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Assessing the quality of early intervention with families Professor Alys Young* [Dr Maria Gascon-Ramos, Dr Malcolm Campbell, Professor John Bamford] *Social.

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Presentation on theme: "Assessing the quality of early intervention with families Professor Alys Young* [Dr Maria Gascon-Ramos, Dr Malcolm Campbell, Professor John Bamford] *Social."— Presentation transcript:

1 Assessing the quality of early intervention with families Professor Alys Young* [Dr Maria Gascon-Ramos, Dr Malcolm Campbell, Professor John Bamford] *Social Research with Deaf People (SORD) group The University of Manchester, UK

2 Growing interest in quality Why important?Why important? –Early identification + quality early intervention = improved outcomes –Family as vital element in understanding differential outcomes –Important for better targeting of services

3 Quality as structure and framework of servicesQuality as structure and framework of services –Standards –Training/skills –Service elements –Best practice Quality as processQuality as process –How services are provided –How professionals behave Preferred underpinning philosophiesPreferred underpinning philosophies –E.g. Family centred practice –Informed choice

4 Quality Quality has objective definitions, markers and standardsQuality has objective definitions, markers and standardsAnd Quality is something perceived/experienced and identified as meaningfulQuality is something perceived/experienced and identified as meaningful

5 Quality problems Quality as something that makes a measurable difference may be problematic if it does not consider the significance of the difference or how it is appraisedQuality as something that makes a measurable difference may be problematic if it does not consider the significance of the difference or how it is appraised Quality as something subjectively perceived/defined maybe problematic? – we only judge by own standards/ experiencesQuality as something subjectively perceived/defined maybe problematic? – we only judge by own standards/ experiences

6 Designing a parent-report quality instrument Allow us to have descriptions of input – both structures and processesAllow us to have descriptions of input – both structures and processes Allow us a window into the relevance/meaningfulness of the inputAllow us a window into the relevance/meaningfulness of the input Allow us to see how perception changes with timeAllow us to see how perception changes with time Allow us to take into consideration parents personal dispositionsAllow us to take into consideration parents personal dispositions

7 Written questionnaire – parents - 6 monthly intervals (1)a description of the of professional services (1)a description of the structure of professional services evaluated according to timeliness and availability (2) the content of intervention evaluated according to importance, quantity and satisfaction; (3) the process of the intervention evaluated according to extent and importance; (4) the overall impact of the intervention in terms of child, family and parent themselves

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9 Content of intervention (22 items)

10 18 items

11 6 items

12 Other instruments Short form TEIQue [Trait Emotional Intelligence Questionnaire]Short form TEIQue [Trait Emotional Intelligence Questionnaire] –Enables control for disposition –Well being, emotionality, self control, sociability Basic demographics and child characteristicsBasic demographics and child characteristics

13 Instrument properties

14 Content of Intervention: Scale development Two subscales to measure content of support with good reliability were identified:Two subscales to measure content of support with good reliability were identified: –Supporting a deaf child (α=0.87) –Supporting parents (α=0.86) Inter-scale correlation was high (r=0.75)Inter-scale correlation was high (r=0.75) Test-retest correlations were also high after:Test-retest correlations were also high after: –6 month (rho=0.88; r= ) –12 months (rho=0.595; r=0.817)

15 Examples from sub scales Supporting a deaf childSupporting a deaf child –Information about how to communicate with my deaf child –Confidence building in parenting a deaf child –Knowledge about how to play with and enjoy my deaf child Supporting parentsSupporting parents –Help to understand how professional support systems work –Emotional support for you and your family –Advocacy (making my needs known)

16 Process of intervention: scale development Content validity – based on review of Family Centred PracticeContent validity – based on review of Family Centred Practice Reliability: High internal consistency (α=0.93)Reliability: High internal consistency (α=0.93) All 18 statements necessary to achieve such a high levelAll 18 statements necessary to achieve such a high level Reliability did not improve with deletion of any statementsReliability did not improve with deletion of any statements Suggests high construct validity for Family Centred Practice ScaleSuggests high construct validity for Family Centred Practice Scale

17 Some results??

18 Questionnaire returns At entry – 82At entry – 82 6 months later – 526 months later – months later – 2312 months later – 23 Distributions of key variables were examined to determine the use of parametric or nonparametric analyses.Distributions of key variables were examined to determine the use of parametric or nonparametric analyses.

19 Perceived Importance of Content of EI Ratings of importance for both sub scales were highRatings of importance for both sub scales were high –Supporting Deaf Child were rated as important or very important (mean 3.5; SD 0.52; n=73) –Supporting Parents took a second place (mean 2.95; SD 0.59; n=73) BUT Intervention that equips parents to support their deaf child is consistently rated as more important than content that addresses their personal support.BUT Intervention that equips parents to support their deaf child is consistently rated as more important than content that addresses their personal support. Differences between ratings of importance in both subscales were statistically significant (paired t= 12.03; p< 0.001) and highly correlated (r=0.75; p< 0.001).Differences between ratings of importance in both subscales were statistically significant (paired t= 12.03; p< 0.001) and highly correlated (r=0.75; p< 0.001).

20 Did length of involvement with EI change perceptions of importance? Comparisons made between:Comparisons made between: –At entry and 6 months later –6 months and 12 months High importance persisted on both sub scalesHigh importance persisted on both sub scales No statistically significant differences on either sub scale between ratings at different time points, or in the relationship between the 2 sub scalesNo statistically significant differences on either sub scale between ratings at different time points, or in the relationship between the 2 sub scales Perceived importance of content remains stablePerceived importance of content remains stable Perceived higher importance of content relating specifically to supporting a deaf child remains stablePerceived higher importance of content relating specifically to supporting a deaf child remains stable

21 Did emotional intelligence make a difference? Mothers TEIQue did not correlate significantly with ratings of perceived importance of content of intervention ( overall, nor on either sub scale)Mothers TEIQue did not correlate significantly with ratings of perceived importance of content of intervention ( overall, nor on either sub scale) SDCSP rprp Global Trait EI Well being Self-control Emotionality Sociability

22 Did educational background matter? YES: Mothers with fewer qualifications rated the importance of content relating to supporting them more highly than those with higher qualifications. [Supporting Parents sub scale (F=4.23; p=0.008)]YES: Mothers with fewer qualifications rated the importance of content relating to supporting them more highly than those with higher qualifications. [Supporting Parents sub scale (F=4.23; p=0.008)] Ratings on the SDC sub scale not affected by educationRatings on the SDC sub scale not affected by education SDCSP MedianSDMeanSD No qualifications High school Higher education certificate Higher education degree, NVQ

23 Parents Satisfaction with Content of EI Parents satisfaction scores on the Supporting a Deaf Child subscale were higher (mean 3.4, SD 0.9) than on the Supporting Parents subscale (mean 3.1, SD 0.8)Parents satisfaction scores on the Supporting a Deaf Child subscale were higher (mean 3.4, SD 0.9) than on the Supporting Parents subscale (mean 3.1, SD 0.8) The difference is statistically significant (t =3.24, df= 55, p = 0.002).The difference is statistically significant (t =3.24, df= 55, p = 0.002). Result not affected by age of child, degree of hearing loss, disability.Result not affected by age of child, degree of hearing loss, disability.

24 Does length of involvement make a difference? Comparing at entry with 6 mths later and 12 months laterComparing at entry with 6 mths later and 12 months later Satisfaction scores do increase over timeSatisfaction scores do increase over time –Not statistically significant for the SDC subscale –Is statistically significant for the SP subscale SDCrpTdfp At entry *6 m * At entry *12 m * At entry (mean 3.5; SD 1.0) 6 months (mean 3.3; SD 0.9) 12 months (mean 3.5; SD 0.9) SPrptdfp At entry *6 m * At entry *12 m * * At entry (mean 3.1; SD 0.8) 6 months (mean 3.1; SD 0.8) 12 months (mean 3.5; SD 0.7)

25 The impact of well being Mothers wellbeing is correlated with satisfaction scores on both subscalesMothers wellbeing is correlated with satisfaction scores on both subscales –[Factor analysis demonstrating a statistically significant association with content] SDCSP rprp Global Trait EI Well being * * Self-control Emotionality Sociability [But mothers educational background does not affect satisfaction scores on either sub scale nor globally].

26 Perceived Impact and Satisfaction with content of EI –No statistically significant relationship was found between satisfaction with content of early intervention and perceived impact of intervention on the child (r= 1.38, p=0.191) –However, a statistically significant relationship was observed between satisfaction and perceived impact of intervention on the parent as an individual (r=0.318, p=0.002) and on the family (r=0.320, p=0.002).

27 Conclusions All content is important and its perceived importance increases over timeAll content is important and its perceived importance increases over time But that which is perceived to be specific to the difference of the deaf child is more significant in the early stages regardless of maternal disposition and child specific characteristicsBut that which is perceived to be specific to the difference of the deaf child is more significant in the early stages regardless of maternal disposition and child specific characteristics initial appraisals of the importance of content of intervention were the best predictor of appraisals 6 months later, over an above any differences associated with child characteristics (e.g. degree of deafness).initial appraisals of the importance of content of intervention were the best predictor of appraisals 6 months later, over an above any differences associated with child characteristics (e.g. degree of deafness). Importance attributed to specialist content not affected by maternal education.Importance attributed to specialist content not affected by maternal education. But importance attributed to personal support was affected by maternal education – those with fewer qualifications attributed greater importance.But importance attributed to personal support was affected by maternal education – those with fewer qualifications attributed greater importance.

28 Conclusions cont. Significant higher satisfaction ratings were associated with content of intervention linked to supporting a deaf child, in comparison with that supporting parents.Significant higher satisfaction ratings were associated with content of intervention linked to supporting a deaf child, in comparison with that supporting parents. satisfaction with content associated with supporting parents did increase with length of involvement in interventionsatisfaction with content associated with supporting parents did increase with length of involvement in intervention Unlike in ratings of the importance of content of intervention, maternal well being is consistently associated with satisfaction of content of interventionUnlike in ratings of the importance of content of intervention, maternal well being is consistently associated with satisfaction of content of intervention Satisfaction with content is more closely associated with impact on parent and family, rather than impact on childSatisfaction with content is more closely associated with impact on parent and family, rather than impact on child

29 References Young, A.M., Gascon-Ramos, M., Campbell, M. Bamford, J. (2009) The Design and Validation of a Parent-Report Questionnaire for Assessing the Characteristics and Quality of Early Intervention Over Time. The Journal of Deaf Studies and Deaf Education. Free full text: Gascon-Ramos, M., Campbell, M., Young, A.M. (2009 under review). Influences on parental evaluation of the content of early intervention following early identification of deafness. Child: Care, Health and Development To register to access a copy of the MVOS: ork/sord/ ork/sord/

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