Using Adult Learning Theory to Enhance Coaching and Early Intervention

Editor's note: This text-based course is a transcript of the webinar, Using Adult Learning Theory to Enhance Coaching and Early Intervention, presented by Pam Smithy, MS, OTR/L, and Rhonda Mattingly Williams, EdD, CCC-SLP.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

After the course, participants will be able to: 

• Analyze the fundamental principles of early intervention and how they positively influence family and child outcomes.
• Analyze how adult learning theory supports effective coaching in early intervention.
• Differentiate attitudes, knowledge, and skills required for professionals to implement coaching strategies that are aligned with adult learning principles.

Introduction

Pam: Welcome, everyone. Rhonda and I are pleased to be here to discuss adult learning.

Early Intervention

Purpose & Philosophy of IDEA Part C-Early Intervention

In my work with IDEA Part C, the Early Intervention System, I ground myself in its core purpose and philosophy. Congress recognized an urgent and substantial need to enhance the development of infants and toddlers with disabilities, to minimize their potential for developmental delays, and to respond to the critical brain development that occurs during a child’s first three years of life. There is also a strong emphasis on reducing long-term educational costs to our society, including our nation’s schools, by decreasing the need for special education and related services once these infants and toddlers reach school age.

In my role, I focus on ensuring that we maximize each individual’s potential to live as independently as possible in society. I work to enhance the capacity of families to meet the special needs of their infants and toddlers with disabilities, and I collaborate closely with state and local agencies to strengthen their ability to identify, evaluate, and meet the needs of all eligible children. I pay particular attention to children from minority and low-income backgrounds, those in inner-city and rural communities, and infants and toddlers involved in the foster care system, so that the promise of early intervention reaches those who need it most.

Central Themes of EI

Dr. Mattingly Williams: In my work in early intervention, I view infants and young children as whole persons. Because of this, I recognize that a single entity or discipline cannot meet their needs. We must employ strategies that transcend traditional professional roles and programmatic or funding boundaries. I have learned that no one system or provider can address the full range of a child’s developmental and family needs in isolation.

I also deeply value the understanding that an infant’s or young child’s development can best be appreciated, promoted, and understood within the context of the family environment in which they live. I approach early intervention with the belief that the family’s routines, culture, values, and priorities are central to how we design and deliver support.

I have observed that early intervention is most effective when parents, who spend the vast majority of their time with their children, are respected and empowered as informed consumers and equal team members collaborating with professionals. My primary goal is to help build caregiver capacity by supporting their ability to promote their child’s optimal development and to facilitate the child’s participation in family and community activities, as well as in all of the experiences that matter most to that family.

Benefits of Early Intervention

When considering the benefits of early intervention, I start with what we know about neuroplasticity. Neuroplasticity enables early intervention to serve as a form of neuroprotection, actively stimulating and supporting brain development during the critical early years.

We also see improved maternal self-efficacy, as parents and caregivers gain confidence in understanding and responding to their child’s needs. Children receiving early intervention often show improved cognitive assessment scores, better motor outcomes, and stronger language skills.

Ultimately, one of the most significant outcomes is that approximately one in three infants and toddlers who receive early intervention services do not later develop a disability or require special education in preschool.

Family Centered Practice

In my work with family-centered practice, I focus on coaching and adult learning theory. I believe it is essential to distinguish between coaching and training clearly. In a coaching model, I support family members in making informed decisions about their daily functional activities and about their child’s participation in those activities. The primary aim is to strengthen the family’s own ability to promote their child’s development.

Overall, I am working to enhance the involvement and well-being of both the child and the family. In a training model, by contrast, a parent is being trained by us as healthcare professionals. We are teaching and demonstrating how to use specific strategies, with the intention to enabling them to implement those strategies effectively. However, it is also a model in which we are essentially the ones deciding what is done, how it is done, and when it is done.

One way this contrast stands out to me is when I think about who is considered the expert. As clinicians, we may be the content experts in our discipline, and in a traditional training model, we spend a considerable amount of time educating others. In a coaching model, however, I recognize that parents are also experts—the experts on their own child. Because of that, it makes far more sense to follow a coaching methodology rather than a pure training approach, so that both of us are acknowledged as experts in our respective areas, and we truly work in partnership.

Aims of Coaching in Early Intervention

Pam: When I consider the objectives of coaching in early intervention, I first focus on enhancing the family’s capacity to participate as an active and equal partner in the intervention process, as described by Zigler & Hadders-Algra (2019). I want families to feel like true collaborators, not passive recipients of services. I also aim to support families so they can make informed decisions and to strengthen caregivers’ self-efficacy and their ability to improve their child’s participation in daily routines.

Dr. Mattingly Williams: Before moving on, I want to highlight the term self-efficacy, as it frequently appears in this context, and in fact, we have an entire presentation devoted to it later. I think we can all appreciate that when a caregiver feels that they have the ability to create a positive change for their child, that belief goes a very long way toward their success. You will often hear the term 'self-efficacy,' and for good reason—it truly cannot be overstated.

Why Do We Care About Coaching in Early Intervention?

When I consider why we care so much about coaching in early intervention, I turn to the literature to help explain it. Salisbury and Copeland (2013) examined how parents and children are impacted when coaching is implemented in a particular, high-fidelity manner targeted toward early intervention. What they found was that when coaching was delivered with strong fidelity, parents reported improved self-efficacy and felt more empowered to help their own child. They also perceived improvements in their child’s motor skills and social skills. That kind of observable progress is incredibly motivating for families because they can see that what they are doing is making a real difference. For children, the study showed significant gains across six developmental domains, which further supports the idea that coaching can positively influence outcomes and fuel parents’ intrinsic motivation to continue.

Kaiser and Roberts (2013) reported on parents’ use of Enhanced Milieu Teaching, or EMT. EMT is a hybrid, naturalistic approach designed to develop and expand a child’s language and communication within everyday environments. What stood out to me in this work is that, even a year later, parents who had been coached in EMT were still using the strategies appropriately. In terms of child outcomes, the researchers saw increased length of utterances during play activities and broad gains in language, showing how coaching supports both sustained caregiver skill and measurable improvements in children’s communication.

A third study, published in 2011, found that families who participated in coaching reported being able to incorporate intervention strategies into their daily routines successfully. As anyone who works in early intervention knows, this is critical. We do not want parents to use strategies only in a sterile or unfamiliar environment; we want these strategies to be embedded in the family’s natural context. Caregivers in this study also reported feeling genuinely engaged in the coaching sessions, which tells me they did not feel talked at, but instead felt like active participants in the process. For infants, outcomes included increased developmental progress, more independent motor behaviors, and continued engagement in activities.

The last study we included in this presentation was Vismara et al. (2012). In terms of parent outcomes, ratings of responsiveness to children increased following coaching. As early intervention professionals, we all recognize the crucial role caregiver responsiveness plays in a child’s development. Through coaching, parents began to feel more responsive and attuned to their children, which can have a profound impact on their children's developmental trajectories. For child outcomes, the study found significant increases in social-communicative behavior, joint attention, shared positive affect, and growth in expressive and receptive language. Taken together, these findings provide strong support for the value of coaching as a way to improve both parent and child outcomes in early intervention.

Coaching Strategies (Rush, Sheldon, and Dunn, 2011)

Pam: Other coaching strategies documented by Rush, Shelden, and Dunn outline the importance of several key steps. The first step in this model is joint planning. I discuss with the caregiver what they would like to work on the next time I visit the home, as well as what they want to focus on during that particular visit. Together, we identify which activities and routines will be addressed in the upcoming session and clarify what is most meaningful or challenging for the family at that time.

Observation is another critical component. I make time to observe the child and caregiver together, often during that first visit or at the beginning of a session. I pay attention to what they are doing, how they interact, and what seems to be going well or posing a challenge. Then, after revisiting the joint plan we created, I ask the caregiver, “What would you like help with today?” and “What do you want to work on today?” This centers the session around their priorities rather than my agenda.

The action stage of this coaching model involves reviewing what early intervention is really about: helping the caregiver, enhancing their learning, and supporting them as they work on developmental skills with their child. During this stage, we identify specific routines that we can work on together, such as diaper changing, snack time, reading a book, or getting into the car seat. I ask where things feel tricky for the family and then embed strategies into those naturally occurring moments.

Reflection is the next essential step. I provide input on what we did, but I avoid imposing my views. Instead, I use open-ended questions to encourage the caregiver to think about what worked, what felt challenging, and what they might want to try next time. This type of reflective conversation helps caregivers develop confidence and improve their problem-solving skills. They need options and the opportunity to make decisions about what we are doing with their children.

The final step is feedback. I share information about what the caregiver did, as well as what the child did and how the child responded. I aim to be specific in this phase, highlighting particular actions or interactions that supported the child’s development. This level of detail enables the caregiver to learn from the session we have just completed, truly. And, as a coach, I am also learning during this stage. Because the parent is the expert on their own child, they often share insights from their experiences that deepen my understanding and help guide future sessions.

Attributes Needed to Coach (Ziegler & Hadders-Algra, 2020)

Dr. Mattingly Williams: When I reflect on the attributes needed to coach, I recognize that some of them are somewhat different from what many of us were taught years ago when we first graduated from graduate school. Not all of them are new, of course. Accepting and promoting family unity, as well as respecting the family, have always been part of my training and practice, even 34 years ago. Acknowledging the family’s knowledge and competencies is also something I was taught to value.

However, I was also trained to see myself as the “expert,” for example, in communication or language. That mindset is somewhat different from what coaching now requires of us. We have always known that families possess knowledge and competencies. Still, this newer perspective emphasizes that their knowledge and competencies can have a direct and meaningful impact on language, motor skills, or any other developmental domain we are addressing.

Coaching requires that I focus on meaningful goals that are based on the family's lead. I need to hold the attitude that what is meaningful to them is truly what they want to and should work on. To do this well, I have to be open to changing my own behaviors and attitudes, whether these came from earlier training or are simply part of my personality.

In terms of knowledge, I need a solid understanding of family-centered practice. I must be able to clearly define coaching, as we did earlier, and distinguish it from other approaches so that I am not actually doing training while thinking I am coaching. I also need knowledge of andragogy, or adult learning theory, and how it connects with coaching strategies. Understanding how adults learn helps me think about how to structure sessions so that caregivers can truly absorb, apply, and retain the information we work on together.

Skills are just as critical. I need to know how to apply family-centered practice, not just define it. I must be able to recognize the needs of the family and determine the most effective way to communicate with them. Sharing relevant information is essential, but in coaching, I am not simply giving directions. Instead, I offer suggestions, observations, and comments, and I engage in genuine two-way communication.

As part of that, I intentionally use open-ended, reflective questions. I know that if I ask something like, “Do you want to work on this?” I will likely get a yes or no answer, which does not open up a deeper conversation. With open-ended questions, I invite parents to share more about their experiences, priorities, and concerns, and I help them become active participants in the process.

I also work to provide practice opportunities. Parents need a chance to try strategies while I am there so that, as a team, we can decide whether to modify an approach, try it a different way, or keep it the same. Throughout this process, I continually reflect on my own behavior and attitudes. I ask myself whether I am truly keeping my practice family-centered, whether I am honoring the idea that the family comes first, and whether I consistently recognize and value the family’s expertise in everything we do. Keeping these reflections at the forefront of my mind is essential to maintaining an effective coaching stance.

I think it is important to remember that we were probably all trained on how to do excellent therapy with children. Coaching asks us to step back and allow the family and child to do the “therapy” together, working on goals that are important to them, while we think about how to infuse knowledge into that session for the parent. We may not be jumping in, we are not at the center of the room, and we are not the ones sitting on the floor manipulating the toys. Instead, we are watching the child and the parent together. That shift—from doing the therapy ourselves to supporting the parent and child as they do it—is really at the heart of how this approach is different.

Challenges to Implementing Coaching in EI

Pam: When I think about the challenges of implementing coaching in early intervention, I recognize that my professional role is really shifting toward a coaching model. This shift requires new attitudes and new behaviors. I need to be more in tune with what parents’ expectations might be, and I have to be honest with myself about where my own knowledge gaps are. I am also aware that terminology in the community can be inconsistent, depending on the state or community in which I practice, and that the exact words may have very different meanings to different people.

I have also come to better appreciate the stress and emotional burden caregivers face, as well as the burden families carry. I do not think I was educated enough early on about how hard it is to raise a child with a developmental delay or a specific diagnosis, or how exhausting it can be to hold that reality every day while also having professionals coming into the home. Even when we frame our visits as coaching, it is still a lot, and the lack of clarity about essential coaching skill components does not make it any easier. That is part of why Rhonda and I felt it would be helpful to offer a workshop on this topic for clinicians in the community. There are unclear pathways for acquiring coaching skills, and a lack of training is often observed in both andragogy (adult learning theory) and specific coaching strategies.

Dr. Mattingly Williams: As we prepared this presentation, one thing that stood out to us on this slide was the point about parental expectations. Many parents don’t know what to expect from therapy or early intervention. In my own experience, I have walked into homes where families expected me to take over completely. They would ask, “How are you going to do this?” or “How are you going to fix that?” They assumed that I would be the one working directly with the child.

For many families, the coaching model represents a novel approach to thinking. Even when we explain the approach, it can still feel unfamiliar. Parents may wonder, “Why are you coming if I am the one doing all of this?” This is where I emphasize that we are collaborating, and that both experts—the parent, as the expert on their child, and I, as the professional with developmental expertise—are in the room together. We know that coaching helps and that it has many benefits, but it does require a shift not only for professionals, but also for families as they come to see themselves as central drivers of their child’s intervention.

Adult Learning Theory

Adult learning theory is a framework that explains how adults acquire knowledge in a manner distinct from children. As adults, we bring a unique set of diverse needs that are shaped by our prior experiences, responsibilities, and motivations. What motivates an adult to invest time and energy into learning often connects directly to their daily life, their roles, and what feels meaningful or immediately valuable for them.

Much of how I learn as an adult is rooted in to previous experiences. My last learning experiences—how I was taught, what worked for me, what did not—shape the way I approach and absorb new information. Adult learning theory acknowledges that all these nuances influence the effectiveness of learning. What I learned previously and the way I learned it affect everything I remember going forward as an adult. This is quite different from how children typically learn, and we will explore those differences in more depth as we move ahead.

Adult Learning Theories

Pam: Adult learning theories encompass a diverse range of ideas and approaches. For anyone who likes to dive deeply into the literature, there is work on transformational adult learning, self-directed learning, experiential and project-based learning, action learning, cooperative and collaborative learning, discovery learning, elaboration theory, social learning, individualized learning, behaviorism, cognitivism, constructivism, and andragogy. All of this reminds me that there is a massive umbrella over how adults learn.

In my experience, many of the families I have seen in their homes did not always have positive experiences in their own school education. There were often hiccups or gaps that affected how they felt about learning and about professionals in general. Because of this, I encourage new practitioners in early intervention to clearly explain what early intervention in their state entails. I make a point of going over some basic definitions, describing what our work together will look like, and emphasizing that we are not coming in to “fix” the child or to address the IFSP outcomes independently. We are there together with the family.

Dr. Mattingly Williams: This connects with something that came up recently in my early intervention evaluation and treatment class. A participant who had previously been a parent of a child in early intervention shared that many providers came into her home and never even told her their discipline or what brought them there. She said she did not necessarily need a lengthy professional introduction, but she did want some basic communication and background information. That really struck me, because one of the first steps in adult learning is to explain the “why”—why we are there, what we are doing, and why it matters. Adults want to know who they are working with and why they should invest their attention and trust in that person.

Pam: As a mother who has had all three of my own boys in early intervention, I also like to know a little bit about the practitioner. I am a very social person, and I am naturally curious about how someone ended up coming into my home. Sometimes that kind of conversation runs beyond the typical 60-minute session, but I believe it is time well spent. It is respectful to the parent, it builds rapport, and it acknowledges that you are a guest in their space.

Dr. Mattingly Williams: We already get a peek into their world when we enter their home; it is only fair and human for them to see us as whole people as well.

Adult Learning Theory-Andragogy

In the next few minutes, I want to focus on andragogy, as it is the adult learning theory we are leaning toward for early intervention. Andragogy is closely tied to how we think about working with caregivers as adult learners in EI.

The term andragogy was coined and developed by Malcolm Shepherd Knowles, an American educator often referred to as the father of adult education. He attended Harvard and went on to teach the very first course in the field of adult education at Boston University back in 1959. As we proceed, I will explain the core concepts and principles of andragogy and demonstrate how they align with and support the coaching strategies employed in early intervention.

Androgogy vs. Pedagogy

Pam: Andragogy is the art and science of helping adults learn applicable knowledge, in contrast to pedagogy, which focuses on the transmittal of knowledge and skills that have stood the test of time. Pedagogy tends to be more content-driven and fact-laden, the kind of information many of us are familiar with from our own education as health care providers. This framework originates from Knowles (1980), and although it has been around for some time, it is not often discussed in relation to early intervention.

Dr. Mattingly Williams: What strikes me, especially when discussing EI with students, is how naturally andragogy aligns with what we emphasize in our work. In early intervention, we frequently discuss routines, building meaningful activities into the family’s daily life, and the importance of context. We also recognize that some children begin to show more difficulties later in school when the supports of predictable routines are less central, and learning becomes more decontextualized, focused on fact-heavy, content-driven tasks.

As I consider this slide, it becomes clear that andragogy is about applying context-based knowledge grounded in past and future experiences, whereas pedagogy is more about delivering established content. In EI, when we coach caregivers, we are squarely in the realm of andragogy—helping adults learn in ways that are immediately relevant to their real lives with their children, rather than simply transmitting abstract information.

Underlying Principles of Andragogy

When I consider the underlying principles of andragogy, I begin with the idea that adults are self-directed learners. We bring valuable life experiences that help us facilitate new learning. For example, if I take a new job and have to learn a different electronic medical record system, my experience with a previous system—even if the two are quite different—still gives me a bit of a head start on learning the new one.

Adults are most engaged when content is relevant, hands-on, and connected to real-world problems. A good example is your participation in a session on coaching in early intervention. You are here because you provide services in EI or a related field, and you want to learn about coaching, so the content is directly relevant to your work. If you were an accountant or in an unrelated field, this material would likely not feel as meaningful.

Adults also want to understand how learning will help them achieve their personal goals. For instance, if I run a private practice and realize I need to strengthen my business skills, I might enroll in an online accounting course. I am motivated to learn because I know it will help me refine my business model. That connects directly to intrinsic motivation: I am driven from within to learn because I see a clear benefit for my own goals.

Finally, adults want to see practical application. In the context of the accounting course, I would apply what I learned to my bookkeeping and other financial aspects of my private practice. I want to see how the new knowledge is used and how it benefits me in practical ways. All of these points—self-direction, relevance, connection to real-life problems, alignment with personal goals, intrinsic motivation, and practical application—are core principles of andragogy and are central to how we think about working with caregivers as adult learners in early intervention.

Adult Learning Principles/EI (Childress, 2021)

Pam: In considering adult learning principles in early intervention, I find Childress (2021) particularly helpful because she outlines specific, practical steps. She reminds us that caregivers learn best when what they are learning is immediately relevant and useful. For example, if a parent is struggling with frequent meltdowns when putting their child into a car seat, we can focus our coaching on that specific routine. I know from my own experience how overwhelming that can be, and how valuable it would feel to have someone help me with that exact situation in real time.

Caregivers also learn best when new knowledge is built on their prior knowledge and experiences. In practice, this might involve helping a parent draw on their existing experience with older children to manage feeding protests with a younger child. Instead of starting from scratch, I work with what they already know and help them adapt or expand those strategies.

Another key principle is that caregivers need to understand what they are learning, why it is essential, and how to use it with their child. Every adult learner needs the “why.” For example, I might explain that reducing screen time can support the development of social and communication skills, or that having a predictable bath time routine in the evening helps children feel relaxed and signals that it is almost time to sleep, which can make bedtime smoother for the whole family.

Dr. Mattingly Williams: Childress also highlights that caregivers learn best through active participation and practice. This is consistent with the 70–20–10 model developed by Charles Jennings, which suggests that about 70 percent of learning comes from hands-on experiences, 20 percent from social interactions, and only 10 percent from formal training. When I work with families, I try to create space for that 70 percent—real, hands-on practice in the moment. This allows the caregiver to experience what works, make adjustments, and see for themselves how a strategy can be changed or refined.

Caregivers learn and remember best when what they are learning is practiced in context and in real time. In early intervention, that means intentionally making time to observe and address the routines that matter most to the family. If bath time, car seat transitions, or feeding are areas of concern, I ask the caregiver to show me what those situations look like in their home. I want to see the real context so that the strategies we discuss are grounded in their everyday reality.

Caregivers also benefit from opportunities to reflect on and receive feedback about their learning and performance. I try to engage with them on real-world issues and help them develop skills that will enable them to analyze situations, consider alternatives, and find solutions independently. In that sense, although we emphasize that coaching is not the same as traditional training, we acknowledge that a learning process is still happening. As early intervention professionals, we are coaching, recognizing both our expertise and the family’s expertise, and we also honor the fact that everyone is learning together in the service of helping the child reach their highest level of functioning within the family unit.

How Can I Use Adult Learning
Principles/EI to Successfully
Implement Coaching Strategies?

Pam: From my perspective as a supervisor, I notice that it often feels easier to give direct feedback to students because I explicitly see them as learners: I can say, “You did great with this, and here is an area to improve.” With parents, it can feel more delicate. I may find myself wondering how to both affirm what they are doing and gently suggest, “I wonder what would happen if we tried it this way,” or ask, “Do you have ideas for how we might get over this particular hurdle?” Using a coaching lens, I challenge myself and other practitioners to think differently about these conversations, leaning into collaboration rather than directive instruction.

Dr. Mattingly Williams: At the same time, I remind myself that parents are the experts on their child and family. Just as I know I can learn from my students, each of whom brings unique experiences, I also know I can learn even more from parents, who live this every day. That awareness shapes the way I communicate, the questions I ask, and the respect I bring to each interaction.

When I consider how to apply adult learning principles in early intervention to implement coaching strategies effectively, I remind myself that this is what almost all states across the nation are now requiring practitioners to do. It helps me to connect each adult learning principle with specific coaching strategies intentionally and to examine how those relationships work in real-time with families.

Starting with the first adult learning principle—caregivers learn best when what they are learning is relevant and valuable—the coaching strategy that fits most closely is joint planning. In joint planning, the caregiver and I identify goals and strategies together that address the caregiver’s specific concerns and the routines that matter most in their home. By centering our planning on what is actually happening in their daily lives, we ensure that what they are learning is meaningful and immediately applicable.

When I consider the principle that caregivers learn best when new knowledge is built upon prior knowledge and experience, the coaching strategies that align with this are observation and joint planning. During observation, I watch what the caregiver already knows and does with their child. I observe how they respond, what works, and where they feel stuck. Then, using joint planning, we problem-solve together and develop new strategies that build upon their existing experience. That process helps make learning feel respectful and relevant rather than like a complete overhaul of what they are already doing.

Caregivers also need to understand what they are learning, why it is crucial, and how to use it with their own child. Here again, joint planning and feedback play a pivotal role. Through joint planning, I explain the purpose of each strategy and how it connects to child development in general and to their child’s development specifically. In feedback, I link their actions to the outcomes we see in the child, reinforcing their understanding and hopefully deepening their motivation. I want caregivers to be able to say, “I see why this matters, and I see what happens when I use it.”

Pam: Continuing with this theme, I keep in mind that caregivers learn best through active participation. That means they need to be involved—on the floor with their child, in the kitchen, in the bathroom, in the car, on the Playground, in the backyard. The coaching strategy that fits here is action. During the action phase, caregivers try strategies within their daily routines, while I offer support and encouragement. This is actual hands-on practice: they are learning by doing. For caregivers who have had previous experiences with therapy where the professional led the entire session, this can be a significant shift. They may be used to sitting back and watching. That is why I explain, every time if needed, that our state is now emphasizing a coaching model and that I genuinely need their engagement and participation so I can see how they and their child interact.

The adult learning principle that caregivers learn and remember best when what they are learning is practiced in context and in real time is closely tied to the coaching strategies of action and observation. In practice, this involves embedding strategies into real-life routines, such as mealtimes, bath times, car-seat transitions, playtime, and so on. When caregivers see the immediate relevance and effectiveness of a strategy in those exact moments, they are more likely to retain and reuse those skills. They can draw on those experiences the next time that routine comes up.

Finally, caregivers benefit from opportunities to reflect and receive feedback on their learning and performance. In the coaching framework, this maps onto the reflection and feedback stages. After trying a strategy, I facilitate a reflective conversation by asking questions such as, “What went well?” “What felt challenging?” and “What changes did you notice in your child?” This reflection, combined with specific, supportive feedback, reinforces practical actions, guides improvement, and supports ongoing learning. I try to do all of this in a kind, open-hearted manner that is calm and nonjudgmental, so caregivers feel safe to share honestly and to experiment with new approaches.

All of these pieces come together in the type of balanced intervention that Childress (2021) describes. When I see these principles and coaching strategies applied in a real case study, it becomes even clearer how adult learning theory and coaching are intertwined in effective early intervention practice.

Seven Steps to Balanced Intervention in EI-Case Study

As I progress through the seven steps to a balanced intervention in early intervention, I utilize this case study framework to tie everything together—adult learning principles, coaching strategies, and real-life family routines. It provides me with a structure to think through how I partner with caregivers from the very beginning of our contact, through planning, observing, acting, reflecting, and providing feedback.

In my mind, I am already thinking about how each step will keep the family at the center, build on their prior knowledge, and ensure that what we do together is relevant, helpful, and grounded in their everyday life.

Kiaan

Kiaan is a 25‑month‑old child diagnosed with developmental delays. He was born at 39 weeks’ gestation via an uncomplicated vaginal delivery. He is the second child in his family, which includes his mother, father, and a 4‑year‑old brother.

At the 21‑month checkup with the pediatrician, his mother began to voice concerns. She described Kiaan as generally a happy child who sleeps pretty well. However, compared to his older brother, he was slower to reach developmental milestones such as sitting up, crawling, and walking. His speech and language development also appeared somewhat delayed in her opinion. He spoke less and did not use words in the same way his brother did at the same age.

His mother described Kiaan as enjoying watching others but being very hesitant to explore his environment. She also noticed sensitivities to certain textures during both eating and play. Based on these concerns, he was referred for an early intervention evaluation in their state. Following the assessment, an IFSP was developed, and he is now receiving services to support his development within a family‑centered model.

Kiaan-IFSP Outcomes

Dr. Mattingly Williams: Based on Kiaan’s IFSP outcomes, the team and family developed the following goals for the next six months: Kiaan and his family will use simple words and sound-making during mealtimes and playtime, so that the family knows what he wants. He will cruise and take steps to play with family and toys at home. He will try new play and food textures with support from his family. He will play with his family during book time, singing songs, and playing face-to-face games twice a day. He will help with dressing himself and follow simple one-step directions from Mom and Dad during home routines.

I cannot stress the importance of the wording in these outcomes enough. If we said, “Kiaan will use ten words,” and left out the rest, we would not truly be reflecting early intervention as we understand it now. The outcomes must include phrases like “so the family knows what he would like” and “with family and toys at home,” because early intervention is about the child within the context of the family and their everyday interactions.

Pam: These outcomes are rooted in the family’s real concerns and priorities, not just in what I was taught in school that “should” happen developmentally.

Step 1: Greeting Everyone

Step one in this model is to take a few extra minutes before the visit to prepare thoughtfully. I review my last note and remind myself of what I documented about the child and family. I think about the IFSP outcomes for the entire team, recognizing that outcomes are no longer discipline-specific. I then text the parent to confirm the upcoming visit date and time, and I make sure to mention the activity we agreed to focus on during our last visit. That plan can certainly change, but it helps to start from what we previously discussed.

When I arrive, I ensure I am on time and greet everyone in the home. I remind myself that I am a guest in their space. The family can say yes or no to my being there, and I want to be respectful and acknowledge each person. I then chat with the primary caregiver—often the mother in this case—and ask how the last week or two has gone since our previous visit. I confirm that she is still interested in the joint plan we discussed last time before moving forward, rather than just barreling in, sitting down, and starting a session while the parent is still trying to remember who I am or why I am there.

Dr. Mattingly Williams: In class this morning, someone made a critical point: by the time families reach early intervention, they may have already seen many different professionals. They often ask, “Am I going to see you again?” or “Who is this person now?” Until the IFSP is in place and the team is clearly defined, parents may be meeting provider after provider, and this is especially true if the child has medical complexity and has seen multiple medical specialists. When I enter their home, I must do the basics well: introduce or reintroduce myself, let them know I am part of their team, and treat them with genuine respect. That simple foundation is the first step toward a strong, trusting relationship.

Step 2: Discuss/Observe

Step two in this model is discussing and observing. As part of Kiaan’s IFSP outcomes, his mother shared that she wanted to work on daily routines. In talking with one of the early interventionists, they identified several areas they hoped to address: increasing hands-together use, encouraging crossing midline, and reducing some of his tactile sensitivity or defensiveness. During that conversation, Mom mentioned that she bakes a lot of bread and really wanted to include Kiaan in that activity. Together, they chose bread-making as a meaningful activity to focus on.

In this step, the visit begins with a simple question: “Do you still want to use the food we discussed last week?” Mom says yes, and she sits Kiaan in his high chair and starts to mix the dry ingredients to bake the bread. The interventionist asks, “Has he helped you before?” and Mom replies No. The next question is, “Do you think he can help stir the ingredients?” Mom says yes, but explains that in the past, when they have tried, he has attempted to eat the dough.

This opens the door for a gentle suggestion: perhaps they could try some hand-over-hand support for stirring so that he experiences the motion without immediately grabbing for the dough. With repetition, Kiaan begins to stir. Mom is then able to successfully fade her assistance over time as he gets the hang of it.

As the coach, the clinician offers a genuine compliment, recognizing that Mom has persevered, provided helpful information about past events, and remained calm and collected throughout the task. The clinician then highlights the developmental opportunities in this activity, such as using both hands at midline—one hand holding the bowl, the other holding the spoon. This allows the coach to weave in information about why this matters, while still honoring Mom’s lead and the activity she chose.

In this step, there is true collaboration. Mom shares her insights about Kiaan and their daily life, and the clinician shares strategies and developmental perspectives. Together, they shape a routine that is meaningful, functional, and supportive of his growth.

Step 3: Problem-Solve Possible Strategies

Pam: Step three involves problem-solving and exploring possible strategies together. As Kiaan and his mother continue stirring the dry ingredients, he is no longer trying to eat them off the spoon. Mom then adds milk or water to form a dough. She shares that she would like to see if her son will actually work with the dough on his tray. She plans to knead it out in front of him, knowing this is a very different texture and remembering that, in the past, this kind of texture has led him to pull his hands away and refuse to engage.

Mom wonders whether he will try to eat the dough, whether he might refuse to touch it altogether, or whether he might surprise her. These reactions are consistent with his past actions. As the clinician, I respond respectfully, making sure she feels heard and understood. I acknowledge that we now have a better understanding of what has happened in the past, and at the same time, I support her desire to continue providing opportunities for him to grow.

We discuss his sensitivities explicitly, which we refer to as tactile defensiveness. Mom has already completed questionnaires about this, but now we are seeing it play out in real life, affecting his willingness to participate in certain types of play and family routines. Together, we begin to brainstorm options. We might ask, “What if we used a spoon so he doesn’t have to touch the dough directly?” or “What if we focused on deep-pressure input—patting the dough, pounding it, pressing it firmly—would that help increase his tolerance?”

Dr. Mattingly Williams: These suggestions draw on my professional knowledge, but Mom is the one who can say, “Here’s how he has reacted before,” or “I think he might prefer this approach over that one.” She may offer, for example, that he has done better with firm pressure in other situations, or that he is more comfortable if he sees her touch something first. In this way, she is clearly playing her role as the expert on her child, and our problem-solving is truly collaborative.

Step 4: Practice Skills

Step four focuses on practicing skills, and I approach this with the understanding that caregiver involvement will naturally vary. Some mothers will jump right in, while others may be more hesitant or passive. The same is true for fathers, grandparents, and other caregivers. Personality plays a role, as do cultural values, preferences, stress levels, and overall life circumstances. Parenting young children alone can be stressful, and when you add jobs, bills, and multiple clinicians coming into the home, it can quickly become overwhelming.

A caregiver’s understanding of the task also influences participation. If they are unsure of what is being asked, feel vulnerable, or are uncertain about their own parenting skills, they may hang back. Many families in early intervention have medically complex histories. If a child was premature or spent time in the hospital, caregivers may have been told repeatedly, “You can’t hold him right now,” or “You can’t do this yet,” for valid medical reasons. Over time, that can erode their confidence and contribute to a sense that they may not be able to handle things on their own. In coaching, I aim to counteract this by fostering safety, confidence, and self-efficacy.

I use collaborative language such as, “How would you feel about practicing while I’m here?” rather than directing them to “do this” or “do that.” My role is not to dictate; it is to support, help, and collaborate. Modeling alone is not always the most effective approach, so I ask permission, narrate my actions, and then invite the parent or caregiver to try as well.

In this case, when Kiaan is hesitant to touch the damp dough, Mom adds some flour and begins to engage in modeling play with the dough. The clinician and Mom engage together: patting, squishing, making dough balls, counting the balls, and alternating hands. This turns into a shared, playful activity. As Kiaan watches the two adults having fun, he becomes more interested and begins to imitate and join in. When that happens, we take a moment to celebrate the success. No one is doing something “to” anyone; instead, it is a collaborative, enjoyable effort that supports both his development and his relationship with his family.

Step Five: Reflection & Feedback

Pam: Step five is the reflection and feedback stage. After the bread has been kneaded, rolled out, and placed in the pan, the clinician invites Mom to share her thoughts about the session. Questions might include, “How do you think the session went?” and “Do you see yourself using any of these strategies in other daily routines?”

In this case, Mom says she can see herself using the same type of encouragement and the hand-over-hand technique, which she had never tried before. She also noticed how we gently blocked one hand to encourage use of the other when we later worked on putting on shoes. She mentions that she might use counting objects during the upcoming week as well. In this way, she is actively thinking about what we did, what went well, what she liked, and what she can carry forward into the following week.

Dr. Mattingly Williams: This ties back to the idea that part of coaching is helping Mom learn to analyze situations in new and more effective ways. Over time, she begins to generate her own ideas for tasks, activities, and strategies she wants to try. When it is done well, this process is very empowering.

Pam: Sometimes parents will ask, “Is this about me, or is this about my child?” during the reflective stage. My response is that it is about whoever needs it in that moment. For a parent to better meet their child’s needs, there are times when we both step back and think about what we are doing and how it is working. Parents may feel like we are giving them something they personally need, and in many ways, we are, because we are working with the whole family to support the most optimal outcomes.

Dr. Mattingly Williams: I also recognize that I am learning in this process. Every time I work with a family, I grow and learn. Some families have taught me a tremendous amount, and those experiences have been incredibly positive and humbling.

Step 6: Planning for the Time Between Now & the Next Visit

Step six focuses on planning for the time between now and the next visit. The clinician asks Mom whether she thinks she can use similar support strategies to help Kiaan with tasks such as walking to the car, retrieving his shoes from a cubby, or placing toys in the bathtub. Together, they begin to connect what was practiced during bread making to other real-life routines.

Mom then expresses interest in working outside during the next visit. This is an opportunity to solidify what has happened during the session and explore how those same principles can be carried into new contexts. The clinician and Mom discuss how these other activities can be encouraged and what they might entail.

Mom shares that she wants to support Kiaan’s play skills and his outdoor walking, and she would like to get him outside more to play. The clinician responds by suggesting an outdoor visit for the next session, perhaps including sandbox play and other outdoor activities that matter to the family. By this point, Mom has likely begun to see some success and is feeling increasingly empowered. She starts to take more ownership, saying, in effect, “This is what is important to me,” such as outdoor play and walking.

Together, they decide that the next visit will focus on outdoor play and walking, using the same coaching and adult learning principles to support Kiaan’s development in a new, meaningful routine.

Step 7: Wrap Up Session and Schedule Next Visit

Pam: Step seven is wrapping up the session and scheduling the next visit. The clinician writes a brief note and summarizes the joint plan so that everyone is clear about what was practiced and what the family wants to focus on between visits. Mom then takes a picture of that plan on her phone. In this case, the next visit is scheduled for the morning so they can go outside before the heat of the day, which makes it more comfortable and realistic for the family and for Kiaan. Before leaving, the clinician thanks Mom for having them in her home and for a great visit, and may add something like, “I feel like this went really well; thank you for your time.”

I cannot stress the importance of that brief written plan enough. It does not have to be long or elaborate, but it should be clear enough that both the family and I can remember what we did and what comes next. Families often feel more confident when they see that we are keeping track, staying organized, and following through on what we have discussed. If we become so rushed that our notes are sparse or unclear, it becomes harder to plan thoughtfully—such as choosing a cool morning for outdoor play—and it can send the unintended message that the work is more routine than relational.

For me, notes help keep me honest and on track so that I am not coming back the following week saying, “Now, what did you say you wanted to do?” A simple, accurate summary demonstrates that I care and am invested in their goals. This note is separate from the computerized documentation I might complete later on our platform; it can be very low-tech and practical.

Sometimes I use carbonless (carbonized) paper so I can leave one copy with the family, especially if they are not frequent phone users or if English is their second language, and they may not use their phones the same way I do. I can tear off their copy and put it in a folder I’ve given them to keep on the refrigerator with a magnet. With other families, I encourage them to take a quick picture of the plan with their phone

Dr. Mattingly Williams: I tend to use my phone a lot myself, and many parents do too, so it can be a very natural way to help them keep the plan visible and handy between visits.

Questions and Answers

Let's now get to some questions. (Both presenters answered these.)

How do you handle this coaching model with families whose first language is not English?

It depends on the family and their cultural comfort level. I try to stay within what they are comfortable with and make it a give-and-take process. For example, I once worked with a child whose mother felt I needed to wait for tea after the visit. I made sure to schedule enough time so I could accept that invitation. Showing respect for their culture and rituals was part of building trust and “buy-in” to the coaching relationship.

How can this coaching model be adapted to use with older individuals?

The same principles can be applied to older children and even adults. Our next presentation, for example, focuses on applying adult learning theory when coaching families of children with pediatric feeding and swallowing disorders, up to approximately 18 years of age. I also use these ideas with adults—for instance, when I’m working with the family of a stroke patient. The core approach remains the same; we adjust the targets, tasks, and examples to suit the specific age group and population.

Do you agree that collaboration with families can change outcomes, even if we don’t strictly call it a “coaching model”?

Yes, completely. Even when people are not explicitly using a “coaching model,” many clinicians following other theorists are seeing different (and often better) outcomes when they collaborate with parents or family members versus doing therapy alone. Having parents, significant others, or family members participate, rather than asking them to “go get coffee while we do therapy,” is changing practice—although this change is occurring more slowly in some outpatient settings. This collaborative involvement is helping us better address the needs of older children beyond traditional early intervention ages.

Should early intervention (EI) be expanded to ages 4 or 5 since school often doesn’t begin until those ages?

Many clinicians and physicians believe EI and related services would ideally extend through age 5. A neonatologist in our area, for example, strongly advocated for extending services because many medically complex children spend a large portion of their first three years in the hospital. They may need extra time beyond age 3 to catch up. While schools do provide therapy services, that is different from in‑home, naturalistic models. Some states offer preschool services to children who qualify, but access and format vary. Overall, it’s an area where we could grow, though changes may be more of a long‑term goal.

How do different service models for preschool-aged children look in practice?

They can take many forms. In some places, preschool services are available to children who qualify, but they may resemble outpatient sessions delivered through the school system. For example, a family might drive their child to school for speech therapy and then leave, rather than opting for a classroom-based or in-home model. Some children are not yet ready to separate from home, which further complicates access. Although services may exist, they may not fully align with a naturalistic or family-centered model, and there is still room to improvement.

Is using tools like Google Translate helpful when working with families who speak other languages?

Yes, tools like Google Translate can be invaluable as one part of communication with families whose primary language is not English. They can support understanding, but we still need to be mindful of cultural differences and find ways to build rapport and respect alongside any technical tools we use.

What should we do in private sessions when families prefer to watch but don’t participate, saying they’re not sure how to integrate themselves?

First, I acknowledge that parents know their child best—they are the true experts in their child. I might say something like, “You are the real expert in your child, and we want this to be a family process, not just something I do alone.” I validate their concern that the child may act differently when they are present, but also highlight that the parent is the one who is there every day. I then gently encourage participation and collaboration, explaining that our goal is to help them feel confident using strategies in daily life, not just for the child to perform during the session.

How do you handle parents in EI who are very focused on wanting their child to speak?

I explain that speech is often like the tip of the iceberg—it’s one of the last pieces to emerge. Before words come, we need strong foundational skills: movement-based exploration, pointing, joint attention (looking at you and then at objects), motor planning, and play. I emphasize having a comprehensive team that thinks about all these underlying areas.

How do you explain the difference between “speech” and “language” to families?

As a speech-language pathologist, I think of speech as how we physically produce sounds—moving the articulators for precise articulation and language as the broader system of communication—gestures, eye contact, play, understanding, using symbols, and social use (pragmatics).

I help parents recognize that even if their child is not yet speaking words, the child may still be communicating and developing language through gestures, facial expressions, sounds, and play.

How can we reassure parents when their child is not yet talking?

Discuss building foundations, including exploration, play, interaction, eye contact, gestures, and shared attention. I emphasize that “no spoken words yet” does not mean “no language” and that many children communicate meaningfully before they speak. I also emphasize collaboration: parents are the experts on their child, and we bring our professional knowledge to support them. Together, we focus on developing strong underlying skills, so that speech and more complex language have a solid foundation to build upon.

References

See additional handout.