“Learning without reflection is a waste. Reflection without learning is dangerous.” Confucius

Mallory is an early intervention service provider for the Singh family and their son Neil, who has a developmental delay and is 26 months old. During each meeting Mallory collaborates with the parents and supports them in developing intervention goals. In addition, she observes the interactions between Neil and his parents and models different strategies they can use. During the past few home visits Neil has been exhibiting some challenging behaviors such as biting, kicking, and hitting. Each time Mallory witnesses these behaviors she notices that the parents are having difficulty responding to and managing the behaviors. Mallory is looking for instructional practices to help the parents understand how changes in their behavior could lead to changes in Neil’s behavior.

Family-centered practices are a hallmark of early intervention (EI) services, which support children birth to age three with or at-risk for disabilities and their families in the U.S. (Dunst et al. 1994). EI service providers are expected to engage in practices that emphasize family strengths, promote family choice and control, and develop collaborative relationships between professionals and families (Bailey et al. 2012; Epley et al. 2011). In 2014 the Division for Early Childhood (DEC) of the Council for Exceptional Children (CEC) released a series of revised recommended practices for the field of EI and early childhood special education. The seven topic elements include: assessment, environment, family, instruction, interaction, teaming and collaboration, and transition. The goal of these recommended practices was to support effective and accurate instructional and behavioral support from service providers in educational or clinical settings (Minor et al. 2014). Within this article, we address practices under multiple topic elements, including instruction and family. The DEC family practices include three themes: (a) family-centered practices: practices that treat families with dignity and respect and involve family members in acting on choices to strengthen child, parent, and family functioning; (b) family capacity-building practices: practices that include the participatory opportunities and experiences afforded to families to strengthen existing parenting knowledge and skills; and (c) family and professional collaboration: practices that build relationships between families and professionals who work together to achieve mutually agreed upon outcomes and goals (DEC 2014). The DEC instructional practices are intentional and systematic strategies to inform what to teach, when to teach, how to evaluate the effects of teaching, and how to support and evaluate the quality of instructional practices implemented by others (DEC 2014). The purpose of this article is to present strategies that: (a) encourage caregiver reflection—a critical, yet challenging, component of coaching, (b) guide service providers in providing feedback to the caregiver, and (c) enhance service providers use of self-reflection.

Coaching Caregivers

Coaching is a relationship-based process used to support the development of specific skills through various activities such as listening, modeling, and practice (NAEYC and NACCRRA 2011). Caregiver coaching is one method that has been used and recommended in EI to encourage family-centered practices (DEC 2014, INS 13: Practitioners use coaching or consultation strategies with primary caregivers or other adults to facilitate positive adult–child interactions and instruction intentionally designed to promote child learning and development). Coaching helps strengthen caregiver capacities (Rush and Shelden 2011), and can facilitate positive adult–child interactions to maximize child learning and development (DEC 2014, F5: Practitioners support family functioning, promote family confidence and competence, and strengthen family–child relationships). In EI, coaching is a collaborative process where EI service providers use a wide variety of adult learning strategies to support caregivers as they develop skills that will lead to better developmental and learning outcomes for their children (NAEYC and NACCRRA 2011; Rush and Shelden 2011). Coaching includes providers’ use of skills such as listening, questioning, shared planning, observation, reflection, prompting, modeling, practice, and feedback (Joyce and Showers 2002; NAEYC and NACCRRA 2011). Coaching is traditionally conducted in natural settings, such as the homes of families or classrooms, to help prompt the implementation of learned skills (Joyce and Showers 2002; Rush et al. 2003). Coaching can be done using different formats and can be implemented by different people (Meadan et al. 2017). Rush and Shelden (2011) developed a list of coaching practice indicators and a scale to assess the use of coaching with caregivers. These indicators include specific guidelines for being an effective coach such as “interact with the parent in a non-judgmental and constructive manner” and “acknowledge the parent existing knowledge, skills, and ability.” See the Online Appendix for additional websites, online readings, and tools related to working with families and coaching caregivers. One step in coaching that is often challenging for providers is encouraging caregiver reflection (Meadan et al. 2018). Therefore, within this article we focus on strategies to facilitate caregiver reflection and guide feedback by EI professionals.

Through effective coaching, caregivers can learn and effectively implement new strategies with their children (Douglas et al. 2017, 2018; Meadan et al. 2013, 2016). In addition, caregiver-implemented interventions are an evidence-based practice (Wong et al. 2013), and coaching has been shown to lead to improved outcomes for adult learners (Trivette et al. 2009). There are many benefits to family-centered practices where EI service providers coach caregivers. First, coaching has been shown to improve caregiver competence and confidence in implementing skills that support child development and learning (Kemp and Turnbull 2014). Caregivers become empowered and feel better prepared to support their child (Rush and Shelden 2011). Additionally, caregivers who engage in coaching practices report positive experiences with the process (Ingersoll and Dvortcsak 2006). Coaching has also been shown to improve outcomes for children in EI (Meadan et al. 2016). Coaching enables caregivers to carry out EI goals in the absence of EI service providers, thereby increasing opportunities for children to practice and learn skills in the natural environment (Mahoney and MacDonald 2007).

The PAR Strategy

To simplify the different coaching components that support family-centered practices service providers need to learn, remember and apply, we suggest the three-step PAR strategy: Plan, Act, Reflect. Each step in the PAR strategy includes two components (see Fig. 1). Various coaching models in the literature include different steps or components for coaching (Ingersoll and Dvortcsak 2006; Meadan et al. 2016; Rush and Shelden 2011).

Fig. 1
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PAR strategy

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For example, Ingersoll and Dvortcsak (2006) include five steps/components: rapport, review, model, feedback and independence, while Rush and Shelden (2011) include joint planning, observation, action/practice, reflection and feedback. Meadan et al. (2016) divided the coaching activities into three steps: pre-observation conference (developing action plan), observation (observing parent–child interaction and collecting data), and post-observation conference (reflection and feedback). In general, however, all of these coaching models include activities related to planning, action, and reflection. Additionally, these components are based on adult learning theory and have been shown to be effective (Dunst et al. 2010; Trivette et al. 2009).

In step one, Plan, service providers collaborate with the caregivers to identify goals for the child/family and develop a plan for how to achieve these goals (Dunst et al. 2010). In step two, Act, the service provider observes the caregiver as they interact with the child and demonstrate how to interact with the child (Dunst et al. 2010; Meadan et al. 2016). In step three, Reflect, the service provider encourages the caregiver to reflect on their knowledge and skills and provides supportive and corrective feedback to the caregiver (Dunst et al. 2010; Meadan et al. 2016). Throughout this process the service provider can also use self-reflection to further ensure adequate support of caregivers as they develop skills and implement practices.

Researchers have explored family-centered coaching strategies used by service providers through interviews and questionnaires with caregivers (e.g., James and Chard 2010; Swafford et al. 2015) and service providers (Fleming et al. 2011). Additionally, observations of coaching sessions (e.g., Jayaraman et al. 2015), implementation of interventions and professional development to change service providers’ practices (Friedman et al. 2012; Marturana and Woods 2012) have all been used to explore providers’ family-centered and coaching practices. Within this body of research, it has been reported that service providers engage in family-centered practices, such as joint interaction, information sharing, and conversations with the caregiver more frequently than child-focused practices, such as direct interaction with the child. However, the specific coaching strategies that encourage caregivers’ reflection and guided practice with feedback were least common among service providers (Colyvas et al. 2010; Jayaraman et al. 2015; Marturana and Woods 2012; Meadan et al. 2018) despite evidence that these practices are critical (Dunst et al. 2010).

In the opening vignette Mallory was struggling to support Mr. and Mrs. Singh with the behavioral challenges of their son Neil. Mallory attended a professional development workshop where she learned thePAR strategy. She decided to apply the model next time she was with the Singh family. On the next visit Mallory asked Mr. and Mrs. Singh if there were any areas in which they needed support. At first, they were hesitant, but then Mrs. Singh mentioned some of the challenges she had been having with Neil, especially his biting and hitting. She expressed concern because they recently found out they were expecting another baby. She worried that Neil’s behaviors might put the new baby in danger if not addressed. Mallory sat down with the parents to collaborate and identify goals for Neil’s behavior and develop a plan that would help them reach these goals (Plan). Next, as Mallory interacted with Neil she demonstrated new practices Mr. and Mrs. Singh could use to address and prevent Neil’s hitting and biting. Then they each took a turn interacting with Neil and trying out the new practices Mallory demonstrated (Act). Finally, on each subsequent visit Mallory asked Mr. and Mrs. Singh to reflect on the effectiveness of the new practices (e.g., What did you do to prevent or address Neil’s biting and hitting in the past week? How did it work? Do you think we need to change anything in our plan?). She also provided feedback to them as they engaged with Neil to further incorporate the new practices to reduce and prevent his challenging behaviors (Reflect). Initially the parents didn’t respond to Mallory’s general question (e.g., “How did things go last week?”), but when she asked more specific questions to help the parents reflect (e.g., “Tell me what happened before Neil bit you this morning. What did you do?” “How did Neil react?”) Mr. and Mrs. Singh opened up and began sharing more details and reflecting. When appropriate, Mallory also provided supportive and corrective feedback to Mr. and Mrs. Singh about the practices they used with Neil (e.g., you did a great job providing Neil transition reminders before starting mealtime). A couple of months later Mr. and Mrs. Singh noted the improvements they had seen. They expressed a feeling of empowerment and talked about how they have been using the strategies in more situations, such as extended family events, outings in public, etc. Mallory praised the family and told them to keep up the great work!

Strategies to Encourage Caregivers’ Reflection

Reflection is a thinking process that gives coherence to unclear situation using self-awareness and assessment, integrating ideas, and evaluation variety of viewpoints (Clarà 2015). Reflection skills are crucial for developing, learning and helping early childhood caregivers and service providers to constantly examine and evaluate the child’s progress. Reflection enables revisiting the sequence of the practice for the purpose of making thoughtful judgment and decisions about improvement. It is a challenging skill because it demands time, emotional engagement, questioning one’s personal beliefs and values, and stepping outside of one’s comfort zone (Amobi 2005; Foong et al. 2018). As illustrated in the vignette above, reflection can be challenging when implementing caregiver coaching strategies. However, encouraging reflection is vital to ensuring caregiver independence (Ingersoll and Dvorscak 2006) and should be used by EI providers.

Questions

To encourage caregivers to reflect on their knowledge, skills, and outcomes, service providers can use questions. Questions can support different types of reflection by allowing caregivers to describe the planning or use of a practice, inform implementation of a practice, and support evaluation and adjustment of the practice. Questions can be general or specific in nature. See Table 1 for example questions.

Table 1 Sample questions for encouraging caregiver’s reflection
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General Questions

General questions are open-ended to help the caregiver think about what has happened. For example, a service provider might ask the caregiver: How has the new practice worked for you? What went well? What were some obstacles you encountered this week? What do you think should be changed? What is frustrating? What else would you like to know about how to use this practice?

Specific Questions

Specific questions are more targeted and help prompt caregivers when they have not reflected about their use of specific practices. Specific questions can also support caregivers in further understanding how to implement a practice or can encourage a more in-depth reflection or discussion of a specific practice. The service provider can also ask questions in response to a caregiver’s question or comment to encourage discussion and reflection. When using specific questions, a service provider might ask: When/where did you try the new practice? Can you tell/show me how you used the practice? How did the child’s behavior change when you used the practice? What will you do next time? How did you feel when you used the practice?

Types of Reflection

The service provider can guide caregiver reflection within different topics, using general or specific questions. Types of reflection may include: (a) Describe: supports reflection on planning and decision making for use of a specific practice; (b) Inform: supports reflection on the actions and use of the practice; and (c) Evaluate and Adjust: supports reflection on what could have been done differently and how the practice could be used or implemented differently in the future (Amobi 2005).

Modeling Reflection

Another way to encourage caregivers to reflect, is to model reflection for them. The service provider can use different types of reflection to ask themselves questions and answer these out loud. The service provider can also discuss with the caregiver what they have done and how it could help them understand what worked and what changes might be needed in the future. For example, the service provider can use a target practice with the child and then reflect out loud on how well the strategy worked. My plan was to create a situation where Mira will need to ask me for something. So, I put Mira’s toy on the shelf and waited for her to ask for it. She didn’t pay attention to it and didn’t request it. However, when I put it on the lower shelf she pointed to the toy and said “more.” This made me realize that it is important to encourage Mira to communicate by putting a favorite toy in a place she can see, but not reach.

Strategies for Providing Feedback to Caregivers

In addition to encouraging caregivers’ reflection, service providers should also provide frequent, positive, constructive, and specific feedback about caregiver performance and self-reflection with an aim to promote caregiver confidence and competence. Feedback is defined as the exchange of information with the intent to support development (Lefroy et al. 2015). Providing feedback has been found to be particularly effective in improving accurate use of practices (Minor et al. 2014). Researchers have reported that specific feedback is a crucial component in effectively changing adults’ behavior and could help to generalize and maintain changes (Barton et al. 2013). Feedback can increase positive communication between the service provider and the caregiver, improve adults’ self-selected behaviors, and build caregiver competence and motivation (Barton et al. 2013; Rathel et al. 2008; Wlodkowski and Ginsberg 2017).

Providing Feedback

Feedback that is specific (versus general), immediate (versus delayed), supportive and corrective (versus judgmental) is most effective and leads to sustained behavior changes (Scheeler et al. 2004). Feedback can be provided while the caregiver is interacting with the child, at the end of a session, or even after a session (via e-mail or text). Feedback can be delivered verbally (e.g., discussion during the session), in writing (e.g., summary visit form or email), or via video (e.g., showing the parent a video of a session and discussing it; Minor et al. 2014; Scheeler et al. 2004). Service providers are encouraged to discuss with the caregivers how (e.g., verbally, written) and when (e.g., at the end of the session, during the session) they prefer to receive feedback (Meadan et al. 2017). Scheeler et al. (2004) identified different types of feedback statements including noncorrective (e.g., only identifying an error), corrective (e.g., describing specific ways to correct an error), general (e.g., vague or nonspecific response such as “okay”), positive (e.g., praising a caregiver’s behavior and practice), and specific (e.g., objective information) feedback.

Components of Performance Feedback

One technique for increasing the use of effective practices is providing feedback to caregivers’ on newly acquired and ingrained practices (Scheeler et al. 2004). Performance feedback is a systematic way to provide guidance following observations on caregiver–child interactions. It can be divided into four components (Codding et al. 2005; Douglas et al. 2016; Minor et al. 2014): (a) Review: the service provider summarizes data from the caregiver’s reflection; (b) Praise: the service provider delivers encouragement when specific practices are implemented correctly which builds the caregiver’s confidence and motivation; (c) Corrective: the service provider uses positive and empowering language to encourage the caregiver to make adjustments to their use of a specific practice; and (d) Comment: the service provider addresses questions, comments and provides additional information to the caregiver to broaden their skills. See Table 2 for examples for the components of performance feedback.

Table 2 Sample statements for providing peformance feedback to caregivers
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Enhancing Service Providers’ Self-reflection

Self-reflection represents a genuinely curious inquiry into one’s emotions, values, thought processes, and attitudes. Self-reflection can improve a service providers’ self-knowledge, self-regulation, coaching techniques, and even influence the service provider-caregiver relationship (Morin 2011; Tomlin et al. 2016). Various models of self-reflection have been proposed (Morin 2011). Brandt (2014) defined three types of self-reflection: (a) Reflective activities: continual processes of actively considering beliefs and knowledge; (b) Reflective process: combining one’s own internal experiences (e.g., ideas, thoughts, instincts) with external knowledge (e.g., research, best practice guidelines, input from others), and (c) Reflective practice: includes slowing down, stepping back, thinking more broadly and deeply about the coaching conversation. Usually, reflective practice comes with experience, and invites the service provider to reflect on the coaching conversation from both their and the caregiver points of view. Reflective practice can occur during the coaching conversation (“reflecting in action”) or after (“reflecting on action”). It has been found that service providers use self-reflection practices only rarely (Tomlin et al. 2016).

A reflective service provider carefully considers their beliefs, assumptions, and practices through multiple dimensions and lenses (Carlson 2019). Self-reflection practice could enhance the awareness of what was done and how the specific action was done. Service providers can focus on “what/why” self-reflection questions rather than “how to” questions, which could lead toward active responding (Gün 2010). Using self-reflection could help the service provider understand the caregiver’s perspectives and change their practices to better support the caregivers and their child (Zeichner and Liston 2013). When service providers ask themselves self-reflection questions such as: What has been effective in the coaching conversation and why? And how can I improve my questions to guide the caregiver to deeper reflection in the future? (Gün 2010; Peterson et al. 2009), they can support not only their own growth and understating, but also the coaching process overall.

Summary

Family-centered practices and caregiver coaching are effective and recommended practices for early childhood (DEC 2014). Many service providers, like Mallory from the opening vignette, use these strategies to strengthen and empower caregivers (Meadan et al. 2018). However, many service providers need additional professional development and tools to improve their coaching strategies with caregivers. Research indicates that service providers who themselves receive feedback on their work (i.e., coaching or mentoring) and reflective supervision or consultation, are more likely to continue to use newly learned strategies (Barton et al. 2013; Brandt 2014). However, it is important that service providers help caregivers understand that although there will be setbacks and anything they try will take time, their coach will continue to support their development of new skills. Research recognizes the benefits of collective reflection due to the critical aspect of the social dimension (Foong et al. 2018; Peterson et al. 2009). These can be interesting possibilities for future professional development areas for early childhood service providers. The PAR strategy, Plan, Act, Reflect, can help service providers to learn, remember, and apply coaching strategies, and might be especially beneficial to help support the implementation of caregiver reflection and guide constructive performance feedback to caregivers.