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Professional skills, concerns, and perceived importance of work with families in early intervention.

The effectiveness of early intervention for children with disabilities and their families is likely to be influenced by the extent to which early intervention professionals are adequately trained. Factors such as age of children served, diverse intervention settings, the need for inter-agency collaboration, and the central role of families all point to the need for specialized training (Bailey, 1989; McCollum & Thorp, 1988). Unfortunately, there are several barriers to assuring a full cadre of qualified professionals: personnel shortages (Meisels, Harbin, Modigliani, & Olson, 1988); diversity in staffing patterns and expertise (McCollum & Hughes, 1988); inadequate preservice training in nearly every discipline (Bailey, Simeonsson, Yoder, & Huntington, 1990); discrepancies between typical and desired practices (Bailey, Buysse, Edmondson, & Smith, in press); and staff turnover, especially among allied health professionals and other consultants (Palsha, Bailey, Vandiviere, & Munn, 1990).

Of special significance is the preparation of personnel to work with families. The requirements of Public Law 99-457 regarding the Individualized Family Service Plan, family assessment, and case management suggest that early intervention personnel will need unique expertise in how to involve and support families. The legislation reflects a philosophical shift in early intervention from a child-focused activity to a family-centered enterprise (Bailey, 1987; Brewer, McPherson, Magrab, & Hutchins, 1989; Dunst, 1985; Shelton, Jeppson, & Johnson, 1987). Despite acceptance of the principles of family-centered care in the professional literature, however, establishing family-centered practices is likely to be a challenging process. Bailey, Simeonsson, Yoder, and Huntington (1990) found course work related to the work with families to be among the weakest aspects of preservice training programs in a number of key disciplines. Bailey et al. (in press) found that professionals reported substantial discrepancies between how they actually worked with families and how they thought they should be working with families. Research by Mahoney and O'Sullivan (1990) and Mahoney, O'Sullivan, and Fors (1989) suggests that family-centered practices have not been well established; in many cases, a family-centered approach is defined as the involvement of families in the treatment of children rather than enhancing the broader goals of family support (Zigler & Black, 1989).

A key to maximizing the effectiveness of training, especially at the inservice level, is linking training to the broader goal of facilitating change in practices. Research on the process of change suggests that many factors are involved, including characteristics of the people involved, the quality of training provided, the ecology in which change is expected, and the provision of support and follow-up (Fullan, 1982; Joyce & Showers, 1988; Mann, 1978). The focus of this article is on the first of these variables, characteristics of the people who are expected to change their practices. We address three domains: perceived ability related to the demands expected by the change, the extent to which the expected role is valued, and concerns about the change.

VARIABLES STUDIED

Perceived Ability

One variable likely to influence the implementation of new practices is the extent to which a person perceives that he or she has the necessary skills. Bandura (1977) proposed a transactional model in which self-efficacy both influences one's willingness to try new procedures and is, in turn, influenced by subsequent success:

Expectation of personal efficacy determines whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Experiences of mastery [produce] further enhancement of self-efficacy. (p. 191)

The locus of control literature (e.g., Joe, 1971; Lefcourt, 1976) has suggested that perception of control over life events is strongly related to achievement and depends in part on perceived perception of competence. Guskey (1988) found teachers' perception of efficacy and self-concept as a teacher to be related to each other and also related to their ratings of the importance of a training experience. Stein and Wang (1988) concluded, "Perceived self-efficacy is the one teacher characteristic that consistently has been found to be related to successful implementation of innovative programs and student learning" (p. 174).

Value of the Training or Innovation

A second variable is the extent to which a person believes that the new role or task is important and is consistent with expectations for professional roles. Berman and McLaughlin (1975), as reported by Stein and Wang (1988), found in the Rand Study that "if the values and goals implicit in the project's design were not congruent with those of the project participants, the innovation was likely to be either symbolically implemented or not implemented at all" (p. 18).

Concerns About the Change

Fuller (1969) suggested that the specific concerns teachers have about a practice or procedure might influence their willingness to learn about it and use it. Fuller described a three-phase developmental sequence of concerns: nonconcern, concern with self, and concern with pupils. Hall and Loucks (1978) proposed a seven-stage model of concerns:

Stage 0 (Awareness): Professionals have little concern about or involvement with the innovation.

Stage 1 (Informational): The primary concern is knowing more about the innovation.

Stage 2 (Personal): Professionals ask how the innovation will affect them personally, often with corresponding concerns about personal adequacy to meet new expectations.

Stage 3 (Management): Concerns focus on the implementation of the intervention--how, when, and where it is to be implemented.

Stage 4 (Consequences): The professional is concerned about the extent to which the innovation will have a positive impact on the children or families served.

Stage 5 (Collaboration): Concerns usually are expressed by administrators or team leaders who are concerned about collaboration and cooperation among professionals in implementing the innovation.

Stage 6 (Refocusing): The professional evaluates the innovation and is concerned about either modifying the innovation to make it more effective or considering alternative innovations.

An assumption underlying the Hall and Loucks model is that effective training must be matched to the needs and concerns of the participants. Concerns are assumed to follow the identified sequence of stages, and various strategies have been suggested for training at each level of concern (Hall, 1979; Hall & Hord, 1987; Hord, Rutherford, Huling-Austin, & Hall, 1987). Bailey and Palsha (in press) demonstrated the applicability of the concerns-based model to early intervention, but presented evidence in support of a simpler five-stage model.

Summary and Research Questions

Research on individual characteristics has focused almost exclusively on teachers and their reactions to proposed changes in teaching strategies. This study examines the concerns, skills, and values of professionals from several disciplines, all of whom are expected to respond to current demands for family-centered practices. The study was designed to answer five questions:

1. How do professionals perceive their ability to work with families?

2. To what extent do professionals value work with families?

3. What concerns do professionals express about changing to family-centered early intervention?

4. What are the interrelationships between perceived ability, value, and concerns about family-centered practices?

5. Are ratings of ability, value, or concerns influenced by variables such as years of experience, discipline, or job type?

METHOD

Subjects

The subjects were 142 professionals from two states working in early intervention programs serving infants and toddlers with disabilities and their families. Sixty-five of the professionals worked in a southern state and 77 in a mid-Atlantic state. They were primarily female (98%) and Caucasian (89%). The majority (51%) held a master's degree. The mean age was 35.9 years (range = 22-58 years); the average professional had worked 7.3 (SD = 5.2) years with persons with disabilities and 5.6 years (SD = 4.2) with infants and preschoolers. Over half (57%) were direct service providers, 16% were administrators, and 3% were consultants. The remainder worked in other positions, such as case manager, social worker, or a combination of both administrator and service provider.

Instrumentation

Each participant provided information about training experience, discipline, and other personal characteristics. Three measures were used to document perceived skills, values, and concerns about working with families.

Perceived Skills. Perceived skills were assessed using Self-Rating of Skills and Knowledge in Early Intervention (Bailey, Buysse, & Palsha, 1990), a measure on which respondents assigned a self-rating regarding knowledge (theories, instruments, or procedures) and skill (clinical expertise) in 16 areas of professional competence. The rating for each was on a 1-5 scale (1 = very little, 3 = some, and 5 = a lot). Previous research has shown that items on the scale cluster into three domains--child skills, family skills, and team skills--with high internal consistency for each factor (Bailey, Buysse, & Palsha, 1990).

Value of Professional Roles. The Interventionist Descriptor Scale (Simeonsson & Bailey, 1983, 1990) was used to determine the extent to which professionals valued family roles in their work. Subjects in the first state completed the original version, consisting of 30 professional roles. Subjects in the second state completed a revised version of the instrument, which included two additional statements. Half the items on both scales are roles related to working with families (e.g., assesses family needs, communicates effectively). The other items refer to child-related roles (e.g., assesses children's skills, designs interventions for children). The interventionists were asked to identify the 10 (original version) or 8 (revised version) descriptors that they felt were most important to their work. For the purpose of this study, a single score was generated indicating the percentage of family-related items identified, providing an estimate of the extent to which each professional endorsed family roles in their work.

Concerns. The Stages of Concern Questionnaire (SoCQ) (Hall, George, & Rutherford, 1986) was used to assess concerns related to family-centered services. The SoCQ consists of 35 statements, each relating to a possible concern about an innovation. Each statement is followed by a scale ranging from 0 to 7 (0 = the concern is irrelevant, 1 = not true of me now, 3 and 4 = somewhat true of me now, and 6 and 7 = very true of me now) indicating the extent to which the statement reflects the respondent's current feelings. Based on an earlier study, (Bailey & Palsha, in press) the original 35-item, 7-stage SoCQ was revised to include only 15 items based on a 5-stage model.

RESULTS

Several techniques were used in the analyses. Given that the sample population came from two different states, all statistical analyses were run and are reported with state of residence as a second independent variable, to control for possible state main effects and state interactions. For all analyses, no interactions were found. Only on the Stages of Concern instrument were significant state main effects found. The southern state had significantly higher concerns for Stages 1, 2, and 5; the mid-Atlantic state had higher concerns for Stage 4. Despite these findings, the pattern of concerns was virtually the same for both states. The results are organized and presented according to each of the five research questions.

Perceived Ability to Work with Families

Perceived competence in working with families was determined by responses to the nine family items on the self-rating of knowledge and skills. The mean item rating of all professionals was 3.4 (SD = .78), out of a maximum rating of 5, indicating a moderate level of perceived competence. A paired t-test comparison revealed that ratings of skills in working with families were significantly lower than ratings of skills in working with children (t = 2.2, p < .03). Figure 1 shows a frequency distribution depicting the number of respondents by level of self-rated competence in family skills.

Perceived Value of Work with Families

The extent to which professionals valued roles associated with working with families was determined on the basis of responses to the Interventionist Descriptor Scale (IDS). The typical professional endorsed 54.3% of their most valued roles as family roles. Nearly half (48%) rated the majority of most important roles as family related; 22% rated an equal number of child and family roles, and 30% endorsed a majority of child roles. Figure 2 shows the distribution of the extent to which respondents valued family roles.

Concerns About Family-Centered Early

Intervention Concerns about moving to family-centered practices were determined by responses to the revised SoCQ (Bailey & Palsha, in press). Figure 3 shows the pattern of concerns for all subjects across the five stages. Relatively low levels of concern were expressed in Stage 1 (Awareness) and Stage 3 (Management), indicating that professionals felt they knew the fundamentals of family-centered services and were relatively unconcerned about how they would manage the implementation of family-centered care. Substantially higher levels of concern were expressed in Stage 2 (Personal), Stage 4 (Impact), and Stage 5 (Collaboration), indicating that professionals were concerned about the impact of this change on themselves, on the families and children served, and how they would work together with other team members in implementing a family-centered philosophy.

Interrelationships Among Measures

The relationships among the three measures were first examined using Pearson correlation coefficients. Self-ratings of family skills were significantly correlated with the perceived value of family roles, r = .395, p < .0001, although the shared variance accounted for was only 15.6%. The extent to which professionals valued family roles was not significantly correlated with the overall level of concerns (total score on the SoCQ) or with any of the five stages. Perceived skills in working with families was not correlated with total concerns; however, small but statistically significant relationships were found between ratings of family skills and stage-specific concerns: Stage 1 (Awareness), r = -.23, p < .005, and Stage 5 (Collaboration), r = .20, p < .02.

To examine these relationships more specifically, we conducted two other analyses. First, two groups were created based on the Interventionist Descriptor Scale scores: High Family (top third, n = 49) and Low Family (bottom third, n = 44). Multivariate analysis of variance (MANOVA) procedures were used to determine if concerns varied as a function of high versus low valuing of roles with families. The overall Wilks' lambda was nonsignificant, F = 1.38, df 5,85, p < .237. Second, two groups were created based on self-ratings of skills: High Family Skills (highest third, n = 48) and Low Family Skills (lowest third, n = 49). A MANOVA was used again to determine if concerns varied as a function of high versus low family skills. The overall Wilks' lambda was significant, F = 2.53, df 5,89, p < .03. The univariate tests revealed that professionals with low skill ratings tended to express higher concerns in Stage 1, F = 7.00, df 3,93, p < .01; Stage 2, F = 3.80, df 3,93, p < .06; and Stage 3, F = 3.62, df 3,93, p < .06. Professionals with high skill ratings tended to express higher concerns in Stage 4, F = 3.27, df 3,93, p < .07, and Stage 5, F = 8.54, df 3,93, p < .004.

Other Variables Influencing Ratings

A final set of analyses was conducted to determine the extent to which ratings were influenced by experience, discipline, or job type.

Experience. To examine differences by experience, we divided the subjects into two groups, those who had worked less than 2 years (n = 28) and those with 5 or more years of experience (n = 89). Years of experience did not relate to concerns about family-centered services or the extent to which professionals valued family roles. On the rating of skills and knowledge, professionals with a high degree of experience rated their child and team skills, but not family skills, higher than did professionals who had only recently begun to work in early intervention.

Discipline. To examine differences by discipline, we identified four groups of direct service providers: educators (n = 28), allied health professionals (physical therapists, occupational therapists, and speech-language pathologists, n = 45), social workers (n = 21), and nurses (n = 14). The MANOVA revealed an overall main effect for discipline in self-ratings of family skills, F = 21.67, df 7,100, p < .0001. Follow-up Tukey's tests revealed that social workers (M = 4.24) and nurses (M = 3.82) rated themselves significantly (p < .05) higher on family skills than did educators (M = 3.23) and allied health professionals (M = 3.05).

A main effect for discipline was also found in the perceived value of family roles, F = 6.47, df 7,100, p < .0005. Nurses (M = 65.5%) and social workers (M = 61.9%) endorsed more family roles than did educators (M = 50%) or allied health professionals (M = 47.5%). Tukey's comparisons indicated that all but the social work versus education comparisons were significant, p < .05.

A MANOVA procedure was used to determine if concerns varied as a function of discipline. Despite the significant discipline differences in skills and perceived value of family roles, no significant differences in concerns emerged as a function of discipline.

Job Type. A final set of analyses was conducted to see if direct service providers (n = 89) differed from those in administrative positions (n = 25) on any of the three measures. The two groups did not differ in the extent to which they endorsed family roles (M = 56.6% for administrators and 54% for direct service providers). MANOVA procedures with the concerns data revealed no significant overall effect, Wilks' lambda F = 1.59, df 5,106, p < .16. To identify trends that might be useful in future studies, we conducted univariate comparisons. They revealed that direct service providers tended to express more Stage 4 (Impact) concerns, F = 4.31, df 3,110, p < .04, whereas administrators expressed more Stage 5 (Collaboration) concerns, F = 3.94, df 3,110, p < .05.

DISCUSSION

A primary purpose of this study was to describe the extent to which early intervention professionals in two states felt competent in working with families, endorsed family-oriented roles, and were concerned about changing to family-centered practices. Of additional interest were the relationships among those variables and the extent to which experience, discipline, and job type affected ratings. Findings from the study suggest a number of implications for personnel preparation activities.

Perceived Skills and Valued Roles

The professionals surveyed generally felt that roles associated with working with families were an important aspect of their work. As a group, they perceived themselves as moderately skilled in working with families; however, they felt more competent working with children. Significant differences in perceived skills and valued roles emerged as a function of discipline. Nurses and social workers endorsed more family roles than did educators and allied health professionals. They also rated their family skills as significantly higher than did educators and allied health professionals.

These findings are consistent with a recent survey of college and university programs across eight disciplines showing that social workers and nurses receive the greatest amount of preservice training related to working with families (Bailey, Simeonsson, Yoder, & Huntington, 1990). The results demonstrate the particular challenges that will be faced when professionals whose training is child focused are asked to become more family centered in their work. These professionals are likely to express lower sense of adequacy related to this role and thus may be less likely to value it than professionals whose preservice training has focused more extensively on families.

Because of the important relationship between perceived efficacy and implementation of innovative programs (e.g., Stein & Wang, 1988), several implications may be drawn from these findings. One is that preservice programs in education and allied health care may need to identify strategies for teaching skills related to working with families and for helping students develop an identity that includes work with families as a part of how they define themselves as professionals. Second, inservice training efforts will need to allow for the variability that is likely to exist in both skills and perceived roles and provide training activities accordingly. Finally, although all early interventionists should view work with families as part of their job, the specialized expertise of nurses and social workers in this area provides a resource for service delivery, as well as for consultation and training of other team members.

Concerns

As a group, the respondents did not fit the classic profile of professionals just beginning to learn about an innovation (Hall & Loucks, 1978). Because many of them had been working in early intervention for some time and the movement to family-centered services has been emerging for several years, the respondents were already aware of many potential implications of these services. Participants in this study were primarily concerned about how changing to family-centered practices would affect them personally and whether their skills were adequate to meet this challenge. They were also concerned about how this change would affect the children and families they serve and how they would work together with other professionals to implement this change. Concerns did not differ as a function of discipline, although administrators were more concerned about collaboration and direct service providers were more concerned about impact.

Hall (1979) suggested that people who express a high degree of personal concern may view the change as a personal threat, a suggestion that is consistent with the finding that those professionals who viewed themselves as less competent expressed greater concerns in the initial stages. Hall suggested that inservice training for those who have intense personal concerns needs to encourage and build confidence, with an emphasis on a gradual implementation and assurances that personal support will be available.

Impact concerns relate to how the innovation might affect the clients being served. Common questions for early interventionists at this level might include: Will a family-centered approach reduce the quality of services for children? Will families want or benefit from this approach? Can I modify the approach to fit my own philosophy, or do I have to follow a single model? Hall (1979) suggested that people with impact concerns generally need little assistance because they have accepted the need for change and are now focused on its effects. This may not translate directly to family-centered services in early intervention, because high impact concerns may reflect a concern that shifting to family-centered services may come at a cost to the child. Training may be needed to help professionals see that a family-centered approach does not mean that children are ignored and ultimately should have the greatest benefit for children because of the supportive services that can be provided.

Hall (1979) reported that collaboration concerns are rare; in the present study, however, it was of primary concern for many professionals. This finding should not come as a surprise. Hall's work centered on innovations in schools, where teachers are involved primarily with implementation within their own classrooms, with their own students, independent of collaboration with fellow coworkers. P.L. 99-457, on the other hand, mandates a family focus carried out in the context of an interdisciplinary team, working in close collaboration to deliver services. This process can lead to uncertainty about the division of roles and responsibilities in working with families. Interdisciplinary collaboration, in fact, may be one of the more critical personnel preparation issues unique to implementing P.L. 99-457. When collaboration is of concern, inservice training activities are likely to be most effective if they include all team members and if the training is directly tied to the institutional context in which professionals work.

Interrelationships Among Measures

The data are consistent with other research suggesting that concerns, efficacy, and skills are relatively independent constructs. Moderate correlations would be expected and were found to be similar to those reported in other studies. For example, Guskey (1988) reported a correlation of .36 between ratings of personal efficacy and congruence of an expected change with current practices, a figure that is remarkably similar to our finding of a correlation of .395 between family skills and perceived importance of work with families. We also found a modest association between skills and concerns, but only in comparison of extreme (high versus low skills) groups. As would be expected, professionals with low family skills expressed more concerns in Stages 1-3, and professionals with high family skills expressed more concerns in Stages 4 and 5.

SUMMARY

The data from this study reinforce previous assertions that staff development activities have often failed to recognize that "trainees" approach proposed changes in practices with varying degrees of interest, skills, and concerns. As Stein and Wang (1988) reported, "Findings from the literature on social-psychological determinants of learning have consistently found an interactive relationship between success in learning, perceptions of self, and motivation" (p. 184). Although further research is needed to understand the mechanisms by which these processes operate, training programs at the preservice and inservice level may need to examine the extent to which training practices are tied to individual needs and concerns and promote skills and values needed for effective work in early intervention. Such sensitivity to individual differences seems pertinent in the context of personnel preparation for roles to promote individualized services for families of young children with disabilities.

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Title Annotation:results of a survey among early intervention professionals
Author:Bailey, Donald B., Jr.; Palsha, Sharon A.; Simeonsson, Rune J.
Publication:Exceptional Children
Date:Oct 1, 1991
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Previous Article:Mainstreaming during the early childhood years.
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