The majority of parent outcomes reported were positive. Most outcomes focused on parents' ability to attain fidelity in the use of strategies related to the intervention protocol (Kaiser & Roberts, 2013; Landry et al., 2012; Roberts & Kaiser, 2012; Vismara et al., 2012; Welterlin et al., 2012). In addition, these studies noted some personal outcomes for parents including (a) increased ratings of responsiveness, (b) increased positive parental perceptions of success about child communication, (c) decreased perception of severity of child's language difficulties, (d) stronger working alliances with primary interventionist, and (e) decreased parental stress. Two of the relationship-directed process studies reported outcomes for parents including (a) increased perception of personal capability, (b) parent-reported increased perception of motor and social skills in their children, (c) increased feelings of self-efficacy, (d) increased engagement by parents, and (e) increased incorporation of educational actions (i.e., spending brief amounts of time playing in child-preferred activities; incorporating variation and trial and error in daily activities) into daily routine (Blauw-Hospers et al., 2011; Salisbury & Copeland, 2013).
Two studies reported outcomes that were less positive. One study reported a decreased parent perception of child language ability when parents did not receive the option of augmented communication support as compared with parents who did (Romski et al., 2011). A second study reported decreased maintenance in the use of intervention strategies by parents for those routines that were not among those directly taught by the coach during intervention. Researchers noted a need to focus on increased generalization across more routines during intervention (Kaiser & Roberts, 2013).
Most of the studies reported developmental gains for children, with some of the improvements reaching statistical significance. Two studies noted gains across all developmental domains (i.e., gross motor, fine motor, cognitive, communication, self-help, and social-emotional; Blauw-Hospers et al., 2011; Salisbury & Copeland, 2013). Other studies noted gains in (a) language (Kaiser & Roberts, 2013; Landry et al., 2012; Roberts & Kaiser, 2012; Romski et al., 2011; Vismara et al., 2012), (b) social-communicative strategies (Vismara et al., 2012), (c) motor behaviors (Blauw-Hospers et al., 2011), (d) book reading skills (Landry et al., 2012), (e) improvement in child independent work skills (Welterlin et al., 2012), and (f) improvement in adaptive skills (Welterlin et al., 2012). One study that focused on parent fidelity to intervention noted reduced child outcomes between 6 and 12 months (Kaiser & Roberts, 2013). This coincided with a reported reduction in parents' use of strategies.
The primary purpose of this article was to review the current definitions, descriptions, and use of coaching with parents alongside the parent and child outcomes resulting from the use of coaching with parents. We found eight articles that met the inclusion criteria for our synthesis.
Early intervention studies, as a whole, offer a continuum of definitions and descriptions for the use of the term “coaching with parents.” This continuum appears to have, at one end, a relationship-directed process and, at the other end, an intervener-directed protocol. The studies in this synthesis fall along this continuum sometimes sharing common elements and at other times using the same term, “coaching with parents,” to mean two very different activities. Five studies in this synthesis would fall primarily toward the intervener protocol end of the continuum. The researchers in these studies have developed an evidence-based intervention that they intend to coach parents to replicate with fidelity. One example is the Kaiser and Roberts (2013) study in which parents are trained to use the Enhanced Milieu Teaching strategies. The researchers in these five studies determine which intervention to use, as well as how and when to use it. These studies have many similarities with traditional parent training studies except it appears that the term “coaching” is now used to describe direct feedback given to parents as they try out prescribed strategies.
The other three studies outline a primarily relationship-directed process. These studies view coaching as a process that encompasses the ideals of family-centered practice. An example of this is the caregiver coaching found in the Salisbury and Copeland (2013) study. The what, how, and when to intervene result from a shared decision-making process. Thus, coaching is a different process than the traditional parent training.
In the studies that described the process for training coaches, four of the studies (Kaiser & Roberts, 2013; Roberts & Kaiser, 2012; Salisbury & Copeland, 2013; Vismara et al., 2012) included fidelity training for the use of coaching. Only the Salisbury and Copeland (2013) study is set in the context of a Part C EI program. In terms of dosage, sessions with parents typically occurred at least weekly ranging from 20 to 90 min in length.
About characteristics, first, with respect to families' characteristics, coaching is used across families with diverse backgrounds (e.g., race, social economic status, and education). With respect to children's characteristics, coaching is used with parents of children with a wide range of diagnoses and functioning levels (e.g., autism, cerebral palsy, Down syndrome, and significant intellectual disability). In reference to the characteristics of the coaches, a variety of disciplines were represented. All coaches held a minimum of a master's degree, and all received some level of professional development to use coaching with parents.
For parent and child outcomes, the researchers reported that the effectiveness of coaching with parents is one contributing factor in a multicomponent intervention for the majority of the parent and child outcomes measured. The most frequently occurring parent outcome was mastery of the strategies that comprised the intervention curriculum. Other outcomes were (a) increased positive perception of their child's ability, (b) increased ratings of parent responsiveness toward their child, (c) decreased parental stress, (d) increased perception of personal capability and feelings of self-efficacy, and (e) a stronger alliance between the parent and the coach. Finally, for the majority of the studies in which coaching is used with parents, children made developmental progress. Children with varying diagnoses and levels of individual functioning made developmental gains in a variety of domains.
Implications for researchers
First, future studies should clearly define and then examine the effect of coaching as separate component. As previously mentioned, regardless of how each study defines coaching, it is difficult to untangle the impact of coaching with parents in EI from the other intervention components in these multicomponent studies. For example, in the studies by Kaiser and Roberts, coaching is only one of several activities used in parent training. In addition to in vivo coaching during intervention implementation with children, parents attended classes, reviewed modules, and observed therapists using the strategies with their children. In the study by Salisbury et al. (2013), coaching is one component of a triadic service delivery approach, which also includes family-guided, routines-based intervention and embedded intervention in naturally occurring activity settings. “When EI providers are uncertain about what constitutes coaching and what it looks like as a collaboration practice, it becomes considerably more difficult for them to understand what about their practice needs to change to effectively coach caregivers” (Friedman et al., 2012, p. 63). These authors join in the call for consensus on a universal definition and description of coaching along with consideration of settings, contexts, dosage, and professional development when using coaching with parents in EI. There is much variation in how coaching is described in the literature. For example, coaching, as described in the work of Rush and Shelden (2011), has been described at times as an interaction style for working with parents and at other times as a service delivery model (Chai, Zhang, & Bisberg, 2006; McWilliam, 2012). A consistent operational definition across researchers and practitioners is needed to build a strong research base.
Second, parallel to the need for a clear definition of coaching is the need to detangle the newer emphasis on coaching from traditional emphasis on parent training. If coaching and parent training are two different approaches, then these differences must be made clear.
Third, researchers should explicate desirable short-term, intermediate-, and long-term child and family outcomes that are expected as a result of coaching and then provide psychometrically sound measurement of these outcomes. In reference to child outcomes, expectations usually involve increase in developmental skills to promote functioning in daily routines and activities. Paired with measurement of developmental skills, outcomes should be measured on successful participation of the child in home and community settings through a focus on the three child outcomes mandated by the Office of Special Education Programs. In addition, because previous literature links coaching to parent–child relationship development, research needs to provide data on exactly how use of coaching impacts the parent–child relationship from the child and parent's perspective. Improvements in social-emotional functioning, including the children's attachment to their parents, should be one outcome studied.
Also related to outcomes, more work needs to be done in investigating the impact of coaching on family outcomes. The studies in this research analysis most often document parent outcomes as they pertain to achievement of child outcomes (e.g., parents being able to replicate strategies with fidelity). Bailey, Raspa, and Fox (2012) argue that a focus on attainment of child outcomes is necessary but not sufficient, given the focus on support of the family that EI can offer. Measurement of coaching with parents should include the impact of this practice on the original five recommended family outcomes developed from the work at the Early Childhood Outcomes Center (Bailey et al., 2006). These five outcomes include how families (a) understand their child's strength, abilities, and special needs; (b) know their rights and advocate effectively for their children; (c) help their child develop and learn; (d) have support systems; and (e) access desired services, programs, and activities in their community. This measurement must be done in such a way that it is clear what the impact of coaching with parents is on these outcomes. Within the studies of this synthesis, it is difficult to ascertain which parent outcomes were a result of coaching and which were a result of other intervention components.
It is worth noting that another often-missing measure is the impact of coaching on parents' quality of life. Wallace and Rogers pointed out:
Parents of infants and toddlers with ASD are not community intervention providers; they are parents of an infant or toddler just diagnosed with a serious chronic developmental disorder. They are experiencing a tragic and life-altering event, one with long-term effects on everyone in the family. They need information, support, and services for their child. How do we support them in this part of their lives and pass on intervention skills? (2010, pp. 1316–1317)
In relation to parental quality of life, the relationship-directed process studies reported greater gains. One of the studies reported that the intervention “did not disrupt or interfere with parents' style of relating to or caring for their children” (Vismara et al., 2012). Parents in the Salisbury and Copeland study reported, “They had developed a stronger sense of self-efficacy, direction, and support” (2013, p. 73). Parent shared statements such as “It gave me a sense of security, gave us guidance” and “I learned not to panic when unpredictable things happen.” In extending this work, one potential measure to document family quality of life, resulting from the use of coaching with parents, is the Beach Center Family Quality of Life Scale (Poston et al., 2003). This psychometrically strong scale contains five subscales: (a) Family Interaction; (b) Parenting; (c) Emotional Well-being; (d) Physical/Material Well-being; and (e) Disability-Related Support (Hoffman, Marquis, Poston, Summers, & Turnbull, 2006).
Fourth, the majority of studies did not offer coaching adaptations in light of specific individual child and parent characteristics. Seven of the studies offered the same protocol and the same dosage to each family, with little discussion of individualization in light of parent or child characteristics. The study by Salisbury and Copeland (2013) offered more individualization as it was conducted with families that had an Individualized Family Service Plan in place. Within the studies, 53% of families were of European American background and 47% were families from culturally or linguistically diverse (CLD) backgrounds; however, none of the studies describe culture or language as a variable to consider when coaching CLD families. The need for culturally responsive coaching is an issue that has received little discussion in the literature to date. This issue needs to be investigated in ensure that coaching with parents is a strategy that is responsive to the long-held EI commitment and legal requirement to design services that meet the unique individual needs of every child and family.
Fifth, only one study focused on the use of coaching in a Part C setting. Given the nationwide movement by technical assistance/professional development providers, state leadership, and local program leadership to promote coaching practices within Part C programs, coaching in Part C contexts should be a priority for research (NECTAC, 2008, 2011). Research in this setting should focus on how coaching with parents is implemented while ensuring compliance with the IDEA, in particular to focus on how coaching with parents is conducted to ensure protection of parental rights and procedural safeguards. In addition, coaching in the context of weekly home visits over the entire course of a child's enrollment brings unique challenges and opportunities for children, parents, and coaches that differ substantially in terms of topic and focus from that found in a short-term research-led intervention. These differences need to be articulated and then measured.
Finally, related to the issue of the need for more research in the context of Part C settings is the need for more research on the type and intensity of professional development required for coaches in these settings to maintain fidelity to coaching practices. Friedman et al. postulated that providers have had “limited training in how to coach caregivers ... to be effective, EI providers need to strengthen and broaden their specific knowledge and skills about how to collaborate with and coach caregivers during intervention sessions to build caregiver capacity” (2012, p. 63). However, emerging research indicates that with “professional development and ongoing support for using collaboration and coaching practices,” (Friedman et al., 2012, p. 63) providers can be effective at coaching with parents. The majority of research studies in this synthesis showed evidence of extensive training for coaches. The Salisbury and Copeland (2012) study, in particular, gave specific detail on what activities occurred within one program to achieve high-quality coaching. Coaches in this program received professional development in caregiver coaching along with and situated within other core elements of EI (e.g., family-guided routines-based intervention). In addition, they receive ongoing support in the form of participation in weekly reflective supervision sessions and in a bimonthly community of practice meeting (Salisbury & Copeland, 2013).
Implications for practitioners
Although coaching with parents is often used to increase children's developmental outcomes, it also shows promise for improving parent outcomes. Although only a few studies used coaching with parents to enhance parent outcomes, positive outcomes resulted in these areas. This evidence suggests that coaching with parents can facilitate outcomes for parents such as increased positive perceptions of their ability to respond to their children's needs, increased self-efficacy, and stronger sense of partnership with the coach with whom they are working. Therefore, coaching with parents is a promising practice.
The synthesis did not provide one universal definition of coaching for practitioners to follow. However, the synthesis found that both coaching as a relationship-directed process and coaching as an intervenor-directed process had a positive benefit on child outcomes. Furthermore, these findings support that whichever process is used, professional development in the use of coaching with parents and implementation with fidelity are essential in obtaining positive parent and child outcomes.
The synthesis cannot yet provide a confirming answer as to how intensive coaching with parents must be implemented to show positive impact on child and family outcomes. The synthesis found, however, that the most commonly reported frequency was weekly between 20 and 90 min. This finding supports a fairly high level of frequency with families.
Coaching with parents is feasible to implement in the home setting with parents and children who reflect a variety of characteristics. Parents, including those from low socioeconomic status backgrounds, showed increases in parent outcomes. In addition, children with a variety of developmental levels and across different diagnoses, including children with significant disability, showed developmental gains in multiple areas.
The synthesis results do not provide direction for how coaching may be individualized according to individual parent and child circumstances and characteristics. Until such a time that this research is conducted, coaches must rely on what should already be in place in EI programs to guide their coaching conversations and decisions in terms of existing focus on family-centered practices that honor the uniqueness of each family and child.
One limitation is the restriction of search criteria to only those studies that use the word “coaching” within the title or text of the article. We acknowledge that sometimes other terms are used to describe strategies or components similar to coaching. As stated in the purpose, this synthesis is designed to review those studies that use the term “coaching.” This is the term currently used by and with EI practitioners and the term that needs to be more fully defined and described.
A second limitation is the inclusion of only articles that were published from 2011 to the present. Narrowing the criteria this way resulted in only eight articles being identified for review. Expansion of these criteria would have resulted in the identification and inclusion of additional articles. Our basis for restricting the date was to focus on those studies that were conducted after the first generation of information on coaching to document how researchers are translating what was learned about coaching in the first decade into intervention and new research questions.
The overall use of coaching with parents in EI supports previous research that indicates that parents can successfully implement interventions with their children; as a result, children's skills improve across the developmental domains measured. To effectively discuss and describe coaching in EI, a key set of tasks is to identify a universal definition for coaching and to explore the continuum of coaching approaches/strategies and make a decision, as a field, that coaching is a relationship-directed process or an intervener-directed process or whether it can be defined as both. This will most likely involve detangling the newer use of coaching from traditional parent training. A universal definition of coaching will enhance the quality of research, which can accurately measure the impact of use of coaching with parents on child and family outcomes. Most importantly, consensus must be sought on the intended outcomes of coaching for children and parents in EI. What is known is that coaching, to this point, seems to do no harm. Infants and toddlers make developmental progress comparable with progress made with therapist-directed interventions, sometimes with increased outcomes and sometimes with comparable gains. What is not known is what are the comprehensive outcomes for parents. The synthesis documents that parents learn to implement interventions. The review also revealed that, in at least one instance, the parent–child responsiveness increased. In another instance, parents reported increased self-efficacy. The synthesis did not offer enough information about the benefit to parents through achievement of family outcomes. If EI is to be of value to families, to match the call set forth by Bailey et al. to “go beyond just family satisfaction with services and increase in child outcomes, to helping families” (2012, p. 216), then measurement of all aspects of intervention including coaching with parents must be from the family outcome lens.
References marked with an asterisk indicate studies included in the rsearch synthesis.
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*. Salisbury C. L., Copeland C. G. (2013). Progress of infants/toddlers with severe disabilities: Perceived and measured change. Topics in Early Childhood Special Education, 33, 68–77.
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Salisbury C. L., Woods J., Copeland C. (2010). Provider perspectives on adopting and using collaborative consultation in natural environments. Topics in Early Childhood Special Education, 30, 132–147.
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*. Welterlin A., Turner-Brown L. M., Harris S., Mesibov G., Delmolino L. (2012). The home TEACCHing program for toddlers with autism. Journal of Autism and Developmental Disorder, 42, 1827–1835.
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Keywords:© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
caregivers; coaching; early intervention; infants; parents; Part C; toddlers