The purpose of this research is to investigate the relationship between early intervention providers’ backgrounds, and their perceptions of caregiver coaching and auditory skill development, to develop professional development programs. An explanatory sequential design was used with participants of varying backgrounds and experience. In the first phase of the study, participants responded to a survey regarding their educational background, and their comfort with caregiver coaching and auditory skill development. Survey results were analyzed using Spearman’s Ranked Correlational Coefficient (Spearman’s rs) to form groups of participants from extreme cases. The second phase of the study consisted of participant interviews from each of the groups. Interviews were coded to identify themes present within and between groups. The information from both phases were analyzed to generate how professional preparation and certifications influence service delivery. Results were subsequently analyzed to determine potential improvements in the EI system, professional development, and policy.

BACKGROUND: Many families of children who are deaf or hard of hearing (DHH) pursue the development of spoken language through the use of advanced hearing technology and intensive, specialized listening and spoken language (LSL) intervention services. LSL practitioners utilize caregiver coaching to transfer knowledge and skills to parents, equipping them to effectively support their child's listening and language development. Caregiver coaching builds parents' capacity to implement intervention strategies within daily routines to maximize learning opportunities to reach this goal. While caregiver coaching is a hallmark of LSL practice, there is a lack of consensus and paucity of evidence to support its use with children who are DHH learning to listen and talk. The purpose of this research was therefore to gain a greater understanding of caregiver coaching practices in LSL services for families of children ages birth-3 who are DHH. OBJECTIVES: 1) to provide a synthesis of the literature and identify gaps in the existing knowledge base regarding coaching in LSL services, 2) to gain insight into practitioners' and caregivers' experiences with coaching in LSL services, and 3) to gain a better understanding of coaching practices in LSL services with families of children who are DHH. METHODOLOGY: The first objective was addressed by performing a scoping review of the literature to synthesize the relevant research and professional practice recommendations and identify gaps in the knowledge base regarding coaching caregivers in LSL practice. The remaining objectives were addressed through qualitative, semi-structured interviews and video observation discussions with LSL practitioners and caregivers to gain insight into caregivers' perspectives and practitioners' perspectives and practices. Interviews were conducted with 14 practitioners and 13 caregivers at three intervention sites in the US and Canada. These sites represent three different service delivery models of LSL intervention for families of children who are DHH. RESULTS: The scoping review findings revealed a lack of consensus in the literature regarding the principles and practices of caregiver coaching in LSL services. We presented the following topics found in the literature: coaching practices, training for coaching, the effectiveness of coaching, and recommendations for coaching. Caregivers reported coaching as a positive experience; however, coaching practices differed among sites and between practitioners, supporting the results of the scoping review. The caregivers indicated factors that contribute to a positive coaching relationship, including practitioner characteristics, establishing explicit expectations, and adapting to caregivers' changing needs over time. The practitioner interviews also supported a lack of consistency in coaching practices between sites and indicated that underlying beliefs impact how practitioners coach and engage caregivers. CONCLUSION: The findings from this dissertation provide practical, actionable steps that LSL practitioners can implement to develop and support the caregiver coaching relationship. These findings have the potential to inform professional preparation and development activities to better equip practitioners to engage caregivers in the intervention process, and ultimately, positively impact the listening and spoken language outcomes of the children they serve.

Sub-Saharan Africa (SSA) has a scarcity of research on autism spectrum disorder (ASD) and available early interventions, as most of what is known about the disorder is from highincome countries. Early detection and intervention methods were found to have positive effects on developmental delays and to alleviate symptom severity in children with ASD or at risk of it. There is a need for scalable interventions in low-resource settings, which are characterised by a lack of highly-trained specialists, infrastructure and funding. This study explored the barriers and facilitators to implementing and sustaining a caregiver-coaching ASD early intervention, informed by the principles of the Early Start Denver Model (ESDM), adapted for South Africa and for delivery by non-specialists. The study also identified some changes that could be made to improve intervention adoption and sustainability. Nine multilevel stakeholders involved in the implementation of the caregiver-coaching intervention were purposively sampled, individual in-depth interviews were conducted, transcribed verbatim and thematically analysed. Major implementation facilitators included: ECD worker baseline ASD knowledge and experience; skills gained from the training received and coaching; clear in-session caregiver-coaching structure; value of strong team relationships; clear video illustration of intervention concepts; and the mastery and generalisation of skills by the ECD workers, ECD supervisors and caregivers. Implementation barriers included: the complexity of the intervention and coaching concepts; misalignment of ECD teacher training with the caregiver-coaching approach; logistical challenges; and mismatch of the video content with the South African context. Facilitators to sustain the intervention included: child outcomes; caregiver ‘buy-in;’ and competence; and the need for ongoing live supervision. Barriers to sustaining the intervention included: structural issues of poverty, transportation and unemployment. Positive child and caregiver outcomes could be offset by larger contextual and system-level issues such as poverty and the need for ongoing support, supervision and local coaching materials in South African languages. The results will inform tailoring of the intervention training and supervision approach for a larger pilot study.