Going Beyond “I’m a Coach”: Adopting a Caregiver Coaching Framework in EI

Elaina is an experienced occupational therapist who has provided early intervention (EI) services for the last 11 years. During a conversation with her colleague about coaching in EI, Elaina explains that she coaches families by offering suggestions, modeling strategies, and reflecting at the end of her sessions. Yaz asks Elaina if she follows a coaching framework or uses any resources to guide her coaching interactions. Elaina has never considered using a framework to guide her coaching and wonders how that would benefit her practices.

“Caregiver coaching is a mutually beneficial practice used by early interventionists (EIs) to build caregivers’ confidence and capacities to support their children.”

Caregiver coaching is a mutually beneficial practice used by early interventionists (EIs) to build caregivers’ confidence and capacities to support their children, which, in turn, leads to EIs gaining knowledge from families and developing new skills (e.g., Douglas et al., 2020; Meadan et al., 2020). Coaches (i.e., EIs) help others (i.e., caregivers) learn to (a) reflect on their actions and (b) create plans to improve their actions (Rush & Shelden, 2020b). EIs who use a coaching framework primarily interact with caregivers, while the caregivers’ role is to work directly with their children. This service delivery model differs from traditional services, in which the primary interactions are between EIs and children, with caregivers mainly assuming the role of observer (Campbell & Sawyer, 2007). In this article, we provide guidance for adopting a coaching framework and cover the following topics: (a) rationale for using a caregiver coaching framework, (b) what coaching frameworks exist, (c) considerations when choosing a framework, and (d) how to individualize coaching for families.

Why Use a Caregiver Coaching Framework?

Professional Responsibility

EI’s professional responsibility requires adherence to the law as well as to their profession’s recommendations. One goal of Part C of the Individuals with Disabilities Education Act (IDEA) is to “enhance the capacity of families to meet the special needs of their infants and toddlers with disabilities” (IDEA, 2004, p. 1). State EI programs, professional organizations, and experts in the field recommend using caregiver coaching to achieve this goal of the law (Division for Early Childhood of the Council for Exceptional Children [DEC], 2014; Early Childhood Technical Assistance Center [ECTA], 2020). While the law does not require that EIs implement caregiver coaching, some states have adopted coaching frameworks into their Part C policies (ECTA, 2020). Though state policies vary, caregiver coaching is recommended by national professional organizations. In fact, coaching aligns with several DEC-recommended practices such as those focused on family (e.g., building trust, being responsive, creating goals and plans together, promoting family skills) and teaming and collaboration (e.g., multiple disciplines working together with families, exchanging expertise with families). Likewise, research and recommendations from EI disciplines such as speech language pathology (American Speech-Language-Hearing Association [ASHA], n.d., occupational therapy (Whipple, 2014), and physical therapy (Ziegler et al., 2019) support the use of caregiver coaching. Therefore, EIs across disciplines can uphold the law and recommendations from their fields by utilizing a coaching framework.

“EIs across disciplines can uphold the law and recommendations from their fields by utilizing a coaching framework.”

“EIs who use a caregiver coaching framework, either with their program or independently, will have specific guidance to follow, which will help improve their practice and the quality of services for children and families.”

Frameworks Provide Guidance

Caregiver coaching is only one way to facilitate family involvement and learning in EI; other approaches include consultation, mentoring, and teaching (Rush & Shelden, 2020b). Phrases such as “coaching,” “family capacity-building,” and “caregiver engagement” can be interpreted differently and are sometimes used interchangeably. The ambiguity can lead to EIs believing they are coaching caregivers, though they are not implementing it as intended (i.e., with fidelity). Research indicates that EIs rated the value of coaching practices higher than their actual use of them (Meadan et al., 2018), and reported higher use than what was documented during EI sessions (Douglas et al., 2020). Romano and Schnurr (2022) recommended that Part C programs adopt evidence-based coaching frameworks to support EIs’ implementation of coaching. EIs who use a caregiver coaching framework, either with their program or independently, will have specific guidance to follow, which will help improve their practice and the quality of services for children and families.

Coaching frameworks include implementation procedures, examples of the practices in action, and/or tools to assess implementation. These components provide more specificity about how to coach caregivers, which may support and encourage EIs to implement practices with fidelity. EIs have reported that structured coaching processes and coaching documents (e.g., flowcharts of practices, explanations of learning strategies, visual models, guided plans for intervention sessions) helped enhance their coaching practices (Stewart & Applequist, 2019; Windsor et al., 2019). Therefore, by following a framework with clearly defined practices and procedures, EIs may be able to increase their skills in coaching caregivers.

Elaina asks her supervisor, Kelsi, where she can learn more about coaching, and Kelsi emails her a list of resources to review and suggests that they engage in continued discussion about adopting a framework (see Figure 1). Elaina learns about several coaching frameworks in EI and notices that many of them focus on caregivers practicing strategies and reflecting while EIs observe and offer feedback. Elaina thinks about her sessions and realizes that her method of coaching does not align with any of the frameworks. While she regularly shares ideas and reflects with families, she rarely invites caregivers to try strategies during sessions and never offers real-time feedback on how it went. Elaina is excited that Kelsi wants to support her and the other EIs in the program to adopt a coaching framework because she believes it will help them make the most of their time with families.

Figure 1

Kelsi’s Email to Elaina

What Caregiver Coaching Frameworks Can EIs Use?

The Early Childhood Coaching Model

Rush and Shelden (2005) identified five coaching characteristics (see Table 1) to provide an operational definition of coaching. The authors determined these characteristics have a strong evidence base by reviewing the coaching literature and identifying which aspects of coaching led to changes for learners. Later, the authors described their coaching framework in two editions of The Early Childhood Coaching Handbook (Rush & Shelden, 2011, 2020b). Their framework is not exclusive to caregiver coaching and can be used by a variety of individuals in multiple contexts (e.g., two teachers in a classroom setting, a supervisor and a new provider in a childcare program). Researchers have used the Early Childhood Coaching Model to critically examine the coaching literature (Artman-Meeker et al., 2015; Kemp & Turnbull, 2014), as well as to check fidelity of coaching interactions between EIs and caregivers in intervention research (Meadan et al., 2020). By using the model, experts in the field have illustrated an acceptance of its use.

Table 1

Rush and Shelden (2019) Early Childhood Coaching Model

Characteristic	Description	When it occurs
Joint Plan	EI and caregiver agree together on the content of the session or the practice opportunities between sessions.	Both EI and caregiver contribute at beginning and conclusion of session.
Observation	Team members directly observe the environment or one another implementing strategies.	Observation occurs throughout sessions and may also occur between sessions by sharing videos.
Action/Practice	The goal of action/practice is for the caregiver to refine and analyze strategies. This can be done through EI modeling or caregiver practice. When an EI models, they explicitly state the purpose of the strategy.	EI models strategies throughout the session for 3–5 min at a time. Caregiver practices strategies with their child throughout and between sessions.
Reflection	EI asks open-ended questions about the observation/action such as “What went well?”; caregiver suggests modifications and alternatives to improve the practice.	Reflection occurs throughout sessions, as well as after observation and practice, but before feedback.
Feedback	EI affirms caregiver’s abilities and offers information to increase caregiver’s understanding. Together, the EI and caregiver generate new ideas and strategies.	Feedback occurs throughout sessions, after reflection and before re-addressing the joint plan near conclusion of visit.

Note. EI = early intervention.

Triadic Framework

The Triadic Framework, also known as Parents Interacting with Infants (PIWI), was designed as a professional training model to bolster the skills of EIs from a variety of disciplines to encourage family participation in intervention occurring in various settings (e.g., home-based, center-based, play groups; McCollum & Yates, 1994). The role of EIs in the triadic framework is to promote caregiver–child interactions and support caregivers’ use of child-directed strategies that support child outcomes, in other words, to coach families. There are six triadic strategies (see Table 2). EIs can implement the strategies using direct statements to the caregiver (e.g., “Let’s see what happens if we sing while she cleans up.”) or indirect statements from the child’s perspective (e.g., “Daddy, sing Old McDonald to me.”) (Center on the Social and Emotional Foundations for Early Learning, 2011). Studies have shown that both caregivers and children benefit when their EI uses the framework. Caregivers reported increases in their targeted knowledge (e.g., speech milestones) and abilities (e.g., parenting) and children made progress toward their communication-related goals (Green et al., 2018). EIs who used the Triadic Framework in teleintervention felt that the quality of their coaching improved, and the caregivers liked and were comfortable with their EIs using the strategies (Harbin, 2021).

Table 2

McCollum and Yates’s (1994) Triadic Framework

Triadic strategy	Description
Establish dyadic context	Arrange the environment so the focus of the session/activity is on caregiver–child interactions. Develop a plan for the session with caregivers based on their priorities for the child.
Affirm caregiver competence	Make positive comments about the caregiver’s behaviors, emphasizing their capabilities and impact on their child.
Focus attention	Comment on aspects of the interaction to draw the caregiver’s attention to them. Ask reflective questions to help caregivers learn how to focus their attention independently.
Provide developmental information	Share information about child development related to the family’s IFSP outcomes, priorities, or concerns. Encourage caregivers to share their expertise about their child and what they know about development.
Model	Engage in brief interaction (between the EI and the child) to demonstrate an activity or strategy.
Offer suggestions	Provide specific suggestions for enhancing caregiver–child interactions. Ask reflective questions to encourage caregivers to think of changes they might make to the interaction themselves.

Note. EI = early intervention.

Family Guided Routines Based Intervention

Family Guided Routines Based Intervention (FGRBI) is a framework that prioritizes individualized supports for families within their natural environments and routines. FGRBI emphasizes that families are the primary decision-makers for their children (Woods, 2021). The role of EIs is to join caregivers and children in their interactions and coach caregivers using adult learning principles, such as learning through repetition and multiple formats. Table 3 provides descriptions of the components of FGRBI. Several researchers have investigated the effectiveness of the FGRBI framework within EI contexts. Caregivers increased their use of child-directed learning strategies when they participated in FGRBI and children used more targeted skills when their caregiver was the one implementing strategies (Windsor et al., 2019). Caregivers reported satisfaction with the FGRBI framework because of the systematic process and because coaching occurred within their daily routines and activities (Salisbury et al., 2018). The frameworks we discussed were chosen given their prevalence in the field and the implementation resources available. Readers are encouraged to explore other frameworks that can be used to support families’ capacities, such as Practice-Based Coaching (National Center for Pyramid Model Innovations, 2022) and Routines-Based Home Visiting (McWilliam, 2010).

“When EIs in a particular state or EI program follow the same coaching framework, families will receive more consistent services.”

Table 3

Woods’s (2021) Family Guided Routines Based Intervention

Component	Description
Set the Stage	EI and caregiver build collaborative partnerships, share developmental information (e.g., milestones, strategies, resources), reflect on the importance of identified family priorities, and jointly clarify the focus of the session (e.g., activities, materials).
Observation	EI intentionally observes caregiver–child interaction without offering feedback. Can include data collection by EI.
Opportunities to Embed	EI provides learning opportunities for the caregiver to understand and implement interventions with the EI’s support through the following strategies: 1. Direct Teaching: EI shares information about specific strategies or development for the caregiver to learn new ways to support their child. Can include visuals (e.g., video clip) for illustration. 2. Demonstration: EI leads in demonstrating a strategy, first informing the caregiver what to look for and why. The caregiver observes while the EI narrates their actions. 3. Guided Practice with Feedback: Caregiver practices using the strategy with specific support and suggestions from the EI. Caregiver Practice with Feedback: Caregiver leads the interaction with child to demonstrate knowledge and competence. EI observes, supporting the interaction as needed.
Problem Solve and Plan	Problem Solve: Throughout the session, EI and caregiver jointly discuss the strategy and progress made. EI supports the caregiver’s evaluation and enhancement of the strategy. Plan: EI supports the caregiver to find additional opportunities to incorporate strategies into routines.
Reflect and Review	Reflect: EI supports the caregiver in reflecting throughout the session by modeling reflective thinking, expanding on caregiver’s statements, and asking reflective questions. Review: EI and caregiver summarize the session, looking ahead to targets for the next session and in between sessions.

Source. Definitions are adapted from Friedman et al. (2012) and Woods (2021).

Note. EI = early intervention.

What Factors Can EIs Consider When Choosing a Caregiver Coaching Framework?

Requirements and Recommendations

In some states, EI programs have adopted specific service delivery frameworks that EIs follow. For example, Tennessee uses FGRBI (Tennessee Department of Education, 2020) and Georgia uses the primary service provider approach (ECTA, 2020; Georgia Department of Public Health, 2017), also known as the primary coach approach (Rush & Shelden, 2005). In this approach, one EI provides direct services (i.e., coaching) to a family, while other team members provide support through consultation. In addition to state requirements, community-based Part C EI programs may require EIs to use a particular framework. When EIs in a particular state or EI program follow the same coaching framework, families will receive more consistent services. Therefore, when selecting a coaching framework, EIs should prioritize their state’s requirements and recommendations as well as the requirements set by the program for whom they work. Table 4 provides examples of how EIs can find their state’s requirements and recommendations, though this process may vary by state.

Table 4

Options to Find Out a State’s Coaching Framework With Examples

Option	Example and directions
Check your state’s EI PD website.	Virginia Early Intervention Professional Development Center https://veipd.org/main/sub_coaching.html Scroll down to “Available Resources” and click “Virginia-Specific Info,” which indicates they use the Early Childhood Coaching Model.
Review your state’s EI Policy Manual.	Georgia Department of Public Health: Babies Can’t Wait Program Policy Manual https://dph.georgia.gov/document/publication/georgia-babies-cant-wait-policy-manual/download Review the Table of Contents and find “Service Delivery: Chapter 500,” which indicates they use the Primary Service Provider Model.
Review your state’s performance plan/annual performance report.	Tennessee Department of Education: State Performance Plan/Annual Performance Report https://sites.ed.gov/idea/files/TN-C-SPPAPR-FFY19.docx Search “service delivery model,” which indicates they use the Family Guided Routines-Based Intervention.
Contact the state Part C coordinator.	Part C State Systems and Coordinators https://ectacenter.org/contact/ptccoord.asp Find the contact information of the Part C coordinator in your state. Email or call the coordinator to ask if your state follows a specific service delivery model.

Note. EI = early intervention; PD = professional development.

Access to Professional Development Opportunities

Engaging in professional development (PD) opportunities related to caregiving coaching helps EIs implement the practice by providing them with an understanding of what to do and how coaching should look (Meadan et al., 2020; Stewart & Applequist, 2019). Therefore, access to PD, as well as its cost, are key considerations when choosing a framework. PD opportunities may include formal trainings, independent study, or learning from others. EIs can consider their personal learning preferences (e.g., watching videos, debriefing with peers, reading) and the opportunities or resources available to support each coaching framework. Some frameworks, such as FGRBI, may be more difficult to implement without formal PD due to their complexity. Others, such as the Triadic Framework, are simpler, meaning formal PD may not be necessary. Furthermore, some EIs may be motivated to independently study coaching frameworks, and therefore, may prefer a framework with an abundance of high-quality resources that fit their learning needs. For example, the Early Childhood Coaching Model is described in multiple books (Rush & Shelden, 2011, 2020b; Shelden & Rush, 2022). Fidelity tools, such as those listed in Figure 1, provide step-by-step procedures for framework implementation. Given the importance of reflective opportunities for EIs to improve their practices (Krick Oborn & Johnson, 2015; Meadan et al., 2020), EIs may benefit from mentoring, peer coaching, reflective supervision, or involvement in a community of practice. For example, supervisors can assist EIs to increase their fidelity by observing their coaching sessions, tracking the number and quality of coaching practices used, and engaging in reflection and feedback afterward. Therefore, choosing a framework that one’s colleagues or supervisors have adopted may be a wise option.

Personal Preferences and Characteristics

Some personal preferences and characteristics, including EIs’ personal philosophies, may influence which coaching framework will work best for them. Some EIs may prefer a delineated framework (e.g., FGRBI), while others may prefer practices they can use at their discretion (e.g., the Early Childhood Coaching Model, Triadic Framework). EIs also may consider how comfortable they are with facilitating learning. The triadic strategies may be a good option for EIs with less experience guiding caregiver learning because there are resources that explain what the strategies look like in practice (see Figure 1 for resources). These are broken down into direct and indirect strategies, which may accommodate EIs who tend to be more passive or nondirective with families. In contrast, some EIs may be comfortable with providing explicit facilitation, such as direct teaching from FGRBI.

During the next staff meeting, Kelsi guides the staff in a conversation about adopting a coaching framework in their program. Elaina shares that she learned that their state does not require or recommend a specific framework, but they do regularly offer PD on the FGRBI framework. Kelsi asks if any of the EIs have experience implementing a specific framework and Yaz shares that she was trained on the Triadic Framework during her master’s program and feels confident she could help others implement it. As a group, they review the resources Kelsi shared with Elaina, discuss the benefits of each framework and how they align with each EIs’ characteristics and preferences, and begin discussing how families might receive each one.

How Can EIs Individualize Caregiver Coaching Within a Framework?

Once an EI or an EI program chooses a coaching framework, they must consider how they will implement it with families. For a coaching framework to be effective, caregivers must be active participants in the process, but the ways they participate might be different for each family. DEC (2014) recommends that families are provided opportunities to participate that are “flexible, individualized, and tailored to [their] preferences” (p. 10). All families come into coaching relationships with different experiences, funds of knowledge, perceptions, and beliefs that may impact their involvement. Although some EIs believe that families with certain characteristics and circumstances may be less interested in coaching than others (Stewart & Applequist, 2019), Rush and Shelden (2020b) warn that EIs be cautious of their perceptions about any family’s “coachability.” Rather than focusing on barriers to coaching some families, EIs can focus on individualizing their coaching to support all families. Rush and Shelden (2020b) provide numerous scenarios of how individualization looks in practice. EIs can use their examples as well as the ones we provide next for guidance; however, EIs may consider additional ways of individualizing for families, as these examples are not exhaustive.

“For a coaching framework to be effective, caregivers must be active participants in the process, but the ways they participate might be different for each family.”

EIs can modify the practices and procedures in any framework to fit a family’s needs. For example, some families may be hesitant to engage in guided practice with feedback. EIs can individualize this FGRBI coaching practice by giving only supportive feedback on caregiver’s typical interactions with their children instead of feedback on the direct practice of a strategy. Another option may be to ask family members to record themselves practicing strategies and send the recording to their EIs. By offering these alternatives, EIs may alleviate some of the pressure related to observation and feedback and build trust with caregivers. After that trust has been built, they might work together on specific strategies during sessions. In addition, when using the triadic strategies, EIs can promote family autonomy by encouraging families to share developmental information about their child, point out what they notice about their child’s skills, and come up with their own ideas for improving interactions.

Another way that EIs can individualize their coaching is by supporting families’ communication and learning needs. It is important for EIs to consider how they can support families to understand the purpose and their roles within a particular framework given family expectations for services has been identified as a barrier to coaching (Stewart & Applequist, 2019). EIs can do this by spending substantial time explaining a framework, integrating services across providers to promote consistent expectations, and individualizing coaching documents (e.g., visual aids, translation, simplified language, descriptive explanations). In addition, a variety of modes can be used to share information throughout the coaching relationship. For example, some caregivers may learn best by watching a video of someone using a targeted strategy, while others may want to see EIs implement the strategy with their children or read about the strategy. EIs also can identify and use the communication mode (e.g., text message, phone call, email) each family prefers. It is important that EIs ask questions regularly about caregivers’ learning and communication preferences so they can respond to their individual needs and wishes. When EIs learn what types of individualization families want, they should communicate these modifications with other EIs on the child’s team to help with continuity of services and to avoid confusion for families.

“It is important that EIs ask questions regularly about caregivers’ learning and communication preferences so they can respond to their individual needs and wishes.”

Once her EI program chooses a framework, Elaina explains it to each family and invites them to ask questions and provide suggestions about the process. One caregiver she works with requested that Elaina brings additional documentation explaining the coaching framework to help her explain it to other family members. On their next visit, Elaina comes during a time when other family members are present and brings a handout with brief explanations of the coaching practices for each of them. During this session, Elaina learns that the family values making decisions together and shares responsibility for addressing the child’s goals. Together, they decide that Elaina will come to the home when more family members are there so they each understand the strategies and have opportunities to practice and receive feedback.

We outlined why it is important to use a coaching framework, how to choose one, and ways coaching can be individualized for families. On her journey, Elaina reflected on her practices, explored coaching frameworks, considered the factors that might help her EI program choose a framework, and began discussing coaching with families. Every EI’s path to select a coaching framework will be different; however, we hope the guidance provided in this article will help EIs make this important decision and improve services for children and families.