Future of Early Intervention With Infants and Toddlers for Whom Typical Experiences Are Not Effective

Interventions Delivered by Natural Caregivers

As the field learns that intervention is what occurs between sessions, it becomes obvious that the interactions from natural caregivers explain much of the variance in child outcomes. By sessions, I mean the formal service encounters—a professional meeting a child and family for an early intervention session. Families are therefore natural caregivers, but so are other adults who spend significant amounts of time with the child. Teachers, grandparents, nannies, and so on can be counted in the ranks of natural caregivers. Data do not exist for the threshold amount of time needed to have an impact on the child’s learning or developmental trajectory, and this threshold probably varies by the type of child. Nevertheless, we can be fairly certain that the amount of time an adult spends with the child is correlated with the impact that adult has on the child’s functioning, if for no other reason than because of the greater number of learning opportunities occurring as duration of caregiving increases. At the low end of the scale, an hour a week is insufficient time to make a difference to a child because very young children, especially those with developmental delays, have difficulty generalizing and learning in massed trials; they are better learning skills in context (Stokes & Baer, 1977) and learning through distributed trials throughout the day. Therefore, children learn from their natural caregivers, whether we want them to or not.

Role of Special Educators and Similar Professionals

Professionals working with the child and family are now recognizing that their primary client is an adult, not a child. Adult-learning principles, then, have become important in the field, along with collaborative consultation and coaching.

Determining the Quantity and Quality of Early Intervention Children Are Actually Getting

If families and child-care teachers are teaching children and providing other interventions (e.g., positioning, ensuring engagement, giving them access to adaptive equipment), how do we document the amount of time spent on intervention? How do we determine the quality of what happens when we are not there? The reasons we need to know this are as follows: (a) They are the proximal outcome of our consultation and (b) they are the moderators if not mediators of the effect of professional services on child outcomes (McWilliam & Casey, 2004). When we coach caregivers, we do so in the hopes that they will use the strategies discussed during the many hours when the coach is absent. That proximal outcome is currently hard to measure, making it difficult to have objective data on the impact of coaching. Caregiver satisfaction is one measurable outcome, but caregiver satisfaction is not necessarily tied to caregiver implementation of strategies. Some researchers have decried the woeful dosage of early intervention, but they referred only to measures of professional services (Bailey, Aytch, Odom, Symons, & Wolery, 1999). The average amount of time early intervention professionals have worked with children has been documented as less than 2 hr a week (Kochanek & Buka, 1998). If that were all the time the child was getting interventions, it would indeed seem like a woefully weak support. But if that were the time the caregiver was getting support, it does not seem so weak. Many adult interventions, such as classes, therapy sessions, and meetings are delivered at that sort of dosage. What we do not know is how much time those adults are intervening with children—the true dosage of intervention. Making this distinction between service time and intervention time will be important for taking this next step.

As researchers, practitioners, and administrators begin to focus on intervention time, they need to judge quality also. The quality of parents’ interactions with their child must be approached cautiously because measuring it is, by definition, judgmental. Yet, once we acknowledge the premise of intervention being what the child receives, clearly we need to know how those interventions vary. The field has recognized the importance of intervention fidelity measures in early intervention research, but it has not solved the problem of measuring it when parents are the interveners.

Studies of parent–child interactions have long existed (Hart & Risley, 1992; Mahoney, Robinson, & Powell, 1992; Tannock, 1988). These studies have measured interactions in analog settings. Indeed, any observation of parenting where a videographer is present provides artificial data. As technology such as LENA™ devices, which audio-record adult talk, child talk, and environmental noises throughout the day, are developed, the field will move closer to capturing implementation fidelity data (Suskind et al., 2013).

If early intervention is designed to support all families of young children with disabilities in enhancing their children’s development, one of its goals is to modify parent–child interactions to the extent the families want this modification. Therefore a host of family factors come into play. What is the baseline quality of interactions? Do families want to change? What is the threshold implementation fidelity needed to effect change in the child? How stable would any change be? So far, the field has approached family-centered supports either as though families were all alike or as though everyone were unique. Identifying commonalities in families might be a step toward better fine-tuning personnel development and services.

Clustering Types of Families to Focus Training and Support

The diversity of families served in early intervention reflects the diversity of the people living in that country (Harry, 2002). In the United States, society is well aware of the increasing cultural and ethnic diversity, and the field has slowly become more aware of the impact of socioeconomic differences among families. Even at the level of ethnocultural diversity, the field is more challenged than ever before, but that is not the only or perhaps even most salient difference among families. Within and across cultural groups, parenting beliefs, socioeconomic status, family composition, and educational level play important roles in the quantity and quality of interventions the family provides to the child. Furthermore, the child is part of the family, so child characteristics (e.g., type of disability, severity, age, function competence) are salient family characteristics. Although both family and child factors have been studied, typologies of families have not yet been created.

It is possible that the field has resisted conducting a cluster analysis of families in early intervention for fear of stereotyping the groups—of type-casting families in a manner that does not fit the individual family (Henry, Tolan, & Gorman-Smith, 2005). Indeed, that would violate principles of individualization and true family centeredness, but that concern should not hamper science. We have thousands of families in early intervention and yet we organize professional development and service delivery as though families were a homogeneous mass. If, however, we were to discover that there are essentially 10 subgroups of families, we could train people to support these 10 subgroups and teach them to individualize within subgroups. For example, preparing to serve families who (a) have an infant with severe motor impairment, (b) are African American, (c) who are college educated, (d) have an external locus of control, and (e) believe that compliance in children is very important differs from preparing to serve families who (a) have a child with a language delay, (b) are Caucasian, (c) are rural poor, (d) have an internal locus of control, and (e) believe that compliance in children is very important (i.e., a shared characteristic with the first type). The purpose of clustering families, scientifically, is not to favor one type over another but is to hone our skills in working with families and to tailor our services more effectively. We would move from treating early intervention as though it were a fabric store with no patterns to one with patterns—patterns that allow for individual adjustments.

Early intervention has been a case study of a well-meaning, scientifically and theoretically valid endeavor stymied by administrative, fiscal, and professional barriers. In the early days, early intervention might not have been universal, but it was, in many places, based on interventions being delivered by natural caregivers, with professionals serving as consultants. The paradox then is that the most significant advances in the field have been a return to this basis. The future should involve an examination of the quantity and quality of those caregiver-mediated interventions and a classification of families enrolled in early intervention.