Breaking barriers: Harnessing implementation mapping to promote caregiver coaching in early intervention

PROJECT SUMMARY Critical to maximizing communication outcomes for children with developmental delays (DD) is access to a high dosage of high-quality early intervention as early in development as possible. Children with DD under 3 years of age qualify for early intervention (EI) services through publicly funded Part C programs under the Individuals with Disabilities Act. A central tenet of Part C is that EI services should occur in the child’s natural environment and include the family, rather than working exclusively with the child via therapist-delivered interventions. Such interventions are often referred to as “caregiver-mediated interventions” (CMIs). Several meta-analyses suggest that CMIs are effective for improving expressive and receptive language, social communication, and joint engagement. Caregiver coaching is a critical element of CMIs, yet despite strong empirical evidence, fewer than 25% of families receive caregiver coaching. Identified barriers to the widespread use of caregiver coaching include: (a) lack of training on caregiver coaching, (b) therapist and caregiver beliefs about their roles in early intervention, and (c) therapist confidence, skill, and self-efficacy in using coaching practices. These barriers and subsequent low rates of uptake highlight the disconnect between robust empirical support for caregiver coaching and implementation. Such a disconnect requires developing and testing implementation strategies that are tailored to address both: (a) the unique barriers to implementation in a given context (e.g., Illinois EI system), and (b) various components of caregiver coaching (e.g., observation, feedback). As such, the proposed study is guided by Implementation Mapping (IM), a 5-step participatory planning process to develop and test strategies that promote the uptake of caregiver coaching. Each of our study aims corresponds to a specific IM step and is informed by a specific implementation science framework. In Aim 1, we will select implementation outcomes that are guided by Proctor’s taxonomy of implementation outcomes. In Aim 2, we will use the Consolidated Framework for Implementation Research (CFIR) to characterize malleable factors that influence implementation outcomes. Specifically, we will analyze qualitative data from focus groups using a rapid deductive CFIR analysis approach. In Aim 3, we will integrate implementation outcomes with determinants to create a working Implementation Research Logic Model that maps implementation strategies to specific determinants. Potential implementation strategies will be selected using Expert Recommendations for Implementing Change (ERIC) and will be reviewed by EI therapists (n=15) and caregivers (n=15) during two, day-long, in-person workshops. In Aim 4, we will create the materials for the operationalized implementation strategies from Aim 3. Even strategies selected from the ERIC list require tailoring to EI and caregiver coaching. Implementation materials will be iteratively designed and refined using the Cognitive Walkthrough for Implementation Strategies. Results of this project will yield a fully developed set of co-created implementation strategies and materials that can be tested in a future hybrid Type 2 (effectiveness + implementation trial; R01).