Raise your hand if you’ve come across any of the following challenges:

• A mismatch between therapist and caregiver goals
• Child behaviors that “get in the way” of therapy and are challenging for caregivers
• Caregivers’ feelings of grief, anxiety, and frustration with their child and/or themselves
• Lack of generalization of strategies beyond the therapy session
• Caregiver comments like “They’re just being difficult. They’re being stubborn.”

I bet all of us have encountered some or most of those!

We know the importance of caregiver coaching, responsiveness, and focusing on children’s increased functional participation in daily family and community life. But from the show of hands just now, it’s clear that we all struggle in some way with actually implementing these ideals in our practice. And for that, allow me to draw your attention to Parent-Child Relationally Informed Early Intervention (PCRI-EI)!
 

What is the PCRI-EI?

PCRI-EI sets the stage for all of your other interventions. It’s not meant to replace your language strategies; rather, it supports caregivers’ attunement with their child which in turn creates the relational context in which you can target functional family goals. It’s based on well-established child attachment theories and interventions and has been made into simple-to-understand strategies to be taught in a specific sequence within the early intervention setting.
 

What’s in the manual?

The PCRI-EI manual is comprehensive, and at first glance may look overwhelming. But it was specifically designed to make this intervention “do-able” and help you through step by step.

It includes:

• Worksheet and process for co-creating goals with families that align with their long-term hopes for the child
• Five-phase curriculum for teaching PCRI-EI strategies
• Scripts for how to explain strategies and answer common questions 
• Caregiver materials including a tip sheet 

The strategies you see within the manual are likely not going to feel drastically different from what you know. That’s because we’re all familiar with responsiveness and already support responsive interactions within our sessions—how many times a day do we say to follow the child’s lead? The real value here is the systematic nature of the program, the precision and specificity of the strategies, and the examples and scripts to help therapists explain concepts. Because remember how you admitted in the first paragraph that none of this is as easy as it seems? Yeah. We need this! For example:

• Task: Helping caregivers to imagine what their child may be communicating through their behavior
  • Script: “It is a bit different to imagine what is going on for your child and what they are telling you in their way. I guess it’s important to know we will always be guessing about these things and that sometimes it will be off the mark, however for our kids the guessing can be very helpful as they make sense of their experience—because if we don’t, they most certainly will. Your tone of voice can help things seem less troublesome. For them, they get “seen” i.e. they get the sense that “someone gets me, my ideas, feelings and what I am trying to let them know.” They may not know the words we use, but our tone of voice and facial expressions and some of the words help make sense of things for them, when it is a bit tricky on their own.”
• Task: Responding to caregivers’ questions about prognosis and concerns
  • Script: “These questions you’re asking are completely understandable. They are reflecting the hopes that you have for your child and their future. I wish I could give you an answer, but we can’t know those things yet. What I do know is that the best place to bring your hope is to the work we are going to ask you to do because that is how we will get to know what might or might not be possible for your child.”

Is the manual available for me to use?

Yes! The researchers have generously allowed us to host the manual so that all of you can have access to it. We’ve worked with them to make it as accessible for clinicians as possible. Download it here!

Is PCRI-EI effective? 

Initial studies demonstrate that it is effective for a variety of outcomes for those involved. Here are some of the initial findings:

• For caregivers:
  • Results across studies demonstrate a reduction in stress levels (especially for those caregivers who had felt that their child was “difficult”), increased well-being, and improved sense of competency. This is important because we know that caregivers' mental health both impacts and is impacted by their child’s disability. 
• For children:
  • Callanan et al. tracked functional goal progress of 56 children, aged 0–6, with developmental disabilities who participated in their intervention. Goals spanned all developmental domains (motor, social, communication) and were co-created between therapists and caregivers. Progress was rated on a scale of 1–10 after each 12-week block of therapy. Caregivers and therapists determined ratings of improvement based on consensus. They found medium to large effect sizes in children’s progress towards their functional goals over a therapy block. While this isn’t the standardized test scores and blinding that we’re used to seeing in research articles, it closely aligns with our clinical practice and demonstrates functional progress (which standardized scores don’t necessarily indicate!). 
  • Additionally, caregiver report revealed that these improvements were generalized across social, community, and educational settings.
• For therapists:
  • The researchers asked therapists directly about their experience learning the intervention. They found that “Feedback from therapists indicated the systematic approach embedded in the protocol combined with reflective supervision built their competence and confidence in working collaboratively with families. At the same time, they reported being better able to generate therapeutic goals that gave preference to family context and priorities over therapist-driven developmental aims.”

One final thing worth mentioning:

There’s been a lot of blaming of EI therapists for not using coaching models or more relationally-based interventions. But these researchers have seen that this is not for lack of effort on our part. Instead, their research shows that limited uptake of these models often boils down to a lack of training and tools on how to use these approaches in a way that is both grounded in theory and evidence and takes real caregivers’ and therapists’ challenges into account. We love that these scientists are committed to helping us do that. 

Callanan, J., Ronan, K., & Signal, T. (2019). Activating parents in early intervention: Preliminary findings from an empirical case study. International Journal of Disability, Development and Education. https://doi.org/10.1080/1034912x.2019.1628186
 

Callanan, J., Signal, T., & McAdie, T. (2021). Involving parents in early intervention: Therapists’ experience of the Parent Child Relationally Informed-Early Intervention (PCRI-EI) model of practice. International Journal of Disability, Development and Education. https://doi.org/10.1080/1034912x.2021.1910933
 

Callanan, J., Signal, T., & McAdie, T. (2021). What is my child telling me? Reducing stress, increasing competence and improving psychological well-being in parents of children with a developmental disability. Research in Developmental Disabilities. https://doi.org/10.1016/j.ridd.2021.103984 [open access]
 

Callanan, J., Signal, T., & McAdie, T. (2021). Engaging parents in early childhood intervention: Relationship as a platform for functional gains. International Journal of Disability, Development and Education. https://doi.org/10.1080/1034912x.2021.1876216

Callanan, J. (2021). Activating parents in early intervention: The role of relationship in functional and family gains. CQUniversity. https://doi.org/10.25946/16807915.v1 [open access]