Evidence-Based Approaches to Improving Results for Infants, Toddlers and Families Carl J. Dunst, Ph.D. Orelena Hawks Pu

1. 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

2. Present a simple, simple framework for conceptualizing ways of measuring State Performance Plan (SPP) outcome indicators. Illustrate what research “tells us” about the indicators and how to measure child outcomes. Integrate SPP outcome indicators with available research evidence. Make suggestions about how Michigan Early On can employ the framework, indicators, and research evidence as part of their redesign. Purposes of the Presentation

3. 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! A Plea for Parsimony

4. 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

5. 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 Part C State Performance Plan (SPP) and Annual Performance Report (APR) Child-Related Indicators

6. 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)

7. Major Elements of an Evidence-Based Part C Model

8. Parenting Knowledge Parenting Competence Parenting Confidence Parenting Enjoyment Family Capacity

9. Everyday Activity Settings Number, Frequency and Variety of Learning Opportunities Learning Opportunity Characteristics Natural Learning Opportunities

10. Positive Social-Emotional Skills Child Social-Adaptive Behavioral Functioning Child Prosocial Behavior Child Development (Emergent Literacy, Communication, etc.) Child Behavior and Development

11. Setting the Stage for Outcome Indicator Selection

12. An Evidence-Based Model of Parent-Mediated Child Learning and Development

13. 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-Centered Helpgiving Practices

14. 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. Family Capacity

15. 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 Natural Learning Environments

16. 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. Child Behavior and Development

17. Framework for Developing Indicators

18. Example of the Conceptualization to Measurement of Indicators

19. 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 A Few Comments and Observations

20. 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 Illustrative Examples of Evidence-Based Practices and Indicators

21. 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 Practice-Based Research Syntheses of the Consequences of Family-Centered Participatory Helpgiving

22. Adherence to Family Support Principles  Family-Centered Practices Influences of Family-Centered Helpgiving  Child, Parent, and Family Functioning Some Illustrative Findings

23. Family, Infant and Preschool Program Degree of Practitioner Adherence to Family Support Principles 100 Relational Indicators 90 Participatory Indicators 80 70 60 PERCENT OF INDICATORS 50 40 30 20 10 0 1990 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 YEAR

24. Indirect Influences of Family-Centered Helpgiving on Parent Well-Being Participatory helpgiving exerts twice as much influence on well-being (mediated by personal control appraisals) compared to relational helpgiving.

25. Indirect Influences of Family-Centered Practices 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.

26. 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 Practice-Based Research Synthesis of Social-Emotional Consequences of Response-Contingent Learning Opportunities

27. Contingency Learning Opportunities

28. 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. Some Illustrative Findings

29. 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

30. 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 Some Illustrative Findings

31. Sources of Everyday Learning Opportunities Interest-Based vs. Adult-Directed Child Learning Opportunities Influences of Contrasting Approaches to Natural Learning Environment Practices Characteristics and Consequences of Everyday Natural Learning Opportunities

32. 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 Learning Opportunities

33. Sources of Everyday Natural Learning Opportunities

34. Sources of Family-Based Children’s Learning Opportunities

35. Sources of Community-Based Children’s Learning Opportunities

36. 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 Interest-Based vs. Adult Directed Child Learning Opportunities

37. Development-Instigating and Development-Enhancing Model of Everyday Child Learning Opportunities

40. 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 Influences of Contrasting Approaches to Natural Learning Environment Practices

41. 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%) Illustrative Findings

42. LEVEL OF USE OF FAMILY ACTIVITY SETTINGS

43. LEVEL OF USE OF COMMUNITY ACTIVITY SETTINGS

44. 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?” Implications for Measuring SPP Indicators

45. Template for Developing Outcome Indicators