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 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 Childrens 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 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

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 Program Degree of Practitioner Adherence to Family Support Principles YEAR PERCENT OF INDICATORS Relational Indicators Participatory 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 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.

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 Childrens Learning Opportunities

Sources of Community-Based Childrens 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

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