Analysis of Transactional Interactions in Triadic Early Intervention Home Visits

Growing evidence shows that triadic intervention can promote caregiver adoption of development-promoting behaviors that are supportive of child learning and development. However, there is a critical gap in our knowledge about the mutual influences of providers’ and caregivers’ actions within the context of early intervention (EI) home visits. Studies and assessment tools have overlooked the reciprocal nature of provider-caregiver interactions as they occur during EI home visits and have not focused on identifying the associations between specific adult behaviors. The primary aim of this study was to revise an existing assessment tool, the Triadic Intervention and Evaluation Rating Scale (TIERS), to capture a richer description of adult interactions as they occur during EI home visits. The revised tool, the TIERS-R, was developed in four phases using a systematic process: (a) content and format revision, (b) expert validation of revised content and format, (c) feasibility testing and revision, and (d) a small-scale evaluation of the TIERS-R in rating EI home visits. The secondary aim of this study was to establish the utility of the TIERS-R for evaluating provider-caregiver interactions as EI home visit sessions progressed. Study participants included: (a) an expert panel of 11 EI professionals who participated in the first three phases and (b) two raters who participated in the small-scale evaluation using the TIERS-R, coding videotapes of triadic home visits using secondary data that included four dyads. Yule’s Q revealed strong positive or negative sequential associations between several specific provider and caregiver behaviors that were defined in the TIERS-R. Further, descriptive analysis indicated that adult behaviors changed from beginning to end EI home visit sessions but varied across the four dyads. Social validity findings, including I-CVI scores of the expert panel’s relevancy ratings, mean scores of their clarity ratings, and User Feedback Survey responses, showed that the TIERS-R items are relevant to home visiting and are observable and measurable. Study limitations and implications for future research and practice are discussed.