discussion

A Mixed-Methods Study of Early Intervention Implementation in the Commonwealth of Pennsylvania: Supports, Services, and Policies for Young Children with Developmental Delays and Disabilities

Janet A. Mattern

Published online: 21 February 2014

� Springer Science+Business Media New York 2014

Abstract Participation in high quality early intervention

programs is critical for eligible young children who expe-

rience atypical development for their future academic

success. High quality programs promote access to services,

incorporate instructional strategies that encourage chil-

dren’s participation, and advocate public policy that sup-

ports professional development and collaboration among

families, early childhood educators, and early intervention

providers. Although program implementation according to

evidence-based practice is recognized as the key, little

research currently exists documenting the implementation

of evidence-based practices in early intervention programs.

The primary goal of this mixed-methods study was to

determine if families, early childhood educators, and early

intervention service providers were knowledgeable about

evidence-based practices for early intervention and if these

practices were currently being implemented consistently

throughout the Commonwealth of Pennsylvania. Families

(n = 11), early childhood educators (n = 149), and early

intervention providers (n = 66) completed online surveys,

and 12 participants participated in semi-structured inter-

views to report their experiences. Early intervention pro-

viders reported a significantly higher perception than early

childhood educators that early intervention services were

implemented according to evidence-based practice. Early

childhood educators were knowledgeable about evidence-

based practices in early intervention, but they did not feel

they were implemented in their programs. Study findings

are discussed in the context of providing early childhood

educators with recommendations for improving the quality

of early intervention implementation for children with

atypical development in their community preschools

including access, participation, and policy support.

Keywords Early intervention implementation � Preschool � Disabilities � Inclusive preschool

Introduction

Early childhood is a distinct period of development. Chil-

dren grow and change more rapidly during the first 8 years

of life than any other time in their life span (Smith and

Rous 2011). Marked changes in physical, cognitive and

social-emotional growth occur throughout these formative

years. However, progression through these developmental

stages varies for each individual child (Smith and Rous

2011).

Some children do not develop along a cognitive, phys-

ical, or social-emotional continuum that would be consid-

ered typical. Children with atypical development

experience a range of disabilities or developmental delays

which are diverse and distinct. For these children, early

identification and effective intervention are critical to

provide the support they need to reach their full potential.

The purpose of early identification is to identify a delay or

disability before it is fully evident in order to implement

interventions that will either prevent or reduce the pro-

gression of the disorder (Shapiro 2011). Early intervention

describes the array of services, programs, supports, and

policies established for improving the development of

young children, from birth to age eight, with special needs

and their families (Smith and Rous 2011).

Meisels and Shonkoff (2000) and Walker (2011) found

that young children, especially those children identified as

J. A. Mattern (&) Indiana University of Pennsylvania, 428 Davis Hall, Indiana,

PA 15705, USA

e-mail: [email protected]

123

Early Childhood Educ J (2015) 43:57–67

DOI 10.1007/s10643-014-0633-x

at-risk or with developmental delays or disabilities, are

more likely to succeed academically when they have the

opportunity to participate in high quality early childhood

programs and receive early intervention services. In addi-

tion, they have a reduced need for continued special edu-

cation services as they progress through school (Bagnato

et al. 2009; Barnett 2008; Burd-Sharps and Lewis 2010).

Evidenced-Based Practice

Research provides an extensive body of knowledge about

recommended evidence-based practice in early interven-

tion. High quality early intervention programs are those

programs that have successful and referral services to

provide access to services, encourage participation, offer

support for providers, family members, and children, and

have professionals who are qualified to deliver high quality

services (Smith and Rous 2011). Evidence-based practice

includes assessment evaluations that are developmentally

appropriate, individualized for children and families, reli-

able, inclusive of multiple measures administered over

multiple points in time, and incorporate feedback from all

members of the early intervention team (Neisworth and

Bagnato 2005). Evidence-based practices suggest that early

intervention providers and early childhood educators

organize the environment to promote children’s safety,

engagement, learning, participation, and membership. The

goals and objectives developed must be based on obser-

vations that encourage and solicit input from parents and

early childhood educators. Early intervention providers

encourage children to learn skills, and to use skills natu-

rally, but also to maintain those skills in various settings

when instruction ceases (Sandall et al. 2005).

Professional development that focuses on pre-service

teacher preparation within the university setting, as well as

training at the in-service level for practicing teachers, is

crucial for the implementation of evidence-based practices.

Training should include knowledge of early intervention

policies and procedures as well as the implementation of

instructional approaches grounded in scientific-based

research in order to improve professional competence

within the field. Training that may require additional

funding in order to provide on-site coaching and support

from highly competent professionals. (Smith and Rous

2011).

Early Intervention Implementation

The IDEA, the Pennsylvania Early Interventions Systems

Act of 1990, and their accompanying regulations prescribe

how aspects of the overall policy for early intervention will

be implemented (Bruder 2010; Hebbeler et al. 2012).

Research supports the idea that the implementation of high

quality, comprehensive early intervention programs

improves the outcomes for children with disabilities that

are the result of biological risks, environmental risks, aut-

ism, or multiple developmental delays (Durlak and DuPre

2008; Guralnick 2005; Odom et al. 2011). Research even

provides a framework to evaluate high quality early inter-

vention programs. High quality early intervention pro-

grams are evaluated based on their ability to provide

access, participation, and support (Sandall et al. 2005).

Access ensures that all eligible children and families

receive services. Participation focuses on the instructional

strategies and intervention approaches used to promote

children’s engagement, learning, and sense of belonging.

Supports include the infrastructure which includes the

public policies which regulate early intervention, the pro-

fessional development of personnel, and the coordination

of service delivery (Odom et al. 2011; Sandall et al. 2005).

Kaczmarek (2011) found that early intervention impleme-

nation is effective when the identification of children with

special needs, implementation of services to meet those

needs, frequency of services, and the coordinated delivery

of those services across educational settings and agencies

are provided with high collaboration and communication

among the professionals involved in the delivery of ser-

vices to eligible children and their families.

Barriers to the successful implementation of the

framework for high quality intervention include: (1) inad-

equate eligibility assessment tools which have not kept

pace with scientific advances in child development, (2)

insufficient professional development in the use of effec-

tive routine-based training models to build the capacity for

service providers to improve family participation, (3) lack

of consistent statewide monitoring procedures to measure

child and family outcomes, (4) the absence of collaboration

and communication among stakeholders, and (5) insuffi-

cient funding to provide the major components of service

delivery as it was intended (Branson and Bingham 2009;

Bruder 2010; Campbell and Anketell 2007; Dunst et al.

2007; Fleming et al. 2011; Guralnick 2005; Neisworth and

Bagnato 2005).

Dane and Schneider (1998) identify aspects of suc-

cessful implementation. Three of these aspects are appli-

cable to early intervention implementation. They are (1)

fidelity, the extent to which the delivered program matches

the intended program; (2) dosage, the frequency and

strength of program delivery; and (3) quality, which refers

to how well the program components are delivered.

Accurate interpretation of child outcomes from early

intervention is dependent upon knowing what aspects of

the early intervention program were delivered and how

well they were conducted. Implementation is affected by

communities, providers, organizational structures, and

support systems. There is strong support for the premise

58 Early Childhood Educ J (2015) 43:57–67

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that effective early intervention is associated with better

outcomes for children with special needs. However,

transferring effective programs into real world settings and

maintaining them there for the benefit of many diverse

children across many diverse communities is a compli-

cated, long-term process (Durlak and DuPre 2008).

Today, little research exists documenting the imple-

mentation of early intervention services to 3–5 year old

children in urban, suburban and rural communities

throughout the United States (Odom 2009; Trivette et al.

2012). Many service providers are familiar with the rec-

ommended practices promoted by the Division for Early

Childhood (DEC) of the Council for Exceptional Children

(CEC) for early intervention and early childhood special

education. Odom (2009) found through a validation survey

that even though many of these practitioners knew what the

recommended practices were for early intervention or early

childhood special education, the implementation of these

practices was not happening in their programs, and if

recommended practices were implemented at all, they were

not implemented according to the evidence-based norm.

The goal of this sequential mixed-methods research

study was to explore early intervention service imple-

mentation in the Commonwealth of Pennsylvania for

3–5 year old children with atypical development to deter-

mine if recommended evidence-based practices were being

implemented in terms of access, participation and support.

Access is promoted through referral and eligibility deter-

mination. Participation is encouraged when instructional

strategies are used which are consistent from home to

school and communicated effectively through the individ-

ualized education plan (IEP). Support is evident through

collaboration and professional development opportunities

that exist for families, early childhood educators, and early

intervention providers as they participate in early

intervention.

In the Commonwealth of Pennsylvania, the Office of

Child Development and Early Learning (OCDEL) con-

tracts early intervention services for 3–5 year old children

through 29 Intermediate Units which serve as the regional

educational service agencies. Some Intermediate Units

serve a single county, and some Intermediate Units serve

several counties across a large geographic territory. Inter-

mediate Units differ in the number of schools and students

within their boundaries, the size of their operating budgets

and the variety of revenue sources (PAIU 2011).

This study was guided by the following research

questions:

1. How do families, early childhood educators, and early

intervention service providers describe their experi-

ences in early intervention in the Commonwealth of

Pennsylvania?

2. How do the reported experiences of families, early

childhood educators, and early intervention service

providers compare as they participate in early inter-

vention in various communities throughout the Com-

monwealth of Pennsylvania?

3. Is there a significant difference in the depth of

understanding regarding the delivery of early inter-

vention services or the frequency of early intervention

services across community settings (urban, suburban,

and rural)?

This article has three purposes: (1) to describe the meth-

odology of this study; (2) to share the results of this study

which describe the experiences of families, early childhood

educators, and early intervention providers as they access,

participate and encounter support for early intervention

services; and (3) to identify some recommendations for early

childhood educators who must navigate early intervention

services for children in their classrooms who may have

developmental delays or disabilities.

Method

Data from families, early childhood educators, and early

intervention providers were collected in two phases. The

first quantitative phase included a fifteen item online survey

completed by 266 participants located in urban, suburban,

and rural communities throughout the Commonwealth of

Pennsylvania. Each participant group completed the same

survey instrument to allow the researcher to compare and

triangulate the data to see if they yielded similar results. The

data from the online surveys were explored in depth in the

second qualitative phase.

Following preliminary analysis of the quantitative data,

12 qualitative interviews were conducted approximately

1 month later to probe significant areas of agreement or

disagreement found within the data and to determine if

common themes existed that described the experiences of

the participants in the early intervention process. An

interview protocol developed by the researcher was used to

provide participants with the opportunity to share their

experiences in depth.

Instrumentation

The two data collection instruments used for this study, the

online survey instrument and the interview protocol, were

both developed by the researcher after reviewing the lit-

erature on current early intervention evidence-based prac-

tices. The survey and interview protocol were piloted by

representatives of the three participant groups (families,

early childhood educators, and early intervention

Early Childhood Educ J (2015) 43:57–67 59

123

providers) who were then excluded from the study. Three

experts in the field of early intervention were also asked to

review the instruments.

The survey instrument included 31 items including Lik-

ert-type rating scale questions, multiple choice questions,

and open-ended questions to determine participants’ expe-

riences with five early intervention program components (1)

early identification, referral, and evaluation (3 questions); (2)

IEP development (4 questions); (3) early intervention prac-

tices including instructional strategies, collaboration, and

communication (13 questions); (4) knowledge of early

intervention implementation (4 questions); and (5) fre-

quency of services (2 questions). The first five questions of

the survey collected demographic data to determine the

certification and years of experience of the early childhood

educators and early intervention providers, the exception-

alities of the children, the community setting, and the

accreditation of the schools where services were provided.

The interview protocol included 11 open ended questions

to gain a more in depth understanding of the participants’

experiences in early intervention with the five program

components as identified by the results of their survey data.

Demographic data were also collected using the interview

protocol. Based on the survey results item 6 (knowledge of

research which supports instructional strategies) and item 10

(knowledge of family engagement opportunities to offer

support) were added to the initial interview protocol to

determine the experiences of interview participants.

Participants

This study included 226 participants who lived throughout

the Commonwealth of Pennsylvania and were involved in

early intervention as (a) family members of children who

received early intervention services (n = 11), (b) early

childhood educators with children in their classrooms who

received early intervention services (n = 149), and

(c) early intervention providers who provided early inter-

vention services to eligible children (n = 66).

Family participants were either currently participating in

early intervention service implementation (45 %) or partici-

pated in early intervention services in the past (55 %). Family

respondents lived in urban (20 %), suburban (60 %), and rural

(20 %) communities throughout the Commonwealth of Penn-

sylvania. The number of responses completed by the family

participants was small due to the inability to forward the survey

link directly to families. The researcher was dependent on

family advocacy groups to forward the online survey link. This

loss of a direct connection affected the survey response rate.

The children of the families who participated received early

intervention services for developmental delays (n = 4), intel-

lectual disabilities (n = 1), speech or language delays (n = 4),

and for a diagnosis of autism (n = 2).

Responses were received from early childhood educators

whose schools were located in urban (20 %), suburban (59 %),

and rural (21 %) settings. Respondents were encouraged to

select all that apply to identify their school’s current accredi-

tation and included schools with NAEYC accreditation (48 %),

Keystone Star Level 3 designation (27 %), Keystone Star Level

4 designation (66 %), and those who did not know their level of

accreditation (2 %). Keystone Stars is an initiative of the

Pennsylvania Department of Education. Early childhood pro-

grams are rated on a continuous quality improvement plan

continuum from Star level 1 to Star level 4 as they work to

improve their early childhood program environment and pro-

mote positive outcomes. The early childhood educator group

included 149 participants. These participants were well-edu-

cated with either a B.S. in Early Childhood Education (n = 55),

a M.Ed. or Ed.D. in Early Childhood Education (n = 27), or a

B.S. or M.Ed. in a related field (n = 66). The majority of early

childhood participants had more than 5 years of experience

serving in their current positions (n = 113).

The early intervention providers who work for one of

the 29 Intermediate Units in the Commonwealth of Penn-

sylvania included providers who deliver services in urban

(12 %), suburban (54 %), and rural (34 %) settings. The

early intervention providers identified the settings where

their children received early intervention services including

NAEYC accredited schools (9 %), Keystone STARS Level

3 settings (8 %), Keystone STARS Level 4 settings (6 %),

multiple settings with various accreditation (56 %), and

unknown accreditation (20 %). Table 1 provides the

demographics for the early intervention providers group

Table 1 Early intervention provider group participant demographics (N = 66)

Current

position

n Educational certification Years in

current

position

B.S.

Spec.

Ed.

M.Ed./

Ed.D

Spec.

Ed.

Licensed \1 1–5 [5

Administrator 8 5 2 1 2 0 6

Occupational

therapist

1 0 0 1 0 0 1

Developmental

specialist

11 6 5 0 0 2 9

Physical

therapist

3 0 0 3 0 0 3

Speech and

language

Pathologist

25 0 2 23 5 4 16

Teacher/service

coordinator

18 5 13 0 0 4 14

60 Early Childhood Educ J (2015) 43:57–67

123

which demonstrates that the early intervention providers’

participant group included a varied group of therapists,

certified in their area of expertise, and with several years of

experience in their field.

Procedure

A cover letter stating the purpose of the study and an

anonymous online survey link were e-mailed to 546

NAEYC and Keystone STARS Level 3 and 4 early

childhood program directors, 5 family advocacy agencies

for children with special needs within the state of Penn-

sylvania, and the Directors of Early Intervention for each

of the 29 Intermediate Units in the Commonwealth of

Pennsylvania. Each of the e-mail recipients were invited to

distribute the survey link and request for participation to

the families of children with special needs they serviced, as

well as the early childhood educators or early intervention

providers they supervised.

The online survey provided respondents with the

opportunity to indicate if they would be willing to partic-

ipate in an in-depth interview with the researcher at a

future date to elaborate on their responses. Interview sub-

jects were selected from the survey participants who vol-

unteered to participate using convenience sampling to

ensure representation of at least four parents, four early

childhood educators, and four early intervention service

providers. The participants included representatives of

public and private schools in urban, suburban, and rural

communities in the Commonwealth of Pennsylvania. One-

on-one interviews were conducted with the sample partic-

ipants using the interview protocol designed for this study.

Data Analysis

The data from the online survey were uploaded to the

Statistical Package for the Social Sciences (SPSS) ( �

IBM

Corporation 2012) for descriptive and inferential analyses.

The five separate early intervention program components

of identification, IEP development, intervention practices,

knowledge, and frequency of services including the overall

experiences of families, early childhood educators, and

early intervention providers were analyzed by adding the

scores from each of the 17 Likert scale items together for a

maximum possible score of 68. A score approaching 68

corresponded to a higher participant group’s perception

that early intervention services were implemented with

fidelity according to the five program components identi-

fied by evidence-based practices.

A series of one-way ANOVA tests were used to deter-

mine if the mean scores which represented the overall

experiences of the families, early childhood educators, and

early intervention providers identified in the survey

responses differed. There was a significant difference [F(2,

170) = 10.302, p \ .05] among the means of the groups which represented the overall perception that early inter-

vention program components were implemented according

to evidence-based practices. In order to determine which

groups demonstrated a significant difference, the Games–

Howell post hoc was used. The Games–Howell post hoc

test is administered when a population is small and the

nature of the family contributes to a large variance like a

family group. The early childhood educator group and the

early intervention provider group demonstrated a signifi-

cant difference in their belief that early intervention ser-

vices were implemented with fidelity according to

evidence-based practices with p \ .0001. The early inter- vention providers average score (M = 58.07) was higher

than the early childhood educators (M = 50.15). The early

intervention providers believed that they were effectively

identifying children eligible for early intervention services,

developing and implementing IEPs in a timely manner, and

collaborating with families and early childhood educators

to implement instructional strategies. Early childhood

educators felt that this level of fidelity was not currently in

place in their schools. The family group did not demon-

strate a significant difference due to the small sample size

of this participant group.

A one-way ANOVA test was used to compare the overall

scores of each participant group based on the 17 Likert scale

items to determine if the experiences of the families, early

childhood educators, and early intervention providers dif-

fered based on their community size and location. The

results of the family participants were removed due to their

small sample size. There was a significant difference in the

means of the scores of the urban, suburban, and rural group

participants’ belief that early intervention services were

implemented with fidelity according to evidence-based

practices [F(2, 169) = 4.42, p \ .05]. The Games–Howell post hoc test revealed a significant

difference between the rural group participants and the

urban and suburban groups. The mean scores of the par-

ticipants who lived in rural areas were the highest of the

participant groups (M = 56.75), indicating their perception

that they understood how early intervention services were

implemented in their communities and that they were

delivered with fidelity as opposed to the beliefs of the

urban (M = 50.79) and suburban (M = 51.19) partici-

pants. This finding is somewhat surprising. There is a

perception that service implementation, communication

and collaboration among agencies and early childhood

settings is more difficult in rural settings. One explanation

could be that rural participants in this study received early

intervention services from Intermediate Units which are

described as self-contained. Self-contained agencies

employ and supervise all of the early intervention staff

Early Childhood Educ J (2015) 43:57–67 61

123

responsible for implementing early intervention program

components.

The second part of research question 3 asked, Is the

frequency of early intervention services influenced by

community size (urban, suburban, rural) within the Com-

monwealth of Pennsylvania? The chi-square test of inde-

pendence was used to determine if there was an association

between population groups and the frequency of early

intervention services. A Phi and Cramer’s V was used to

determine the strength of the association. A chi-square test

for independence indicated no significant association

between population (urban, suburban, rural) and frequency

of services, v2(2, 194) = .34, p = .84, / = .04. The significant differences between the perceptions of

the early childhood educators and the early intervention

providers as demonstrated in the data were explored in

depth through the interview process. The interview ques-

tions focused on the differences found in the survey data in

the areas of early identification, IEPs, instructional prac-

tices, and knowledge of the early intervention process.

Results

Early Identification, Referral, and Evaluation

Evidence-based practice requires early intervention agen-

cies to adopt and use a system to identify eligible young

children and young children thought to be eligible who

reside within the boundary served by the early intervention

agency. Each early intervention agency is required to

conduct awareness activities to inform the public of early

intervention services and programs and the manner by

which to request these services and programs through

annual public notification, published or announced in

newspapers or other media, or both, with circulation ade-

quate to notify parents throughout the area served by the

agency of child identification activities and of the proce-

dures followed to ensure confidentiality of information

pertaining to eligible young children. This process is called

Child Find (22 Pa. Code §§ 14.152 a–c). The family par-

ticipants reported on the survey and through the interviews

that none of their children were identified using Child Find.

The early childhood educators reported similar results with

only 2 % of the children identified using Child Find.

However, the early intervention providers perceived Child

Find to be a much more significant method of identification

with 52 % reporting the identification of children with

child find.

Families (40 %), early childhood educators (80 %), and

early intervention providers (83 %) identified the preschool

as the setting where children who were perceived to be

eligible and in need of early intervention services were first

identified. Table 2 contains some representative comments

from the family group related to the identification of their

children for early intervention services.

Evidence-based practice suggests that high quality early

childhood programs be required as part of their accredita-

tion to administer developmental screenings within

3 months of a child’s program entry, and then to continu-

ously monitor child development in the five developmental

domains using this information to guide teaching practices,

and make referrals to appropriate professionals when nec-

essary (NAEYC 2013). However, 2 of the 4 early child-

hood educators in the interview phase of the study reported

difficulties contacting their Intermediate Unit with a

referral for a child who they suspected may be eligible and

would benefit from early intervention services.

Early childhood educators reported that evaluations for

eligible children occurred within the early childhood set-

ting 75 % of the time, but the child was always pulled into

a private room for evaluation. The evaluation did not occur

within the classroom setting, even if the early childhood

educators indicated that concerns were evidenced within

the classroom setting. Evaluations were conducted by an

early intervention provider who used their own assess-

ments, materials, and resources. Early childhood educators

described experiences where parents received question-

naires in the mail as part of the evaluation tool but ‘‘they

were intimidated by the questions’’ and decided not to

proceed through the evaluation process for their child.

Individualized Education Plan Implementation

Once a child is identified, referred, evaluated and deter-

mined to be eligible for early intervention services, an IEP

Table 2 Family group participants’ early identification experiences for their children

Interview excerpt Respondent

‘‘So I was glad when the (early childhood

educator) said you might want to think about

this for him. I was glad it was done early and it

progressed the way it did. It would have been

more difficult without the preschool. The

preschool was instrumental in organizing all of

that.’’

Family member

(Group 1)

‘‘Well I really liked how they came into the

preschool and they worked with him here.’’

Family member

(Group 1)

‘‘It is a big jump to take a child from 3 years old

because the child is little anyways and having

the confidence to place them in a quality early

childhood setting which is the best place for

them. It is extremely important to start

accessing services early on. Communicating

with the teachers who are going to be part of

that transition.’’

Family member

(Group 1)

62 Early Childhood Educ J (2015) 43:57–67

123

is developed to identify the goals and related special edu-

cation services needed. This plan is developed in collabo-

ration with the family, early childhood educator, and early

intervention personnel who will address the needs of the

child (Rous and Smith 2011).

Families (80 %), early childhood educators (81 %) and

early intervention providers (92 %) who responded to the

online survey reported that they were invited to participate

in IEP meetings and they received a written copy of the IEP

for their children receiving early intervention services. This

finding was not reported by the early childhood educators

during their interviews. Table 3 contains representative

comments from the early childhood educators reflecting

their experiences with the IEP process for children eligible

for early intervention services in their schools.

The family members indicated that, although some

families (25 %, N = 4) knew they could invite a teacher or

advocate to attend the meeting, they felt that this infor-

mation was not communicated by the Intermediate Unit to

them; therefore, it was not well known. Family members

indicated that they received a written copy of the IEP to

take with them from the meeting, and they just assumed

that the early childhood educators where their children

attended preschool would receive a copy as well.

Three of the four early intervention service providers

reported that early childhood educators were not present at

the IEP meeting. One of the early intervention providers,

an administrator of an early intervention agency, believed

that early childhood educators needed to be present at the

meeting and have a copy of the IEP since ‘‘classroom

teachers need to work on those goals as well as the early

intervention staff. The early intervention teacher may only

be there an hour a week. The expectation is that the EC

teacher will reinforce the goals of the child.’’

Early Intervention Instructional Practices

The Division for Early Childhood of the Council for

Exceptional Children identifies evidence-based practices

based on research which recommend using instructional

strategies which are consistent within and across environ-

ments, activities, and routines to promote children’s

learning and participation in inclusive environments. Rec-

ommended practice promotes collaboration and commu-

nication between families and all professionals that interact

with the child working together to jointly achieve goals and

outcomes (Sandall et al. 2005).

Early intervention providers (88 %) reported a much

stronger belief that they collaborated and communicated

with families and early childhood educators as they

developed, modeled, and evaluated instructional strategies

for children who participated in early intervention. This

belief was reported by only 73 % of the early childhood

educators, and 67 % of the families.

The most appreciated component of early intervention

practices reported by the family interview participants was

the use of a communication folder or notebook by the early

intervention therapists. The families liked seeing the ses-

sion notes which described the strategies being used or the

goals addressed during the day. Families especially

appreciated those therapists who would take the time to

share ideas to practice or implement these strategies in the

home. This communication tool was perceived as vital

since many of the parents did not have direct contact with

the early intervention providers, especially if services were

provided in the school.

Although services were provided in the early childhood

setting, early childhood educators (75 %, N = 4) expres-

sed frustration reporting that they did not receive a copy of

the session notes unless they made a copy of the session

notes before they were placed in the child’s folder or

notebook. The early childhood educators also stated that

the early intervention providers typically pulled the chil-

dren into separate classrooms to work with the children.

Because of this, the educators were not able to see the

strategies the therapist used, nor were the strategies mod-

eled for them or communicated to them. The early

Table 3 Early childhood educators’ IEP experiences

Interview excerpt Respondent

‘‘It is a lot of us pressing the parents saying,

‘We want to be on the team with you. We

want to be able to know what your child’s

goals are on the IEP and put that into the

lesson plans and make sure we are all on

the same page and doing things the same

way.’ So, we ask them to be a part of the

meeting. We ask them for a copy of the

IEP. And, 9 times out of 10 we’re not even

invited to the meeting.’’

Early childhood

educator (Group 2)

‘‘We are not notified about the child’s IEP

meeting unless the parent has a really

good relationship with us, or the parent is

just as concerned as we are. 90 % of the

time they do not get a copy of the IEP. We

say to the parents we need your IEP or we

can’t meet the goals if we do not know

what they are.’’

Early childhood

educator (Group 2)

‘‘I was invited to that IEP meeting because

mom had said to me ‘I have this IEP

meeting. I don’t know what to expect.’

And I said, well I could go with you. And

so I kind of invited myself to the meeting.

And I was glad that I had done that

because she really felt intimidated by the

situation. She was kind of afraid of it all.

She didn’t know what to expect. And I felt

that having someone there on her team,

made the experience a little easier for

her.’’

Early childhood

educator (Group 2)

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123

childhood educators reported that ‘‘they did not have a high

level of communication with the therapists. Some tips,

some techniques, some games to play, that would help the

children when they are in the classroom would really

promote what they are doing in those individual sessions.’’

Families (50 %) and early childhood educators (55 %)

reported on the survey that they did not feel that early

intervention providers shared the research which supported

the instructional approaches they used with children

receiving early intervention services. Another area of

weakness was support for families. The families (60 %)

and early childhood educators (59 %) reported that early

intervention services did not connect families with one

another for mutual support. Significant differences were

reported in the responses of the early intervention providers

with 71 % of the respondents reporting that they connected

families with one another for mutual support, and 87 %

reporting that they shared the research which supported the

strategies they used.

Knowledge and Frequency of Early Intervention

Services

Knowledge of access, participation, and support for early

intervention services is a key issue for effective implemen-

tation of early intervention services (Rous and Smith 2011).

The mean scores of the overall knowledge of families, early

childhood educators, and early intervention providers ana-

lyzed with the one-way ANOVA indicated a statistically

significant difference regarding their knowledge of the early

intervention process and the personnel involved with the

delivery of early intervention services. The early interven-

tion providers demonstrated a much higher confidence in

their knowledge, followed by the early childhood educators,

and finally the families. One of the family members

expressed her concern during the interview for other family

members who might not have the resources or education to

push for early intervention services for their children. She

stated, that ‘‘Where early intervention could have come in

and really helped push that child where they needed to be, it

wouldn’t happen until they got to kindergarten because

probably that mother wouldn’t have been able to afford

preschool.’’ One of the early childhood educator participants

felt that oftentimes early childhood educators ‘‘don’t have

the confidence and understanding that if I have a child that is

having these issues, how do I connect them with what they

need? What supports do I get to make them successful?’’

The chi-square test was used to determine if there was

an association between the community size of the partici-

pants and the frequency of services delivered. A significant

difference was not found between participant groups and

the frequency of services received based on whether or not

they lived in urban, suburban, or rural communities.

Supports and Barriers to Effective Early Intervention

Implementation

Supports and barriers to evidence-based early intervention

implementation were common themes in the qualitative

phase of the study. The last question on the interview

protocol invited families, early childhood educators and

early intervention providers to describe the supports and

barriers to early intervention implementation.

The most commonly reported supportive evidence-

based practice that early childhood educators identified that

they wanted to have, but was not currently implemented,

mirrored the findings of Kaczmarek (2011). Educators

wanted to be included in the process of early intervention

implementation for their students, including evaluation,

IEP development, and instructional strategy implementa-

tion. Early childhood educators identified joint professional

development as a method to improve the quality of com-

munication, collaboration, and knowledge that currently

exists between families, early childhood educators, and

early intervention providers. This sentiment was echoed by

one early intervention provider who coordinates profes-

sional development for all of the early intervention staff

and early childhood educators together at least three times

a year to ensure that ‘‘everybody is on board with new

training initiatives to make sure it (early intervention

instructional practices) actually happens.’’ Odom et al.

(2011) and Sandall et al. (2005) found that high quality

early intervention programs coordinated service delivery

and provided professional development of all personnel

who interact with the child receiving services.

The most commonly reported barriers to successful

early intervention implementation reported by participant

groups included (1) the use of authentic assessments; (2)

presence of service coordinators; (3) perception that fewer

children are determined to be eligible to receive services

after identification and evaluation; (4) communication of

evidence-based instructional strategies; and (5) accessibil-

ity, dependability, and training of technology used to report

early intervention data.

Throughout the Commonwealth of Pennsylvania evalu-

ation procedures varied from Intermediate Unit to Inter-

mediate Unit. These evaluations included assessments

which did not follow evidence-based practices. Assess-

ments used were not administered in natural learning

environments, and were not developmentally appropriate.

During the interview phase of the study, the four early

childhood educators reported that children were taken into

private rooms with an evaluator who was not familiar to

them, to sit at a table to complete tasks with toys taken

from test kits. Bagnato et al. (1997) found this method of

evaluation to be inappropriate when considering young

children with special needs.

64 Early Childhood Educ J (2015) 43:57–67

123

Service coordinators who were so vital in the Birth to

Three, Part C program delivery of services did not con-

sistently exist in the implementation of Part B services.

This study found very few educators, providers, or families

who had or knew of a service coordinator to help them

understand the process and coordinate service delivery. A

family interview participant expressed frustration because

he felt that ‘‘he was never sure who was actually in charge

or who he should talk to in the Intermediate Unit.’’ Inter-

mediate Units independently determine whether their

budget can support service coordinators. The variability of

funding among Intermediate Units influences the presence

of service coordinators and many other aspects of service

delivery.

Although funding has neither decreased nor increased

for early intervention services in the Commonwealth of

Pennsylvania over the past few years, the number of chil-

dren referred for services has increased (Office of Child

Development and Early Learning 2012). The early inter-

vention providers stated that they are required to stretch

their dollars more and more to meet the needs of children

in early intervention. Early childhood educators felt that

fewer children were determined to be eligible for services

due to these funding issues. Early intervention providers

reported that ‘‘the kids (eligible for services) are not going

away, so we still need to serve them, but we have to do it

with less and less money.’’ These funding issues also

influence the availability of training for service providers

and early childhood educators.

Early Intervention providers felt that there was a lack of

training and accessibility when using the online data

reporting system. When they struggled to access the

resources and enter data for their caseload, either the sys-

tem was down, or they were not clear on how to enter the

data, and their supervisors did not have the knowledge base

to provide support. One interview participant felt that

‘‘nobody seems to have a really great handle on exactly

what it is you are supposed to be doing in the system.’’

They reported spending several hours outside of their

contracted time to complete paperwork and scan reports.

The early intervention providers also reported that due

to the lack of training, IEPs were not consistently com-

pleted in the same manner across the state or even within

their own Intermediate Unit. This becomes a barrier when

children move from one Intermediate Unit to another

within the state.

Conclusion

Kaczmarek (2011) found that early intervention imple-

mentation is effective when high collaboration and

communication exist among the professionals involved in

the delivery of services to eligible children and their

families. This collaboration must exist throughout the

identification process, and the coordination of service

delivery. Families, early childhood educators, and early

intervention providers in this study differed significantly in

their knowledge of early intervention service program

components. Evidence-based early intervention practices

were not consistently implemented across the Common-

wealth of Pennsylvania. The analysis of the quantitative

and qualitative data together in this research study found

that the best indicator of high quality implementation of

early intervention services according to evidence-based

practices was dependent on the quality and resources of

the Intermediate Unit (early intervention provider) pro-

viding early intervention services in a setting. The fami-

lies, early childhood educators, and early intervention

providers who were serviced by Intermediate Units that

were self-contained with strong leadership that could

closely monitor the delivery of the early intervention

program reported receiving services with higher collabo-

ration and communication among participants as opposed

to Intermediate Units which contracted out services and

served multiple counties. Self-contained agencies with

adequate resources were able to provide joint professional

development opportunities, and maintain a high level of

collaboration and communication between families, early

childhood educators, and early intervention providers

improving access, participation and support. Dane and

Schneider (1998) found that early intervention imple-

mentation was successful when delivered programs mat-

ched the intended program, the frequency and strength of

program delivery was consistent, and the components of

the program were delivered effectively.

Recommendations

Access

Early childhood educators were reported as the personnel

who most often identified children who might be eligible

for early intervention services. Knowledge of evidence-

based practices and early intervention regulations and laws

are critical for early childhood educators. Professional

development that explains eligibility determination and

evaluation procedures, early intervention personnel roles

and responsibilities, appropriate assessment techniques in

eligibility determination, and research based instructional

strategies which can be implemented across settings needs

to be provided for preservice as well as veteran teachers

(Odom 2009; Sandall et al. 2005).

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Participation

The goals and learning objectives developed must be based

on observations which encourage and solicit input from

families and early childhood educators. Instructional

strategies used by early intervention therapists need to be

shared with the families and also the early childhood

educators to ensure that the skills children learn throughout

the routines of their day are maintained in various settings

when instruction ceases (Sandall et al. 2005). The use of

any type of tool to communicate strategies and learning

objectives to families also needs to be shared with early

childhood educators. It may mean that educators need to be

proactive in their communication with early intervention

providers and families to receive the session notes which

describe the instructional strategies and goals addressed

during each therapy visit, and to contribute information

from observations which are relevant to the child’s growth

and development.

Support

Early childhood educators need to actively engage with

their Intermediate Units (early intervention providers) if

they do not currently have a strong relationship. They need

to ask for professional development to understand identi-

fication, referral, evaluation, and implementation proce-

dures. Early childhood educators who have a strong

understanding of early intervention implementation need to

share their knowledge with their colleagues in their com-

munities and professional organizations promoting collab-

oration among families, teaching staff, and early

intervention providers. Early childhood educators must

establish a culture of openness and a willingness to learn

from early intervention providers. If advocacy efforts do

not work with the local agency which implements the early

intervention program, early childhood educators should

contact the state or governing agency responsible for early

intervention implementation.

Highly effective early intervention implementation

occurs when evidence-based practices are implemented

with fidelity and consistency. High quality early interven-

tion programs that implement their programs with fidelity

and consistency are those programs which have successful

child find and referral services to provide access to ser-

vices, encourage participation, offer joint professional

development support for providers, family members, and

educators, and have professionals who are qualified to

deliver high quality services (Smith and Rous 2011).

Meisels and Shonkoff (1990) found that coordination and

communication between education communities at the

local level is particularly critical to the successful imple-

mentation of early intervention services. Evidence-based

practices suggest that early intervention includes authentic

assessments, encourages children to learn new skills which

can be sustained in various settings, provides environments

which encourage participation, and develops goals and

objectives that are developed and implemented with input

from parents and early childhood educators (Sandall et al.

2005). In order to ensure inclusive opportunities for chil-

dren with special needs, early childhood educators need to

be aware of the process, programs and supports available to

confidently share these supports with families and connect

them with the resources available to help the children in

their classrooms succeed.

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