Examination of Early Intervention Delivered Via Telepractice with Families of Children Who are Deaf or Hard of Hearing

The Individuals with Disabilities Education Act (IDEA) assures infants and toddlers with disabilities and their family members receive family-centered early intervention (FCEI). There is an extant body of evidence documenting the use, or lack of use, of FCEI provider behaviors when therapy is delivered in the traditional face-to-face (F2F) condition. This disparity between best practice and actual practice is investigated in this study. This study investigated providers’ use of FCEI strategies when intervention was delivered to infants and toddlers who were deaf or hard of hearing via telepractice. Telepractice is the use of information and telecommunications technology to provide health services to people who are located at some distance from a provider. The intent of the study was to look at ways in which telepractice might impact providers’ implementation of FCEI. There were two purposes for this exploratory study. The first purpose was to examine the potential relationships between provider attributes (i.e., highest degree, experience delivering FCEI, and experience with telepractice) and the use of FCEI provider behaviors (i.e., observation, direct instruction, parent practice with feedback, and child behavior with provider feedback) by professionals delivering FCEI. Statistical analyses were designed to identify any relationships among provider attributes, any associations between provider behaviors, and any connections between provider attributes and provider behaviors. The second purpose was to examine the frequency of occurrence of desired FCEI provider behaviors during telepractice sessions and to contrast them to the same behaviors used in F2F therapy. The main intent of telepractice is to provide access to qualified practitioners for families living in remote or rural areas. Sometimes, however, opportunities for change are incidental. The combination of video-conferencing technology and web-based software supporting synchronous two-way communication has created new opportunities for the delivery of FCEI. Many researchers, program administrators, and FCEI practitioners anticipate that the use of FCEI strategies will be enhanced through telepractice. Information about participant attributes was collected using a survey tool. The use of FCEI provider behaviors was measured by directly observing and coding digitally-recorded intervention sessions. There were 16 participants in this study working in eight different programs nationwide. Therapy sessions included the provider, the mother, and a child who was deaf or hard of hearing who was 36 months of age or younger. The attributes of providers and the use of four FCEI behaviors were investigated using Fisher’s Exact Test. A log-linear count model was applied to the data to assess the effects of provider attributes on provider behaviors. In addition, the data were used to identify the percentage of time FCEI provider behaviors occurred in the telepractice condition and contrast these with the use of these same behaviors in the F2F condition. There were some significant and marginally significant results demonstrating associations between provider attributes, relationships between provider characteristics and use of specific provider behaviors, and associations between provider behaviors. While there was a poor goodness of fit between the predicted and observed counts, the use of one provider behavior parent practice with feedback was generally the most closely associated with provider attributes. The Poisson distribution gave an expected frequency count for each FCEI provider behavior. This information uncovered relationships between experience and the use of specific FCEI provider behaviors. The results of the study demonstrated that selected FCEI provider behaviors occur in the telepractice condition more frequently than they occur in the F2F condition reported in the literature. Three of the provider behaviors observation, parent practice with feedback, and child behavior with provider feedback were used more frequently in the telepractice condition than in F2F therapy. Direct instruction was used in similar amounts in both treatment conditions. The findings can be applied to a training program for providers using or learning about telepractice. In future studies, it will be of interest to include more participants from more agencies. The information applies to infants and toddlers with all types of disabilities; therefore, future studies might investigate the provider skills of professionals from different disciplines. In future studies, with more participants, more than four provider behaviors documented could be included. The findings showed there were differences in the use of FCEI provider behaviors when therapy was conducted in telepractice. This increasingly accessible service delivery platform may make therapy more accessible to the parents of infants and toddlers with all types of disabilities. Telepractice is currently funded unevenly throughout the United States. If it can be shown that family-centered early intervention is conducted as well, if not more robustly, when it is delivered via telepractice, then funding agencies may be more willing to support it

Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method

The use of telehealth as a service delivery method for early intervention (EI) is in its infancy and few studies have examined its use within the context of a statewide program.  The focus of this report was to determine the factors that influence providers’ utilization of telehealth in Colorado’s Part C Early Intervention program (EI Colorado).  This report presents information that was gathered through surveys sent to Part C program administrators, service coordinators, providers, and caregivers. Surveys were used to understand perceptions of telehealth, actual experiences with telehealth, and perceived benefits and challenges using this service delivery method.  Follow-up focus groups were conducted with program administrators and family members to gather more nuanced information. Participants identified several benefits associated with telehealth including its flexibility, access to providers, and more family engagement. The primary barriers included access to high speed internet and the opinion that telehealth was not as effective as in-person treatment. The results in the report served to identify next steps in the implementation of telehealth in Colorado’s Part C EI program.

Working with Families of Young Children who are Deaf or Hard of Hearing Through Tele-Intervention

Tele-intervention services have been utilized for many years to serve families of young children, in addition to or in lieu of traditional in-person intervention services. Recently, the COVID-19 pandemic cultivated urgent dependence on access to effective services via a distance connection. As such, the need for information, guidance, and resources related to tele-intervention as a primary service model has increased. This article serves as the introduction to a monographic series aiming to describe practices, circumstances, and perceptions surrounding tele-intervention services for families of children aged birth to five who are deaf or hard of hearing. Topics include: (a) a brief history of tele-intervention as a service delivery model, (b) an overview of tele-intervention for families of children who are deaf or hard of hearing, including the impact of COVID-19 on emergency virtual services, (c) a description of the components of a tele-intervention session with families of infants and toddlers, and (d) a discussion of the challenges implementing services via tele-intervention. Figures containing information related to state funding and ideal session components for tele-intervention services are provided

The Development of Statewide Policies and Procedures to Implement Telehealth for Part C Service Delivery

The use of telehealth has been discussed nationally as an option to address provider shortages for children, birth through two, enrolled in Part C of the Individuals with Disabilities Education Act (IDEA) Early Intervention (EI) programs. Telehealth is an evidence-based service delivery model which can be used to remove barriers in providing EI services to children and their families. In 2016, Colorado’s Part C Early Intervention (EI) program began allowing the use of telehealth as an option for providers to conduct sessions with children and their caregivers. This article outlines the process taken to develop the necessary requirements and supports for telehealth to be incorporated into EI current practice

Provider Perspectives in Serving Children Who Are Deaf or Hard of Hearing and Their Families using Tele-Intervention

Purpose: In the second of a two-part survey series, this cross-sectional survey study explored professionals’ perceptions of tele-intervention (TI) services for young children who are deaf or hard of hearing. Using Likert rating scales and open-ended questions, the survey queried professional’s confidence in providing TI services, including their views and recommendations. Data were collected March-May 2020, not realizing the survey release would coincide with the Covid-19 pandemic and the influx of unexpected virtual services. For this reason, data were stratified between those who had been providing TI services for more than versus less than three months. Responses for in-person providers were also evaluated for additional context. Methods: Responses from 123 participants who provided TI and 21 participants who provided in-person services (n=144) were analyzed using descriptive statistics. Cronbach’s alpha showed high internal consistency for all Likert scales; items of each subscale were sum-scored to examine relationships across queried areas of service delivery. Results: Provider perceptions of TI services were largely favorable. However, providers with more than three months’ experience were significantly more confident in coaching and supporting parents through TI, including more overall favorable views of a TI delivery than providers with less than three months of TI experience. There were no differences in provider confidence in coaching and supporting parents between providers with more than three months’ TI experience using TI delivery and in-person providers using in-person delivery. Conclusions: Experienced providers reported confidence in service delivery and positive views of the TI model. Programs seeking to implement virtual services should consider TI training, with a commitment to TI longevity to improve provider efficacy and confidence in TI services

Parents’ Perspectives about Tele-Intervention Services for their Children who are Deaf or Hard of Hearing

Purpose: In the first of a two-part survey series, this cross-sectional survey study explored parent perceptions of tele-intervention (TI) services for their young children who are deaf or hard of hearing. Using Likert rating scales, the survey queried parent confidence in understanding their child’s language development, perceptions of the coaching and support they received, the parent-professional partnership, and overall views and recommendations. Data were collected March-May 2020, not realizing the survey release would coincide with the Covid-19 pandemic and the influx of unexpected virtual services. For this reason, data were stratified between those who had received TI services for more than versus less than three months. Responses for in-person services were also evaluated for additional context. Methods: Responses from 48 participants who received TI and 18 participants who received in-person services (n=66) were analyzed using descriptive statistics. Cronbach’s alpha showed high internal consistency for all Likert scales; items of each subscale were sum-scored to examine relationships across queried areas of service delivery. Results: Ninety-six percent of all respondents were highly or mostly satisfied with their TI services and 90% would definitely or probably recommend TI to other families. Overall positive findings were found across Likert scale queries, with no differences between parent perceptions of TI and in-person services, nor between TI for more than versus less than three months. However, findings also highlighted areas in which TI and in-person providers could improve intervention effectiveness, including coaching and supports to optimize parent confidence in understanding and facilitating their child’s language and communication goals. Conclusions: Parent perceptions of the TI delivery model were favorable. Implications and recommendations for both TI and in-person providers are discussed

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Coach, Caregiver, and Child Working Together: Everyone Learns