Integrating and sustaining evidence based practices in the community: A LENA Start™ Example

Marianne Elmquist1, Erin Lease1, Scott McConnell1, Liza Finestack2, and Amanda Kriese2

1Department of Educational Psychology, 2Department of Speech Language and Hearing Sciences, University of Minnesota, Minneapolis, MN, USA

Introduction

Preliminary Descriptive Results

Methods

Discussion

• A child’s language environment and experiences within the first three years of life greatly influence their language development trajectory: by the age of three, children from lower- income families hear 30 million fewer words compared to their peers from higher-income families (Hart & Risley, 1995).

• A multicomponent prevention approach should be used to maximize closing the word gap: one component is to provide services at the community level (Greenwood et al. 2017) to ensure that all parents and caregivers have the strategies and skills needed to create language rich environments.

• LENA Start™ is a 13-week parent training program that teaches parents and caregivers strategies that increase adult language input and parent-child interactions. Through a group format, parents learn about language and brain development, as well as activities and strategies that create a language rich environment.

• Programs like LENA Start™ will only be able to close the 30-million-word gap, if they are integrated and maintained within the community. Within the field of implementation science there are multiple models and frameworks (e.g. Fixsen et al. 2005; Damshroeder et al. 2009; Kilo 1998) on how to scale up practices, but the field is lacking ‘how to’ examples.

Study PurposeUsing a “Plan, Do, Study, Act” model the current study will 1) Evaluate the efficacy of LENA Start ™ in increasing adult language input and adult-child interactions and 2) Evaluate if local Early Childhood Family Education (ECFE) programs would be a good fit for implementing LENA Start™

Participants and Setting• Families were recruited through ECFE programs in 5 local school

districts• Children aged 1-39 months were recruited to either participate in

LENA Start classes or the comparison group. • Parent educators were trained by LENA Start ™ to implement the

parent training program. • To assess the feasibility and efficacy of LENA Start™ within ECFE, the

program was implemented in a variety of different classes e.g. Teens and Spanish speaking classes.

DesignTwo phase study over 2 years. • Phase 1. Implementation-only (Cohort 1): 0ne-group pretest-

posttest design • Phase 2. Evaluation phase (Cohort 2 & Comparison group):

Nonequivalent comparison group design

• Preliminary results show that LENA Start™ may increase the quality of language environments for young children by increasing adult language input and adult-child interactions.

• Preliminary results show that it is feasible to implement LENA Start™ in ECFE programs.

• However, there are factors to consider if LENA Start™ can be fully scaled up and integrated into ECFE programs. • Funding: In order to integrate and sustain LENA Start™ within

ECFE programs: a reliable funding source will have to be identified.

• Goodness of fit: Typically ECFE parents choose different topics to be covered. Although, both parents and parent educators reported that they liked LENA Start™ and would like to see the program continue, to increase the likelihood that it can be fully integrated within ECFE programs, there is a need to determine how to incorporate ECFE’s parent driven approach.

• There are several limitations to the current study. First, there was no comparison/control group for cohort 1. Secondly, the comparison group for cohort 2 is not equivalent, and lastly the sample size of the current study is small.

• LENA Start™ through ECFE may not be able to target the families that would benefit the most from programs like it. Future research is needed to investigate how to reach families that will benefit the most from community level language intervention programs.

Selected References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. https://doi.org/10.1186/1748-5908-4-50

Fixsen, Dean, L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature.

Greenwood, C. R., Carta, J. J., Walker, D., Watson-Thompson, J., Gilkerson, J., Larson, A. L., & Schnitz, A. (2017). Conceptualizing a Public Health Prevention Intervention for Bridging the 30 Million Word Gap. Clinical Child and Family Psychology Review, 20(1), 3–24. https://doi.org/10.1007/s10567-017-0223-8

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children. Paul H Brookes Publishing.

Kilo, C. M. (1998). A framework for collaborative improvement: lessons from the Institute for Healthcare Improvement’s Breakthrough Series. Quality Management in Health Care, 6(4), 1–13. https://doi.org/10.1097/00019514-199806040-00001

FundingThis work is funded by a challenge grant from the LENA Research Foundation, the Bush Foundation, and the University of Minnesota. Thanks are due to Gerri Fisher,

Jacqueline Perez, and Dianne Haulcy at Think Small, and administrators, parent educators, parents and children in Minneapolis, Anoka/Hennepin, Wayzata, and

Saint Paul Public Schools

Methods Continued

Plan

Prepare for implementation

Do

Implement practice as intended

Study

Evaluate implementation

Act

Reflect, incorporate adjustments and

scale up

Self-sustaining

implementation

sites

Figure 1. Scaling up practices framework.

Table 1Participant demographics by cohorts

Note. Not all participants filled out every question in the demographic surveys. Responsesare recorded for those that did.

MeasuresPhase 1 and 2• Adult word count (AWC) - measured with LENA recorder• Conversational turns (CT) – measured with LENA recorder• LENA Snapshot – 52 parent questionnaire.• Demographic survey

Phase 2 only• MacArthur Bates Communicative Development Inventory• 6-minute video observation of parent-child interactions

LENA Start™ Intervention• 13 weekly parent training sessions implemented by parent

educator. • Combination of PowerPoint presentation, videos, and group

sharing. • Families complete one weekly all day language recording,

with LENA recorder.• Receive weekly recording report showing breakdown of

AWC, CT, and electronic noise. • Families receive weekly shared reading book and are

encouraged to create shared reading opportunities at home.

• LENA Start™1.0 – 8 sessions with optional ‘graduate sessions’ afterwards

• LENA Start™ 2.0 – switched to 2.0 (13 week format)

Figure 3. Sample recording report that LENA Start™ families receive weekly, weeks 3-13.

• One a scale of 1-5 (5= strongly agree), 70.8% of parents from cohort 2 would recommend LENA Start™ to a friend and reported that they enjoyed attending the program.

• Parent educators stated that overall LENA Start™ is feasible to implement in ECFE, but at times the structured nature of the program conflicts with ECFE’s parent focused approach e.g. not being able to address parent identified topics.

Cohort 1

N=54

Cohort 2

N=39

Comparison group

N=21

Groups 7 5 1

Income

Less than $850 11.1% 5.1% 4.8%

$850-$1599 31.5% 12.8% 4.8%

$1600-$2349 7.4% 20.5% 4.8%

$2350-$3349 3.7% 18% 9.5%

$3350 or more 27.8% 30.8% 62%

Ethnicity

Asian/Asian-American 1.9% 2.6%

Black/African American 5.6% 2.6%

Hispanic/Latino 26% 28.2% 4.8%

Multiple 22.1% 10.3%

White/Caucasian 44.4% 56.3% 81%

Age M (range)

Parents 25yrs (15-50) 33yrs (21-41) 30yrs (19-39)

Children 20mos (3-39) 17mos (1-32) 23mos (5-33)

Gender - Children

Female 57.4% 48.7% 52.4%

Figure 2. Preliminary descriptive results for the nonequivalent comparison group design (Phase 2). Showing changes in percentiles for AWC, CT and CDI. AWC= adult word count. CT= conversational turns. CDI= MacArthur Bates communicative inventory – words produced. Participants in the LENA Start™ groups demonstrated larger gains in AWC, CT, than those in the comparison group.

Post-testPre-test

Figure 4. LENA snapshot results from phase 2, showing that children in the LENA Start™ groups saw a 6 month growth in 13 weeks compared to 3 months for the comparison group.