evidence-based approaches to improving results for infants, toddlers and families carl j. dunst,...

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