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Evidence-Based Approaches to Improving Results for
Infants, Toddlers and Families
Carl J. Dunst, Ph.D.Orelena Hawks Puckett Institute
Asheville, North Carolina
Presentation prepared for the Early On Michigan Redesign Meeting, Lansing, October 20, 2005
Purposes of the Presentation
1. Present a simple, simple framework for conceptualizing ways of measuring State Performance Plan (SPP) outcome indicators.
2. Illustrate what research “tells us” about the indicators and how to measure child outcomes.
3. Integrate SPP outcome indicators with available research evidence.
4. Make suggestions about how Michigan Early On can employ the framework, indicators, and research evidence as part of their redesign.
A Plea for Parsimony
In 1989, two years after the passage of the P.L. 99-457 early intervention program, I wrote as President of the Division for Early Childhood a Communicator message asking for parsimony in how the Part H program was being implemented. I wrote, “We should never employ a more complex system of assessment and intervention when a less complex one will do the job!” To say my plea was not heard is an understatement!
Complex = Confusion
With a sharp pencil, a good eye for detail, and a pocket calculator, one can demonstrate without much trouble that any policy will fail, simply by counting the number of discrete decision (or steps) in a hierarchy.
Richard Elmore
Part C State Performance Plan (SPP) and Annual Performance Report (APR)
Child-Related Indicators
Monitoring Priority: Early Intervention Services in Natural Environments
• Implementing Early Intervention in Home and Community Settings
• Improvements in Child Social-Emotional Skills, Developmental Skills (including language and communication), and Prosocial Child Behavior
• Family Rights, Parents Effectively Communicating Their Children’s Needs, and Parents Helping Their Children Develop and Learn
Operationalizing the SPP/APR Indicators
PART C MONITORING INDICATORS
Early Intervention Services in Home and Community Settings
Improved Child Functioning
Helping the Family Know Their Rights, Help Their Children Learn and Develop
EVIDENCE-BASED INDICATORS
Everyday Natural Learning Opportunities
Child Functional Behavior and Adaptive Development
Family Capacity (Parenting Competence and Confidence)
Major Elements of an Evidence-Based Part C Model
Family Capacity
• Parenting Knowledge• Parenting Competence• Parenting Confidence• Parenting Enjoyment
Natural Learning Opportunities
• Everyday Activity Settings• Number, Frequency and Variety of Learning
Opportunities• Learning Opportunity Characteristics
Child Behavior and Development
• Positive Social-Emotional Skills• Child Social-Adaptive Behavioral
Functioning• Child Prosocial Behavior• Child Development (Emergent Literacy,
Communication, etc.)
Setting the Stage for Outcome Indicator Selection
An Evidence-Based Model of Parent-Mediated Child Learning and Development
Family-Centered Helpgiving Practices
Relational Practices
• Behaviors typically associated with good clinical practice.
• Helpgiver beliefs and attitudes about family strengths and capacity.
Participatory Practices
• Family decision-making and family action based on choices.
• Practitioner flexibility and responsiveness to family choices and
priorities.
Family Capacity
Parenting Knowledge • Parent Rights, Knowledge of Child Development, Recognition of
Child Strengths, etc.
Parenting Competence • Parenting Interactional Styles, Use of Child Interests as the Context
of Child Learning, Providing Support and Guidance, etc.
Parenting Confidence • Self Efficacy Appraisals, Perceived Capability, etc.
Parenting Enjoyment • Mutual Parent/Child Enjoyment, Parenting Gratification,
Satisfaction with Parenting, etc.
Natural Learning Environments
Activity Settings • Home (Family Routines, Child Routines, Chores, Play,
Rituals, etc.) • Community (Family Outings, Outdoor Activities, Art/Entertainment
Activities, etc.)
Learning Opportunities • Number of Activity Settings • Frequency of Participation • Variety of Learning Opportunities
Learning Opportunity Characteristics • Interest-Based, Engaging, Child Exploration, and Child
Competence Expression
Child Behavior and Development
Social-Emotional Behavior
• Increased Positive Behavior
• Decreased Negative Behavior
Prosocial Behavior
• Child/Child Interactions
• Child/Parent Interactions
Child Development
• Cognitive, Problem Solving, etc.
• Literacy, Language, Communication, etc.
• Social-Adaptive, Self-Help, etc.
• Motor, Ambulation, etc.
Framework for Developing Indicators
Example of the Conceptualization to Measurement of Indicators
A Few Comments and Observations
• Need for A Balanced Perspective of Process and Outcome Measures
Outcomes Do Not Occur in a Vacuum
Cannot Improve Practices If You Don’t Understand the Relationship Between Practice Characteristics and Their Consequences (Outcomes)
• Goal of Early Intervention is Supporting and Strengthening Parent Capacity to
Provide Their Children Development Enhancing Learning Opportunities
Practitioner Implemented Interventions In the Absence of Parent Capacity Building Even Two Hours A Week for 50 Weeks Accounts for Only About 1% of a Child’s Waking Hours; Hardly Enough Time To Make Any
Meaningful Difference• To Be Effective, Interventions (Child, Parent, Family) Must Focus on Strengthening
Individual and Collective Capacity to Produce Desire Effects
Stimulation and Passive Manipulation of Behavior is Ineffective and In Many Cases is Related to Poor Outcomes and Functioning
The goal par excellence of early intervention is strengthened child, parent and family social adaptive competence
Illustrative Examples of Evidence-Based Practices and Indicators
• Consequences of Family-Centered Participatory Helpgiving Practices
• Social-Emotional Consequences of Response Contingent Learning Opportunities
• Influences of Caregiver Responsiveness on the Development of Young Children With Or At Risk for Developmental Disabilities
• Characteristics and Consequences of Everyday Natural Learning Opportunities
Practice-Based Research Syntheses of the Consequences of Family-Centered
Participatory Helpgiving
• Family Support Program Quality and Child, Parent, and Family Benefits
Eighteen Studies of 1,100 Parents in One Early Intervention Program
• Benefits and Consequences of Family-Centered Practices
More Than 30 Studies of 2,500+ Parents
• Influences of Family-Centered Practices on Child, Parent, and Family Functioning
More Than 80 Studies of 5,000+ Parents
Some Illustrative Findings
• Adherence to Family Support Principles Family-Centered Practices
• Influences of Family-Centered Helpgiving Child, Parent, and Family Functioning
Family, Infant and Preschool ProgramDegree of Practitioner Adherence to Family Support Principles
19
9019
9219
9319
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
04
YEAR
0
10
20
30
40
50
60
70
80
90
100
PE
RC
EN
T O
F IN
DIC
AT
OR
S
Relational IndicatorsParticipatory Indicators
Participatory helpgiving
exerts twice as much
influence on well-being
(mediated by personal
control appraisals)
compared to relational
helpgiving.
Indirect Influences of Family-Centered Helpgiving on Parent Well-Being
The pathways between helpgiving and well-being are essentially the same in different studies where the magnitude of the relationships are almost identical.
Indirect Influences of Family-Centered Practices on Parent Well-Being
Practice-Based Research Synthesis of Social-Emotional Consequences of
Response-Contingent Learning Opportunities
• Forty two (42) studies including 1,017 infants and young children
Thirteen (13) studies of children with delays or disabilities (N=155)
Twenty nine (29) studies of typically developing infants (N=862)
• Child Production of Behavior Followed by a Reinforcing Consequence
Social Reinforcement (N=7 studies)
Nonsocial Reinforcement (N=32 studies)
Combination (N=3 studies)
• Outcomes
Increases in Child Operant Behavior
Concomitant Increases in Positive Social-Emotional Responding
Concomitant Decreases in Negative Social-Emotional Responding
Contingency Learning Opportunities
Some Illustrative Findings
• Use of response-contingent learning opportunities as an “early intervention” promoted acquisition of child instrumental behavior.
Noncontingent or nonpredictable stimulation impeded learning.
• Positive social-emotional responding occurred when the relationship between the child’s behavior and its consequences was clear and unequivocal.
Child contingency awareness was optimized when the temporal relationship between the child’s behavior and its consequences was easily detectable.
• Negative social-emotional responding occurred when there were expectancy violations or responses to child behavior was inconsistent.
Practice-Based Research Synthesis of the Influences of Caregiver Responsiveness on the Development of Young
Children With or At-Risk for Developmental Disabilities
• Thirteen (13) studies of 1,336 children Infants born prematurely/low birth weight (N=713) Identified disabilities (N=356) Environmental at-risk (N=164) Typically developing (N=103)
• Child Behavior Followed by Caregiver Responsiveness (Promptness, Sensitivity, and Appropriateness)
• Outcomes Child Developmental Status Social-Emotional Behavior
Some Illustrative Findings
• Caregiver Responsiveness to Child Behavior Was Associated With Improved Child Developmental Status
Caregiver Responsiveness “Attuned” to Child Behavior Supported and Strengthened Child Functioning
• Caregiver Responsiveness to Child Behavior Was Associated With Increased Child Social-Emotional Responding
A Supportive Parenting Style Was More Likely to Produce Increased Positive or Decreased Negative Child Social- Emotional Behavior
Characteristics and Consequences of Everyday Natural Learning Opportunities
• Sources of Everyday Learning Opportunities
• Interest-Based vs. Adult-Directed Child Learning Opportunities
• Influences of Contrasting Approaches to Natural Learning Environment Practices
Sources of Everyday Learning Opportunities
• National Survey of Everyday Child Learning Opportunities
(N=3,300 Participants)
60 Everyday Activity Settings
• Findings
Twenty (22) Categories of Everyday Learning Opportunities
Sixty five (65) Percent are Family Activities and 35% are Community Activities
Child Frequency of Participation in the Activities is Associated With Positive Child, Parent, and Family Benefits
Sources of Everyday Natural Learning Opportunities
Family Activities (Example) Community Activities (Example)
Family Routines (Cooking)
Parenting Routines (Child’s bedtime)
Child Routines (Dressing/undressing)
Literacy Activities (Telling child stories)
Play Activities (Lap games)
Physical Play (Rough housing)
Entertainment Activities (Dancing/singing)
Family Rituals (Saying grace at meals)
Family Celebrations (Holiday dinners)
Socialization Activities (Having friends “over”)
Gardening Activities (Vegetable garden)
Family Excursions (Car/bus rides)
Family Outings (Visiting friends/neighbors)
Play Activities (Playgrounds)
Community Activities (Library/book mobile)
Outdoor Activities (Nature trail walks)
Recreation Activities (Swimming)
Children’s Attractions (Petting zoos/animal farms)
Art/Entertainment Activities (Concerts/theater)
Church/Religious Activities (Sunday school)
Organizations and Groups (Children’s clubs)
Sports Activities (T-Ball)
Sources of Family-Based Children’s Learning Opportunities
Organizations/Groups
2%
Community Activities10%
Outdoor Activities5%
Recreation Activities7%
Children's Attractions11%
Art/Entertainment Activities
10%
Church/Religious Activities
10%
Sports Activities5%
Family Routines15%
Play Activities11%
Family Outings14%
Sources of Community-Based Children’s Learning Opportunities
Interest-Based vs. Adult Directed Child Learning Opportunities
• Comparative Study of 50 Children With Identified Disabilities
Interest-Based Intervention Group (N=25)
Adult-Directed Intervention Group (N=25)
• Outcome Measures
DOCS Developmental Scale
Linear Growth Trends
Development-Instigating and Development-Enhancing Model of
Everyday Child Learning Opportunities
0 2 4 6 8 10 12 14 16 18 20
WEEKS OF INTERVENTION
20
25
30
35
40M
EA
N C
HI L
D D
EV
ELO
PM
EN
TAL
AG
E Child Asset-Based
Family-Directed
Relative Effectiveness of Two Contrasting Approachesto Natural Environment Intervention Practices
Influences of Contrasting Approaches to Natural Learning Environment Practices
• Comparative Studies of Different Ways of Conceptualizing Natural Environment Practices National Studies of 800+ parents of children in Part C
Programs State Studies of 800+ parents of children in Part C Programs
• Types of Natural Environment Practices Practitioners Implementing Interventions In Everyday Activities Parents Using Everyday Activities As Sources of Child Learning Opportunities
• Outcomes Child, Parent, and Family Well-Being; Parent Perceived Control Appraisals; Parenting Competence; Child Behavior
Illustrative Findings
• Using Everyday Activity Settings as Sources of Child Learning Opportunities Was Associated With Positive Benefits in 23 out of 25 Analyses (92%)
• Implementing Interventions in Everyday Activity Settings Had Positive Effects in Only 2 Analyses (8%), No Effects in 14 Analyses (56%), and Negative Effects in 6 Analyses (24%)
LEVEL OF USE OF FAMILY ACTIVITY SETTINGS
LEVEL OF USE OF COMMUNITY ACTIVITY SETTINGS
Implications for Measuring SPP Indicators
Stated SPP Indicator: Percent of infants and toddlers (with IFSPs) who primarily receive early intervention services in home or community settings.
Restated SPP Indicator: Percent of parents of infants and toddlers (with IFSPs) who use everyday family and community activities as sources of child learning opportunities.
Measurement: Parents’ responses to the question: “To what extent did the practitioner(s) working with your child provide you guidance about using the following activities to help your child learn desired skills and behaviors?”
Template for Developing Outcome Indicators