strategies. Using a single-case experimental multiple-probe design, the study examined the impact of training and coaching on three caregivers’ implementation of naturalistic intervention strategies with children with autism spectrum disorder (ASD) in Saudi Arabia. The caregivers received individual training and coaching sessions on naturalistic strategies via videoconferencing. Results showed a functional relation between caregiver training and coaching and their use of naturalistic strategies. Results also showed improvement in the children’s social communication, including verbal requests and the number of words per utterance. The caregivers reported positive perceptions of the study’s goal, procedures, and outcomes. This study has two key contributions. It enhanced the effectiveness and feasibility of training Arab families on naturalist strategies via telepractice. It also strengthened the benefits of naturalistic strategies on child social communication outcomes.
The utilization of educators and providers as leaders has been a focal point of educational discourse as instrumental to whole-school reform and child outcomes. However, the landscape of early intervention (EI) and early childhood special education (ECSE) remains relatively unexplored regarding educator or provider-based leadership. In this study, data were collected from 80 EI and ECSE providers through an online survey featuring quantitative and qualitative questions. Findings highlight the centrality of child- and family-centered interpersonal approaches to EI/ECSE leadership with a need for more collaboration and administrative support within the EI/ECSE context. Findings also point to how the Division for Early Childhood’s Recommended Practices for leadership could be used as a foundation for understanding the implementation of leadership within EI/ECSE. The following study contributes to understanding the unique context of EI/ECSE and underscores implications for practice and future research.
Coaching is a relational approach used in early intervention and early childhood special education to empower families in supporting the development of their children with autism or other developmental disabilities (DD). While various individuals can coach caregivers, this flexibility underscores the importance of understanding the factors that influence the fidelity of coaching practices. This study examined how the coach’s role, shaped by their training and professional background, impacts their application of key coaching practices with caregivers of young children with autism or other DD. Data were collected from 12 coaches (Board Certified Behavior Analysts, early interventionists, and parent coaches), who collectively conducted 92 baseline and 110 intervention sessions with 15 caregivers of young children with autism or other DD. The fidelity of caregiver coaching was evaluated using the Coaching Fidelity Scale, which measures the extent to which professionals implement a set of coaching practices with fidelity. The findings indicated that the coach’s role significantly predicts coaching fidelity in the baseline phase, with varying effects based on role, but not in the intervention phase. Moreover, significant improvements in coaching fidelity were observed for all coaches from the baseline to the intervention phase, with different levels of improvement among roles.
This paper examined object play in a new cross-sectional sample of 203 children developing with delays using a highly differentiated set of play categories to provide more detailed descriptions of these developments. Thirty-minute videotaped observations of children playing with a caregiver in their homes were taken at 8, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months of age. Participants included children with: autism ( n = 38); Down syndrome ( n = 27); language delays ( n = 55); delays in one or more other domains ( n = 76); and children born prematurely ( n = 7). Play activities were coded into 21 qualitatively different categories and analyzed in terms of frequency of activities and variety of examples expressed within categories. These children’s play activities were compared to a sample of 289 typically developing (TD) children, observed contemporaneously at the same age points. The groups were comparable in frequency. The children with delays expressed the same play categories as the TD children, but expressed more complex categories at later age points with less variety. Particular difficulties were identified for children with autism and children with Down syndrome. Implications for assessment and intervention center on evaluation using differentiated play categories, determining variety within them, and setting goals based on a developmental model.
The roles and responsibilities of early intervention service coordinators are complex and require them to manage multiple workload factors. This study examined the current status of seven workload factors outlined in the joint position statement, Service Coordination in Early Intervention (Division for Early Childhood and IDEA Infant Toddler Coordinators Association, 2020). Findings from a national survey and focus groups indicate that a collection of interrelated factors impact service coordinators’ workload, how they coordinate services, and their confidence with completing their work. Most participants reported using a dedicated model, serving families with medium levels of need, and feeling supported by supervisors. Service coordinators felt that workload intensity, including serving high number of families and completing significant documentation requirements, interfered with their abilities to provide high-quality service coordination and engage families. Focus group participants agreed that ideal caseload numbers would be between 40 and 50 families per service coordinator, yet only few participants were actually serving number of families in this range. Participants perceived that they were engaged with families; but the more families they served, the less engaged they felt. Level of engagement and confidence were also both significantly related to levels of family need. Implications for research and practice are discussed.
Parent-implemented interventions are evidence-based interventions carried out by parents and caregivers in children’s natural environments. Social validity assessment is crucial for acceptance and sustainability of these interventions. In this systematic review, we examined the social validity assessment practices used in parent-implemented interventions for young children with disabilities and those from disadvantaged backgrounds, as well as whether the recommendations for social validity assessment were followed. Results show that of 67 studies included, 36 reported social validity. Most studies measured social validity at the end of interventions using Likert-type questionnaires to gather social validity data from parents who participated in studies and reported limited information regarding social validity data. Results also indicate that parent-implemented intervention studies were limited in following recommendations in the literature for social validity assessment. Implications for research and practice, as well as recommendations, are provided.
The primary objective of this study was to examine the perceptions, common referral practices, and resources utilized by pediatricians and Early Intervention (EI) personnel in facilitating the direct enrollment of children with established medical conditions into EI program. A survey, developed through a literature review, policy document review, and cognitive interviewing with pediatricians and EI personnel, was completed by 69 general pediatricians and 193 EI personnel involved in intake and eligibility evaluations in Michigan and Washington. Descriptive analysis was used to analyze the results. Most pediatricians (76%) and EI personnel (81%) rated the EI referral system as “ Excellent ,” “ Very good ,” or “ Good .” EI personnel primarily rely on state-approved established conditions list, internet searches, and colleague consultations for eligibility determination. Pediatricians reported “ Rarely ” utilizing the established conditions list, and instead they “ Often ” refer children to EI for eligibility determination, with limited or no accompanying medical information. Inconsistencies in key referral practices among these professionals were observed. Understanding perceptions and practices of pediatricians and EI personnel is crucial for improving early childhood preventive care. Addressing identified gaps and promoting consistency in referral practices can enhance access to EI services for children with established medical conditions and developmental delays.
This paper examines the historical, policy, and practice landscape shaping early childhood intervention (ECI) and inclusive education for young children with special educational needs and their families in Ireland. By tracing developments from early segregated provision to contemporary rights-based frameworks, the paper situates current practice within broader sociopolitical, legislative, and international influences. Key national and international policy drivers, such as the United Nations Convention on Rights of the Child and Irish education and disability legislation, illustrate how ECI and inclusive education have evolved. The paper critically reviews contemporary models of provision across the education and health sectors, identifies major challenges, including the disconnect between education and disability services, systemic barriers to translating policy into practice, and workforce shortages and instability. The authors call for strengthened interagency collaboration, more coherent family-centered frameworks, and a shift from child-centered toward family-centered approaches.
There is a critical shortage of early intervention (EI) professionals who work with families of infants and toddlers with developmental delays and disabilities. Research suggests that many EI professionals are dissatisfied with pay and opportunities for career advancement and face stress due to overwork or lack of training. To inform efforts to retain EI professionals, we surveyed 427 EI professionals consisting of EI specialists, service coordinators, therapists, administrators, and staff to examine the relationship between various facets of job satisfaction (e.g., compensation, work, supervisors, management, co-workers, culture, training/mentoring), work-related factors (e.g., job roles, years of experience, program turnover/shortages, intent to leave), and socio-demographics (e.g., age, Hispanic ethnicity, educational attainment). Our findings suggested that respondents' dissatisfaction with work was most closely associated with their intent to leave in the next year. In addition, respondents working in programs with high levels of turnover were more dissatisfied with management, while respondents working in programs with staff shortages were more dissatisfied with EI work. Implications and suggestions for future research are discussed.
Responsive interaction strategies (RIS) are commonly recommended to encourage engagement, joint attention, and communication in young children with and without disabilities in authentic contexts. Related-service providers, including behavior support specialists and school psychologists, commonly address communication-related goals of young children but may lack adequate training in naturalistic instruction, including RIS. The primary purpose of this study was to evaluate baseline-level performance of pre-service related service providers to better understand their use of RIS before receiving training, as well as to identify areas that need specific attention when planning training. Second, the extent to which these professionals displayed increased and accurate use of RIS following training embedded within a university-based course on communication was evaluated. Participants were generally responsive during the pre-test but lacked skills in tailoring linguistic input to and offering play-based support for the child. Following the training, the results were mixed. Pre-service professionals likely need ongoing support to implement naturalistic strategies at criterion. Findings, implications for instructors and researchers, and limitations of this study are provided.
Maternal depression causes distress within a family system and can lead to poor social-emotional development among children if left unaddressed. Caregivers who experience economic distress are disproportionately affected, but early intervention programs, such as Early Head Start (EHS), have been shown to be effective at reducing maternal depressive symptoms and promoting children's social-emotional health when families are highly engaged in services. However, less is known about longitudinal associations between family engagement in EHS services, maternal depressive symptoms, and children's social-emotional development. The current study explores whether EHS service delivery type (home based or center based) influences within- and between-year linkages among family engagement, maternal depressive symptoms, and children's social-emotional development across ages one to three (n children at age 1 = 980, n caregivers = 690). Results indicate that greater family engagement in EHS services predicts lower caregiver depressive symptoms in subsequent years, regardless of service delivery type. Greater caregiver depressive symptoms may also predict lower engagement in subsequent years among home-based (but not center-based) families. There was some evidence that family engagement at age one predicts children's social-emotional competence at age three through depressive symptoms at age two; however, this mediation effect did not vary as a function of EHS service type. Our findings suggest that promoting family engagement in EHS services can reduce maternal depressive symptoms over time.
Relationships between families and preschool teachers are important for promoting child outcomes. However, families and teachers face barriers to establishing the type of quality relationships that can promote child outcomes, especially for those from historically minoritized backgrounds. The current qualitative study sought to describe parent, teacher, and family coordinator identified barriers to quality parent-teacher relationships, following the COVID-19 pandemic. Barriers were organized within Bronfenbrenner's Bioecological Systems Theory highlighting the interconnections between the Process, Person, Context, and Time (PPCT). Results suggest six major barriers, each crossing several PPCT levels affecting the process between parents and teachers. Findings suggest that investments at the context level are needed.
Improving early childhood intervention in Spain has been a concern and commitment on the part of professionals, families and the government in the last decades that have been reflected in changes in conceptual aspects, policies, practices and research. Our aim is, first, provide a general overview of these changes with particular reference to inclusion education in the early years (0–6). Next, we discuss current policies and practices in the field of inclusion, as well as the needs in both the initial training of the various professionals working in this field and in-service training. Third, we analyze the state of research and evaluation of early childhood services and inclusion. Fourth, we examine the challenges of inclusion in ECI to ensure that all children, without exception, are welcomed in preschools and can develop their full potential alongside their peers. Finally, we specify the steps that, in our view, would contribute to the improvement and strengthening of early childhood inclusion in Spain.
Children diagnosed with autism display impairments in social communication functioning. Parents of children with autism most commonly identify verbal expressive language delays as the primary concern. Intervention studies demonstrating effectiveness for improving outcomes for toddlers with autism tend to focus either on nonverbal social behavior, such as joint attention, or on verbal expressive language, but rarely on both. Although there are calls for efficient, cohesive interventions that effectively address these multiple outcome domains of functioning, there is little research to guide practice. Naturalistic studies document that soon after the emergence of joint attention, verbal expressive language emerges. Hence, parent-mediated interventions, which demonstrate effective promotion of joint attention in toddlers with autism, hold particular promise for experimental study of potential auxiliary effects on emergent verbal expressive language. This article reports effects of a joint attention-focused, parent-mediated intervention on subsequent emergence of verbal expressive language in toddlers with autism in a randomized controlled trial. Parent-child interaction videos were coded using a direct observational measure of emergent verbal expressive language of 90 toddlers with autism. Results showed that a nonverbal social communication focused intervention resulted in significant pre-post growth in single and multiple word utterances of toddlers in the intervention group as compared to those in the control group. Results provide preliminary evidence that parent-mediated interventions, targeting nonverbal social communication, can increase verbal expressive language. Implications for future research, policy, and practice are discussed.
This study investigated patterns of clinical follow-up exhibited by primarily Spanish-speaking families whose children were referred for diagnostic evaluation based on language concerns identified from a commonly used developmental screener, and investigated child and family factors associated with subsequent follow-up. A total of 440 children (211 females) ages 1-36 months (M = 20.55, SD = 9.45) agreed to participate in the study. Of the total sample, 71 children (30 female) ages 5-36 months (M = 23.51, SD = 6.71) were referred for diagnostic evaluation due to language concerns from the developmental screener. One month after the referral recommendation, the 71 families were contacted to determine the status of the referral for a diagnostic evaluation. Logistic regression was used to obtain odds ratios of factors hypothesized to influence pursuing a diagnostic evaluation. Findings revealed that of participants contacted 61.82% had pursued a diagnostic evaluation within one month of the recommendation. Of all the families contacted, 29.09% reported their child was receiving speech-language therapy within the 1-month timeframe. Consistent with our hypothesis, the younger the child was at the point of referral, the more likely the family was to pursue a diagnostic evaluation. Inconsistent with our hypothesis, maternal education and access to private insurance were not significantly related to the outcome of pursuing an evaluation. Additional information is needed to more fully understand the factors involved in deciding to pursue a diagnostic evaluation following language concerns identified through screening.
