1276423

review-article2024
PBIXXX10.1177/10983007241276423Journal of Positive Behavior InterventionsGerow et al

Literature Review
Journal of Positive Behavior

Addressing Challenging Behavior and

Interventions
1­–16
© Hammill Institute on Disabilities 2024
Social–Emotional Skills in Home-Based Article reuse guidelines:
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https://doi.org/10.1177/10983007241276423

Services: A Systematic Review DOI: 10.1177/10983007241276423

jpbi.sagepub.com

Stephanie Gerow, PhD1, Emily Exline, PhD2,

Lindsey Swafford, MS2, David Cosottile, PhD3 ,
Maureen Conroy, PhD4, Wendy Machalicek, PhD3,
Tonya N. Davis, PhD2, Qi Wei, PhD5, and Amy James, MLIS2

Abstract
Children with developmental delays are more likely to experience difficulties in social-emotional skills and challenging
behavior, which can lead to poor long-term outcomes if left untreated. The purpose of this literature review was to
synthesize the literature related to home-based interventions to address social–emotional skills and challenging behavior.
A systematic review of the literature resulted in the identification of 26 single-case design studies and 31 group design
studies that evaluated a home-based intervention to improve social–emotional skills or challenging behavior for young
children with a disability or delay. The most common interventions implemented were differential reinforcement, functional
communication training, and antecedent-based interventions. Data based on the quality of experiment, characteristics of
participants, and characteristics of interventions were analyzed. Fewer than half of the studies (41%) met design standards
with or without reservations. However, the majority of studies that met design standards demonstrated strong or moderate
evidence for the efficacy of the intervention (67%). Overall, the literature indicates caregivers can accurately implement
established evidence-based practices with their young children to improve social–emotional skills and challenging behavior.
Implications for practice and future research directions are discussed.

Keywords
parent training, disability, challenging behavior, social skills

Young children with developmental delay and disabilities Young children with developmental delay qualify for
(e.g., autism spectrum disorder [ASD], language delay, services through Individuals with Disabilities Education
attention deficit/hyperactivity disorder [ADHD], opposi- Act (IDEA, 2024) Part C (for children younger than 3 years
tional defiant disorder [ODD]) are more likely to have defi- old) or IDEA Part B (for children 3 years and older). Home-
cits in the areas of social–emotional skills and challenging based services, in which a professional delivers evidence-
behavior than their typically developing peers (Baker et al., based practices in the context of the home setting, are a
2002; Center for Disease Control and Prevention [CDC], common method for delivering interventions to young chil-
2022; Roberts et al., 2011). Social–emotional skills are the dren. One of the primary purposes of home-based services
skills needed to recognize emotions, control emotions, and is to ensure individuals who spend time with the child,
engage in appropriate behavior rather than challenging including caregivers (e.g., parents, grandparents), learn to
behavior (Collaborative for Academic, Social, and
Emotional Learning [CASEL], 2020). Children with devel- 1
University of Nevada, Las Vegas, NV, USA
opmental delay tend to engage in more severe and persistent 2
Baylor University, Waco, TX, USA
3
challenging behavior, such as severe tantrums, aggression, University of Oregon, Eugene, OR, USA
4
self-injury, and property destruction (Baker et al., 2002; University of Florida, Gainesville, FL, USA
5
University of Wisconsin-Whitewater, USA
CDC, 2022; Green et al., 2005). If left untreated, difficulties
with social–emotional skills and challenging behavior lead Qi Wei is also affiliated to University of Nebraska-Omaha, Omaha, NE, USA
to poor long-term outcomes, including low peer interaction, Corresponding Author:
exclusion from social settings, placement in alternative Stephanie Gerow, University of Nevada-Las Vegas, 4505 S. Maryland
education settings, missed instructional time, lower aca- Parkway, Box 453014, Las Vegas, NV 89154-3014, USA.
demic performance, and parent stress (Hemmeter et al., Email: [email protected]
2008; Waddington et al., 2020). Action Editor: Grace Gengoux
2 Journal of Positive Behavior Interventions 00(0)

implement evidence-based practices, resulting in increased delay (Landa, 2018; U.S. Department of Education, 2021).
access to evidence-based practices for children across the However, there is a need for further investigation of recom-
lifespan. Two common providers are Part C services and mended practices related to social–emotional and challeng-
Head Start home-based services. Children age birth to 3 ing behavior intervention. Upon exiting Part C services at
years old with a developmental delay or disability often age 3, children have continued deficits in the areas of
qualify for Part C services, which are provided in a natural social–emotional skills and use of appropriate behavior
environment (e.g., home or daycare; IDEA, 2004). Eighty- (Guralnick, 2017; U.S. Department of Education, 2021).
nine percent of services provided under IDEA Part C are Similarly, children 3 years and older enrolled in Part B ser-
delivered in-home (U.S. Department of Education, 2021). vices may be eligible for in-home support, but often do not
Home-based services are delivered by early intervention receive social–emotional skills interventions in this context
professionals with a variety of backgrounds (e.g., early (Pathways.org, 2023). Half of caregivers with children who
childhood educator, speech–language pathologist), usually engage in challenging behavior report that they do not
using a model in which the early intervention professional receive effective support through their home-based services
coaches the caregiver (e.g., parent, grandparent) to imple- (McGill et al., 2006). Early intervention professionals
ment the intervention with their child (Center for Parent report insufficient training in these areas, which likely con-
Information and Resources, 2017; IDEA, 2004). This model tributes to difficulties addressing social–emotional skills
is intended to promote caregiver involvement in the inter- and challenging behavior (Hemmeter et al., 2008; McGill
vention, which can lead to continued use of the intervention et al., 2006; Sapiets et al., 2021). These findings in the area
across settings and time. Head Start provides similar ser- of social–emotional skills and challenging behavior high-
vices to families with children birth to 5 years old, in which light the importance of identifying effective intervention
professionals provide in-home support to the caregiver and strategies for use in home-based services for young children
their child (U.S. Department of Health and Human Services, with developmental delay.
2023). Across home-based early intervention models, col- There are a few existing literature reviews on the topic of
laboration with the caregivers is key to positive child out- caregiver-mediated interventions for children with develop-
comes (Sandbank et al., 2020). mental disability or delay. Barton and Fettig (2013) reviewed
Including caregivers in interventions is integral to effec- nine education journals to describe trends related to collect-
tive social–emotional development and challenging behav- ing caregiver implementation fidelity data. This review pro-
ior intervention for young children (Division for Early vided valuable information related to the reporting of
Childhood, 2014; Rankin et al., 2019; Sandbank et al., caregiver implementation fidelity, but a more recent and
2020). Caregiver involvement promotes long-term mainte- comprehensive review related to caregiver-implemented
nance and generalization of improvements in child behavior interventions is needed to identify research-supported inter-
and can decrease reliance on professionals throughout the ventions and caregiver coaching practices. Three reviews
child’s life (Division for Early Childhood, 2014; Miles & have evaluated specific interventions implemented by care-
Wilder, 2009; Preas et al., 2023). Several studies have dem- givers, including function-based interventions (Fettig &
onstrated the lasting meaningful improvements following Barton, 2014), functional communication training (FCT;
caregiver training in social–emotional and challenging Gerow et al., 2018), and play-based interventions (Deniz
behavior interventions (e.g., Derby et al., 1997; Jhuo & Chu, et al., 2022). These reviews have added valuable informa-
2022; Mancil et al., 2009; Oono et al., 2013; Wacker et al., tion to the literature regarding specific interventions, but
2011). These studies indicate caregiver training results in they do not present the breadth of the literature related to
high implementation fidelity and improvements in child varied interventions available to improve social–emotional
behavior. However, there is limited research examining and challenging behavior outcomes. Five existing reviews
coaching practices of professionals who typically provide have evaluated caregiver-implemented interventions for a
home-based services. It is important to examine the feasibil- specific disability — ASD (Althoff et al., 2019; Hendrix
ity and fidelity of caregiver coaching provided in the context et al., 2022; Nevill et al., 2018; Oono et al., 2013; Tarver
of early intervention services, with professionals coaching et al., 2019). Home-based services are often available to
caregivers. Caregiver-mediated interventions are associated children with developmental disability or delay. For this rea-
with lower stress and depression in caregivers of young chil- son, it is critically important to evaluate and synthesize the
dren with developmental delays and disabilities (Estes et al., literature related to effective interventions and caregiver
2014; Postorino et al., 2017). Caregiver training in evidence- coaching strategies to improve social–emotional and chal-
based practices is one of the primary purposes of home- lenging behavior outcomes for use with young children
based services, which are often provided to young children across disability categories. Thus, the purpose of this review
with developmental delay and their families. was to synthesize the literature related to caregiver-imple-
Home-based services are effective in improving devel- mented home-based interventions to address social–emo-
opmental outcomes for young children with developmental tional skills and challenging behavior for young children
Gerow et al 3

(age birth to 6 years old). We sought to identify the charac-

teristics of participants, the common caregiver coaching and

Identification
Studies identified from
intervention strategies, the resources needed, and the extent databases: (n = 15,822) Duplicate studies removed:
of the evidence supporting home-based caregiver coaching (n = 6,632)

for social–emotional skills and challenging behaviors.

Method Studies screened for eligibility:

(n = 9,190)
Studies excluded: (n = 9,147)

A team of reviewers conducted a systematic database search Reasons for exclusion:

• Age (n = 1,501)
and ancillary searches to identify articles evaluating the effi- • Dependent variable
cacy of home-based interventions to improve social–emotional (n = 1,280)

Screening
Studies meeting eligibility
skills or challenging behavior for young children with devel- criteria: (n = 43) • Intervention (n = 7,725)
• No disability or delay
opmental delay. These reviewers (all authors on the paper) (n = 2,190)
included two doctoral-level graduate students, a postdoctoral • Setting (n = 2,084)

fellow, and two faculty members. A librarian with expertise in Studies identified through
education research and database searches assisted with the ancillary search: (n = 14)

development of the search and review procedures. In the fol-

lowing section, we included an overview of the methodology
(see Online Supplemental Materials for detailed information).

Included
Studies included in review:
(n = 57)
Inclusion Criteria and Systematic Search
We reviewed articles for inclusion review based on six inclu-
sion criteria: (a) the child participants were age birth to 6 Figure 1. PRISMA Diagram.
years 11 months old, (b) the child participants were diag-
nosed with a disability or delay, (c) the dependent measure in
the study was social–emotional skills or challenging behav- design studies rated as Meets without Reservations or Meets
ior, (d) the study evaluated the efficacy of an educational or with Reservations, we also rated the study based on the
behavioral (i.e., nonmedical) intervention, (e) some or all obtained results. For group design studies, we evaluated the
intervention sessions occurred in the home, and (f) a care- results of the study based on the procedures described in the
giver (e.g., parent, grandparent) received coaching in the WWC Procedures Handbook (WWC, 2022). For single-
home. The database search, conducted in January 2021, case studies, we conducted visual analysis to evaluate the
yielded 9,190 articles; 43 of those met the inclusion criteria results (WWC, 2017).
(see Figure 1). An additional 14 articles were identified via
the ancillary search, for a total of 57 included articles. Inter-Rater Reliability
To evaluate inter-rater reliability (IRR) (i.e., percent agree-
Descriptive Information ment between two reviewers), two reviewers evaluated
23% of articles identified through the database search; they
Descriptive information was extracted using a combination
agreed on the inclusion or exclusion 99% of those articles.
of categorical and descriptive coding. For categorical cod-
For IRR of the descriptive information, design quality, and
ing, reviewers selected as many categories as needed (e.g.,
outcomes, a second reviewer recorded information from
more than one intervention strategy, if applicable). The
100% of the included studies; IRR was 89%, 84%, 88%,
reviewers extracted data related to participants, method-
and 92% for single-case descriptive information, single-
ological characteristics (e.g., setting, dependent variable),
case design quality and outcomes, group descriptive infor-
intervention and coaching strategies, resources required,
mation, and group design quality and outcomes, respectively.
and involvement of community agencies.
Two or more reviewers discussed all disagreements and
agreed on a final decision.
Design Quality and Outcomes
For group (n = 31) and single-case (n = 26) studies, we Results
evaluated the quality of the design based on the What Works
Clearinghouse (WWC, 2022) design standards (see Online
Child Participants
Supplemental Materials for procedures). Each study The 31 group design studies included 3,752 child partici-
received a rating of Meets without Reservations, Meets with pants (see Table 1). Most of the participants were between
Reservations, or Does Not Meet. For each of the group 3 and 6 years old (n = 2,292; 61%). Over half of the
4 Journal of Positive Behavior Interventions 00(0)

Table 1. Participant Demographic Information.

Group design Single case Combined

Variable n (%) n (%) n (%)
Child participants (n = 3,752) (n = 88) (n = 3,840)
Gender
Female 889 (24%) 23 (26%) 912 (24%)
Male 1,949 (52%) 56 (64%) 2,005 (52%)
Not reported 914 (24%) 9 (10%) 923 (24%)
Age (average)a
0–2 years old 345 (9%) 23 (26%) 368 (10%)
3–6 years old 2,292 (61%) 65 (74%) 2,357 (61%)
Older than 7 years old 1,027 (27%) 0 (0%) 1,027 (27%)
Not reported 88 (2%) 0 (0%) 88 (2%)
Race or ethnicityb
American Indian or Alaska Native 1 (< 1%) 0 (0%) 1 (<1%)
Asian, Native Hawaiian, or Other Pacific Islander 32 (<1%) 2 (2%) 34 (<1%)
Black or African American 376 (10%) 1 (1%) 377 (10%)
Hispanic or Latino/a/x 300 (8%) 3 (3%) 303 (8%)
White 1,331 (35%) 16 (18%) 1,347 (35%)
Two or more races 87 (2%) 0 (0%) 87 (2%)
Other 39 (1%) 0 (0%) 39 (1%)
Not reported 1,617 (43%) 66 (75%) 1,683 (44%)
IDEA disability category
Autism spectrum disorder 1,252 (33%) 43 (49%) 1,295 (34%)
Deaf-blindness 0 (0%) 0 (0%) 0 (0%)
Deafness 0 (0%) 0 (0%) 0 (0%)
Developmental delay 591 (16%) 8 (9%) 599 (16%)
Emotional disturbance 19 (<1%) 0 (0%) 19 (<1%)
Hearing impairment 2 (<1%) 1 (1%) 3 (<1%)
Intellectual disability 0 (0%) 13 (15%) 13 (<1%)
Orthopedic impairment 2 (<1%) 0 (0%) 2 (<1%)
Other health impairment 586 (16%) 14 (16%) 600 (16%)
Specific learning disability 306 (8%) 1 (1%) 307 (8%)
Speech or language impairment 495 (13%) 21 (24%) 516 (13%)
Traumatic brain injury 0 (0%) 0 (0%) 0 (0%)
Visual impairment 7 (<1%) 3 (3%) 10 (<1%)
Specific disability not reported 981 (26%) 0 (0%) 981 (26%)
SES metric reported
Receiving or not receiving public assistance 1,516 (40%) 0 (0%) 1516 (39%)
Household income 802 (21%) 0 (0%) 802 (21%)
Category (i.e., low, middle, upper) 0 (0%) 48 (55%) 48 (1%)
Other 0 (0%) 6 (7%) 6 (<1%)
Not reported 1,434 (38%) 34 (39%) 1,468 (38%)
Caregiver participants (n = 3,783) (n = 98) (n = 3,881)
Gender
Female 1,315 (35%) 67 (68%) 1,382 (36%)
Male 75 (2%) 16 (16%) 91 (2%)
Not reported 2,393 (63%) 15 (15%) 2,408 (62%)
Age (average)
20–29 years 594 (16%) 4 (4%) 598 (15%)
30–39 years 479 (13%) 10 (10%) 489 (13%)
40+ years 58 (2%) 3 (3%) 61 (2%)
Not reported 2,652 (70%) 81 (83%) 2,733 (70%)
(Continued)
Gerow et al 5

Table 1. (Continued)

Group design Single case Combined

Variable n (%) n (%) n (%)
Race or ethnicityb
American Indian or Alaska Native 2 (< 1%) 0 (0%) 2 (< 1%)
Asian, Native Hawaiian, or Other Pacific Islander 2 (< 1%) 0 (0%) 2 (< 1%)
Black or African American 65 (2%) 5 (5%) 70 (2%)
Hispanic or Latino/a/x 18 (<1%) 3 (3%) 21 (< 1%)
White 432 (11%) 31 (32%) 463 (12%)
Two or more races 0 (0%) 0 (0%) 0 (0%)
Other 51 (1%) 0 (0%) 51 (1%)
Not reported 3,154 (83%) 60 (61%) 3,214 (83%)
Caregiver role
Father 34 (< 1%) 16 (16%) 50 (1%)
Mother 156 (4%) 67 (68%) 223 (6%)
Familial caregiver (e.g., grandmother) 97 (3%) 1 (1%) 98 (3%)
Nonfamilial caregiver 17 (< 1%) 0 (0%) 17 (< 1%)
Parent/caregiver, not further described 3,479 (92%) 14 (14%) 3,493 (90%)
Marital status
Single 767 (20%) 26 (27%) 793 (20%)
Married/living with partner 1,052 (28%) 9 (9%) 1,061 (27%)
Divorced or separated 72 (2%) 0 (0%) 72 (2%)
Widowed 4 (<1%) 0 (0%) 4 (< 1%)
Not reported 1,888 (50%) 63 (64%) 1,951 (40%)
Educationc
Some high school/diploma/GED 452 (12%) 14 (14%) 466 (12%)
Some college/college degree 722 (18%) 23 (23%) 745 (19%)
Graduate/advanced degree 175 (4%) 8 (8%) 183 (5%)
Not reported 2,555 (65%) 53 (54%) 2,608 (65%)
a
In some group design studies, participants older than the inclusion criteria were also included and we were not able to disaggregate the data for those
participants in each of the demographic categories. bRace aligns with categories described by U.S. Census Bureau (2020). “Asian” and “Native Hawaiian
or Other Pacific Islander” were combined due to lack of specificity in reporting. The total number of participants in this category exceeds the included
participants because some studies reported both race and ethnicity. cThe total number of participants in this category exceeds the number of caregiver
participants due to studies reporting education level for two caregivers, but not indicating which caregiver(s) was the implementer.

participants were male (n = 1,949; 52%); one quarter of the assistance was reported, 41% (n = 621) qualified for or
participants were female (n = 889; 24%). Gender was not received public assistance. Of the 802 families (21%) for
reported for the remainder of the participants (n = 914; whom household income was reported, 256 (32%) had a
24%). We recorded each disability reported for the included household income of less than $50,000.
participants based on IDEA categories (IDEA, 2004). The The single-case studies included 88 child participants
most commonly reported categories were ASD (n = 1,252; across 26 studies (see Table 1 for demographic informa-
33%), developmental delay (n = 591; 16%), and other tion.). Most of the participants were between 3 and 6 years
health impairment (n = 586; 16%). For the studies report- old (n = 65; 74%). Most participants were male (n = 56;
ing participants with a disability falling under our coding 64%); one quarter of participants were female (n = 23;
category of “other health impairment,” common examples 26%). For the 25% of participants for whom the race or
included ADHD and ODD. The child’s race or ethnicity ethnicity was reported, 2 identified as Asian, Native
was reported for 57% of the participants (n = 2,135). Of Hawaiian, or Other Pacific Islander (9%), 1 identified as
those participants, 1 identified as American Indian or Alaska Black or African American (5%), 3 identified as Hispanic or
Native (<1%), 32 identified as Asian, Native Hawaiian, or Latino/a/x (14%), and 16 identified as White (73%). The
Other Pacific Islander (1%), 376 identified as Black or most common disability categories were ASD (n = 43;
African American (18%), 300 identified as Hispanic or 49%), speech or language impairment (n = 21; 24%), other
Latino/a/x (14%), 1,331 identified as White (62%), 87 iden- health impairment (n = 14; 16), and developmental delay
tified as two or more races 87 (4%), and 39 identified as (n = 8; 9%). Some information related to socioeconomic
other 39 (2%). Of the 1,516 participants for whom public status (SES) was reported for 54 participants (62%). Income
6 Journal of Positive Behavior Interventions 00(0)

level was the most common SES reporting method for the bachelor’s degree or higher (n = 12; 86%) and received
participants (n = 48; 55%); 18 participants were classified training or had previous relevant experience (n = 12; 86%).
as lower income (38%), 25 as middle income (52%), 5 as Additional demographic information was reported in one
middle to upper income (10%), and none as upper income study (3%).
level. Of the 26 single-case studies, the profession of the coach
or coaches was researcher for most studies (n = 22; 85%).
Information related to education and training was reported
Caregiver Participants
for 14 studies (50%). A college degree and/or certification
In the 31 included group studies, 3,783 caregivers partici- was reported for over half of the studies (n = 17; 61%).
pated with their children (see Table 1). For the 304 caregiv- Additional demographic information was not reported for
ers whose relationship to the child was reported, mother any coaches.
was the most common relation to the child (n = 156, 51%).
Of the 30% of caregivers for whom age was reported, Assessment. We recorded the types of assessments used in
approximately half were 20–29 years old (n = 594; 53%) included studies. One of the included group studies
and 42% were 30–39 years old (n = 479). Of the 50% of described conducting an assessment of social–emotional
participants for whom marital status was reported, 767 skills to inform the intervention (Raulston et al., 2020).
reported being single (40%) and 1,053 reported being mar- Eight (22%) of the group studies included assessments of
ried or living with a partner (56%). Of the 35% of caregiv- challenging behavior to inform their intervention proce-
ers for who education level was reported, 452 completed dures. Of the 26 single-case studies, 20 reported challeng-
some high school or obtained a diploma/General Educational ing behavior assessments to inform intervention procedures
Diploma (GED) (34%), 722 completed some college or (77%) and none reported an assessment of social–emotional
obtained a college degree (54%), and 175 obtained a gradu- skills.
ate or advanced degree (13%). Across single-case and group studies, caregivers were
In the 26 included single-case studies, 98 caregivers par- involved with implementing the challenging behavior assess-
ticipated in the studies (see Table 1). The most common ments in each of the studies that included challenging behav-
caregiver role described was mother (n = 67; 68%). Of the ior assessment (n = 28; 100%). The types of assessments
17% of caregivers for whom age was reported, four were included functional assessment interviews (n = 3; 38%),
between 20 and 29 years old (24%), over half were between functional analyses (n = 2; 25%), and observation (n = 1;
30 and 39 years old (n = 10; 59%), and three were over 40 13%). Specific assessment procedures were not described for
years old (18%). Of the 36% of caregivers for whom marital three of the eight group studies (38%). The function targeted
status was reported, most reported being single (n = 26; by the intervention was reported for 60 participants across
74%) and one quarter reported being married or living with group and single-case studies (2%). Challenging behavior
a partner (n = 9; 26%). Of the 46% of caregivers for whom was reported to be maintained by negative reinforcement
education level was reported, 14 completed some high (e.g., escape) for 31 participants (52%), positive reinforce-
school or obtained a diploma/GED (31%), 23 completed ment (e.g., tangible, attention) for 24 participants (40%), and
some college or obtained a college degree (51%), and 8 multiple functions for 22 participants (37%).
completed some graduate school or obtained a graduate
degree (18%). Outcome Measures. Of the 62 studies included in this
review, 44 studies (71%) measured challenging behavior, 4
studies (6%) measured social–emotional skills, and 14 stud-
Study Characteristics
ies (23%) measured both challenging behavior and social–
We collected information related to study characteristics for emotional skills.
each of the group and single-case studies (see Table 2). For
the 31 group studies, we identified 36 treatment groups. We Social–Emotional Skills. Of the 36 group studies, outcome
describe study characteristics for the 36 group studies and measures related to social–emotional skills were reported for
26 single-case studies in Table 2. 11 studies (31%). Social awareness and/or relationships skills
were evaluated for eight studies (72%). Self-awareness and/
Individuals who Coached the Caregivers. Of the 36 group or self-management were evaluated for four studies (36%).
studies, the most commonly reported profession of the Responsible decision-making was not evaluated for any
coach was researcher (n = 29; 81%). Other professions group studies. Interviews were used as a measure to assess
were speech–language pathologist, teacher, nurse, social progress on social–emotional skills in all 11 of these studies.
worker, psychologist, and family counselor. The coach’s One of those studies also included an observational measure
education or training was reported in over a third of group and one included partial interval recording (Anderson et al.,
studies (n = 14; 39%). Most of these coaches obtained a 1987; Wacker et al., 1998).
Gerow et al 7

Table 2. Intervention Characteristics.

Group design studies Single-case studies Combined

Variable (n = 36a) (n = 26) (n = 62)
Intervention categories
Antecedent-based interventions 14 (39%) 16 (62%) 30 (48%)
Augmentative and alternative communication 2 (6%) 1 (4%) 3 (5%)
Cognitive behavioral/instructional strategies 0 (0%) 0 (0%) 0 (0%)
Differential reinforcement 12 (33%) 7 (27%) 19 (31%)
Discrete trial teaching 4 (11%) 1 (4%) 5 (8%)
Extinction 2 (6%) 0 (0%) 2 (3%)
Functional communication training 2 (6%) 17 (65%) 19 (31%)
Naturalistic intervention 11 (31%) 1 (4%) 12 (19%)
Peer-based instruction and intervention 0 (0%) 1 (4%) 1 (2%)
Prompting 6 (17%) 8 (31%) 14 (23%)
Reinforcement 8 (22%) 4 (15%) 12 (19%)
Response interruption/redirection 4 (11%) 4 (15%) 8 (13%)
Social narratives 0 (0%) 1 (4%) 1 (2%)
Task analysis 0 (0%) 1 (4%) 1 (2%)
Not reported 8 (22%) 0 (0%) 8 (13%)
Caregiver coaching strategies
Written instructions 12 (33%) 14 (54%) 26 (42%)
Verbal instructions 11 (31%) 14 (54%) 25 (40%)
Goal setting 2 (6%) 1 (4%) 3 (5%)
Modeling 12 (33%) 20 (77%) 32 (52%)
Video examples 8 (22%) 6 (23%) 14 (23%)
Role-play without child 12 (33%) 8 (31%) 20 (32%)
Role-play with child 4 (11%) 13 (50%) 17 (27%)
Coaching or verbal prompting 9 (25%) 17 (65%) 26 (42%)
Observation without coaching 9 (25%) 8 (31%) 17 (27%)
Immediate feedback 8 (22%) 12 (46%) 20 (32%)
Delayed feedback 3 (8%) 5 (19%) 8 (13%)
Feedback using video 2 (6%) 2 (8%) 4 (6%)
Review of graphs or data 2 (6%) 7 (27%) 9 (15%)
Reflection or self-feedback 1 (3%) 3 (12%) 4 (6%)
Problem solving 7 (19%) 5 (19%) 12 (19%)
Answering questions 2 (6%) 8 (31%) 10 (16%)
Homework/lessons 7 (19%) 2 (8%) 9 (15%)
DVD 2 (6%) 0 (0%) 2 (3%)
Meeting to review progress 0 (0%) 1 (4%) 1 (2%)
Not reported 6 (17%) 0 (0%) 6 (10%)
a
36 treatment groups across 31 group design studies. Percentages calculated out of 36 treatment groups.

Outcome measures related to social–emotional skills Challenging Behavior. Across the 62 studies, 58 reported
were reported for 7 (27%) of the 26 single-case studies. Of an outcome measure related to challenging behavior (94%).
the participants for whom social–emotional outcomes were Of the 36 group studies, nearly all reported an outcome
measured, all evaluated social awareness and/or relation- measure related to challenging behavior (n = 35; 97%).
ships skills. Social–emotional skills were evaluated using The most common measurement tools used to evaluate
observational measures for most studies (e.g., percent cor- challenging behavior were interviews and questionnaires (n
rect, rate; n = 6; 86%). One study (14%) also used a parent = 33; 94%; e.g., Child Behavior Checklist; Achenbach &
interview to evaluate social–emotional skills (Barton & Rescorla, 2000; Eyberg Child Behavior Inventory; Eyberg
Cohen Lissman, 2015). & Pincus, 1999). Observational measures included interval
8 Journal of Positive Behavior Interventions 00(0)

recording (n = 8; 23%) and frequency/rate (n = 3; 19%). We recorded the extent to which caregivers were involved
Seven of the group studies (20%) reported the topography in the implementation of the intervention, the coaching strate-
of participants’ challenging behavior and often collected gies used to teach caregivers, and the obtained caregiver treat-
data on multiple topographies; disruptive behavior, aggres- ment fidelity. In accordance with our inclusion criteria,
sion, and restrictive/repetitive behaviors were the most caregivers received coaching and implemented at least one
commonly measured. intervention session in all included studies. In most group stud-
Outcomes related to challenging behavior were reported ies (n = 21; 58%), caregivers implemented most of the inter-
for most of the single-case studies (n = 23; 88%). Time vention sessions (i.e., 76%–100% of the intervention sessions).
sampling recording from an observation was used most The specific number of intervention sessions implemented by
often to measure challenging behavior. All of the single- the caregiver was not reported for eight group studies (22%).
case studies reported the topography of challenging behav- The specific coaching strategies were reported in 25 group
ior; disruptive behavior, aggression, property destruction, studies (69%). The most common coaching strategies used
and self-injurious behavior were the most commonly were role-play without the child (n = 12; 48%), verbal instruc-
reported topographies. tions (n = 12; 48%), and modeling (n = 12; 48%). Treatment
fidelity for caregiver implementation was assessed in five
Intervention Characteristics. We recorded the specific inter- (14%) group studies. Some of the studies (n = 9; 25%) reported
vention procedures and the named intervention used (see caregiver behavior such as use of intervention strategies or
Table 2). Of the 28 group studies that reported specific positive (e.g., implementing intervention strategies, appropri-
intervention procedures (78%), the most common interven- ate attention) or negative caregiver behavior (e.g., reinforce-
tions were antecedent-based interventions (n = 14; 50%), ment of challenging behavior, inappropriate attention), as a
differential reinforcement (n = 12; 43%), naturalistic inter- dependent measure. In these studies, the data showed that the
ventions (n = 11; 39%), reinforcement (n = 8; 29%), caregivers’ positive behavior increased and negative behavior
prompting (n = 6; 21%), and discrete trial teaching (n = 4; decreased during intervention compared to baseline.
14%). The interventions reported most often in single-case Across the 26 single-case studies, caregivers received
studies were FCT (n = 17; 65%), antecedent-based inter- coaching and implemented at least one intervention session
ventions (n = 16; 62%), prompting (n = 8; 31%), differen- in all studies. Caregivers implemented the majority of inter-
tial reinforcement (n = 7; 27%), reinforcement (n = 4; vention sessions (i.e., 76%–100% of intervention sessions)
15%), and response interruption/redirection (n = 4; 15%). for most studies (n = 20; 77%). Treatment fidelity of care-
Of the 54 total studies reporting their intervention proce- giver implementation was assessed for less than half of
dures, 44 used a multicomponent intervention (81%; 25 studies (n = 11; 41%). Other data related to caregiver
group, 19 single case). Antecedent-based interventions implementation (e.g., use of strategies, caregiver behavior)
were most often combined with differential reinforcement were reported for six studies (23%).
(n = 12; 40%), prompting (n = 11; 37%), FCT (n = 10; Telehealth technology was used in nine of the group stud-
33%), or reinforcement (n = 10; 33%). The FCT was typi- ies (25%) and two single-case studies (8%; Derby et al.,
cally used with antecedent-based intervention (n = 10; 1997; Fettig et al., 2016); corresponding with families via
53%) or by itself (n = 7; 37%). Differential reinforcement phone calls was the most common method (nine studies),
was used most often with antecedent-based interventions (n and video calls were used in two studies. A community
= 12; 63%), prompting (n = 7; 37%), response interrup- agency was involved in most group studies (n = 25; 69%)
tion/redirection (n = 5%), and naturalistic interventions (n and in half of the single-case studies (n = 13; 50%). Of the
= 5%). Prompting was most often combined with anteced- 38 studies for which a community agency was involved,
ent-based intervention (n = 11; 79%), differential rein- community agencies served as an additional setting (n = 27;
forcement (n = 7; 50%), response interruption/redirect (n 71%), provided training outside of the home in three studies
= 6; 43%), or reinforcement (n = 5; 36%). Naturalistic (8%), and were involved in diagnosing and assessment in
interventions were typically used with differential rein- two studies (5%; Derby et al., 1997; Lucyshyn et al., 2007).
forcement (n = 5; 42%) or antecedent-based interventions The coaching of the caregiver was delivered by a profes-
(n = 4; 33%). Finally, reinforcement was most often used sional from the community agency in six of these studies (n
with antecedent-based interventions (n = 10; 83%) or = 7; 11%). The most common types of community agencies
prompting (n = 5; 42%). We also recorded the name of involved included schools (n = 10; 37%), clinics (n = 6;
named or packaged interventions; Early Intensive Behavior 22%), and IDEA Part C providers (n = 3; 11%).
Intervention (Reichow & Wolery, 2009), Parent Child
Interaction Therapy (Eyberg et al., 1995), and Stepping Time and Resources. We recorded the length of intervention
Stones Triple P (Sanders et al., 2004) were common exam- and the amount of time in intervention per week. The length
ples from the included studies. of the intervention was reported for 39 of the 62 included
Gerow et al 9

studies (63%). Nearly half of the group studies reported an for a total of 32 reviewed experiments. Across all 31 experi-
intervention length of 6 months or less (n = 17; 49%); 20% ments, 8 received a rating of Meets without Reservations
reported an intervention length of 6 months to 1 year (n = (26%), 11 received a rating of Meets with Reservations
7); and 14% reported 1–3 years of intervention (n = 5). Of (35%), and 12 received a rating of Does Not Meet Standards
the group design studies that reported intervention time per (39%). Of the 21 studies rated as Meets without Reservations
week, the weekly intervention time was 10 hr or less for or Meets with Reservations, 12 studies received a rating of
47% (n = 16), 11–20 hr for 9% (n = 3), 21–30 hr for 12% Positive Effect (57%), 6 received a rating of Indeterminate
(n = 4), and 31–40 hr for 3% (n = 1). Single-case studies Effect (29%), and 1 received a rating of No Effect (5%).
reported the intervention time for nine studies (35%). Of Two of the 21 studies were found to have statistically sig-
those nine studies, five (56%) reported an intervention time nificant effects, but they were not between the intervention
of less than 6 months and two (22%) reported an interven- and control group for the dependent measures targeted in
tion time of 6 months to 1 year. Only 2 studies (22%) this review. Therefore, we did not give them a rating. Of the
reported an intervention time of over 1 year. studies eligible for an evidence rating (n = 19), six studies
The use of additional supplies that were not readily rated as Strong Evidence (32%), six studies rated as
available in the home was reported for 36 studies (58%). Moderate Evidence (32%), and seven studies rated as No
Half of the group studies reported the use of additional sup- Evidence (37%).
plies (n = 19; 53%). Most of these materials consisted of We reviewed the 26 included single-case studies based
homework or teaching manuals for the caregivers (n = 13; on the WWC single-case design standards (WWC, 2022;
68%). In addition, materials for the child’s intervention see Figure 2). Many of the studies included multiple experi-
were provided in several studies (e.g., visual schedules, ments (experiment was defined as an opportunity to demon-
timers; n = 5; 26%). Technology that was not already avail- strate experimental control), such as multiple ABAB/
able in the home was used in four of the group studies reversal designs or multiple dependent measures. These
(21%). Use of supplies not from the home was reported for studies included 78 experiments with participants who met
all single-case studies. The use of materials consisting of the inclusion criteria. There were 13 experiments that
homework or other course materials was reported for eight received a rating of Meets with Reservations, which spanned
studies (31%). Technology not readily available in the home across five included single-case studies (19%). Of these
was used for nine studies (35%). Additional materials nec- experiments, 11 (85%) received a rating of Strong Evidence
essary for the child’s intervention were used for six single- and two (15%) received a rating of No Evidence. The 11
case studies (23%) experiments rated as demonstrating Strong Evidence
spanned 4 studies (80% of the studies with sufficiently rig-
Social Validity. Of the 62 studies, 38 (61%) assessed caregiv- orous methodology).
ers’ opinions regarding the social validity of the interven- The interventions used in studies rated as Moderate or
tion. Across the 36 group studies, 19 (53%) included Strong Evidence across single and group design studies
measures of social validity. All group studies used inter- were antecedent-based interventions, alternative and aug-
views and questionnaires to evaluate social validity. A mentative communication, differential reinforcement, dis-
researcher-developed Likert-type scale questionnaire was crete trial teaching, FCT, naturalistic instruction, prompting,
used in eight of these studies (42%). Results of the social reinforcement, and response interruption/redirection. The
validity questionnaires were reported in 12 of the group coaching strategies used in these studies were (a) written
studies that evaluated social validity (63%). Each study and/or verbal instruction, (b) additional instruction separate
reported findings of social validity that indicated an overall from working with the child (modeling, role-play without
positive response from participants. Measures related to the child, video examples), (c) observation or role-play with
social validity were reported for 19 (73%) of the 26 included the child (with or without coaching/verbal prompting), (d)
single-case studies. A researcher-developed Likert-type feedback (immediate or using video), and/or (e) additional
scale questionnaire was used in 11 studies (58%). Results of conversation with the caregiver (including answering ques-
the social validity measures were reported for over half of tions, homework, goal setting, problem solving, and review
the studies in which social validity was measured for (n = of graphs, data, or progress).
11; 58%). Reported findings indicated an overall positive
response from participants.
Discussion
The purpose of this study was to synthesize and analyze the
Design Quality and Outcomes existing literature related to home-based caregiver coaching
We reviewed the 31 included group design studies based on to improve social–emotional skills and challenging behav-
the WWC design standards (WWC, 2022; see Figure 2). ior for young children with disabilities. Following a system-
One study included two experiments (Shapiro et al., 2014), atic search of the literature, we identified 57 included
10 Journal of Positive Behavior Interventions 00(0)

Design Evaluation Experiments (n = 58)

Group Design (n = 32) Single Case (n = 26)

Meets Meets
without without
Reservations Reservations
Does Not Does Not
(n = 9) (n = 0)
Meet Meet
(n = 11) (n = 21)
Meets with Meets with
Reservations Reservations
(n = 12) (n = 5)

Strong Moderate No Strong Moderate No

Evidence Evidence Evidence Evidence Evidence Evidence
(n = 6) (n = 6) (n = 7) (n = 4) (n = 0) (n = 1)

Figure 2. What Works Clearinghouse Design Quality.

Note. Two group design studies found significant results for one or more of their research questions, but did not find significant results across the
control and treatment groups for the targeted dependent variables in this literature review; therefore, they were not given a strength of evidence
rating.

studies for review. Out of those 57 identified studies, 26 studies. It is critically important that future research
were single-case-design studies, which included 88 partici- describes demographic characteristics of child participants,
pants, and 31 were group design studies, which included caregivers, and coaches, and that the participants are reflec-
3,752 participants. Together, this information indicates tive of the diversity of the population. For the studies that
there is a large body of research evaluating interventions to reported race or ethnicity of the child participants, <1% of
improve social–emotional skills and challenging behavior participants identified as American Indian or Alaska Native,
in this population. 2% identified as Asian, Native Hawaiian, or Other Pacific
Islander, 17% identified as Black or African American, 14%
identified as Hispanic or Latino/a/x, 62% as White, 4%
Research Question 1: Characteristics of identified as two or more races, and 2% identified as other.
Individuals Receiving and Providing Services White participants were overrepresented in this review,
There are several interesting findings related to the partici- with 62% of included participants and 58% of the popula-
pant characteristics in the included studies. There were a tion identifying as White (U.S. Census Bureau, 2022),
large number of participants in both the 0- to 2-year-old and aligning with results from a previous review indicating that
the 3- to 6-year-old age range, indicating there is research White participants are overrepresented in the literature
related to children who would qualify for IDEA Part C ser- (Robertson et al., 2017). Several races and ethnicities were
vices and IDEA Part B services. The most common disabili- underrepresented in the literature, including American
ties reported were ASD, developmental delay, other health Indian or Alaska Native (1.3% of population, <1% of
impairment, and speech or language impairment. included participants), Asian, Native Hawaiian, or Other
In the present literature, child race or ethnicity was not Pacific Islander (7% of population, 2% of included partici-
reported for approximately half of the participants; child pants), and Hispanic or Latino/a/x (20% of population, 14%
race or ethnicity was not reported for 43% of participants in of included participants) participants (U.S. Census Bureau,
group design studies and 75% of participants in single-case 2022). In addition, 17% of included participants and 14% of
Gerow et al 11

the U.S. population identify as Black or African American. analysis were more frequently conducted in the single-case
Due to lack of reporting of race and ethnicity, the extent of literature than the group design literature. These findings
the underrepresentation across races and ethnicities is may be reflective of the resources required to implement
unclear. It may be the case that each of these and other race functional analysis and FCT or that researchers with exper-
and ethnicity categories are more underrepresented than the tise in these interventions are more likely to conduct single-
data indicate. Furthermore, due to the extremely small sam- case studies. Together, the intervention findings support the
ple sizes in some categories (e.g., one American Indian or use of several interventions for improving social–emotional
Alaska Native participant and 34 Asian, Native Hawaiian, skills and challenging behavior for young children in this
or Other Pacific Islander participants), the extent to which context.
the interventions evaluated are effective, acceptable, and Caregivers typically received training using instructions,
culturally responsive across races and ethnicities remains modeling, role-play, coaching, and/or feedback, and the
unclear. caregiver coaching procedures often resulted in high levels
There was a high level of consistency in the caregivers of implementation fidelity. The caregiver coaching strate-
and coaches included across the studies. For the vast major- gies aligned with some or all of the features of behavioral
ity of participants, the caregivers’ relationship to the child skills training (Miles & Wilder, 2009; Snyder et al., 2015;
(e.g., father, grandparent, mother) was not defined or the Ward-Horner & Sturmey, 2012). These findings align with
caregiver was described and was the participant’s mother. previous reviews (e.g., Barton & Fettig, 2013; Fettig &
Therefore, there is ample evidence regarding effective Barton, 2014; Gerow et al., 2018), indicating caregivers can
methods to coach mothers and include mothers in the inter- accurately implement behavior analytic interventions to
vention. There is relatively little research regarding other improve skills with their children. Studies often included a
familial and nonfamilial caregivers in this context. Similarly, coaching feature from each of the following categories: (a)
nearly all of the individuals who coached caregivers were instruction, (b) additional instruction separate from work-
researchers. It is critically important to conduct further ing with the child (e.g., modeling, role-play), (c) observa-
evaluation of effective strategies when professionals who tion with the child with or without coaching, and (d)
work with caregivers in typical service delivery models feedback (e.g., immediate, using video).
(e.g., home-based IDEA Part C services, Head Start) pro- The social validity information reported indicated care-
vide coaching to the caregivers. For example, six included givers found interventions to be socially valid. The most
studies included IDEA Part C early intervention profession- common method for gathering feedback from key stake-
als as the caregiver coaches (e.g., Agazzi et al., 2019; holders was a social validity survey with the caregiver. It is
Dunlap et al., 2006). Without sufficient research with pro- important to note that social validity encompasses more
fessionals who provide home-based services, it is difficult than key stakeholders’ perspectives and experiences. The
to evaluate whether interventions and coaching strategies studies in this literature consistently adhered to several of
are acceptable, feasible, and effective in this context. the guidelines for social validity described in Horner et al.
Discrepancies between researchers and early intervention (2005), such as addressing a socially significant dependent
professionals as coaches due to a mismatch of the interven- variable and evaluating the intervention fidelity. Together,
tion in the home-based services context (e.g., insufficient the social validity information from the included studies
resources, lack of training on specific strategies) may con- indicates caregivers find the interventions acceptable and
tribute to caregivers’ feelings that services do not address feasible.
their child’s challenging behavior (McGill et al., 2006).
Further investigation of the efficacy, feasibility, and social
Research Question 3: Resources Needed for
validity of interventions in typical service delivery models
is needed. Implementation
Another important contribution from these findings is the
Research Question 2: Common Interventions extent to which interventions are feasible and sustainable
within typical service delivery models. We found that typi-
and Caregiver Coaching Strategies cal service delivery providers, such as IDEA Part C and
Several identified interventions had a large body of support Head Start providers, have largely been excluded in this
from the studies included in this review. Common interven- work. Therefore, the extent to which professionals and
tions included antecedent interventions, differential rein- community agencies find these models acceptable and fea-
forcement, FCT, naturalistic intervention, and reinforcement. sible remains unclear. It will be important to continue to
Each of these common intervention strategies are based on evaluate these interventions and coaching strategies with
applied behavior analysis, indicating interventions based on professionals who deliver home-based services. The analy-
applied behavior analysis have ample support in this con- sis of resources used in included studies indicated that the
text. Functional communication training and functional materials needed to implement the interventions were
12 Journal of Positive Behavior Interventions 00(0)

available in the home or are often available to home-based that should be considered when analyzing the current find-
professionals (e.g., visual schedules). The length of time ings. First, social–emotional skills are a broad concept. We
varied widely by study, making the resource of time diffi- used specific criteria for inclusion in our review, based on
cult to analyze for the purpose of this review; it will be previously described definitions (CASEL, 2020). However,
important to continue to evaluate the extent to which the there are several definitions of social–emotional skills, and
time required to deliver evidence-based coaching and inter- different studies likely would have met or not met our inclu-
ventions in the homes aligns with the resources available to sion criteria, depending on the definition chosen. The pri-
service delivery providers. mary purpose of the study was to evaluate home-based
services for young children. Due to Part C services primar-
ily being conducted in homes and aligning directly with the
Research Question 4: Strength of the Evidence
purpose of the review (i.e., home-based services for young
The results of this study yielded several new and relevant children), we included search terms related to Part C ser-
findings. First, this study synthesized the evidence across vices specifically, in addition to broader search terms that
single-case and group designs, which both have made unique were likely to encompass young children served through
and important contributions to the literature. This is espe- Part B and Part C. However, the search terms may have
cially important given that some interventions were more resulted in some studies related to services provided under
likely to be evaluated with a specific design (e.g., FCT and Part B not being identified. Many of the included studies
single-case designs); for this reason, this review provided did not meet the design quality criteria, meaning that we
more comprehensive information regarding effective inter- only analyzed study outcomes for a portion of the studies.
ventions in this context than previous reviews focusing solely Due to the variety of outcomes measured, interventions
on a specific type of design. Similarly, the emphasis on used, and experimental designs used, we did not conduct a
social–emotional skills and challenging behavior provided meta-analysis of included studies. Future research should
the opportunity to identify effective interventions in home- consider conducting statistical analysis to analyze this lit-
based services across two closely related outcomes. However, erature base. Finally, this search was conducted in January
fewer studies evaluated social–emotional skills interventions, 2021, and more articles may have been published since the
meaning that the evidence is more limited for that outcome. search was conducted. Since the database search yielded a
Approximately half of the included studies utilized single- large number of studies, it was not feasible to conduct the
case design and half utilized group design. Five single-case search again. Therefore, due to the size and scope of the
studies contained experiments that Met Standards with review, there is a gap between the search and dissemination
Reservations (19%). However, for the studies with sufficient of the findings.
quality, the results indicated the intervention was effective,
with 80% of studies receiving a visual analysis rating of
Strong Evidence for at least one of their included experi-
Directions for Future Research
ments. For the group design studies, most of the studies met The findings of this literature review have opened many
the standards with or without reservations (n = 19, 59%). For more avenues of research that could be pursued in the
this literature base, group studies typically included stronger future. The majority of included studies evaluated proce-
designs than the single-case studies, based on the WWC stan- dures to reduce challenging behavior; however, 29% of
dards. Across the group studies rated as Meets without included studies (n = 18) evaluated procedures to increase
Reservations or Meets with Reservations, the majority (n = social–emotional skills. Future research should continue to
12; 63%) were rated as Strong or Moderate Evidence. Since investigate home-based intervention’s effects on social–
the design rigor requirements are vastly different for single- emotional skills. Future research should include more
case design and group design, it is difficult to draw conclu- detailed demographic information for the participants and
sions about what this outcome indicates. Given that 16 caregivers and ensure included participants reflect the
studies met the design requirements and received ratings of diversity of the U.S. population. Much of the research has
Strong or Moderate Evidence, additional research is war- been conducted with mothers; there is a need to conduct
ranted in this area and there is a need to continue to identify research with other familial and nonfamilial caregivers.
interventions and coaching practices with a large body of Furthermore, it is critically important to continue to evalu-
strong evidence supporting their use. ate the efficacy of interventions in the context of typical
service delivery models, in which professionals—rather
than researchers—provide coaching to caregivers. For
Limitations example, in Shapiro et al. (2014), early intervention profes-
The findings of the present systematic review add to the sionals coached caregivers to implement Stepping Stones
current body of literature of early intervention implemented Triple P (Sanders et al., 2004) with their children in the con-
by caregivers in the home. However, there are limitations text of IDEA Part C services. However, evaluating
Gerow et al 13

caregiver coaching in the context of typical service delivery verbal prompting during visits, observation without coach-
models was rare in the literature, and there is a need for ing, immediate feedback, delayed feedback, and reviewing
further evaluation of the efficacy of caregiver coaching in data or graphs. Again, these practices align with behavioral
authentic contexts. skills training practices. The majority of studies also col-
lected treatment fidelity data on implementation. The use of
these coaching practices led to high treatment fidelity from
Conclusions and Implications for Practice caregivers. Furthermore, these intervention strategies were
The findings of the present review indicate that caregiver- rated as socially valid in this context, although it is impor-
implemented interventions based on applied behavior anal- tant to monitor and assess social validity with each family.
ysis leads to improvements in social–emotional skills and The results of this review indicated that there is support
challenging behavior. Based on the results of the literature for several established evidence-based practices—includ-
review and established guidelines for developing individu- ing antecedent-based interventions, FCT, differential rein-
alized interventions, we developed the following steps that forcement, naturalistic interventions, prompting, and
clinicians can consider when implementing home-based reinforcement—in the context of home-based services for
services (National Center on Intensive Intervention, 2018; young children with developmental disabilities or delays.
National Professional Development Center on Autism Caregivers often rate these interventions as socially valid
Spectrum Disorder, 2023): (a) assess social–emotional and the interventions can be implemented with materials
skills and/or challenging behaviors, (b) develop an individ- already available in the home or with relatively inexpensive
ualized intervention for the child based on family input, materials. The interventions typically lasted fewer than 6
child strengths and needs, and evidence-based practices, (c) months and required fewer than 10 hr per week, which may
develop jargon free, easy to understand instructions, (d) or may not be feasible, depending on the service delivery
teach the caregiver to implement the intervention, and (e) model. The results of this review indicate practitioners
provide continued support, observation, coaching, and data should seek to actively involve caregivers in the implemen-
monitoring. The first step is to assess social–emotional tation of identified effective interventions to improve
skills and challenging behaviors. Common assessment social–emotional skills and challenging behavior.
strategies in the literature are interviews, observations, and
questionnaires. Assessment of the current skill repertoire of Authors’ Note
children is essential for developing individualized interven- Stephanie Gerow was previously affiliated with Baylor University
tions. The next step is to develop an individualized inter- at the onset of this project.
vention for the child based on family input, child strengths
and needs, and evidence-based practices. The most com- Declaration of Conflicting Interests
mon interventions in the literature are antecedent-based The authors declared no potential conflicts of interest with respect
interventions, FCT, differential reinforcement, naturalistic to the research, authorship, and/or publication of this article.
interventions, prompting, and reinforcement. Studies often
included two or more of these interventions, indicating that Funding
using the interventions in combination, as appropriate, is The author(s) disclosed receipt of the following financial support
recommended. Each of these interventions has support from for the research, authorship, and/or publication of this article: The
high-quality studies indicating they yielded improvements research reported here was supported by the Institute of Education
in child outcomes in this context. Sciences, U.S. Department of Education, through Grant
Next, the clinician should develop jargon free, easy to R324B220002 to the University of Nevada, Las Vegas. The opin-
understand instructions for the caregivers and explain the ions expressed are those of the authors and do not represent views
written instructions to the caregiver. The two most common of the Institute or the U.S. Department of Education.
caregiver coaching strategies were verbal and written
instructions. Therefore, developing jargon free language is ORCID iD
essential when communicating with caregivers. The next David Cosottile https://orcid.org/0000-0002-2874-0954
step is to teach the caregiver how to implement the inter-
vention. The current studies used strategies that aligned Supplemental Material
with behavioral skills training. Clinicians should consider Supplemental material is available on the webpage with the online
using some or all components of behavioral skills training version of the article.
when coaching caregivers. In addition to written and verbal
instructions, the most common practices in the literature References
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