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toddler intervention programs
Studies in EducationalEvaluation. Vol. 8, pp. 305-316, 1983
0191-491X/83/030305-12506.00/0 Copyright© 1983PergamonPressLtd.
Printedin GreatBritain.All rights reserved.
EVALUATION OF INFANT/TODDLER INTERVENTION PROGRAMS Alice Sterling Honig College for Human Development, Syracuse, New York, USA
The need for infant enrichment programs has b e e n h i g h l i g h t e d in t h e p a s t decades. R e s e a r c h e v i d e n c e has a c c u m u l a t e d t h a t i n f a n t s w h o w e r e r a i s e d in families that did not provide rich language and play experiences dropped drast i c a l l y in IQ b y t h r e e y e a r s o f age c o m p a r e d t o t h o s e r a i s e d in d e v e l o p m e n t a l l y more stimulating environments (Golden, Birns, Bridger, & Moss, 1971). Also, increasing numbers of single and working parents have found quality substitute c a r e f o r i n f a n t s t o be a r a r e c o m m o d i t y . Their concerns have lent urgency to e f f o r t s to e v a l u a t e t h e e f f e c t s o f i n f a n t c a r e p r o g r a m s .
Historical Background T h e c a r e o f v e r y y o u n g c h i l d r e n in o t h e r t h a n o w n home s e t t i n g s has b e e n a social c o n c e r n in m a n y a g e s . P l a t o l o n g ago s u g g e s t e d t h a t i d e a l l y i n f a n t s be reared by specially trained surrogate caregivers. In F r a n c e , p l a c i n g i n f a n t s "en nourrice" served for centuries as a s y s t e m w h e r e b y r u r a l p e a s a n t w o m e n reared nurslings of urban parents unable to care for their own children during the early years. L a n g u a g e d e l a y s h a v e b e e n f o u n d in c h i l d r e n w h o w e r e r e a r e d "en nourrice" (Brunet & Lezine, 1965). S p i t z ( 1 9 4 5 ) , a p s y c h o a n a l y s t i n t e r e s t e d in t h e e f f e c t s o f i n f a n t s e p a r a t i o n f r o m t h e m o t h e r , e v a l u a t e d t h e e f f e c t s o f f o u r v a r i e t i e s o f i n f a n t r e a r i n g c o n d i t i o n s in South America. M a r k e d c o n t r a s t s w e r e f o u n d in c l i n i c a l l y a s s e s s e d b e h a v i o r s a n d in d e v e l o p m e n t a l q u o t i e n t s b e t w e e n t h e f i r s t t h i r d a n d t h e l a s t t h i r d o f t h e f i r s t y e a r o f l i f e in d i f f e r e n t g r o u p s . I n i t i a l l y , i n f a n t s r e a r e d in p r o f e s s i o n a l f a m i l i e s differed greatly in d e v e l o p m e n t a l q u o t i e n t s ( I Q 133) f r o m t h o s e r a i s e d in an isolated poor fishing v i l l a g e ( I Q 107) o r in p r i s o n nurseries with attentive maternal care available (IQ 101.5). Y e t in t h e s e g r o u p s , b a b i e s d e v e l o p e d welt d u r i n g t h e f i r s t y e a r a n d t h e i r mean IQs r e m a i n e d r e s p e c t i v e l y t h e same o v e r t h e first year of life. In c o n t r a s t , S p i t z r e p o r t e d a s e v e r e d r o p in d e v e l o p m e n t a l s c o r e , f r o m 124 t o 72, f o r i n f a n t s b o r n t o m o t h e r s o u t o f w e d l o c k a n d s u b s e q u e n t l y g i v e n u p t o a f o u n d l i n g home a t a b o u t t h r e e m o n t h s . Such naturally occurring d i f f e r e n c e s in o u t c o m e as a f u n c t i o n o f d i f f e r e n t i n f a n t r e a r i n g s i t u a t i o n s led t o i n i t i a l a p p r e h e n s i o n a n d c o n c e r n f o r i n f a n t w e l f a r e in o t h e r t h a n home c a r e . Clinicians became alarmed that group day care for infants w o u l d i n e v i t a b l y lead to d e f i c i t s s u c h as h a d b e e n f o u n d in i n s t i t u t i o n a l l y r e a r e d babies. T h e c l i n i c i a n ' s i n f l u e n c e was s u c h t h a t i n i t i a l l y , p i o n e e r i n f a n t d a y c a r e programs chose their evaluation measures to alleviate just such concerns. Keister 305
306
A. S. Honig
(1977) for example, set out to demonstrate that enriched group care with attention t o i n f a n t d e v e l o p m e n t a l n e e d s n e e d n o t be d e t r i m e n t a l to c o g n i t i v e f u n c t i o n i n g . No d e c l i n e o f d a y c a r e i n f a n t s ' s c o r e s was f o u n d r e l a t i v e to h o m e - r e a r e d c o n t r o l s . C a l d w e l l a n d h e r c o l l e a g u e s ( 1 9 7 0 ) also c o n f i r m e d t h e l a c k o f d e c l i n e in C a t t e l l s c o r e s f o r i n f a n t s r e a r e d in g r o u p c a r e o v e r a t w o y e a r p e r i o d . Findings of strong maternal-infant a t t a c h m e n t d e s p i t e d a y c a r e a t t e n d a n c e h a v e s i n c e been c o n f i r m e d b y o t h e r s ( K a g a n , K e a r s l e y , & Z e l a z o , 1977; R a m e y , t 9 8 1 ) . Note that the intervention projects for which such evaluative data are available provide University based, high quality infant nursery care. Such findings have answered some of t h e f e a r s o f t h o s e w h o c o n f o u n d e d t h e d i s a s t r o u s e f f e c t s of f u l l t i m e i n s t i t u t i o n a l r e a r i n g , b e r e f t o f l o v i n g p e r s o n a l i n t e r a c t i o n s o r of l e a r n i n g g a m e s , w i t h t h e s i t u a t i o n in w h i c h i n f a n t s a r e c a r e d f o r in small g r o u p s f o r p a r t of a day.
V a r i a t i o n s in I n f a n t I n t e r v e n t i o n Models Quite different intervention strategies h a v e been c a r r i e d out specifically to e n h a n c e i n f a n t d e v e l o p m e n t a n d t o p r o v i d e w h a t C a l d w e l l ( 1 9 6 7 ) has d u b b e d t h e "optimal learning environment". Some of t h e s e p r o g r a m m a t i c v a r i a t i o n s h a v e b e e n predominantly o r i e n t e d t o w a r d p r o v i s i o n o f s e r v i c e o r t o w a r d d e v e l o p m e n t of an implementation process for a given curricular model to f u r t h e r language skills, socioemotional or cognitive functioning, nutrition or physical development. Consequently, e v a l u a t i o n d a t a a r e l a c k i n g f o r some i n n o v a t i v e i n f a n c y i n t e r v e n t i o n efforts. Three examples are: Project lending
L i t t l e K i d s in G r e e n v i l l e , S o u t h C a r o l i n a , w h i c h p r o v i d e s b o o k a n d t o y facilities and group meetings for families with infants--in a public library.
Gerber without
(1981), who encourages infants direct interference by adults.
Neser & Gaughan's Core/Pals w h i c h f o c u s e s on p a r e n t / i n f a n t
to
attain
stages
of
motor
p r o g r a m ( 1 9 8 1 ) f o r p a r e n t s of i n f a n t s dance and movement synchronies.
development
and toddlers,
Fortunately, many infant intervention programs have undertaken evaluative procedures. B r o m w i c h ( 1 9 8 1 ) has s u c c i n c t l y i n d i c a t e d t h e d u a l p u r p o s e of a s s e s s m e n t , both diagnostic and evaluative: B e h a v i o r a l a s s e s s m e n t s e r v e s t w o p u r p o s e s in i n t e r v e n t i o n programs: 1) to e s t a b l i s h t h e c u r r e n t s t a t u s of t h e i n d i v i d u a l ' s b e h a v i o r o r p e r f o r m a n c e in s p e c i f i e d a r e a s so t h a t an e d u c a t i o n a l o r c l i n i c a l p l a n can be made t h a t is l i k e l y to p r o d u c e c h a n g e in t h e d e s i r e d d i r e c t i o n , a n d 2) t o e v a l u a t e t h e e f f e c t i v e n e s s of t h e p r o g r a m b y c o m p a r i n g b e h a v i o r or performance before the program begins with behaviors or performa n c e a f t e r t h e p r o g r a m has b e e n in e f f e c t f o r a set p e r i o d o f t i m e . ( p . 32-33)
E v a l u a t i o n Measures R e f l e c t Pro(jrams D i f f e r e n c e s P r o g r a m s d i f f e r on a n u m b e r o f p a r a m e t e r s , a n d e v a l u a t i o n m e a s u r e s o f t e n r e f l e c t these differences. T a b l e 1 o f f e r s a c o m p a r i s o n o f t h e d i f f e r e n t k i n d s of e v a l u a t i o n m e a s u r e s u s e d b y some o f t h e m a j o r i n t e r v e n t i o n p r o g r a m s w i t h o r g a n i c a l l y n o r m a l infants.
Infant/Toddler Intervention Programs
307
Within the table, an X i n d i c a t e s p r e s e n c e o f an a t t r i b u t e or measure. For e x a m p l e , an X i n d i c a t e s w h e t h e r a c o n t r o l g r o u p was a v a i l a b l e , e i t h e r m a t c h e d o r randomly selected. B u r d e n ( 1 9 8 1 ) has c o m m e n t e d e x t e n s i v e l y on t h e " i n a d e q u a c y o f l a b o r a t o r y b a s e d e x p e r i m e n t a l d e s i g n t o t e l l us v e r y m u c h o f w o r t h a b o u t t h e real world" (p. 132). T h e p a r a d i g m t h a t a s s i g n s v a l i d i t y o n l y to e v a l u a t i v e d a t a in p r o j e c t s w i t h r a n d o m a s s i g n m e n t o f i n f a n t s to e x p e r i m e n t a l o r c o n t r o l g r o u p s w o u l d c a u s e us t o r e j e c t t h e c o n t r i b u t i o n s o f m a n y o f t h e p r o j e c t s l i s t e d . Choice o f e v a l u a t i o n m e a s u r e s can be seen in T a b l e 1 t o v a r y w i d e l y as a f u n c t i o n o f program goals, practices and parameters. Lack of equivalent attributes or measures makes program comparison difficult. For example, the target of program e f f o r t s m a y be t h e i n f a n t , t h e p a r e n t o r b o t h . Format and locale. M o d e l s d i f f e r in t h e f o r m a t a n d l o c a l e o f i n t e r v e n t i o n , whether at h o m e , in g r o u p c a r e s e t t i n g , in a s p e c i a l t u t o r i a l r o o m , in a p a r e n t g r o u p meeting or combinations of the above. In t h e case o f S k e e l s ' ( 1 9 6 6 ) i n n o v a t i v e p l a c e m e n t o f low IQ o r p h a n a g e b a b i e s w i t h l o v i n g s u r r o g a t e m o t h e r s w h o w e r e r e s i d e n t s o f an i n s t i t u t i o n for mentally retarded girls and women, the locale differs radically from other projects. Y e t i n f a n t s p l a c e d f r o m 6 t o 52 m o n t h s in such "enrichment" s e t t i n g s g a i n e d f r o m 7 t o 58 IQ p o i n t s a n d w e r e s u b s e q u e n t l y adoptable. C o m p a r i s o n b a b i e s l e f t b a c k a t t h e o r p h a n a g e l o s t f r o m 9 to 45 IQ points and remained mostly wards of state institutions. Duration. Intervention duration varies widely. Gordon and colleagues (1977) carried out parametric variations to determine whether one, two, or three years ( o r c o m b i n a t i o n s of y e a r s ) o f a home v i s i t a t i o n i n t e r v e n t i o n model w o u l d i m p a c t differentially on d e v e l o p m e n t a l o u t c o m e s c o r e s . Few p r o j e c t s h a v e b e e n d e s i g n e d to a l l o w f o r a s s e s s m e n t o f d i f f e r e n t duration of intervention. Actually, some p r o j e c t s w e r e d e s i g n e d f o r q u i t e l i m i t e d t i m e p e r i o d s s u c h as 12 w e e k s o f p a r e n t meetings (Karnes & Zehrback, 1977). Blank & Solomon's program (1968) for older i n f a n t s was d e l i b e r a t e l y d e s i g n e d t o d e m o n s t r a t e t h e e c o n o m y a n d e f f i c i e n c y o f their tutorial model. T h e f u l l model c o n s i s t e d o f a t h r e e m o n t h , f i v e d a y a w e e k , one hour per day tutorial program to teach thinking skills and sequencing of concepts to disadvantaged 36 m o n t h o l d s d e f i c i e n t in j u s t t h o s e c o n c e p t u a l a n d language skills. Contrast groups received no p r o g r a m , a three-day-a-week program, or a daily time for personal attention without the specific reasoning skills curriculum. Only children who had participated in t h e f i v e - d a y - a - w e e k v a r i a n t made s u b s t a n t i a l IQ g a i n s . Program Delivery. More subtle evaluation difficulties arise when program models are not carried out uniformly w i t h all f a m i l i e s . For example, Lally (1969) reported that para-professionals in G o r d o n ' s home v i s i t a t i o n p r o j e c t ( t o t e a c h low SES, r u r a l m o t h e r s in F l o r i d a s e n s o r i m o t o r a n d l a n g u a g e games t o use w i t h t h e i r infants) were not always able to carry out their projected schedules. Trust building with families takes time. Some f a m i l i e s w e r e less l i k e l y t h a n o t h e r s t o keep appointments. Some p a r a p r o f e s s i o n a l s f o u n d i t h a r d t o be a u t o n o m o u s l y responsible for their own schedules of visits. Y e t o n l y g r o u p mean s c o r e s a r e a v a i l a b l e f o r i n f a n t s in p r o j e c t f a m i l i e s . I f , in f a c t , home v i s i t a t i o n is c a r r i e d o u t more frequently w i t h some f a m i l i e s c o m p a r e d to o t h e r s , can t h e e v a l u a t i o n s c o r e s o f all f a m i l i e s be l e g i t i m a t e l y c o m p a r e d w i t h c o n t r o l s w i t h i n p r o j e c t s a n d c o m p a r e d w i t h o u t c o m e s o f i n t e r v e n t i o n in o t h e r p r o j e c t s ? Staff. The level of training o f p r o j e c t s t a f f t h a t d e l i v e r s p r o g r a m has b e e n insufficiently considered as a s o u r c e o f v a r i a t i o n in o u t c o m e e f f i c a c y . Some models engage highly trained professionals. In Fraiberg's (1980) "Kitchen therapy" model, highly trained psychiatric social w o r k e r s patiently and painstakingly build relationships with mothers whose infants show serious failure to thrive. W i t h i n t h i s r e l a t i o n s h i p w o r k e r s t h e n e n g a g e t h e m o t h e r s to deal w i t h a n c i e n t e m o t i o n a l w o u n d s a n d f e a r s so t h a t t h e p a r e n t can b e c o m e e m o t i o n a l l y a b l e
of Model
(1968)
&/or Group
Infant
~o
X
~o
Learning
X
Personality
Measures
~ ....
Health
~
X
Language
Measures
Assessment Parent&ChildTogthr.(PACT) Home i n t e r v i e w Physic al Env. De sc r p.(PED) M a t e r n a l :~tyles of Hom~ Management
Clinical
Rotte~ [nte~nal-External Loc. of C o n t r o l SCI. HISM Score Parent i n t e r v i e w Parent Educ. W e e k l y Report
C a l d w e l l ST[M Fe]s P a r e n t B e h a v i o r ~ a r n e r ' s Index of Social C h a r a c t e r i s t i c s
Maternal Behavior Research instrument Maternal Behavior with T u t o r & Child I n v e n t o r y
Family
Home Env. I n v e n t o r y M o t h e r - i n f a n t Verbal I n t e r a c t i o n Rec. {VIR) Mother ObservChecklist (MOCL) Ypsilanti PiC. Sort. Inv.
X
.1 ~ ~.~ .~ ~
or Concept
¥psilantiC a r n e g i e Infant E d u c a t i o n Pro3ect (Lambie, Bond & Weikart, 1974)
~
Cog./Dev.
Parent B e h a v i o r Progresslon (in Home M o t h e r - I n f . interaction) Clinical Assessments
.one or two yr. Toy Demonstra. in home .matched controls .replication r a n d o m controls
.experimental g r o u p are y o u n g e r sibs. of disadvan, p r e schoolers .low-income controls
Control Contrast
P a r e n t - l n f a n t Interaction Model (Bromwich, [gBI)
1977)
Home
(1980
Mother Child Program (Levenstcin,
Fraiberg
Florida P a ~ e n t E d u c a t i o n Inf. & T o d d l e r Programs (Gordon, G u i n a g h & Jester, 1977)
HOME VISITATION: FOCUS ON M O T H E R INFANT D Y A D
Painter
Infant E d u c a t i o n R e s e a r c h Pro]ect (Schaefer & A a r o n s o n 1977)
HOME V I S I T A T I O N : FOCUS ON I N F A N T
Type
1
Evaluation Measures Used by Infant/Toddler Intervention Programs
TABLE
Supervisor Evaluation Toy D e m o n s t r a t o r Evaluations
O 00
Family Rehabilitation Project (Heber et. al.) 1972)
Children's Center (Caldwell et. al., 1968
1981)
A b e c e d a r i a n Project (Ramey & Campell)
.low income c o n t r o l s .high-ed uc. c o m m u n i t y contrast g r o u p s
.two hour w e e k l y group mtgs.& biw e e k l y home visits .low income control parents not e n r o l l e d in training prog.
Karnes & Z e h r b a c h (1977)
E N R I C H E D DAY CARE FOR INFANTS
.mothers in classes with infants weekly .comparison groups of h o m e - v i s i t e d mothers & infants
.infants with surrogate m o t h e r s in institutions for retarded .control inf. left in orphanage
.Concept Trng Group .Discovery G r o u p .non-participating control
Infant S t i m u l a t i o n / Mother Training (Badger, 1977)
PARENT GROUP M E E T I N G
Skeels (1966)
FOSTER PARENTING
P a l m e r & Siegel (1977)
.experimental infants removed from o r p h a n a g e for tutor. enrich.
Dennis & Sayegh (1965)
.controls left in orphanage
.experimental tutored 5x or 3x/week .controls in classrm. or given indiv. attention 5x/week
Blank & Solomon (1968)
T U T O R I A L WITH INFANT IN L E A R N I N G S E T T I N G
Table
] -
CONTINUED
APPROACH Classroom Interaction
Teacher Activity Checklist
Hess b S h i p m a n M o t h e r Child Learning Tasks
Implicit Parental LearningTheory(IPLET) C a l d w e l l STIM M a t e r n a l Child Interact. d u r i n g Physical Exam
S u r v e y on ParentalExp. C a l d w e l l ' s HOME Rotters Internality E x t e r n a l i t y Scale
Sparling/CampbellOpinion
Parent At ~ Res Ins.(PARI) Schaefer & Aaronson's Infant Beh. Inv. S c h a e f e r ' s Child B e h a ~ & P a r e n t Inventory
T e a c h e r Study Groups
Teacher Competency Checklist
CO O £O
O"
{Johnson et. al. 1975)
Parent Child Development Center (PC DC)
Family Development Research Prog. (Lally & Honig, 1977)
O M N I B U S MODELS: E N R I C H E D CARE FOR INFANTS PLUS PARENT PROGRAM
.experimental infants in day care a ram receiving home visitation .low income controls .high ed. contrast
.experimentals working & middle class Chinese & Caucasian children .home-~eared controls
Kagan et. al. 1977
K e i s t e r 1970
.experimentals mostly advantaged .home-reared controls
Fowler 1974
X
X
XX
Table 1
X
×
-
CONTINUED
Cornell U n l v e r s l t y De script. Scanning Record of Infant A c t i v i t y & infant Environment Emmerich O b s e r v e [ Ratings Schaefer Classroom B e h a v i o r Inventory Schaefer Classroom B e h a v i o r Checklist
Maternal Interactlom S t r u c t u r e d S1tuatlom (MISS] HOME (Caldwell) English-Spanish Receptive Vocab. T r a d i t i o n a l Family Ideology Index of A c h i e v e m e n t Values Child Rearing B e l , e f s P s y c h o l o g i c a l Well Being Psychologlcal Mindedness Locus of Control Scale iJarent Pract. I n t e r v ~ e w
Expectant Mothers' Diet Form W e e K k y & Monthly Home Visit Report STIM (inventory of Home Stimulation) IPLET Famlly Data Record CDT Ratings of Parents PEPI Parent Eval. of P r o g r ~ Intervimw
A t t a c h m e n t to Mo t~er vs. Careglver S e p a r a t i o n Protest
Home Interview (WAIS)
ABC I, II, & I I I (Assessing the Beh a v i o r s of Caregivers) Piagetian Task Checklist (Teacher Self Record)
~3
O
GO
Infant/Toddler Intervention Programs
311
t o f o c u s on t h e p r e s e n t n e e d s o f h e r b a b y f o r n u r t u r a n c e . The superior level of therapeutic skill and commitment of time and effort required to make it difficult to c o m p a r e t h e e f f i c a c y o f each a p r o g r a m d e l i v e r y s y s t e m w i t h less i n t e n s i v e , less focused models. S t a f f r a t i o o f a d u l t s to i n f a n t s as well as t h e t o t a l n u m b e r of s t a f f in a c h i l d c a r e s e t t i n g m u s t be c o n s i d e r e d i n f l u e n t i a l v a r i a b l e s t h a t can a f f e c t i n f a n t d e v e l o p mental outcomes. T h e A b t d a y c a r e s t u d y ( 1 9 7 9 ) f o u n d t h a t small g r o u p size a n d higher adult to child ratios were strongly related to measures of programmatic quality for infants and toddlers. Furthermore, "the number of different individu a l s r e l a t i n g t o a c h i l d , t h e a b i l i t y o f t h e s t a f f , a n d t h e q u a n t i t y a n d q u a l i t y o_ff i n t e r a c t i o n s m a y also h a v e an i n f l u e n c e " ( K i l m e r , 1979, p. 1 0 4 ) . Theoretical base. P r o g r a m s d i f f e r on s o u r c e o f m o d e o f i n s t r u c t i o n o r t h e o r e t i c a l base. A s c h e m a t i c a n a l y s i s o f some i n f a n t i n t e r v e n t i o n programs by curricular d i m e n s i o n , s u c h as d e n s i t y a n d v a r i e t y o f p e o p l e , m o d e o f i n s t r u c t i o n (whether d i d a c t i c o r s e q u e n c e d ) a n d s o u r c e of a c t i v i t i e s has b e e n c o m p i l e d b y A m b r o n (1977). Some p r o j e c t s m i x t h e o r i e s . L a l l y & H o n i g ( 1 9 7 7 a ) b a s e d on t h e FDRP infant day care curriculum on P i a g e t , E r i k s o n a n d l a n g u a g e d e v e l o p m e n t p r i n ciples. The family intervention c o m p o n e n t o f t h e p r o g r a m was b a s e d on Saul A t i n s k y ' s t h e o r y t h a t s h a r e d social d e c i s i o n s a r e a m e t h o d f o r g i v i n g p o w e r t o t h e p o w e r l e s s in o r d e r to e f f e c t u a t e p o s i t i v e social c h a n g e . Fraiberg's model is highly psychoanalytic. Herbert-Jackson and colleagues (1980) base their infant care curriculum on a b e h a v i o r i s t i c mode. Do t h e o r i e s m a k e a d i f f e r e n c e in assessed program outcomes? T h i s q u e s t i o n is n o t t e s t a b l e at p r e s e n t p a r t l y because of the differing nature of the populations served by models with differing theoretical orientations. Psychoanalytic models have been used more often with more disturbed parents. Learning-activities curricula have been more often used with mothers not considered at as high a risk for child a b u s e or neglect. T h e large n u m b e r s of variables on which p r o g r a m s of their efficacy a dubious exercise at present.
differ m a k e s direct comparison
Selection of E v a l u a t i o n Measures a n d C o n t r o l G r o u p s I t is d i f f i c u l t t o c o m p a r e t h e e f f e c t i v e n e s s o f o n e i n f a n t i n t e r v e n t i o n model w i t h another when the selection of instruments chosen for monitoring differs widely among models. As can be seen in T a b l e 1, d i f f e r e n c e s in d e v e l o p m e n t a l q u o t i e n t s from a variety of infant tests have been used to demonstrate program efficacy w i t h i n f a n t s in p r o g r a m s c o m p a r e d t o t h o s e n o t s e r v e d . Those not served have u s u a l l y b e e n c a r e f u l l y m a t c h e d on d e m o g r a p h i c v a r i a b l e s o r a s s i g n e d t o a c o n t r o l group. Some p r o g r a m s s e r v i n g l o w - i n c o m e f a m i l i e s p r o v i d e s c o r e s f o r a c o n t r a s t g r o u p o f home r e a r e d h i g h SES i n f a n t s . T h e v a l u e o f t h i s t h i r d g r o u p is d e m o n strated when low SES e x p e r i m e n t a l children show significant differences in c o m p a r i s o n t o low SES c o n t r o l s a n d y e t a r e n o t f u n c t i o n i n g a t o p t i m a l l e v e l s t h a t permit high expectations f o r l a t e r school w o r k . Ramey and Campbell (1981) report significant IQ a d v a n t a g e s f o r low SES A b e c e d a r i a n p r o g r a m i n f a n t s ( I Q 9 3 . 4 ) a t f o u r y e a r s o f age c o m p a r e d to c o n t r o l s ( I Q 8 1 . 3 ) . Yet, compared with o t h e r i n t e r v e n t i o n o u t c o m e s , s u c h as t h e r e s p e c t i v e s c o r e s o f 1 0 9 . 9 7 , 1 0 0 . 7 7 a n d 136.05 at four years for the experimentals, low-income controls, and high education contrast chldren o f t h e FDRP p r o g r a m ( L a l l y & H o n i g , 1 9 7 7 b ) , t h e A b e c e d a r i a n e x p e r i m e n t a l c h i l d r e n seem a t h i g h e r r i s k a t t h e e n d o f i n f a n c y f o r later difficulty with academic work. O n l y l o n g i t u d i n a l f o l l o w u p s o f i n f a n t s in t h e s e p r o g r a m s w i l l p e r m i t a r e l a t i v e a n a l y s i s of t h e i m p o r t a n c e o f IQ s c o r e s to predict the future s c h o l a s t i c a n d o t h e r l i f e a c h i e v e m e n t s of t h e i n f a n t s s e r v e d . C a u t i o n s h o u l d be u s e d in u s i n g IQ s c o r e s a l o n e at t h e e n d o f p r o g r a m as an index of Iongterm impact of the program.
312
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Some p r o g r a m s Lest i n f a n t s f r e q u e n t l y . F r e q u e n t t e s t i n g of i n f a n t s , p a r t i c u l a r l y i f f a m i l y is p r e s e n t , m a y well be c o n c e p t u a l i z e d as a u n i q u e i n t e r v e n t i o n p r o c e d u r e o r " t r e a t m e n t " in i t s e l f ( H o n i g , 1981; L a m b i e et a l . , 1 9 7 4 ) .
Effects of Testing Conditions T h e c o n t e x t in w h i c h a s s e s s m e n t s a r e c a r r i e d o u t can i n f l u e n c e s c o r e s s i g n i f i cantly. High-risk t o d d l e r s w h o a t t e n d e d an e n r i c h e d d a y c a r e p r o g r a m s h o w e d more communication maturity when tested by strange, white adults then did controls, who found the strange adults more stressful. The enriched program i n f a n t s d i d n o t e x h i b i t m o r e c o m p e t e n c y t h a n c o n t r o l s w h e n in c o m m u n i c a t i v e interactions with their mothers (O~Connell & Farran, 1982). When a n d w h e r e d a t a on c a r e g i v e r - i n f a n t interactions are collected may influence test scores. Situation and setting may alter adult-child interaction frequency and quality. Honig & Wittmer (1979) have found that the least amount of caregivert o d d l e r i n t e r a c t i o n a n d t h e l o w e r s r a t e s of t o d d l e r c o m p l i a n c e w i t h a d u l t s d i r e c tives occurred in g r o s s m o t o r a c t i v i t y s e t t i n g s c o m p a r e d t o e a t i n g , s t o r y / s o n g , fine motor or creative activities. Optimal testing conditions that guarantee a comfortable, well-fed, alert, cooperat i v e t o t m a y be c r i t i c a l in d e t e r m i n i n g w h e t h e r e x p e r i m e n t a l p r o g r a m m a t i c e f f o r t s h a v e r e a l l y e f f e c t e d i m p o r t a n t c h a n g e s in t e s t r e s u l t s ( H o n i g & L a l l y , 1 9 7 5 ) . Heber and colleagues (1972) provided intensive interventions for infants whose m o t h e r s h a d l o s u n d e r 70. Mean l o s o f c h i l d r e n w h o h a d b e e n in t h e e n r i c h e d d a y c a r e p r o g r a m f r o m t h r e e m o n t h s u n t i l s i x t y m o n t h s was 126. Yet, under o p t i m a l t e s t i n g c o n d i t i o n s , t h e low SES c o n t r o l s a c h i e v e d a mean IQ s c o r e of 9 5 . 7 .
Proc_ess Evaluation:
The Missing Link in Program Comparisons?
E v a l u a t i o n is t h e s c i e n c e o f p r o v i d i n g i n f o r m a t i o n f o r d e c i s i o n m a k i n g . The four functions of planning, programming, implementing and then recycling (given the i n f o r m a t i o n g a t h e r e d ) in o r d e r t o i m p r o v e p r o g r a m h a v e b e e n l a b e l e d C . I . P . P . - Conduct, Input, Process and Product evaluation (Stufflebeam, 1968). Thus e v a l u a t i o n s o c c u r in a s e r i e s of s t a g e s d u r i n g t h e life o f a p r o j e c t . T h e goal o f m a n y i n f a n t i n t e r v e n t i o n p r o g r a m s has b e e n p r e v e n t i o n of s o c i o c u l t u r a l d e f i c i t in i n f a n t s r e a r e d in l o w - i n c o m e , l o w - e d u c a t i o n f a m i l i e s . Another i m p o r t a n t goal m a y be s u p p o r t f o r such f a m i l i e s . Early program development efforts o f t e n f o c u s e d on d e v e l o p m e n t o f s t r a t e g i e s a n d r e s o u r c e s t o a c h i e v e p r o g r a m g o a l s a n d to m e a s u r e t h e i m p a c t of p r o g r a m . For example, one early c h a l l e n g e was to d e v i s e w a y s to o p e r a t i o n a l i z e P i a g e t i a n t h e o r y so t h a t a c u r r i c u l a r model f o r i n f a n t s c o u l d be e s t a b l i s h e d a n d m o n i t o r e d ( H o n i g & L a l l y , 1981). Currently, dozens of such curricula are available, although evaluation m e a s u r e s to assess t h e i r e f f e c t i v e n e s s a r e in f a r s h o r t e r s u p p l y ( H o n i g & W i t t m e r , 1982). A t t h i s e a r l y s t a g e o f k n o w l e d g e c o n c e r n i n g t h e e f f e c t s of i n f a n t i n t e r v e n t i o n , p r o c e s s e v a l u a t i o n , sometimes c a l l e d f o r m a t i v e e v a l u a t i o n , m a y be m o r e c r i t i c a l f o r increasing the knowledge base. C a l d w e t l ( 1 9 7 7 ) has u r g e d t h a t " w e m u s t e n g a g e in c o n t i n u i n g e v a l u a t i o n of t h e e x t e n t t o w h i c h we a r e i n d e e d i m p l e m e n t i n g o u r o w n ideas a n d t r a n s l a t i n g those ideas into practice" (p. 50). For f o r m a t i v e e v a l u a t i o n to be f u l l y i n f o r m a t i v e of w h e t h e r a p r o g r a m is a c t u a l l y h a p p e n i n g a n d is w o r k i n g , all d o m a i n s in w h i c h t h e r e a r e p r o g r a m g o a l s and o b j e c t i v e s s h o u l d be samoled.
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New Measures
N e i t h e r f o r m a t i v e n o r s u m m a t i v e e v a l u a t i o n of s h o r t t e r m c o g n i t i v e g a i n s in i n f a n t p r o g r a m s may be as i m p o r t a n t as e v a l u a t i o n of s o c i a l - p e r s o n a l s k i l l s , p r o b l e m s o l v i n g s k i l l s , and a d v a n c e s in a c h i e v e m e n t m o t i v a t i o n . C l i n i c a l and e c o l o g i c a l e v a l u a t i o n m e a s u r e s can i m p r o v e p s y c h o m e t r i c t e s t p r e d i c t a b i l i t y . I n t e r v i e w s to elicit parent or caregiver judgments about programs have provided insights into p r o g r a m s t r n e g t h s and w e a k n e s s e s . A d d i t i o n a l l y , u n o b s t r u s i v e m e a s u r e s , such as t h e n u m b e r of p r o g r a m m o t h e r s w h o h a v e c o m p l e t e d a h i g h school d i p l o m a , can be used to i n d e x e f f e c t i v e n e s s o f p r o g r a m ( H o n i g , 1979).
Collcl usiolrls
D i f f e r e n c e s in p r o g r a m g o a l s , t h e o r y , populations served, methods, duration, s t a f f , and e v a l u a t i o n m e a s u r e s make i t d i f f i c u l t to c o m p a r e t h e e f f e c t i v e n e s s o f different infant intervention programs. I n c r e a s e d e m p h a s i s on f o r m a t i v e e v a l u a t i o n is s u g g e s t e d as a w a y of e n s u r i n g t h a t p r o g r a m is b e i n g c a r r i e d o u t . Where e f f e c t i v e n e s s is in d o u b t , p r o c e s s e v a l u a t i o n can p r o v i d e d a t a to a d d r e s s such c o n c e r n s . Useful a s s e s s m e n t s c o u l d i n c l u d e c l a s s r o o m c l i m a t e , m a t e r n a l i n f a n t t r a n s a c t i o n s , home v i s i t o r i n t e r a c t i o n s w i t h m o t h e r , and a d u l t r e s p o n s i v e ness to c h i l d b i d s f o r e n g a g e m e n t . F i n a l l y , i t is s u g g e s t e d t h a t t h e r e p e r t o i r e of p s y c h o m e t r i c c h i l d m e a s u r e s n e e d s to be b r o a d e n e d to i n c l u d e s y s t e m a t i c c l i n i c a l a s s e s s m e n t s o f c h i l d f u n c t i o n i n g w i t h i n d a i l y s e t t i n g s , a c t i v i t i e s and i n t e r a c t i o n s . P r o m p t f e e d b a c k f r o m such f o r m a t i v e e v a l u a t i o n to p r o j e c t p e r s o n n e l w o u l d p e r m i t r e a s s e s s m e n t of p r o j e c t m e t h o d s and e f f o r t s . Thus, p r o c e s s e v a l u a t i o n c o u l d p r o v i d e a key to m o r e s u s t a i n e d , s u c c e s s f u l o u t c o m e s in i n f a n c y i n t e r v e n t i o n p r o g r a m s .
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P a l m e r , F . , & S i e g e l , R. Minimal i n t e r v e n t i o n at ages t w o and t h r e e and s u b sequent intellective changes. In IVI.C. Day & R . K . P a r k e r ( E d s . ) , The p n e school in action (2nd ed.). Boston: A l l y n & B a c o n , 1977. Ramey, C. C o n s e q u e n c e s of i n f a n t d a y c a r e . In B. W e i s s b o u r d & J. M u s i c k (Eds.), Infants: Their social environments. Washington, DC: National A s s o c i a t i o n f o r t h e E d u c a t i o n of Y o u n g C h i l d r e n , 1981. Ramey, C . , & C a m p b e l l , F . A . E d u c a t i o n a l i n t e r v e n t i o n f o r c h i l d r e n at r i s k f o r mild retardation: A longitudinal analysis. In P. IVlittler ( E d . ) , F r o n t i e r s o f knowledge in mental retardation. Baltimore: University P a r k P r e s s , 1981. S c h a e f e r , E . , & A a r o n s e n , M. I n f a n t e d u c a t i o n r e s e a r c h p r o j e c t : Implementation and i m p l i c a t i o n s of a home t u t o r i n g p r o g r a m . In M . C . Day & R . K . P a r k e r (Eds.), Zhe preschool i n a c t i o n ( 2 n d e d . ) . Boston: Allyn & Bacon, Inc., 1977. Skells, H.M. A follow
A d u l t s t a t u s of c h i l d r e n w i t h c o n t r a s t i n g e a r l y life e x p e r i e n c e s : u p s t u d y . Monographs of the Societ U for Research in Child Development, 1966, 31(3, Serial N. 105). An i n q u i r y i n t o t h e g e n e s i s of p s y c h i a t r i c c o n d i t i o n s Hospitalism: In A . F r e u d et al. ( E d s . ) , The p s y c h o a n a l y t i c study o f childhood. New Y o r k : International Universities Press, 1945. the c h i l d ( V o l . 1).
Spitz, R.A. in e a r l y
Stufflebeam
D.L.
Toward
a science of e d u c a t i o n a l
evaluation.
Educational Tech-
nology, 1968, 8 ( 1 4 ) , 5-12. THE A U T H O R A L I C E S T E R L I N G HONIG is P r o f e s s o r of C h i l d D e v e l o p m e n t in t h e C o l l e g e f o r Human D e v e l o p m e n t at S y r a c u s e U n i v e r s i t y . She is a u t h o r of P a r e n t I n v o l v e m e n t in E a r l y C h i l d h o o d E d u c a t i o n ( N a t i o n a l A s s o c i a t i o n f o r t h e E d u c a t i o n of Y o u n g Children).
0191-491X/83/030305-12506.00/0 Copyright© 1983PergamonPressLtd.
Printedin GreatBritain.All rights reserved.
EVALUATION OF INFANT/TODDLER INTERVENTION PROGRAMS Alice Sterling Honig College for Human Development, Syracuse, New York, USA
The need for infant enrichment programs has b e e n h i g h l i g h t e d in t h e p a s t decades. R e s e a r c h e v i d e n c e has a c c u m u l a t e d t h a t i n f a n t s w h o w e r e r a i s e d in families that did not provide rich language and play experiences dropped drast i c a l l y in IQ b y t h r e e y e a r s o f age c o m p a r e d t o t h o s e r a i s e d in d e v e l o p m e n t a l l y more stimulating environments (Golden, Birns, Bridger, & Moss, 1971). Also, increasing numbers of single and working parents have found quality substitute c a r e f o r i n f a n t s t o be a r a r e c o m m o d i t y . Their concerns have lent urgency to e f f o r t s to e v a l u a t e t h e e f f e c t s o f i n f a n t c a r e p r o g r a m s .
Historical Background T h e c a r e o f v e r y y o u n g c h i l d r e n in o t h e r t h a n o w n home s e t t i n g s has b e e n a social c o n c e r n in m a n y a g e s . P l a t o l o n g ago s u g g e s t e d t h a t i d e a l l y i n f a n t s be reared by specially trained surrogate caregivers. In F r a n c e , p l a c i n g i n f a n t s "en nourrice" served for centuries as a s y s t e m w h e r e b y r u r a l p e a s a n t w o m e n reared nurslings of urban parents unable to care for their own children during the early years. L a n g u a g e d e l a y s h a v e b e e n f o u n d in c h i l d r e n w h o w e r e r e a r e d "en nourrice" (Brunet & Lezine, 1965). S p i t z ( 1 9 4 5 ) , a p s y c h o a n a l y s t i n t e r e s t e d in t h e e f f e c t s o f i n f a n t s e p a r a t i o n f r o m t h e m o t h e r , e v a l u a t e d t h e e f f e c t s o f f o u r v a r i e t i e s o f i n f a n t r e a r i n g c o n d i t i o n s in South America. M a r k e d c o n t r a s t s w e r e f o u n d in c l i n i c a l l y a s s e s s e d b e h a v i o r s a n d in d e v e l o p m e n t a l q u o t i e n t s b e t w e e n t h e f i r s t t h i r d a n d t h e l a s t t h i r d o f t h e f i r s t y e a r o f l i f e in d i f f e r e n t g r o u p s . I n i t i a l l y , i n f a n t s r e a r e d in p r o f e s s i o n a l f a m i l i e s differed greatly in d e v e l o p m e n t a l q u o t i e n t s ( I Q 133) f r o m t h o s e r a i s e d in an isolated poor fishing v i l l a g e ( I Q 107) o r in p r i s o n nurseries with attentive maternal care available (IQ 101.5). Y e t in t h e s e g r o u p s , b a b i e s d e v e l o p e d welt d u r i n g t h e f i r s t y e a r a n d t h e i r mean IQs r e m a i n e d r e s p e c t i v e l y t h e same o v e r t h e first year of life. In c o n t r a s t , S p i t z r e p o r t e d a s e v e r e d r o p in d e v e l o p m e n t a l s c o r e , f r o m 124 t o 72, f o r i n f a n t s b o r n t o m o t h e r s o u t o f w e d l o c k a n d s u b s e q u e n t l y g i v e n u p t o a f o u n d l i n g home a t a b o u t t h r e e m o n t h s . Such naturally occurring d i f f e r e n c e s in o u t c o m e as a f u n c t i o n o f d i f f e r e n t i n f a n t r e a r i n g s i t u a t i o n s led t o i n i t i a l a p p r e h e n s i o n a n d c o n c e r n f o r i n f a n t w e l f a r e in o t h e r t h a n home c a r e . Clinicians became alarmed that group day care for infants w o u l d i n e v i t a b l y lead to d e f i c i t s s u c h as h a d b e e n f o u n d in i n s t i t u t i o n a l l y r e a r e d babies. T h e c l i n i c i a n ' s i n f l u e n c e was s u c h t h a t i n i t i a l l y , p i o n e e r i n f a n t d a y c a r e programs chose their evaluation measures to alleviate just such concerns. Keister 305
306
A. S. Honig
(1977) for example, set out to demonstrate that enriched group care with attention t o i n f a n t d e v e l o p m e n t a l n e e d s n e e d n o t be d e t r i m e n t a l to c o g n i t i v e f u n c t i o n i n g . No d e c l i n e o f d a y c a r e i n f a n t s ' s c o r e s was f o u n d r e l a t i v e to h o m e - r e a r e d c o n t r o l s . C a l d w e l l a n d h e r c o l l e a g u e s ( 1 9 7 0 ) also c o n f i r m e d t h e l a c k o f d e c l i n e in C a t t e l l s c o r e s f o r i n f a n t s r e a r e d in g r o u p c a r e o v e r a t w o y e a r p e r i o d . Findings of strong maternal-infant a t t a c h m e n t d e s p i t e d a y c a r e a t t e n d a n c e h a v e s i n c e been c o n f i r m e d b y o t h e r s ( K a g a n , K e a r s l e y , & Z e l a z o , 1977; R a m e y , t 9 8 1 ) . Note that the intervention projects for which such evaluative data are available provide University based, high quality infant nursery care. Such findings have answered some of t h e f e a r s o f t h o s e w h o c o n f o u n d e d t h e d i s a s t r o u s e f f e c t s of f u l l t i m e i n s t i t u t i o n a l r e a r i n g , b e r e f t o f l o v i n g p e r s o n a l i n t e r a c t i o n s o r of l e a r n i n g g a m e s , w i t h t h e s i t u a t i o n in w h i c h i n f a n t s a r e c a r e d f o r in small g r o u p s f o r p a r t of a day.
V a r i a t i o n s in I n f a n t I n t e r v e n t i o n Models Quite different intervention strategies h a v e been c a r r i e d out specifically to e n h a n c e i n f a n t d e v e l o p m e n t a n d t o p r o v i d e w h a t C a l d w e l l ( 1 9 6 7 ) has d u b b e d t h e "optimal learning environment". Some of t h e s e p r o g r a m m a t i c v a r i a t i o n s h a v e b e e n predominantly o r i e n t e d t o w a r d p r o v i s i o n o f s e r v i c e o r t o w a r d d e v e l o p m e n t of an implementation process for a given curricular model to f u r t h e r language skills, socioemotional or cognitive functioning, nutrition or physical development. Consequently, e v a l u a t i o n d a t a a r e l a c k i n g f o r some i n n o v a t i v e i n f a n c y i n t e r v e n t i o n efforts. Three examples are: Project lending
L i t t l e K i d s in G r e e n v i l l e , S o u t h C a r o l i n a , w h i c h p r o v i d e s b o o k a n d t o y facilities and group meetings for families with infants--in a public library.
Gerber without
(1981), who encourages infants direct interference by adults.
Neser & Gaughan's Core/Pals w h i c h f o c u s e s on p a r e n t / i n f a n t
to
attain
stages
of
motor
p r o g r a m ( 1 9 8 1 ) f o r p a r e n t s of i n f a n t s dance and movement synchronies.
development
and toddlers,
Fortunately, many infant intervention programs have undertaken evaluative procedures. B r o m w i c h ( 1 9 8 1 ) has s u c c i n c t l y i n d i c a t e d t h e d u a l p u r p o s e of a s s e s s m e n t , both diagnostic and evaluative: B e h a v i o r a l a s s e s s m e n t s e r v e s t w o p u r p o s e s in i n t e r v e n t i o n programs: 1) to e s t a b l i s h t h e c u r r e n t s t a t u s of t h e i n d i v i d u a l ' s b e h a v i o r o r p e r f o r m a n c e in s p e c i f i e d a r e a s so t h a t an e d u c a t i o n a l o r c l i n i c a l p l a n can be made t h a t is l i k e l y to p r o d u c e c h a n g e in t h e d e s i r e d d i r e c t i o n , a n d 2) t o e v a l u a t e t h e e f f e c t i v e n e s s of t h e p r o g r a m b y c o m p a r i n g b e h a v i o r or performance before the program begins with behaviors or performa n c e a f t e r t h e p r o g r a m has b e e n in e f f e c t f o r a set p e r i o d o f t i m e . ( p . 32-33)
E v a l u a t i o n Measures R e f l e c t Pro(jrams D i f f e r e n c e s P r o g r a m s d i f f e r on a n u m b e r o f p a r a m e t e r s , a n d e v a l u a t i o n m e a s u r e s o f t e n r e f l e c t these differences. T a b l e 1 o f f e r s a c o m p a r i s o n o f t h e d i f f e r e n t k i n d s of e v a l u a t i o n m e a s u r e s u s e d b y some o f t h e m a j o r i n t e r v e n t i o n p r o g r a m s w i t h o r g a n i c a l l y n o r m a l infants.
Infant/Toddler Intervention Programs
307
Within the table, an X i n d i c a t e s p r e s e n c e o f an a t t r i b u t e or measure. For e x a m p l e , an X i n d i c a t e s w h e t h e r a c o n t r o l g r o u p was a v a i l a b l e , e i t h e r m a t c h e d o r randomly selected. B u r d e n ( 1 9 8 1 ) has c o m m e n t e d e x t e n s i v e l y on t h e " i n a d e q u a c y o f l a b o r a t o r y b a s e d e x p e r i m e n t a l d e s i g n t o t e l l us v e r y m u c h o f w o r t h a b o u t t h e real world" (p. 132). T h e p a r a d i g m t h a t a s s i g n s v a l i d i t y o n l y to e v a l u a t i v e d a t a in p r o j e c t s w i t h r a n d o m a s s i g n m e n t o f i n f a n t s to e x p e r i m e n t a l o r c o n t r o l g r o u p s w o u l d c a u s e us t o r e j e c t t h e c o n t r i b u t i o n s o f m a n y o f t h e p r o j e c t s l i s t e d . Choice o f e v a l u a t i o n m e a s u r e s can be seen in T a b l e 1 t o v a r y w i d e l y as a f u n c t i o n o f program goals, practices and parameters. Lack of equivalent attributes or measures makes program comparison difficult. For example, the target of program e f f o r t s m a y be t h e i n f a n t , t h e p a r e n t o r b o t h . Format and locale. M o d e l s d i f f e r in t h e f o r m a t a n d l o c a l e o f i n t e r v e n t i o n , whether at h o m e , in g r o u p c a r e s e t t i n g , in a s p e c i a l t u t o r i a l r o o m , in a p a r e n t g r o u p meeting or combinations of the above. In t h e case o f S k e e l s ' ( 1 9 6 6 ) i n n o v a t i v e p l a c e m e n t o f low IQ o r p h a n a g e b a b i e s w i t h l o v i n g s u r r o g a t e m o t h e r s w h o w e r e r e s i d e n t s o f an i n s t i t u t i o n for mentally retarded girls and women, the locale differs radically from other projects. Y e t i n f a n t s p l a c e d f r o m 6 t o 52 m o n t h s in such "enrichment" s e t t i n g s g a i n e d f r o m 7 t o 58 IQ p o i n t s a n d w e r e s u b s e q u e n t l y adoptable. C o m p a r i s o n b a b i e s l e f t b a c k a t t h e o r p h a n a g e l o s t f r o m 9 to 45 IQ points and remained mostly wards of state institutions. Duration. Intervention duration varies widely. Gordon and colleagues (1977) carried out parametric variations to determine whether one, two, or three years ( o r c o m b i n a t i o n s of y e a r s ) o f a home v i s i t a t i o n i n t e r v e n t i o n model w o u l d i m p a c t differentially on d e v e l o p m e n t a l o u t c o m e s c o r e s . Few p r o j e c t s h a v e b e e n d e s i g n e d to a l l o w f o r a s s e s s m e n t o f d i f f e r e n t duration of intervention. Actually, some p r o j e c t s w e r e d e s i g n e d f o r q u i t e l i m i t e d t i m e p e r i o d s s u c h as 12 w e e k s o f p a r e n t meetings (Karnes & Zehrback, 1977). Blank & Solomon's program (1968) for older i n f a n t s was d e l i b e r a t e l y d e s i g n e d t o d e m o n s t r a t e t h e e c o n o m y a n d e f f i c i e n c y o f their tutorial model. T h e f u l l model c o n s i s t e d o f a t h r e e m o n t h , f i v e d a y a w e e k , one hour per day tutorial program to teach thinking skills and sequencing of concepts to disadvantaged 36 m o n t h o l d s d e f i c i e n t in j u s t t h o s e c o n c e p t u a l a n d language skills. Contrast groups received no p r o g r a m , a three-day-a-week program, or a daily time for personal attention without the specific reasoning skills curriculum. Only children who had participated in t h e f i v e - d a y - a - w e e k v a r i a n t made s u b s t a n t i a l IQ g a i n s . Program Delivery. More subtle evaluation difficulties arise when program models are not carried out uniformly w i t h all f a m i l i e s . For example, Lally (1969) reported that para-professionals in G o r d o n ' s home v i s i t a t i o n p r o j e c t ( t o t e a c h low SES, r u r a l m o t h e r s in F l o r i d a s e n s o r i m o t o r a n d l a n g u a g e games t o use w i t h t h e i r infants) were not always able to carry out their projected schedules. Trust building with families takes time. Some f a m i l i e s w e r e less l i k e l y t h a n o t h e r s t o keep appointments. Some p a r a p r o f e s s i o n a l s f o u n d i t h a r d t o be a u t o n o m o u s l y responsible for their own schedules of visits. Y e t o n l y g r o u p mean s c o r e s a r e a v a i l a b l e f o r i n f a n t s in p r o j e c t f a m i l i e s . I f , in f a c t , home v i s i t a t i o n is c a r r i e d o u t more frequently w i t h some f a m i l i e s c o m p a r e d to o t h e r s , can t h e e v a l u a t i o n s c o r e s o f all f a m i l i e s be l e g i t i m a t e l y c o m p a r e d w i t h c o n t r o l s w i t h i n p r o j e c t s a n d c o m p a r e d w i t h o u t c o m e s o f i n t e r v e n t i o n in o t h e r p r o j e c t s ? Staff. The level of training o f p r o j e c t s t a f f t h a t d e l i v e r s p r o g r a m has b e e n insufficiently considered as a s o u r c e o f v a r i a t i o n in o u t c o m e e f f i c a c y . Some models engage highly trained professionals. In Fraiberg's (1980) "Kitchen therapy" model, highly trained psychiatric social w o r k e r s patiently and painstakingly build relationships with mothers whose infants show serious failure to thrive. W i t h i n t h i s r e l a t i o n s h i p w o r k e r s t h e n e n g a g e t h e m o t h e r s to deal w i t h a n c i e n t e m o t i o n a l w o u n d s a n d f e a r s so t h a t t h e p a r e n t can b e c o m e e m o t i o n a l l y a b l e
of Model
(1968)
&/or Group
Infant
~o
X
~o
Learning
X
Personality
Measures
~ ....
Health
~
X
Language
Measures
Assessment Parent&ChildTogthr.(PACT) Home i n t e r v i e w Physic al Env. De sc r p.(PED) M a t e r n a l :~tyles of Hom~ Management
Clinical
Rotte~ [nte~nal-External Loc. of C o n t r o l SCI. HISM Score Parent i n t e r v i e w Parent Educ. W e e k l y Report
C a l d w e l l ST[M Fe]s P a r e n t B e h a v i o r ~ a r n e r ' s Index of Social C h a r a c t e r i s t i c s
Maternal Behavior Research instrument Maternal Behavior with T u t o r & Child I n v e n t o r y
Family
Home Env. I n v e n t o r y M o t h e r - i n f a n t Verbal I n t e r a c t i o n Rec. {VIR) Mother ObservChecklist (MOCL) Ypsilanti PiC. Sort. Inv.
X
.1 ~ ~.~ .~ ~
or Concept
¥psilantiC a r n e g i e Infant E d u c a t i o n Pro3ect (Lambie, Bond & Weikart, 1974)
~
Cog./Dev.
Parent B e h a v i o r Progresslon (in Home M o t h e r - I n f . interaction) Clinical Assessments
.one or two yr. Toy Demonstra. in home .matched controls .replication r a n d o m controls
.experimental g r o u p are y o u n g e r sibs. of disadvan, p r e schoolers .low-income controls
Control Contrast
P a r e n t - l n f a n t Interaction Model (Bromwich, [gBI)
1977)
Home
(1980
Mother Child Program (Levenstcin,
Fraiberg
Florida P a ~ e n t E d u c a t i o n Inf. & T o d d l e r Programs (Gordon, G u i n a g h & Jester, 1977)
HOME VISITATION: FOCUS ON M O T H E R INFANT D Y A D
Painter
Infant E d u c a t i o n R e s e a r c h Pro]ect (Schaefer & A a r o n s o n 1977)
HOME V I S I T A T I O N : FOCUS ON I N F A N T
Type
1
Evaluation Measures Used by Infant/Toddler Intervention Programs
TABLE
Supervisor Evaluation Toy D e m o n s t r a t o r Evaluations
O 00
Family Rehabilitation Project (Heber et. al.) 1972)
Children's Center (Caldwell et. al., 1968
1981)
A b e c e d a r i a n Project (Ramey & Campell)
.low income c o n t r o l s .high-ed uc. c o m m u n i t y contrast g r o u p s
.two hour w e e k l y group mtgs.& biw e e k l y home visits .low income control parents not e n r o l l e d in training prog.
Karnes & Z e h r b a c h (1977)
E N R I C H E D DAY CARE FOR INFANTS
.mothers in classes with infants weekly .comparison groups of h o m e - v i s i t e d mothers & infants
.infants with surrogate m o t h e r s in institutions for retarded .control inf. left in orphanage
.Concept Trng Group .Discovery G r o u p .non-participating control
Infant S t i m u l a t i o n / Mother Training (Badger, 1977)
PARENT GROUP M E E T I N G
Skeels (1966)
FOSTER PARENTING
P a l m e r & Siegel (1977)
.experimental infants removed from o r p h a n a g e for tutor. enrich.
Dennis & Sayegh (1965)
.controls left in orphanage
.experimental tutored 5x or 3x/week .controls in classrm. or given indiv. attention 5x/week
Blank & Solomon (1968)
T U T O R I A L WITH INFANT IN L E A R N I N G S E T T I N G
Table
] -
CONTINUED
APPROACH Classroom Interaction
Teacher Activity Checklist
Hess b S h i p m a n M o t h e r Child Learning Tasks
Implicit Parental LearningTheory(IPLET) C a l d w e l l STIM M a t e r n a l Child Interact. d u r i n g Physical Exam
S u r v e y on ParentalExp. C a l d w e l l ' s HOME Rotters Internality E x t e r n a l i t y Scale
Sparling/CampbellOpinion
Parent At ~ Res Ins.(PARI) Schaefer & Aaronson's Infant Beh. Inv. S c h a e f e r ' s Child B e h a ~ & P a r e n t Inventory
T e a c h e r Study Groups
Teacher Competency Checklist
CO O £O
O"
{Johnson et. al. 1975)
Parent Child Development Center (PC DC)
Family Development Research Prog. (Lally & Honig, 1977)
O M N I B U S MODELS: E N R I C H E D CARE FOR INFANTS PLUS PARENT PROGRAM
.experimental infants in day care a ram receiving home visitation .low income controls .high ed. contrast
.experimentals working & middle class Chinese & Caucasian children .home-~eared controls
Kagan et. al. 1977
K e i s t e r 1970
.experimentals mostly advantaged .home-reared controls
Fowler 1974
X
X
XX
Table 1
X
×
-
CONTINUED
Cornell U n l v e r s l t y De script. Scanning Record of Infant A c t i v i t y & infant Environment Emmerich O b s e r v e [ Ratings Schaefer Classroom B e h a v i o r Inventory Schaefer Classroom B e h a v i o r Checklist
Maternal Interactlom S t r u c t u r e d S1tuatlom (MISS] HOME (Caldwell) English-Spanish Receptive Vocab. T r a d i t i o n a l Family Ideology Index of A c h i e v e m e n t Values Child Rearing B e l , e f s P s y c h o l o g i c a l Well Being Psychologlcal Mindedness Locus of Control Scale iJarent Pract. I n t e r v ~ e w
Expectant Mothers' Diet Form W e e K k y & Monthly Home Visit Report STIM (inventory of Home Stimulation) IPLET Famlly Data Record CDT Ratings of Parents PEPI Parent Eval. of P r o g r ~ Intervimw
A t t a c h m e n t to Mo t~er vs. Careglver S e p a r a t i o n Protest
Home Interview (WAIS)
ABC I, II, & I I I (Assessing the Beh a v i o r s of Caregivers) Piagetian Task Checklist (Teacher Self Record)
~3
O
GO
Infant/Toddler Intervention Programs
311
t o f o c u s on t h e p r e s e n t n e e d s o f h e r b a b y f o r n u r t u r a n c e . The superior level of therapeutic skill and commitment of time and effort required to make it difficult to c o m p a r e t h e e f f i c a c y o f each a p r o g r a m d e l i v e r y s y s t e m w i t h less i n t e n s i v e , less focused models. S t a f f r a t i o o f a d u l t s to i n f a n t s as well as t h e t o t a l n u m b e r of s t a f f in a c h i l d c a r e s e t t i n g m u s t be c o n s i d e r e d i n f l u e n t i a l v a r i a b l e s t h a t can a f f e c t i n f a n t d e v e l o p mental outcomes. T h e A b t d a y c a r e s t u d y ( 1 9 7 9 ) f o u n d t h a t small g r o u p size a n d higher adult to child ratios were strongly related to measures of programmatic quality for infants and toddlers. Furthermore, "the number of different individu a l s r e l a t i n g t o a c h i l d , t h e a b i l i t y o f t h e s t a f f , a n d t h e q u a n t i t y a n d q u a l i t y o_ff i n t e r a c t i o n s m a y also h a v e an i n f l u e n c e " ( K i l m e r , 1979, p. 1 0 4 ) . Theoretical base. P r o g r a m s d i f f e r on s o u r c e o f m o d e o f i n s t r u c t i o n o r t h e o r e t i c a l base. A s c h e m a t i c a n a l y s i s o f some i n f a n t i n t e r v e n t i o n programs by curricular d i m e n s i o n , s u c h as d e n s i t y a n d v a r i e t y o f p e o p l e , m o d e o f i n s t r u c t i o n (whether d i d a c t i c o r s e q u e n c e d ) a n d s o u r c e of a c t i v i t i e s has b e e n c o m p i l e d b y A m b r o n (1977). Some p r o j e c t s m i x t h e o r i e s . L a l l y & H o n i g ( 1 9 7 7 a ) b a s e d on t h e FDRP infant day care curriculum on P i a g e t , E r i k s o n a n d l a n g u a g e d e v e l o p m e n t p r i n ciples. The family intervention c o m p o n e n t o f t h e p r o g r a m was b a s e d on Saul A t i n s k y ' s t h e o r y t h a t s h a r e d social d e c i s i o n s a r e a m e t h o d f o r g i v i n g p o w e r t o t h e p o w e r l e s s in o r d e r to e f f e c t u a t e p o s i t i v e social c h a n g e . Fraiberg's model is highly psychoanalytic. Herbert-Jackson and colleagues (1980) base their infant care curriculum on a b e h a v i o r i s t i c mode. Do t h e o r i e s m a k e a d i f f e r e n c e in assessed program outcomes? T h i s q u e s t i o n is n o t t e s t a b l e at p r e s e n t p a r t l y because of the differing nature of the populations served by models with differing theoretical orientations. Psychoanalytic models have been used more often with more disturbed parents. Learning-activities curricula have been more often used with mothers not considered at as high a risk for child a b u s e or neglect. T h e large n u m b e r s of variables on which p r o g r a m s of their efficacy a dubious exercise at present.
differ m a k e s direct comparison
Selection of E v a l u a t i o n Measures a n d C o n t r o l G r o u p s I t is d i f f i c u l t t o c o m p a r e t h e e f f e c t i v e n e s s o f o n e i n f a n t i n t e r v e n t i o n model w i t h another when the selection of instruments chosen for monitoring differs widely among models. As can be seen in T a b l e 1, d i f f e r e n c e s in d e v e l o p m e n t a l q u o t i e n t s from a variety of infant tests have been used to demonstrate program efficacy w i t h i n f a n t s in p r o g r a m s c o m p a r e d t o t h o s e n o t s e r v e d . Those not served have u s u a l l y b e e n c a r e f u l l y m a t c h e d on d e m o g r a p h i c v a r i a b l e s o r a s s i g n e d t o a c o n t r o l group. Some p r o g r a m s s e r v i n g l o w - i n c o m e f a m i l i e s p r o v i d e s c o r e s f o r a c o n t r a s t g r o u p o f home r e a r e d h i g h SES i n f a n t s . T h e v a l u e o f t h i s t h i r d g r o u p is d e m o n strated when low SES e x p e r i m e n t a l children show significant differences in c o m p a r i s o n t o low SES c o n t r o l s a n d y e t a r e n o t f u n c t i o n i n g a t o p t i m a l l e v e l s t h a t permit high expectations f o r l a t e r school w o r k . Ramey and Campbell (1981) report significant IQ a d v a n t a g e s f o r low SES A b e c e d a r i a n p r o g r a m i n f a n t s ( I Q 9 3 . 4 ) a t f o u r y e a r s o f age c o m p a r e d to c o n t r o l s ( I Q 8 1 . 3 ) . Yet, compared with o t h e r i n t e r v e n t i o n o u t c o m e s , s u c h as t h e r e s p e c t i v e s c o r e s o f 1 0 9 . 9 7 , 1 0 0 . 7 7 a n d 136.05 at four years for the experimentals, low-income controls, and high education contrast chldren o f t h e FDRP p r o g r a m ( L a l l y & H o n i g , 1 9 7 7 b ) , t h e A b e c e d a r i a n e x p e r i m e n t a l c h i l d r e n seem a t h i g h e r r i s k a t t h e e n d o f i n f a n c y f o r later difficulty with academic work. O n l y l o n g i t u d i n a l f o l l o w u p s o f i n f a n t s in t h e s e p r o g r a m s w i l l p e r m i t a r e l a t i v e a n a l y s i s of t h e i m p o r t a n c e o f IQ s c o r e s to predict the future s c h o l a s t i c a n d o t h e r l i f e a c h i e v e m e n t s of t h e i n f a n t s s e r v e d . C a u t i o n s h o u l d be u s e d in u s i n g IQ s c o r e s a l o n e at t h e e n d o f p r o g r a m as an index of Iongterm impact of the program.
312
A. S. Honig
Some p r o g r a m s Lest i n f a n t s f r e q u e n t l y . F r e q u e n t t e s t i n g of i n f a n t s , p a r t i c u l a r l y i f f a m i l y is p r e s e n t , m a y well be c o n c e p t u a l i z e d as a u n i q u e i n t e r v e n t i o n p r o c e d u r e o r " t r e a t m e n t " in i t s e l f ( H o n i g , 1981; L a m b i e et a l . , 1 9 7 4 ) .
Effects of Testing Conditions T h e c o n t e x t in w h i c h a s s e s s m e n t s a r e c a r r i e d o u t can i n f l u e n c e s c o r e s s i g n i f i cantly. High-risk t o d d l e r s w h o a t t e n d e d an e n r i c h e d d a y c a r e p r o g r a m s h o w e d more communication maturity when tested by strange, white adults then did controls, who found the strange adults more stressful. The enriched program i n f a n t s d i d n o t e x h i b i t m o r e c o m p e t e n c y t h a n c o n t r o l s w h e n in c o m m u n i c a t i v e interactions with their mothers (O~Connell & Farran, 1982). When a n d w h e r e d a t a on c a r e g i v e r - i n f a n t interactions are collected may influence test scores. Situation and setting may alter adult-child interaction frequency and quality. Honig & Wittmer (1979) have found that the least amount of caregivert o d d l e r i n t e r a c t i o n a n d t h e l o w e r s r a t e s of t o d d l e r c o m p l i a n c e w i t h a d u l t s d i r e c tives occurred in g r o s s m o t o r a c t i v i t y s e t t i n g s c o m p a r e d t o e a t i n g , s t o r y / s o n g , fine motor or creative activities. Optimal testing conditions that guarantee a comfortable, well-fed, alert, cooperat i v e t o t m a y be c r i t i c a l in d e t e r m i n i n g w h e t h e r e x p e r i m e n t a l p r o g r a m m a t i c e f f o r t s h a v e r e a l l y e f f e c t e d i m p o r t a n t c h a n g e s in t e s t r e s u l t s ( H o n i g & L a l l y , 1 9 7 5 ) . Heber and colleagues (1972) provided intensive interventions for infants whose m o t h e r s h a d l o s u n d e r 70. Mean l o s o f c h i l d r e n w h o h a d b e e n in t h e e n r i c h e d d a y c a r e p r o g r a m f r o m t h r e e m o n t h s u n t i l s i x t y m o n t h s was 126. Yet, under o p t i m a l t e s t i n g c o n d i t i o n s , t h e low SES c o n t r o l s a c h i e v e d a mean IQ s c o r e of 9 5 . 7 .
Proc_ess Evaluation:
The Missing Link in Program Comparisons?
E v a l u a t i o n is t h e s c i e n c e o f p r o v i d i n g i n f o r m a t i o n f o r d e c i s i o n m a k i n g . The four functions of planning, programming, implementing and then recycling (given the i n f o r m a t i o n g a t h e r e d ) in o r d e r t o i m p r o v e p r o g r a m h a v e b e e n l a b e l e d C . I . P . P . - Conduct, Input, Process and Product evaluation (Stufflebeam, 1968). Thus e v a l u a t i o n s o c c u r in a s e r i e s of s t a g e s d u r i n g t h e life o f a p r o j e c t . T h e goal o f m a n y i n f a n t i n t e r v e n t i o n p r o g r a m s has b e e n p r e v e n t i o n of s o c i o c u l t u r a l d e f i c i t in i n f a n t s r e a r e d in l o w - i n c o m e , l o w - e d u c a t i o n f a m i l i e s . Another i m p o r t a n t goal m a y be s u p p o r t f o r such f a m i l i e s . Early program development efforts o f t e n f o c u s e d on d e v e l o p m e n t o f s t r a t e g i e s a n d r e s o u r c e s t o a c h i e v e p r o g r a m g o a l s a n d to m e a s u r e t h e i m p a c t of p r o g r a m . For example, one early c h a l l e n g e was to d e v i s e w a y s to o p e r a t i o n a l i z e P i a g e t i a n t h e o r y so t h a t a c u r r i c u l a r model f o r i n f a n t s c o u l d be e s t a b l i s h e d a n d m o n i t o r e d ( H o n i g & L a l l y , 1981). Currently, dozens of such curricula are available, although evaluation m e a s u r e s to assess t h e i r e f f e c t i v e n e s s a r e in f a r s h o r t e r s u p p l y ( H o n i g & W i t t m e r , 1982). A t t h i s e a r l y s t a g e o f k n o w l e d g e c o n c e r n i n g t h e e f f e c t s of i n f a n t i n t e r v e n t i o n , p r o c e s s e v a l u a t i o n , sometimes c a l l e d f o r m a t i v e e v a l u a t i o n , m a y be m o r e c r i t i c a l f o r increasing the knowledge base. C a l d w e t l ( 1 9 7 7 ) has u r g e d t h a t " w e m u s t e n g a g e in c o n t i n u i n g e v a l u a t i o n of t h e e x t e n t t o w h i c h we a r e i n d e e d i m p l e m e n t i n g o u r o w n ideas a n d t r a n s l a t i n g those ideas into practice" (p. 50). For f o r m a t i v e e v a l u a t i o n to be f u l l y i n f o r m a t i v e of w h e t h e r a p r o g r a m is a c t u a l l y h a p p e n i n g a n d is w o r k i n g , all d o m a i n s in w h i c h t h e r e a r e p r o g r a m g o a l s and o b j e c t i v e s s h o u l d be samoled.
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313
New Measures
N e i t h e r f o r m a t i v e n o r s u m m a t i v e e v a l u a t i o n of s h o r t t e r m c o g n i t i v e g a i n s in i n f a n t p r o g r a m s may be as i m p o r t a n t as e v a l u a t i o n of s o c i a l - p e r s o n a l s k i l l s , p r o b l e m s o l v i n g s k i l l s , and a d v a n c e s in a c h i e v e m e n t m o t i v a t i o n . C l i n i c a l and e c o l o g i c a l e v a l u a t i o n m e a s u r e s can i m p r o v e p s y c h o m e t r i c t e s t p r e d i c t a b i l i t y . I n t e r v i e w s to elicit parent or caregiver judgments about programs have provided insights into p r o g r a m s t r n e g t h s and w e a k n e s s e s . A d d i t i o n a l l y , u n o b s t r u s i v e m e a s u r e s , such as t h e n u m b e r of p r o g r a m m o t h e r s w h o h a v e c o m p l e t e d a h i g h school d i p l o m a , can be used to i n d e x e f f e c t i v e n e s s o f p r o g r a m ( H o n i g , 1979).
Collcl usiolrls
D i f f e r e n c e s in p r o g r a m g o a l s , t h e o r y , populations served, methods, duration, s t a f f , and e v a l u a t i o n m e a s u r e s make i t d i f f i c u l t to c o m p a r e t h e e f f e c t i v e n e s s o f different infant intervention programs. I n c r e a s e d e m p h a s i s on f o r m a t i v e e v a l u a t i o n is s u g g e s t e d as a w a y of e n s u r i n g t h a t p r o g r a m is b e i n g c a r r i e d o u t . Where e f f e c t i v e n e s s is in d o u b t , p r o c e s s e v a l u a t i o n can p r o v i d e d a t a to a d d r e s s such c o n c e r n s . Useful a s s e s s m e n t s c o u l d i n c l u d e c l a s s r o o m c l i m a t e , m a t e r n a l i n f a n t t r a n s a c t i o n s , home v i s i t o r i n t e r a c t i o n s w i t h m o t h e r , and a d u l t r e s p o n s i v e ness to c h i l d b i d s f o r e n g a g e m e n t . F i n a l l y , i t is s u g g e s t e d t h a t t h e r e p e r t o i r e of p s y c h o m e t r i c c h i l d m e a s u r e s n e e d s to be b r o a d e n e d to i n c l u d e s y s t e m a t i c c l i n i c a l a s s e s s m e n t s o f c h i l d f u n c t i o n i n g w i t h i n d a i l y s e t t i n g s , a c t i v i t i e s and i n t e r a c t i o n s . P r o m p t f e e d b a c k f r o m such f o r m a t i v e e v a l u a t i o n to p r o j e c t p e r s o n n e l w o u l d p e r m i t r e a s s e s s m e n t of p r o j e c t m e t h o d s and e f f o r t s . Thus, p r o c e s s e v a l u a t i o n c o u l d p r o v i d e a key to m o r e s u s t a i n e d , s u c c e s s f u l o u t c o m e s in i n f a n c y i n t e r v e n t i o n p r o g r a m s .
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