Family Centered Practices

Supporting Indiana’s Early Intervention System to Implement Evidence-Based Home Visiting

A major goal of Indiana's Part C/First Steps State Systemic Improvement Plan (SSIP) has been to increase the number of agencies and providers that carry out evidence-based practices for improving the engagement of all families in their children's learning and development. To that end, ECC has provided professional development for over 450 early intervention providers between 2017 and 2019.

This professional development has focused on taking family centered evidence-based practices and translating them into 11 specific and realistic activities for early interventionists to use with families during home visits. In order to accomplish this, we first did a literature review and compiled research from a variety of sources including the Division for Early Childhood (DEC) as well as evidence-based national frameworks such as parent coaching and routines-based intervention. After distilling the research into concrete practices relevant to Indiana, we provided a series of regional, in-person trainings grounded in adult-learning principles. We followed up with on-going webinars designed to give providers attempting to change their practice opportunities to dive deeper into areas they identified as challenging. Although these trainings were evaluated positively, we know that high quality training is not enough; coaching is necessary for skill acquisition.

We provided coaching in a very intentional way by adopting an evidence-based method called Practice-Based Coaching (PBC). PBC, which occurs in the context of collaborative relationships, is a cyclical process that begins with strengths and needs assessment, goal setting and action planning, then moves to focused observation and finishes with reflection and feedback before the cycle begins again. Since PBC always begins with assessment, we asked early intervention providers to complete a self-assessment during their training days to evaluate their use of the evidence-based practices introduced in the trainings. Using the self-assessment and observations from the coach, providers and their coaches identified areas to focus on for improvement. Coaches and providers met on a monthly basis and used the PBC framework. Coaching sessions always centered around a specific goal and action plan related to a specific evidence based practice.Observations were done via recordings of home visits that providers took and shared via a video sharing technology called GoReact.

Introducing new practices and supporting their implementation is only effective if the new practices can be maintained over time. It was important to support early intervention providers to sustain this practice over time. We supported early intervention agencies to sustain changes by facilitating the development of a local implementation team at each agency. This team was charged with supporting successful implementation given the specific culture and needs of their agency. This included problem solving, adapting processes and procedures, communicating with staff and planning for the future. ECC staff facilitated these meetings and provided a framework for these conversations based on principles of implementation science.

Finally, we feel strongly that our decisions and decisions made by our partners should be grounded in research and data. We promoted data decision-making opportunities throughout this project in a variety of ways. At the onset, we provided agency implementation teams with data dashboards to use as a tool to see how the new practices may impact outcomes of interest to the agencies (e.g., family no-show rates, family missed sessions, # of sessions completed, provider retention). Additionally, agencies had the opportunity throughout their work with us to make requests for specific data relevant to their needs. Our staff developed checklists and worked closely with agency coaches to measure the fidelity with which coaches used the PBC framework. We gave coaches feedback after each session to allow them to improve their coaching skills and increase fidelity.