Evidence-Based Approaches to Improving Results for

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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 Presentatio
n prepared for the Early On Michigan Redesign
Meeting, Lansing, October 20, 2005
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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.

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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!

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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
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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 Childrens Needs, and Parents Helping Their
  Children Develop and Learn

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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)
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Major Elements of an Evidence-Based Part C Model
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Family Capacity

• Parenting Knowledge
• Parenting Competence
• Parenting Confidence
• Parenting Enjoyment

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Natural Learning Opportunities

• Everyday Activity Settings
• Number, Frequency and Variety of Learning
  Opportunities
• Learning Opportunity Characteristics

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Child Behavior and Development

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

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Setting the Stage for Outcome Indicator Selection
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An Evidence-Based Model of Parent-Mediated Child
Learning and Development
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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.

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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.

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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

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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.

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Framework for Developing Indicators
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Example of the Conceptualization to Measurement
of Indicators
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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 Dont
  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 Childs 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

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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

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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

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Some Illustrative Findings

• Adherence to Family Support Principles
• ? Family-Centered Practices
• Influences of Family-Centered Helpgiving
• ? Child, Parent, and Family Functioning

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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.
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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.
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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 (N155)
• ? Twenty nine (29) studies of typically
  developing infants (N862)
• Child Production of Behavior Followed by a
  Reinforcing Consequence
• ? Social Reinforcement (N7 studies)
• ? Nonsocial Reinforcement (N32 studies)
• ? Combination (N3 studies)
• Outcomes
• ? Increases in Child Operant Behavior
• ? Concomitant Increases in Positive
  Social-Emotional Responding
• ? Concomitant Decreases in Negative
  Social-Emotional Responding

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Contingency Learning Opportunities
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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 childs
  behavior and its consequences was clear and
  unequivocal.
• ? Child contingency awareness was optimized
  when the temporal relationship between the
  childs behavior and its consequences was easily
  detectable.
• Negative social-emotional responding occurred
  when there were expectancy violations or
  responses to child behavior was inconsistent.

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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 (N713)
• ? Identified disabilities (N356)
• ? Environmental at-risk (N164)
• ? Typically developing (N103)
• Child Behavior Followed by Caregiver
  Responsiveness
• (Promptness, Sensitivity, and Appropriateness)
• Outcomes
• ? Child Developmental Status
• ? Social-Emotional Behavior

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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

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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

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Sources of Everyday Learning Opportunities

• National Survey of Everyday Child Learning
  Opportunities
• (N3,300 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

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Sources of Everyday Natural Learning
Opportunities
Family Activities (Example) Community Activities (Example)
Family Routines (Cooking) Parenting Routines (Childs 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) Childrens Attractions (Petting zoos/animal farms) Art/Entertainment Activities (Concerts/theater) Church/Religious Activities (Sunday school) Organizations and Groups (Childrens clubs) Sports Activities (T-Ball)
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Sources of Family-Based Childrens Learning
Opportunities
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Sources of Community-Based Childrens Learning
Opportunities
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Interest-Based vs. Adult Directed Child Learning
Opportunities

• Comparative Study of 50 Children With Identified
  Disabilities
• ? Interest-Based Intervention Group (N25)
• ? Adult-Directed Intervention Group (N25)
• Outcome Measures
• ? DOCS Developmental Scale
• ? Linear Growth Trends

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

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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)

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LEVEL OF USE OF FAMILY ACTIVITY SETTINGS
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LEVEL OF USE OF COMMUNITY ACTIVITY SETTINGS
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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?

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Template for Developing Outcome Indicators