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Full article FREE at Abstract An exploratory study is reported of the delivery of the Early Support and Key Working (ES&KW) training program in England for multiagency professionals and parents. This qualitative study examined how ES&KW training principles and content relate to contemporary pillars in early childhood intervention; how this training is structured to meet the program’s principles and desired outcomes; and its impact on training participants’ competences to fulfill the key working functions in partnership with parents/carers and families they work with. The study involved, throughout its different phases, 42 participants, comprising trainers, training participants, mostly working with small children (aged 0–8 years), and families. On the basis of document analysis, training observations, focus groups, reflective practice, and semistructured interviews, results show that overwhelmingly participants found ES&KW training very significant to their work with children, families, and other professionals but some gaps between the program’s intentions and reality emerged. We explore the reasons for the program’s success and the implications for its further development. Key words: family-centered intervention, key working, professional development, team collaboration and partnership
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
Understanding the initial impact of Early Support and Key Working training through the
voices of trainers, training participants and families
Ana Teresa Brito and Geoff Lindsay
An exploratory study is reported of the delivery of the Early Support and Key Working (ES&KW)
training program in England for multi-agency professionals and parents. This qualitative study
examined how ES&KW training principles and content relate to contemporary pillars in Early
Childhood Intervention; how this training is structured to meet the program’s principles and desired
outcomes; and its impact on training participants’ competences to fulfill the key working functions
in partnership with parents/carers, and families they work with. The study involved, throughout its
different phases, 42 participants, comprising trainers, training participants, mostly working with
small children (0 to 8), and families. Based on document analysis, training observations, focus
groups, reflective practice and semi-structured interviews, results show that overwhelmingly
participants found ES&KW training very significant to their work with children, families, and other
professionals, but some gaps between the program’s intentions and reality emerged. We explore the
reasons for the program’s success and the implications for its further development.
Key words: Professional development, Key working, Family centered intervention, Team
collaboration and partnership
A set of fundamental principles underpins current concepts and best practices in early childhood
intervention (ECI) and early childhood special education (ECSE). These are founded on research
and scientific evidence, namely a family-centered orientation based on a collaborative team process,
held in inclusive, natural learning environments (Bruder, 2010), embedding “intervention strategies
into everyday activities and routines to provide maximum child learning opportunities” (Sawyer, &
Campbell, 2012, p.122). Family-centered practices treat families with respect and dignity, offer
family members the information they need to make knowledgeable decisions and choices, and
actively involve families in accessing resources and support (Dunst, 2002). They involve both
relational and participatory components, relying on a collaborative process, enhancing integration
and coordination at all levels of the ECI system; potentially reducing redundancy, improving service
efficiency, and making those services more functional for the child and family (Dunst, 2002;
Guralnick, 2008). Family- centered practices are well established in the ECI literature. McWilliam
(2010) underlines the work of Dunst, Trivette, and Bailey as strong contributors to this approach,
both in research and practice. Moore (2008) outlined trends in ECI which were becoming
established. These include developments from professionally-directed to family-centred practice,
from simple linear causal models to complex transactional models, and from a deficit model of
disability to a social construction model. Moore also identified emergent ECI trends including the
shift from fragmented services to seamless service integration, from a professional skill-based
approach to a relationship-based approach, and from interdisciplinary to transdisciplinary teamwork
and key worker models.
In the U.S. the primary service provider (PSP) model is closely connected to transdisciplinary team
work (McWilliam, p119). In this kind of approach, “one professional (the PSP) has ongoing contact
with the family, with other members providing consultation to the family and the PSP” (McWilliam,
2010, p.107). Alternatively, in the U.S., there is an early intervention service coordination approach
mandated under Part C of IDEA. There are two basic models of service coordination: dedicated and
combined. Dedicated service coordinators “conduct intakes, organize evaluations, and complete
individualized family service plans, but they do not provide ongoing services beyond service
coordination” (McWilliam, 2010, p.12). Combined service coordinators associate these service
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
coordination activities with “ongoing services such a special instruction, family counselling, or
whatever they are qualified for” (McWilliam, 2010, p.12). In England key working functions are
particularly comparable to the U.S. dedicated and combined service approach.
Within this framework, training and professional development are critical elements for the
success of both the well-established and emergent trends, demanding a development of ECI
professionals’ knowledge, skills, and attitudes towards the new intervention requirements (Bruder,
& Dunst, 2005; Klein, & Gilkerson, 2000; Lindsay et al. 2011; Snyder, Hemmeter, & McLaughlin,
2011). These involve not only technical quality - regarding knowledge, expertise, and competence
held by the professional in this field - but also the practical and reflective expression of this
competence, founded in empathic qualities of collaborative involvement, leading to a
transdisciplinary provision of services, focusing on family and their natural context (Brazelton, &
Sparrow, 2003; Dunst, 2002; Klein, & Gilkerson, 2000; Snyder et al., 2011). Emphasizing these
fundamental ECI and ECSE pillars, the Division for Early Childhood (DEC) launched
recommended practices (Sandall, Hemmeter, McLean, & Smith, 2005; Miller, & Stayton, 2005),
updated in 2014, including personnel preparation with emphasis on the delivery process of pre-
service and in-service education programs. These recommended practices aim to ensure that:
families are involved in learning activities; learning activities are interdisciplinary and interagency,
systematically designed and sequenced, and include study of cultural and linguistic diversity;
faculty and other personnel trainers are qualified and well prepared for their role in personnel
preparation; and that professional development activities are systematically designed and
In England issues related to ECI and ECSE are included in the wider domain of special
educational needs (SEN), which was recently subject to Government review (Department for
Education, 2011; 2012) and legislation, the Children and Families Act 2014, with guidance
provided by the revised SEN Code of Practice (Department for Education and Department of
Health, 2014). This socio-political framework constitutes a challenge and opportunity to promote
high quality services to a diverse group of children with SEN and their families.
Early Support
Considering this new frame of action, the Department for Education (DfE) Green Paper on SEN,
which preceded the legislation, recognized Early Support as a fundamental approach to meeting the
needs of children, young people, and families (Department for Education, 2011). Early Support was
originally developed during 2003-2009 as a national program for children with SEN under five,
with over a 10,000 families having used this service by 2009 (Department for Education, 2011). It
was the central government mechanism to achieve better-coordinated, multiagency assignment and
service delivery comprising resources designed to assist families and professionals move away from
crisis to planned, early childhood intervention (Carpenter, 2008). In England there is no specific
University or College training for professionals in ECI (Brito & Lindsay, 2015). Thus, this training
program is central to inspire and guide professionals’ intervention with young children and their
families’. The DfE recognises Early Support as “highly regarded by parents and professionals alike
and has been proven to make a significant difference to families” (Department for Education, 2011,
p.43). The Early Support Trust Consortium comprising more than 50 voluntary, community, and
private sector organizations was created, with the remit to develop, deliver, and sustain Early
Support materials, resources, and training across the age range, from birth to adulthood (0 to 25).
Thus, Early Support became a core delivery partner supporting the implementation of the proposals
set out in the Government's Green Paper.
Early Support aims to ensure that services are well-coordinated, with a key working
practitioner offering “a single point of contact, coordination and support where families need it
ensuring that service delivery is child, young person, and family centered and that services and
practitioners work in partnership with children, young people, and their families.” (Early Support,
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
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2012a). The DfE (2011) underlined the importance of this approach to families, funding the
voluntary and community sector to offer free training of key working to diverse practitioners
(Department for Education, 2011). This led to the national Early Support and Key Working
(ES&KW) training - two days training, free at point of delivery - and capacity building model for
The Early Support and Key Working training model and approach
Theoretical base, principles, and learning outcomes
The training model combines the concepts of its constituents to produce the Early Support and Key
Working training model. Early Support is presented as a way of working, underpinned by ten
principles (Table 1), aiming to improve the way services are delivered. These principles focus on
ensuring a person-centered approach (i.e., child, young person, and family-centered service
delivery) and that practitioners work in partnership with children, young people, and their families.
Table 1
The learning outcomes are closely connected to the perspective of key working as a set of
functions (Table 2), rather than as a key worker role. Hence it is stressed that this set of functions
can be carried out by an extensive range of practitioners or by parent carers or young people
themselves (Early Support, 2012b). The ES&KW training uses the family partnership model,
developed by Davis, Day, and Bidmead (2002), as a theoretical base. The relationship between
parents and those helping them is based on partnership, defined by “mutual participation shared
power, involving the expertise of both partners, agreement about aims and process, negotiation,
mutual respect, and trust, and open and honest communication” (Davis, & Meltzer, 2007, p.23).
Based on the family partnership model, the ES&KW training specifies that “the qualities, values,
principles, ethos and skills of trainers needed to facilitate learning in this course are very much the
same as those needed by parent carers/young people and practitioners to work effectively in
partnership” (Early Support, 2013a, p.5).
Table 2
Learning outcomes therefore include understanding key working functions and how the
principles of Early Support influence the use relevant skills and knowledge to implement key
working; identifying why it is important for practitioners to understand the experiences of children
with SEN and their families; explaining partnership working with children with SEN and their
families and with other agencies; and how to use reflection to improve their own key working
practice (Early Support, 2013c, p.3).
ES&KW training organization and approach
These theoretical bases, principles, and learning outcomes inform the ES&KW training organization
and approach, namely in what concerns participant recruitment and involvement, families’
involvement, training sequence, and content, and training delivery. It is emphasised that the aims of
the training can only be successfully achieved if it has the right mix of participants, including
representatives from health, social services, education, voluntary sector organisations, parent carers,
other family members, and advocates if required. It is stressed that in order to reach the ultimate
aim of improving services for families, sharing experiences, values, principles, and approaches
amongst a mixed training group is essential. Training documents highlight the fundamental value of
families’ involvement as training participants and as trainers and co-trainers. Guidance is provided
to inform this approach to ensure that parent carers have equal access to training and that all aspects
of their participation are addressed: from the planning stage to the support after the event has ended.
Pre-reading is required prior to Day1, covering major areas of policy and legislation, an overview of
ES&KW, and an introduction to Early Support resources, supported by questions to check and
enhance learning. Day 1 comprises content about Early Support principles, the aims and process of
helping and working in partnership. Interim reading is also required covering elements such as
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
communication skills and ensuring that links are made between the two days of training and that
participants take the opportunity to reflect on Day 1 and plan for Day 2. Day 2 comprises content
about Key Working – its functions and application in times of transition and change – multi-agency
meetings, management, and supervision considerations (Early Support, 2013b).
Training delivery involves a cycle of attentive preparation, delivery, and reflection over the
two days. Since it should be conducted in the spirit of partnership, trainers need to be doing what
they are facilitating or teaching. This requires demonstrating respect and empathy, using active
listening and observation of nonverbal responses, communicating clearly, and highlighting the
abilities of training participants, thereby enabling them to develop their own self-efficacy, self-
esteem, and self-understanding (Early Support, 2013a). Because it is intended to be participant led it
should build on participants’ existing knowledge and strengths, encouraging open discussion and
providing constructive feedback at all training stages. Methods are experiential and interactive,
relating discussions to the specific aims and tasks of the course.
Early Support and Key Working trainers are urged to be actively involved in delivering and
monitoring pre-course information to training participants and that they should involve families,
keep to time, and maintain momentum; supervise participant numbers, organize physical space and
seating arrangements; capture participants’ views and feedback; use local materials; advocate for
anti-discrimination, diversity, and inclusion; and master terminology used and avoid jargon. These
fundamental organization and approach requirements provide the framework to examine the impact
of the training.
The research, conducted over the period June 2012 to July 2013, aimed to enhance the
understanding of the initial impact of ES&KW training on different providers, especially in the way
they work together and with families with young children. Although ES&KW training is now
available across the age range, we particularly wanted to understand if the fundamental principles
that underpinned Early Support from its beginning - which were centered on children aged 0 to 5
and their families - remained as core elements of the new, combined Early Support and Key
Working training. This is important as Early Support still remains the program in England that
supports children 0 to 5 and their families: ES&KW training is intended to be an enhancement of
Early Support, inspiring and guiding professionals in an ECI approach. Our study examines the
early stage of the development of the combined ES&KW training, examining its relationship with
the principles of Early Support and practical aspects of its implication.
Four research questions (RQ) guided our work:
RQ1. How do ES&KW training principles and content relate to the contemporary body of
knowledge regarding ECI and ECSE? (i.e., family-centered orientation based on a
collaborative team process, held in inclusive, natural learning environments)
RQ2. How are ES&KW training content and delivery processes structured to meet its
principles and desired outcomes?
RQ3. What impact does ES&KW training have on the motivation and competence of
practitioners working with children aged 0-8 years to fulfill the key working functions in
partnership with parents/carers?
RQ4. What impact does key working have on the well-being and quality of life of families
served by the training participants, in view of their individual needs and strengths?
The research design followed the chronological structure of the new ES&KW training program.
Thus, it began by the analysis of training content, from drafts to final documentation, followed by
observations of two pilot trainings and of a training for trainers (T4T), before the final ES&KW
training version took place. The study of the ES&KW final program then involved observation of
three ES&KW training courses, focus groups with training participants, and semi-structured
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
interviews with trainers. The post-training follow-up included ongoing reflective practice and
follow up semi-structured interviews with training participants, and semi-structured interviews with
families with whom these training participants were working. This gave us the possibility of
progressively ‘zooming in’, in order to create “well grounded, rich descriptions and explanations in
identifiable local contexts” (Miles, & Huberman, 1994, p.1), where words intend to translate the
concrete world of participants with different roles in connection to ES&KW training.
The research sample comprised a total of 42 participants: three trainers, 33 ES&KW training
participants, most working with small children aged 0 to 8 years (n = 29), and six family members.
A purposive sample plan began by inviting ES&KW trainers undertaking T4T to be involved in the
research. Seven trainers agreed to participate, from whom three were selected to provide a diverse
sample and because their ES&KW training deliveries did not occur simultaneously. Although these
three trainers had the same ethnicity (White British), their working and training experience was
different: one was an experienced Early Support trainer who also coordinated a team of
practitioners working with children and families 0 to 5 with diverse cultural and social background;
the second likewise had a seven year experience of training in early childhood and health programs,
supporting different types of organizations, cultures, and organizational structures, but was starting
as an Early Support trainer; and finally, the third was a parent of two young adults with special
needs and a parental involvement coordinator, with some experience in training with and for
parents, but none in Early Support training.
All 33 ES&KW training participants (31 female, 2 male) accepted being part of the
research; 14 were working in education or community areas; six in the voluntary sector; six were
working in the health service in roles that included engagement with education, community, and
social care; four in social care exclusively; and three in the independent sector. Ethnicity was
predominantly White/White British (n = 23) followed by Black/Black British (n = 8) and
Asian/Asian British and Mixed, White & Black Caribbean (one each). Nine had substantial
experience in Early Support or in key working, 12 had some experience, nine had little experience
and three had none. Seven were also family members of a child or young person with SEN. Twelve
of these 33 training participants then agreed to participate in one of three focus groups, of whom
nine actually participated (three per group) (Table 3); three were unable to take part due to family or
professional reasons. From these nine focus group participants, six completed an ongoing reflective
practice and were individually interviewed approximately four months after the training took place.
Participants from the last focus group did not contribute at this point of the research since the last
training observation occurred just before the summer holiday break when the research study ended.
Table 3
Interviews were also held with five families, chosen by participants from groups 1 and 2
who were each supporting one family as key workers. Participants selected families that were
particularly challenging for them, namely considering the complexity of their child’s condition (all
children had complex additional needs, aged one to seven years); their diverse cultural backgrounds
(three families were of Somalian, Russian, and Nigerian heritage) and their family characteristics
(single parent families, blended families, and one family in which both parents had learning
disabilities). Although mothers were the main interviewees, several family members (i.e., siblings,
grandparents, and fathers) were at times present, with occasional contributions to the dialogue; in
one interview both the child’s mother and grandmother contributed to the conversation; in another
interview the family chose to have the key worker present.
Measures and procedures
Training materials, including ES&KW trainers’ and participants’ guides and distance learning
readings were analyzed to gather information about ES&KW training ethos, proposed content and
delivery processes, always bearing in mind the research questions, in which ECI and ECSE
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
principles and their expression in training were central. A comprehensive content analysis was
completed with reference to these principles (Bogdan, & Biklen, 2003). Two days of observations
were undertaken of each of three different training deliveries, in different regions: North London,
South London and South East England. These non-participant observations enabled direct
understanding of the impact of three of the first examples of the ES&KW training program.
Detailed descriptive and reflective field notes (Bogdan, & Biklen, 2003) were taken, considering
each training activity aims, content, and delivery process. Particular attention was also given to
what trainers and all training participants in each training delivery said and did, the way they
worked together, and what that involved. With respect to program delivery, the ES&KW training
manual specifies that trainers should “endeavour to fulfil all the aims and learning outcomes of the
training” (Early Support, 2013a, p.3) but that program delivery should be adapted as appropriate:
the aims and learning outcomes do not necessarily have to be fulfilled exactly in the way suggested
in the trainer guides. It is underlined that trainers should bring both skills and experience to the
training process and should use these to adapt the training, ensuring that it meets the needs of the
training group and of the local area in the most appropriate way (Early Support, 2013a).
Focus groups were conducted immediately after each of the three ES&KW trainings by the
lead researcher; they presented “a more natural environment than that of an individual interview
because participants are influencing and influenced by others – just as they are in life” (Krueger, &
Casey, 2009, p. 7). The size of the focus group was intentionally small with the purpose of having
an in-depth insight of ES&KW training impact on training participants (Krueger, & Casey, 2009). A
consistent set of questions and probes were used to explore aspects that did not arise spontaneously
from the broad themes. These comprised asking what was particularly helpful to fulfill the key
working functions: training content, the process inherent to this training, training methodology and
training delivery.
Participants were asked to conduct reflective practice activities with the aim of actively
engaging training participants in “thinking critically about their own reactions, judgments, behavior,
and intentions, integrating that thinking with their actions” (Brazelton Touchpoints Project, 2006,
p.25). Six training participants from focus groups 1 and 2, completed the five reflective practice
activities, sent every 15 days over a three months period, in a sequence that progressively requested
them to more explicitly connect ES&KW principles and functions to their daily work, asking for
concrete illustrations. These included, for example, reflective practice 4: Please choose one key
working function that you have put into practice with a family and reflect upon it; Briefly describe
the family; How did the family respond to the key working function that you have put in practice?;
What meaning did you make of this?
Semi-structured interviews with both trainers and participants, examining their views on the
training’s impact, were conducted in their workplace approximately four months after the training
program. Interviews with trainers entailed questions about the program’s principles, aims, content,
and training delivery process; the concrete impact of ES&KW training on participants; and the
challenges and opportunities regarding the implementation of key working. Questions to training
participants included reflecting changes in their practice after the training; how they saw ES&KW
in action in their organization, in their own practice, and in the practice of their co-workers;
examples of how they offered the key working functions as part of their work; and the impact of
having a key working approach for children and their families. We were invited by two participants
to spend the interview day with them, allowing us to observe the practical expression of key
working functions with families and professionals they worked with. This provided the opportunity
to discuss everyday challenges, thus developing further a “shared understanding about the aspects
of the work that matter” (Beyer & Holtzblatt, 1998, p.38) in relation to the ES&KW training.
Interviews with families were conducted four to five months after the training in their chosen
location: four in their homes and one in the key worker’s workplace. Topics comprised the profile
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
of the child and family, the four key working functions and how each one was part of their key
worker’s support of them, asking for concrete examples (Table 4).
Table 4
Observations, focus groups, reflective practice and interviews were pre-arranged by a letter
that provided information about them and assured confidentiality, anonymity, and the right to
withdraw at any time without adverse effects. Participants gave their written consent to participate.
Ethical agreement was provided for the study by the identifier removed Humanities and Social
Science Research Ethics Committee, which adheres to the British Psychological Society guidelines.
Data analysis procedures
All the interview and focus group data were collated, transcribed, and analyzed by the lead
researcher. The qualitative software NVivo10 (NVivo, 2012) was applied to integrate the various
data sources, namely clustering patterns/themes, but also highlighting contrasts and singularities.
Triangulation of data sources (different persons, time, and places) and methods (documents,
observation, interviews/focus-groups) aimed to bring “different foci and strengths, so that they can
complement each other” (Miles, Huberman & Saldana, 2014, p.300). Peer debriefing between the
two authors about the establishment of codes, themes, and sub-themes, how they merged and
developed considering the research questions, formed an integral part of the research process.
Coding of participants’ responses is as follows. Trainers are coded T1 to T3. Training participants
are coded TP and also by group (1 to 3) and letter, e.g. TP2c. Members of families are coded by
letter code (e.g. A & M Family).
Relationship between ES&KW training principles and content and the contemporary body of
knowledge in ECI and ECSE
As outlined above, although ES&KW training is now implemented across the age range, we
particularly wanted to understand if the principles that underpinned Early Support from its inception
(that addressed children aged 0 to 5 and their families) remained as core elements of the new
combined ES&KW training. As previously emphasized, while the age range was extended, Early
Support still remains the program in England that addresses children aged 0 to 5 and their families.
Our content analysis of the ES&KW training specifications, from drafts to final documentation,
revealed that the program’s training principles and content are clearly related to current knowledge
regarding optimal ECI and ESE. Each fundamental ECI element - family centered orientation based
on collaborative team process and implementation, held in inclusive, natural learning environments
- can be directly articulated with the program’s principles, content and key working functions as
presented in Table 5. This alignment reinforces the desired integration of ECI and ECSE
contemporary pillars in the work of training participants.
Table 5
Connection between ES&KW principles, desired outcomes, training content and delivery
Delivery processes includes (a) participant recruitment;, (b) families’ involvement; and, training (c)
content, and (d) sequence, and (e) training delivery. The results are organized in relation to these
five types of outcomes. , which will now be addressed considering ES&KW principles, desired
outcomes and training contents.
Both trainers and training participants acknowledged that ES&KW (a) training recruitment was
challenging, particularly in achieving intended multi-agency groups. This was often explained by
the difficulty in reaching different services and cascading information: “I found this by complete
accident; there wasn’t a coordinated approach to existing coordinators to say ‘this is the training,
this is what’s happening’” (TP2a). The role of trainers and regional facilitators involved in
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
recruiting participants wasn’t always clearly defined, leading to insufficient communication
between them before the training, contrary to the specification in the training documentation:
The model is great, you have the regional facilitator, the trainers, and the Central Early
Support team next door . . . but perhaps the mechanism [is missing] for making sure that it
happens systematically rather than from good will and enthusiasm. (T2)
On the other hand, (b) families’ participation was greatly valued and vividly expressed by
participants: “To have a parent there… it made me have a different train of thought; I’ve learnt to
listen more, and being more attuned to what the parents want and feel” (TP1b). Training
participants also valued the experience of having a trainer that also was a parent:
She was able to change some of the activities [sharing her own family experience], and
actually it was very good. I think people don’t quite understand how many services a child
or a family can actually have… it suffocates… suffocates. (TP3b)
The impact of videos with parents, children and young people with SEN sharing their story,
was also described positively as a good way of bringing their voices into the training: “The
complexity comes through in a few minutes time…” (TP2e)
About three quarters of training participants described the ES&KW training (c) content and
(e) delivery as well structured and meaningful, underlining the effectiveness of its delivery model:
“It was nicely structured, everything was very clear, step by step, and so if you didn’t have an
understanding of this it would be very clear and straightforward.” (TP3b). Yet, one quarter of
participants highlighted that there seemed to be many activities proposed in a short period of time:
“In all training the timing was really hard, and I understand that when you have to fit it in a two day
program, [it’s difficult to choose] what takes priority...” (TP2a). These training participants
furthermore reflected on the training groups’ range of experiences and knowledge about ES&KW
having an impact on the depth to which the content were approached and discussed: “Because it
was trying to give so much more of an overview, you were almost exploring it from the very
beginning, and so you weren’t able to dig deep into some of these concepts.” (TP2a)
As to the coherence between the two training days, all training participants proposed that the
(d) sequence of some content related to key working defined by Early Support should be changed:
“The information from Day 2 would have more benefit if it was in Day 1. This key working
function [emotional support], we need to understand it, before we know about aims and processes
of helping [Day 1 content].” (TP1a). Trainers also observed that Day 1 was particularly intense
taking into consideration its amount of content, and expressed their concern about the way they
delivered the training: “Day 1 is really heavy, there’s a lot to get through, and certainly for me on
the course that you observed, perhaps I haven’t quite thought through.” (T1). The fact that key
working content was addressed in Day 2 was also stressed by all trainers:
Doing it all in Day 2… you don’t have time for the group to come back and ask any
questions [about key working], whereas if you got it in Day 1, there is a potential that you
could then have some reflection, particularly around practice. (T1)
Although content, and sequence proposed by Early Support were followed by trainers, as
indicated by our observations, their characteristics, experience in training delivery, and knowledge
about Early Support, created a personalized approach to (e) training delivery. Trainer 1 was
particularly successful in keeping to time and maintaining momentum. All sessions were completed,
as well as most of the activities, with strong group participation. Throughout each session,
participants were observed becoming progressively more willing to share their experiences and
thoughts with the group. In fact, some group members, besides being professionals, were also
family members of children with SEN, only revealing this during the training. From this ethos of
trust, a supportive training atmosphere emerged: “It was an exceptionally good group, in terms of
having worked together and produced. Day1, as they didn’t know each other, certain personalities
[were] taking over the day. That changed on the second day, how they worked together.” (T1).
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Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
Trainer 2 particularly explored with participants the meaning they attributed to the training’s
content, capturing participants’ views, decisions, and feedback. All the training process was
registered and shared with participants, and activities were built on their perspectives and thoughts,
aiming for complete understanding of what was being discussed. Consequently, although all
activities were completed, some were more deeply explored than others, underlining a participant
led dynamic process in training: “It’s a very dynamic process! You know you potentially can cover
[Day1 content] on the second day, if that’s what the group needs . . . it’s not a formal process of
‘this exercise takes this long’.” (T2). Finally, Trainer 3 was a parent and therefore her own parenting
experiences were present in all activities, along with experiences of working with other families in
similar situations. When reflecting about the challenge of integrating both roles in training, the
intention of giving participants a parent’s view based on a parent journey, in a non-judgmental way
was emphasized: “Everyone that works with children, they’re coming because they want to help. It
can be difficult to make sure it’s not just about me and my children and what they would need; I
think I’ve just learnt to adapt it.” (T3). We also observed how this trainer particularly encouraged
participants to apply the program’s content to their practice using local experiences, consistently
bringing them to the training dynamic. Together, participant recruitment, family involvement, and
training delivery made the principles and desired outcomes of the training ‘come alive’, underlining
the importance of the process to achieve the program’s desired outcomes.
The impact of ES&KW training on the practitioners’ motivation and competence to fulfill the
key working functions in partnership with parent/carers
The impact of ES&KW training on the practitioners’ motivation and competence to fulfill the key
working functions in partnership with parent/carers will now be addressed.
In the follow up interviews, participants underlined the importance of reflective practice
proposed by the researchers after the ES&KW training: “Reflective practices… it makes
you think all the time” (TP1b). Reflective work offered a context for examining their
thoughts, experience and insight. Participants’ reflections highlighted the impact of
ES&KW training in different dimensions, from integrating the key working approach when
working with families: “Although I am not a key worker officially I can still carry out some of
the functions in my current role and change the way my approach” (Reflective Practice
/RP, TP2c), to reflection about how this approach should be accomplished:
Some of the ‘softer’ skills required for key working are more difficult to disseminate, but I
feel these are the most crucial elements in offering ES&KW with integrity to its
underpinning ethos. By this, I mean the skills required to be approachable, non-judgmental
and acting with understanding but maintaining a person-centered approach. This is
something I am working hard to address and I will now use the principles and parts of the
training to further address this. (RP, TP2a)
Interviewees highlighted several transformations that occurred in connection to ES&KW training,
related to working in partnership with other professionals and parents: “The most important thing
was enhancing my learning of work in partnership with all the different professionals and the
parents, and to listen to the parent’s voice, and not just to make assumptions.” (TP1b). Key working
functions, as a way of working, were also emphasized:
I found it actually a useful way of looking at it. I think in the past three or four years in
practice that’s what we’ve been providing, it felt we were getting that right, and the training
validated that. We’ve devised a new key working leaflet based on the functions, and I’m
looking at it and thinking, “Yes, this is exactly what we offer”. (TP2b)
The concrete impact of training on specific professional practices was likewise underlined:
I often ask professionals “what would the child think about that idea?” I also make sure that
the priorities for the family are discussed at the beginning of the meeting. Any actions will
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
then relate to these specific priorities. We will also focus on the positive aspects of a child’s
life and try to clearly understand why this works. (TP2b).
Impact of ES&KW training on the well-being and quality of life of families being served by
the training participants, in view of their individual needs and strengths
Finally, interviews with five families with whom these training participants worked, examined their
experiences with respect to the four key working functions, in view of their individual needs and
strengths. These interviewees emphasized how the training in the emotional and practical support
underpinned the other key working functions, since building a trusting relationship was
foundational for them: “She knows and she understands where we’re coming from; we know we
can trust her. It’s not somebody coming in that just got it out of a book. She does fit into the family.”
(A&M Family). When families spoke about their key workers they emphasized what their life was
like before and after the key working support. Feelings of deep loneliness and distress were
contrasted with feelings of hope and a sense of security in being supported to face complex
She puts hope and puts smile upon me, when there was nothing… It’s like when you’ve
been abandoned: you are nobody, you’re frustrated, you don’t know what to do. We didn’t
know where to go since we were new in the country… so much to learn, especially when
you have a special needs child. (D. Family)
Families emphasized that their key workers worked with them, helping to understand what is
involved in particular situations, so they can face them autonomously in similar future
With M. we understand together. (K. Family)
When I go to school they tell me this is this. I will be quiet there, but when I get out I call C.
and say: “Please can you inform me in this area, what it is about?” She will give me more
knowledge about it so, in case next time I come across this I’ll know what to do, to say, to
have my idea about it, to decide about it. (D. Family)
Because their children have multiple and complex needs a large number of professionals are
involved in supporting them: “When people say to me ‘Who’s he under?’ I’m like, ‘Who’s he not
under, really?’” Coordinating services and practitioners around the child, young person, and family
was described as essential, as exemplified by a mother of twins with multiple needs:
At times, we had almost about 20 people, all professionals. They come here now, because I
said, “I can’t do this, I can’t travel around…”, and that’s where C. and R. [key workers]
coordinated everybody; they literally called everybody: “You have to come to the family
home, because they can’t do it”. (A&M Family)
Considering planning and assessment, families highlighted the key worker’s role in
supporting, directly or indirectly, all family members; direct support particularly involved children’s
siblings; indirect support addressed housing (three families) or the use of personal budgets (two
families) that increased the quality of each family’s life. Finally, in what concerns information and
specialist support, providing information and signposting was underlined as essential by all
families: their key workers provided clarity and consistency about services and practical support.
The power of information and specialist support on children’s and families’ lives was clear when
families described how new knowledge and materials impacted on their child’s development and
their well-being: “These last three weeks I see her smiling; now she is starting to know her mum
and I told my [other] children to start the Makaton - we have the book, we read how to use” (K.
Family). Families also expressed their hope and trust concerning their child’s near future, based on
choices made with professionals and key workers, sharing their views about what helped them
feeling supported. Many topics, from parent and community support groups to the empowerment of
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
families themselves, are closely connected to the key working functions, namely of information and
signposting that meets each family’s needs:
There’s one workshop we did [where] I learned a lot from other mothers. We talk a lot, you
come out it with some ideas… you think you’re the only one with this kind of situation but
then you are amazed… and that lifts you up. (D. family)
This exploratory study of a new, combined training programme of ES&KW, developed out
of an existing programme of Early Support, was guided by four research questions which we will
now address. Some emergent gaps between the trainings’ vision and delivery will also be
highlighted. Considering the first research question (RQ1), although the ES&KW is now aimed at
the age range 0-25 years, analysis of the training materials indicated that Early Support principles,
key working functions, and the family partnership model (Davis, Day, & Bidmead, 2002), which
underpin the training’s content and delivery, remain having a family-centered orientation and
directly relate to ECI and ECSE principles. Families are at the centre of the training program, not
only as principal recipients, but also as active training partners, which meets the DEC recommended
practices for personnel development (Hemmeter, Smith, Sandall, & Askew, 2005; Miller, &
Stayton, 2005). Training principles and content were also built and developed around a
progressively more integrated and collaborative team work. Nevertheless, key working functions in
the ES&KW program seem to be closer to the U.S. dedicated and combined service coordinator role
than to that of a primary service provider, highlighting the need for evidence-based transdisciplinary
team work principles to be considered (McWilliam, 2010). Regarding intervention in natural
environments, training participants were invited to apply training content and to embed
“intervention strategies into everyday activities and routines to provide maximum child learning
opportunities” (Sawyer & Campbell, 2012, p.122), in partnership with families.
Regarding RQ2, analysis of the results derived by a range of methods indicated that, overall,
ES&KW training content and the delivery processes observed and analysed, matched the intended
principles and desired outcomes of the program, namely by supporting professionals’ competences,
skills, and knowledge to work in partnership with families, including two components of family-
centered interventions emphasised by Dunst (2002) as central in family centered interventions. The
relational component includes practices typically associated with good clinical skills such as active
listening, compassion, and empathy, together with professional beliefs about and attitudes toward
families, particularly those concerning parenting capabilities and competencies; the participatory
component includes practices that provide families with opportunities to be actively involved in
decision making and family–professional collaboration. Nevertheless, questions about participant
recruitment and, particularly, about the ES&KW training curriculum - length, content, choice, and
sequence - were highlighted by trainers and one quarter of training participants as complex. To face
this constraint, trainers’ training, enhancing their ability to deliver ES&KW content in the spirit of
partnership, seemed crucial to meet its principles and desired outcomes. Training observations
showed that all trainers, despite their different training experience, delivered the training as
intended, since a limited degree of variation based on judgement was allowed by Early Support in
order to make programme delivery appropriate to the participants and the settings (Early Support,
2013a). On the other hand, the possibility of training participants themselves undertaking T4T
offered by Early Support after this initial ES&KW training presented, as stated in follow-up
interviews, an added possibility of cascading the training to their teams and communities. This
provided a basis for a more holistic, coordinated, and seamless service delivery. Families’ active
participation in training was recognized by all focus group participants as having a major positive
influence on the achievement of the training program’s outcomes with concrete impact on the way
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
they work together and with families. Thus, regardless of curriculum constraints, follow up
interviews and reflective practice highlighted that training enhanced the collaborative approach
increasing participants’ motivation and competence to meet the key working functions in
partnership with parents/carers (RQ3). Training participants particularly underlined how key
working functions became more integrated in their work with families, both in terms of content and
specific professional practice. Considering the impact of key working on the well-being and quality
of life of families in view of their individual needs and strengths (RQ4), by interviewing families,
we confirmed the positive impact it had on their lives: families affirmed how they felt supported to
make their own decisions and choices, and the difference key working had on their well-being. The
emotional and practical elements of the training underpinned the other three key working functions,
with families stressing the importance of building trusting relations with practitioners. Families’
comments indicate that ES&KW was providing a basis for practitioners to work together,
coordinating services around the child and family, supporting a single planning and joint assessment
The research design comprised a progressively more focused approach. The researcher’s role,
varied from a discrete presence in observations, to a progressively closer role: participants’
involvement in focus-groups, reflective practice and interviews was increasingly more profound,
demanding insightful decisions on how much opinion to reveal, how much to advocate or have a
neutral position. Making sure our intentions were clear for participants - why we were there, what
we were studying, how we would collect information, and what we would do with it - helped
address this limitation. Considering specific limitations, although trainers delivered the training as
intended by Early Support - with a limited degree of variation based on professional judgement as
allowed by the program - fidelity cannot be assessed as easily as when compared to a programme
required to be implemented without deviation from the training manual. However, within this
limitation we were able to identify a high level of adherence to the training guidance. A second
limitation was that the number of participants involved in the focus groups, reflective practice, and
follow up individual semi-structured interviews was smaller than originally planned limiting the
range of experiences shared about the training’s impact. Nevertheless, the proposed methodology
was thoroughly followed. The aim of the study was primarily to have an in-depth understanding of
the relationship between the foundational Early Support principles and the first impact of the
combined ES&KW training, rather than seeking to produce results that could be generalised to the
program itself. Consequently, our study should be seen as providing support for the usefulness of
the program but should also be a means to facilitate a continuous debate about the ES&KW
training, suggesting further questions, directions, and training implications.
Conclusions and implications
The present study highlighted that ES&KW training principles, content and delivery processes
reflect current knowledge regarding ECI and ECSE. Participants underlined the importance of
ES&KW training in supporting the implementation of ES&KW principles and functions, which
were emphasized by families as truly valuable for their well-being. Moreover, the study also
indicated possible improvements to ES&KW training based on previous and the current research.
Closely monitoring the different training stages, and checking at all phases if the proposed training
aims were being accomplished, would limit the fading away of training impact with time (Trivette,
Dunst, Hamby, & Herin, 2009), starting from the preparatory stage of participants’ recruitment to
achieve the intended multi-agency groups. A review concerning the training curriculum and its
practical implementation, based on trainers’ and participants’ observations about the impact of
length and sequence, would be profitable so that training can more clearly be participant led,
namely including fewer activities and giving more time for participants to discuss and reflect about
Final submission Infants and Young Children 9.7.15 later published in Infants and Young
Children, 29(1), 71-88. DOI: 10.1097/IYC.0000000000000047
each of those proposed. Providing participants with follow-up support, to enhance ongoing
professional development plans, encouraging reflective practice, giving feedback and guidance
through consultation, could usefully be addressed so that the impact of the training is sustained.
After an initial period of ES&KW training delivery, with very positive impact for participants,
revisiting the training program on the basis of a rigorous evaluation can increase its impact. Thus, to
realize the ES&KW training’s vision a “Team around the training” is needed. All involved with key
working, from families to health, social care, and education professionals and managers, should
continue the debate and reflection with those developing the training, in a partnership approach,
helping to harmonize the training with their needs and strengths.
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Full-text available
Quantitative and qualitative research evidence is reviewed and synthesized with regard to the family-centeredness of early intervention, preschool, and elementary and secondary school practices. Early intervention and school practices are not as family-centered as is generally claimed, and one finds less presumption of being family-centered at each level from early intervention to preschool to elementary school to secondary school programs. The need for better research is noted, and research that would advance our understanding of family-centered practices is suggested.
The field of early childhood intervention for infants and young children with disabilities or delays has a rich history that spans many disciplines of practice. Both legislation and research has provided a foundation for how services are delivered to this population, and there are several recommended practices that govern service delivery to this group, the most prominent being familycentered care, team process, and natural and inclusive environments. Unfortunately, the field is facing many challenges because of the growing heterogeneity of children's and families' needs, the increasing complexity and variability of service systems, and dwindling resources available to support an infrastructure. Recommendations to address the future of early childhood intervention include adopting a culture of accountability across all dimensions of service provision, developing and instituting evidence-based practice, implementing comprehensive systems of professional development, and collaborating and merging with the early care and education movement that is growing rapidly across the country.
Relatively little is known about the role of early interventionists as teachers of caregivers. The current study was conducted to better understand interventionists' perspectives about teaching caregivers. A national sample of 1,525 multidisciplinary interventionists completed an online questionnaire, which elicited information about interventionists' preferences for use of caregiver teaching strategies, factors influencing decisions about teaching strategy use as well as comfort in, frequency of, and barriers to teaching caregivers. Use of a range of teaching strategies across contexts was reported. Differences emerged in teaching strategy preference based on experience in teaching specific skills and years of experience in early intervention. Ten themes emerged as rationales for teaching strategy selection. Interventionists reported moderate confidence in and frequency of caregiver teaching and few barriers to teaching. Results suggest a preference for use of multiple strategies and selection factors based on experience, perceived caregiver benefit, or other general factors such as interventionist preference.
We describe historical foundations of professional development (PD) in early childhood intervention (ECI) and where we stand on the silver anniversary of PL 99-457. To advance its scientific basis, we assert that it is important to define what is meant by PD; identify structural and process features of PD hypothesized to be effective for supporting improvements in intervention quality and effectiveness; specify theories of action or change related to how specific features of PD are assumed to affect practitioner behaviors and, in turn, child or family outcomes; and conduct experimental studies that provide evidence to support or refute specified theories of action. We describe progress being made in each of these areas and discuss several challenges and future directions related to advancing the scientific basis of PD in ECI.
In this article, the author presents a framework for establishing an agenda to design or strengthen early intervention systems from an international perspective. Given the extraordinary diversity of potential factors that can influence early intervention around the world, a set of early intervention principles is put forward that appears to have achieved international consensus. The framework utilizes these generally accepted principles to derive agenda items and therefore forms the basis for establishing common ground across international communities. Examples of specific agenda items and possible barriers are discussed for each of the principles.
University faculty were surveyed to ascertain the degree to which students in early childhood special education, occupational therapy, physical therapy, speech—language pathology, and multidisciplinary personnel preparation programs received training in five early intervention practices (family-centered, individualized family service plans, natural environments, teaming, and service coordination). Findings indicated a primary emphasis on family-centered practices across disciplines, with minimal emphasis on service coordination and teaming practices. Findings also showed that physical therapy faculty provided the least amount of training in the majority of early intervention practices as compared to faculty in other disciplines. Implications for improving student training are described.