First Advisor

Luckner, John L.

Second Advisor

Bowen, Sandy K.

Document Type


Date Created



The Individuals with Disabilities Education Act (IDEA) assures infants and toddlers with disabilities and their family members receive family-centered early intervention (FCEI). There is an extant body of evidence documenting the use, or lack of use, of FCEI provider behaviors when therapy is delivered in the traditional face-to-face (F2F) condition. This disparity between best practice and actual practice is investigated in this study. This study investigated providers’ use of FCEI strategies when intervention was delivered to infants and toddlers who were deaf or hard of hearing via telepractice. Telepractice is the use of information and telecommunications technology to provide health services to people who are located at some distance from a provider. The intent of the study was to look at ways in which telepractice might impact providers’ implementation of FCEI. There were two purposes for this exploratory study. The first purpose was to examine the potential relationships between provider attributes (i.e., highest degree, experience delivering FCEI, and experience with telepractice) and the use of FCEI provider behaviors (i.e., observation, direct instruction, parent practice with feedback, and child behavior with provider feedback) by professionals delivering FCEI. Statistical analyses were designed to identify any relationships among provider attributes, any associations between provider behaviors, and any connections between provider attributes and provider behaviors. The second purpose was to examine the frequency of occurrence of desired FCEI provider behaviors during telepractice sessions and to contrast them to the same behaviors used in F2F therapy. The main intent of telepractice is to provide access to qualified practitioners for families living in remote or rural areas. Sometimes, however, opportunities for change are incidental. The combination of video-conferencing technology and web-based software supporting synchronous two-way communication has created new opportunities for the delivery of FCEI. Many researchers, program administrators, and FCEI practitioners anticipate that the use of FCEI strategies will be enhanced through telepractice. Information about participant attributes was collected using a survey tool. The use of FCEI provider behaviors was measured by directly observing and coding digitally-recorded intervention sessions. There were 16 participants in this study working in eight different programs nationwide. Therapy sessions included the provider, the mother, and a child who was deaf or hard of hearing who was 36 months of age or younger. The attributes of providers and the use of four FCEI behaviors were investigated using Fisher’s Exact Test. A log-linear count model was applied to the data to assess the effects of provider attributes on provider behaviors. In addition, the data were used to identify the percentage of time FCEI provider behaviors occurred in the telepractice condition and contrast these with the use of these same behaviors in the F2F condition. There were some significant and marginally significant results demonstrating associations between provider attributes, relationships between provider characteristics and use of specific provider behaviors, and associations between provider behaviors. While there was a poor goodness of fit between the predicted and observed counts, the use of one provider behavior parent practice with feedback was generally the most closely associated with provider attributes. The Poisson distribution gave an expected frequency count for each FCEI provider behavior. This information uncovered relationships between experience and the use of specific FCEI provider behaviors. The results of the study demonstrated that selected FCEI provider behaviors occur in the telepractice condition more frequently than they occur in the F2F condition reported in the literature. Three of the provider behaviors observation, parent practice with feedback, and child behavior with provider feedback were used more frequently in the telepractice condition than in F2F therapy. Direct instruction was used in similar amounts in both treatment conditions. The findings can be applied to a training program for providers using or learning about telepractice. In future studies, it will be of interest to include more participants from more agencies. The information applies to infants and toddlers with all types of disabilities; therefore, future studies might investigate the provider skills of professionals from different disciplines. In future studies, with more participants, more than four provider behaviors documented could be included. The findings showed there were differences in the use of FCEI provider behaviors when therapy was conducted in telepractice. This increasingly accessible service delivery platform may make therapy more accessible to the parents of infants and toddlers with all types of disabilities. Telepractice is currently funded unevenly throughout the United States. If it can be shown that family-centered early intervention is conducted as well, if not more robustly, when it is delivered via telepractice, then funding agencies may be more willing to support it.

Abstract Format



Deaf; Hearing impaired; Telecommunication


288 pages

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Copyright is held by author.