Coaching Caregivers of Children who are Deaf or Hard of Hearing: A Scoping Review

Abstract

Caregiver coaching is an expected practice in early intervention. However, little is known about coaching with caregivers of children who are deaf or hard of hearing, receiving services for listening and spoken language (LSL). A systematic review of 7 databases, the gray literature, and consultation with 7 expert LSL practitioners yielded 506 records for full-text review, 22 of which were ultimately included in the review. Our findings are presented as 3 themes: coaching practices, training for coaching, and effectiveness of coaching. Eight models of coaching were identified in the literature, from which we identified commonalities to propose a consolidated model that illustrates the recommendations and process of caregiver coaching found in the LSL literature.

Children who are deaf or hard of hearing (D/HH) are identified and enrolled in early childhood intervention programs ideally no later than 3–6 months of age (Joint Committee on Infant Hearing [JCIH], 2019). The provision of timely, appropriate, and effective hearing intervention aims to foster communication development. For families who choose to pursue spoken language, hearing aids and/or cochlear implants enable children who are D/HH to gain auditory access and develop spoken language through audition. Research has shown that early aided audibility and consistent device use contribute to improved language and auditory development (Moeller & Tomblin, 2015; Tomblin et al., 2015). In addition, quality linguistic input from caregivers leads to better early language outcomes (Ambrose, Walker, Unflat-Berry, Oleson, & Moeller, 2015; Cruz, Quittner, Marker, & DesJardin, 2013; DesJardin & Eisenberg, 2007) and early intervention (EI) leads to better language outcomes at 5 years of age (Ching, 2015; Ching et al., 2017). It is imperative for caregivers, including family members and anyone regularly involved in the child’s care, to receive support in order to understand their role in establishing consistent device use, as well as how they can facilitate their child’s listening and language development.

Practitioners who work with families of children who are D/HH require specialized knowledge and skills in the development of listening and spoken language (LSL) through audition (JCIH, 2019; Moeller, Carr, Seaver, Stredler-Brown, & Holzinger, 2013). Some practitioners undergo extensive training and mentorship to obtain certification as a Listening and Spoken Language Specialist (LSLS) through the AG Bell Academy for Listening and Spoken Language (https://agbellacademy.org/certification/). The LSLS principles that guide certified practitioners include early diagnosis and access to sound through appropriate hearing technology and highlight the importance of guiding and coaching caregivers to become the primary facilitators of listening and language for their children (AG Bell Academy for Listening and Spoken Language [AG Bell Academy], 2017). The primary goals of LSL practice are for children who are D/HH to learn to listen and talk with conversational competence, to be included in general education, and to maximize their educational and social choices throughout their lives (Estabrooks, 2012; JCIH, 2019).

Caregivers are considered key contributors to their child’s language development. Coaching is utilized in LSL practice to empower caregivers to take on the role of primary facilitators of language development for their children within the meaningful context of their day-to-day activities (DesJardin, Ambrose, & Eisenberg, 2009; Quittner et al., 2013; Simser & Estabrooks, 2012). Through coaching, caregivers actively participate in planning intervention sessions, observe and practice strategies during sessions, and engage in reflective discussions with LSL practitioners to evaluate their understanding.

Since coaching positions caregivers as the primary learners in the intervention process, it is widely recommended for practitioners to utilize practices geared toward adult learners. Adult learning involves a readiness-to-learn, self-directed learning, active participation in the learning process, and a solution-centered, contextual approach to learning (Cox, 2015; Dunst & Trivette, 2009, 2012; Knowles, Holton III, & Swanson, 2011). Active learner participation, opportunities to practice new knowledge and skills, and reflection are important components of the coaching process for effective adult learning (Trivette, Dunst, Hamby, & O’Herin, 2009). Reflection is an essential element in adult learning, and caregiver coaching is an inherently reflective process (Jackson, 2004; Merriam, 2008). Broadly defined as the deliberate, purposeful, metacognitive thinking and/or action in which an individual engages in order to improve their performance or practice (Sellars, 2017), reflection is an interactive process that encourages caregivers to think about the effectiveness and consequences of their actions during the coaching cycle as they work toward mastery.

There is a lack of agreement on the definition or specific practices of coaching in the literature (Friedman, Woods, & Salisbury, 2012). Best practice guidelines for EI services indicate that family/professional partnerships are critical for intervention that is family-centered and effective (JCIH, 2019; Moeller et al., 2013). In addition, key LSL practice guidelines, principles, and best practice documents not only provide insight into the centrality of coaching in LSL practice but also highlight a lack of specificity regarding coaching skills and strategies (AG Bell Academy, 2017; Dickson, Morrison, & Jones, 2013; Kendrick & Smith, 2017). Although these guidance documents support LSL practice, less attention has been paid to the application of caregiver coaching within this specialized field of practice.

This scoping review sought to determine how coaching is conceptualized and implemented in LSL practice and identify whether there is a consensus within the LSL literature. Therefore, the objective of this review was to gather and summarize what is known about coaching caregivers of children who are D/HH, including definitions, coaching practices, and the impact of coaching.

Methods

This scoping review of the literature was informed by the framework outlined by Arksey and O’Malley (2005) and subsequent recommendations for increasing the clarity and rigor of the methodology (Levac, Colquhoun, & O’Brien, 2010; Peters et al., 2015). Our review complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (Tricco et al., 2018). We utilized the five steps of Arksey and O’Malley’s (2005) framework to complete this review: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting the results.

Identifying the Research Question

We developed the research question following the structure of population, concept, and context (Peters et al., 2015), whereby studies of caregivers of children who are D/HH and LSL practitioners (population), caregiver coaching (concept), and LSL services for the development of LSL (context) were included. The primary research question addressed was: What is known from the existing literature about caregiver coaching in LSL services for families of children who are D/HH?

The primary research question was left intentionally broad, as the focus of the review was to map the breadth of the existing knowledge about coaching in LSL practice (Arksey & O’Malley, 2005; Levac et al., 2010). To focus the scope of the inquiry, we developed several subquestions, including (a) what are the definition(s) of coaching? (b) what is known about coaching practices, training, professional practice recommendations, and active caregiver participation and reflection in the caregiver coaching process? and (c) what is known about the impact of coaching in LSL services?

Identifying Relevant Studies

In consultation with a research librarian, a comprehensive search strategy was developed to identify relevant articles from the inception of databases through October 2019, with a check for new literature in June and September 2020. We conducted the search in the following databases: Web of Science, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Education Resources Information Center (ERIC), Medline, and ComDisDome. Major concepts included in the search strategy were caregiver/parent coaching, LSL or auditory–verbal practice, early intervention, and children who are D/HH. The terminology used in this field is diverse and has changed over time; therefore, the search strategy included terminology (such as “parent education”) to capture the concept of “coaching” before the term was widely used in the literature (details regarding the search strategy are included in Supplementary Material A1).

In addition, we hand searched key journals, websites of professional organizations, and reference lists of included studies to identify further relevant documents (see Supplementary Material A2). We contacted authors and utilized the interlibrary loan system and electronic scan-on-demand services for documents identified in the search that we could not otherwise locate. Finally, seven experienced professionals in the field of LSL practice provided recommendations for resources that they find helpful in their coaching practice with families.

Inclusion criteria consisted of primary studies (published articles and dissertations), literature reviews, and professional commentaries that were (a) specific to LSL services for children who are D/HH, aged birth - 6 years, and their caregivers, (b) contained information specific to coaching or teaching caregivers, and (c) published in English. In order to gain a broad understanding of the practice of coaching caregivers since the inception of LSL practice, no date constraints were set. Because this review sought to map the literature specific to families pursuing spoken language outcomes, articles related to the development of sign language, total communication, or bilingual/biculturalism were excluded.

Study Selection

Covidence systematic review software (http://www.covidence.org) was used to manage the study selection. We removed all duplicates and documents that included duplicate information (retained document with most relevant information). We proceeded to study selection in two stages: (a) title and abstract screening and (b) full-text review.

Two reviewers (D. N. and V. G. or D. D.) completed the independent screening process of the title and abstracts. Each reviewer participated in a calibration exercise with 10 articles to ensure that the inclusion criteria were clear and consistently applied and met throughout the screening process to address any ambiguities (Levac et al., 2010). Nonconsensus titles/abstracts were discussed or resolved with additional members of the research team (E. F. and S. M.). Articles that were tagged as “yes” or “maybe” were retrieved for full-text review. Two reviewers (D. N. and D. D.) independently screened the full-text articles against the inclusion criteria. We resolved discrepancies through discussion and consultation with members of the research team as needed to reach consensus on the included documents.

Charting the Data

Two data extraction forms were developed to extract contextual and process-oriented information from the included documents (Colquhoun et al., 2014; Peters et al., 2017). The first data extraction form was developed for empirical studies, to extract data including study design, aim of study, and relevant methods and results, in addition to information pertaining to coaching practices. The second data extraction form was developed for documents such as conceptual papers and guidance documents, to extract relevant and meaningful information pertaining to caregiver coaching. Data from both types of documents included information related to caregiver coaching, definitions, descriptions, and recommendations for coaching, as well as practitioner training, active caregiver participation, and reflection. Data from the extraction sheets were coalesced for data analysis.

Two reviewers (D. N. and D. D.) piloted the data extraction forms with three articles and recalibrated after 10 articles to ensure that information extracted was standardized and consistent with the research questions and purpose (Levac et al., 2010). One reviewer extracted data from the remaining articles (D. N.) and the second reviewer (D. D.) verified all data.

Analysis was facilitated using NVivo (version 12.6.0), a qualitative data analysis software package. We organized the documents by type (i.e., empirical study, gray literature, conceptual paper) and synthesized the data across types thematically. Initial categories were defined a priori based on the research questions, including definitions, practices, types of training for coaching, and the impact of caregiver coaching. Categories were expanded and added as we identified themes in the literature related to coaching steps and recommendations. One researcher (D. N.) completed the iterative process of open coding, creating categories, and organizing the data into main concepts. The research team reviewed and refined the resulting concepts.

Results

The search and review process are represented in Figure 1. Of 1,819 records initially screened, 506 underwent a full-text review. Reasons for exclusion of articles are provided. A total of 22 articles were included in the analysis, six of which were primary research publications, including five dissertations and one peer-reviewed study. Five peer-reviewed conceptual papers, nine book chapters, one curriculum manual, and one report pertaining to caregiver coaching in LSL practice were also included (see Supplementary Material A3). Evidence from the included gray literature augmented and reinforced information about caregiver coaching contained in the peer-reviewed literature. This “clinical wisdom” provided additional information as well as context for the implementation of coaching in LSL services, particularly due to the lack of consensus on the measurement or practices of LSL coaching and the low volume of empirical evidence (Benzies, Premji, Hayden, & Serrett, 2006).

Figure 1 .

PRISMA flow diagram for search and selection process. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

We synthesized and grouped the results of our literature review into three main themes: (1) coaching practices, including definition and purpose, roles of the practitioner and caregiver, coaching steps, recommendations, and the incorporation of caregiver participation and reflection; (2) practitioner training for coaching, and (3) the impact of coaching. Finally, we explored the commonalities between the various stages of coaching represented in the literature and organized them into a framework for coaching caregivers of children who are D/HH.

Coaching Practices

Definition and purpose of coaching

The most widely referenced model of coaching was that of Rush and Shelden, a model of coaching for EI, not specific to children who are D/HH (Rush & Shelden, 2011; Rush, Shelden, & Hanft, 2003). Six papers quoted or referenced Rush and Shelden’s definition of coaching (Brooks, 2017; DesJardin, 2017; MacIver-Lux, Estabrooks, & Smith, 2020; Martin-Prudent, 2018; Morrison, 2017; Voss & Stredler-Brown, 2017), whereas two (Hamren & Quigley, 2012; Houston, 2020) referenced steps outlined by Doyle (1999), whose model of coaching in business is cited in the development of Rush and Shelden’s model of coaching for EI (Rush & Shelden, 2005, 2011).

A total of 15 of the included 22 articles defined coaching; yet, definitions and descriptions of caregiver coaching varied, and there was little consensus between them. In four studies, coaching tended to be narrowly defined (Brooks, 2017; Estabrooks et al., 2020; Roberts, 2019; Voss & Stredler-Brown, 2017) and in a further three studies, it was more broadly presented as a description of a philosophy rather than a specific set of practices (Brown & Nott, 2005; DesJardin, Eisenberg, & Hodapp, 2006; Hamren & Quigley, 2012). In addition, eight articles referred to the foundational principles of adult learning when describing the coaching paradigm (Brooks, 2017; Brown & Nott, 2005; Clark & Watkins, 1985; MacIver-Lux et al., 2020; Morrison, 2017; Rhoades & MacIver-Lux, 2016; Stredler-Brown, 2015; Voss & Stredler-Brown, 2017). See Table 1 for examples of coaching definitions found in the literature.

Table 1.

Definitions of coaching in the literature

Author	Definition	Specific to LSL?
DesJardin, 2017 Martin-Prudent, 2018 Also referenced in: Brooks, 2017; MacIver-Lux et al., 2020; Morrison, 2017; Voss & Stredler-Brown, 2017	Variations of Rush and Shelden’s definition:   Coaching is an interactive process of observation, reflection, and action in which a coach promotes the learner’s ability to support a child’s learning and participation in both family and community contexts (Rush et al., 2003; Rush & Shelden, 2011; DesJardin, 2017, p. 685) Coaching is “an ongoing process that promotes self-observation, self-correction, and an ongoing learning process thru examination, reflection, discussion, and refinement of one’s knowledge and skills” (Rush et al., 2003, p. 34; Martin-Prudent, 2018, p.22)	No
King, 2017	Caregiver coaching consists of strategies used by EI professionals to enlist the caregiver as a partner in the process of facilitating the child’s development and builds the caregivers’ capacity to implement language-enhancing strategies within the natural environment (Roberts & Kaiser, 2011)	No
Rhoades & MacIver-Lux, 2016	Parent coaching is an evidence-based interactive and developmental process that facilitates adult learning and competencies (Friedman et al., 2012; Hanft, Rush, & Shelden, 2003)	No
Brooks, 2017 a	For the purpose of this study, real-time embedded coaching is the act of providing suggestions, comments, and support to a parent/caregiver while the parent is engaged in an activity with her child (Brooks, 2017, p. 12).	Yes
Brown & Nott, 2005 b	The coaching role of the teacher of the deaf is so named to convey the idea that in family-centered intervention, the teacher does not work directly with the child but supports the parent to do so (Brown & Nott, 2005, p. 159)	Yes

^aExample of narrow definition of coaching.

^bExample of broad description of coaching.

A total of 11 of the 22 articles did not provide a precise definition of coaching, but instead described components of a program or model (Brown & Nott, 2005; DesJardin et al., 2006; Estabrooks et al., 2020; Hamren & Quigley, 2012; Roberts, 2019), goals for a program (Bruce, 1986; Clark & Watkins, 1985), or simply did not include any definition or description (Daczewitz, 2015; Houston, 2011, 2020; Nevins & Sass-Lehrer, 2015).

Overwhelmingly, the purpose of coaching was consistently described as a means to equip and empower caregivers to increase and improve language interactions with their children, ultimately resulting in self-efficacy and carryover of intervention strategies into their daily routines. Even the coaching models with more of a practitioner-as-expert approach mentioned the purpose of coaching as increasing caregiver confidence and emphasized caregiver–child interaction (Bruce, 1986; Clark & Watkins, 1985; Daczewitz, 2015; Martin-Prudent, 2018; Nardine, 1974).

Role of practitioner

There was a consensus in the literature that caregivers play an important role in a child’s LSL development. The role of the practitioner in facilitating this involvement was described as a collaborative partnership (Daczewitz, 2015; Stredler-Brown, 2015; Voss & Stredler-Brown, 2017) and involved inviting the caregivers to participate (Martin-Prudent, 2018), supporting them to implement learned strategies (Brown & Nott, 2005; DesJardin, 2017; DesJardin et al., 2006; Martin-Prudent, 2018), and positioning them as the primary communication partners with their child (Blaiser, Edwards, Behl, & Muñoz, 2012; Brown & Nott, 2005; Estabrooks et al., 2020; Stredler-Brown, 2015). In addition to “coach,” the practitioner was described as a “facilitator” (Clark & Watkins, 1985), “navigator” (Estabrooks et al., 2020), and “consultant” (Morrison, 2017; Nardine, 1974; Voss & Stredler-Brown, 2017).

Studies on practitioner roles have shown various results. In interviews following the implementation of real-time embedded coaching, Brooks (2017) found that teachers reported a shift in thinking from being the expert whose role it was to plan activities and teach strategies to an individual who recognized the value of including caregivers as collaborative team members capable of making decisions, planning, and taking the lead in sessions. In contrast, student practitioners were expected to deliver intervention strategies according to an established sequence and criteria and invite the caregivers to participate in a preplanned, structured session, in more of a practitioner-as-expert approach in a model described by Martin-Prudent (2018). This study included a caregiver involvement rating to categorize the type and degree of engagement in the intervention sessions. Caregiver involvement was categorized as “excessive” when caregivers demonstrated strategies before the graduate student was able to model them (or led the session by showing their child’s skills or suggesting activities). Caregiver involvement was categorized as “expected participation” when caregivers actively engaged in the session and practiced strategies when invited by the graduate student. “Excessive” caregiver involvement resulted in the graduate students’ inability to implement the coaching model with fidelity according to a standard established by the researcher. Three publications highlighted the importance of moving from teacher to facilitator as the caregivers developed confidence and proficiency with strategies (Estabrooks et al., 2020; Morrison, 2017; Nardine, 1974).

Stredler-Brown (2015) investigated the role of the practitioner in face-to-face compared with remote intervention (telepractice); specifically, the relationship between provider attributes and provider behaviors related to caregiver coaching. Of the four provider behaviors examined—observation, direct instruction, parent practice with feedback, and child behavior with provider feedback—only direct instruction was used with similar frequency in face-to-face and telepractice sessions. The other three were used more frequently during telepractice sessions compared with in-person sessions. Providers with fewer years of experience were more likely to implement parent practice with feedback in telepractice sessions, which is a provider behavior closely linked to caregiver coaching. The author speculated that this may be related to the content and temporal proximity of their graduate training. This study suggests that there may be a difference in the role of the practitioner, including caregiver coaching, in different practice conditions.

Stages of coaching

A number of coaching steps were presented in the literature, and like the definitions, the steps in a caregiver coaching session and the language used to describe them varied widely. For example, modeling and demonstration were used to describe the same concept (Brooks, 2017; DesJardin, 2017; DesJardin et al., 2006; Estabrooks et al., 2020; Houston, 2011; King, 2017; MacIver-Lux et al., 2020; Rhoades & MacIver-Lux, 2016; Stredler-Brown, 2015). Practice was described as action (DesJardin, 2017; Hamren & Quigley, 2012; Houston, 2020; MacIver-Lux et al., 2020; Martin-Prudent, 2018; Nevins & Sass-Lehrer, 2015), carrying out the skill (Bruce, 1986; Clark & Watkins, 1985), repeating the activity (Houston, 2011), or simply, the parent trying the strategy (Voss & Stredler-Brown, 2017). We synthesized and organized the coaching steps found in the literature into three stages of caregiver coaching: setting the stage, application, and wrap-up. The stages of the coaching process and examples of each step are included in Table 2. See Supplementary Material  A4 for the distribution of coaching stages in the included literature.

Table 2.

Stages of caregiver coaching represented in the literature

Stage of coaching		Examples from the literature
Setting the stage
	Planning the session (n = 15)	The coach and parent cooperatively develop a plan that includes a purpose and an outcome (Houston, 2020, p. 8)
	Initiation (n = 14)	The caregiver provides updates regarding the child or family, and the two participants (caregiver and provider) share information and prepare for the session (King, 2017, p. 43)
	Introducing the strategy (n = 13)	The interventionist may observe the parent and child interacting to identify which strategy or technique to explore first. Or the parents may select the strategy that is most important or appealing to them. Once the technique is identified, it is briefly discussed (Voss & Stredler-Brown, 2017, p. 11)
Application
	Observation (n = 17)	One way it (observation) could occur is for a professional to watch a parent interacting with the child while practicing a new skill previously discussed in a coaching session … An observational situation might also occur with the parent observing the professional demonstrate a particular skill, technique, or strategy (DesJardin, 2017, p. 692)
	Modeling (n = 19)	Modeling the targeted strategy provides the parent or caregiver an opportunity to see how the strategy should be employed (Martin-Prudent, 2018, p. 116)
	Practice (n = 20)	Following demonstration, the practitioner turns the activity over to the parent for practice (Morrison, 2017, p. 271)
	Feedback (n = 20)	Providing guided practice with feedback involves opportunities for parents to practice implementing strategies, to obtain feedback from the practitioner, and to refine those skills that are critical for optimal parent–child interactions (Rhoades & MacIver-Lux, 2016, p. 334)
	Evaluation (n = 13)	Evaluation requires a conscious effort for the provider to identify the child’s current skill level and any perceived behavioral responses to the strategy being used. In a family-centered approach, the evaluation also includes an assessment of the family members’ use of new strategies (Stredler-Brown, 2015, p. 57)
Wrap-up
	Planning for carryover (n = 12)	The practitioner … jointly evaluates the outcomes of the activity with the parent and talks about ways to generalize the outcomes at home during the family’s everyday life (Estabrooks et al., 2020, p. 597–598)
	Final discussion (n = 6)	Before the session ended, the parent was given ample opportunity to discuss any concerns about the child’s progress, ask questions about short- or long-term communication goals, or seek input about troubleshooting the child’s hearing technology (e.g., digital hearing aids and/or cochlear implants, FM systems) (Houston, 2011, p. 68)

Recommendations for coaching

Four themes related to recommendations were identified from this scoping review. Caregiver coaching with families of children who are D/HH should be individualized (n = 20), context-driven (n = 19), collaborative (n = 19), and strengths-based (n = 13). Table 3 describes and provides examples of each of these recommendations. The list of documents that incorporated these recommendations is provided in Supplementary Material A5. Individualized services take into account the unique needs and environments of each family (e.g., Daczewitz, 2015). Context-driven services utilize the family’s everyday routines as a context for their child’s learning to ensure that activities are functional and generalizable (e.g., Martin-Prudent, 2018). LSL services should be a collaborative effort between a practitioner and family, as well as between all professionals working with that child (e.g., Hamren & Quigley, 2012; Rhoades & MacIver-Lux, 2016). Less frequently mentioned in the literature, strengths-based services acknowledge and build upon on the family’s strengths (e.g., Brown & Nott, 2005; Daczewitz, 2015).

Table 3.

Recommendations for coaching from the literature

Recommendation		Description	Examples
Individualized	n = 20	Models of coaching ranged from prescribed curricula or strict protocols to more flexible practices, but almost all of the articles espoused some level of individualization of coaching based on the needs of the child and family	“Each individual AVT session, situation, and/or family presents with a number of human variables that can determine how the coaching components occur, and the order of transition from one component to another will change depending on the parents’ knowledge and competency” (MacIver-Lux et al., 2020, p. 567)
Context-driven	n = 19	The majority of articles described routines-based, context-driven activities as an important avenue through which children who are D/HH learn language and coaching as a means by which to equip caregivers to utilize strategies to increase and improve language interactions with their children in these contexts. LSL strategies learned through coaching were expected to be carried over to the everyday contexts of family life	“The coaching experience provides opportunities to apply learned skills to all aspects of one’s daily routine and life activities” (Brooks, 2017, p.102)
Collaborative	n = 19	A majority of articles described coaching as a collaborative process between practitioner and family. Collaborative practices mentioned were including caregivers in decision-making, planning, and goal setting (n = 7), emphasizing the reciprocal relationship and role of parents as experts on their child (n = 3) and working collaboratively within a session (n = 2) or with other professionals (n = 3)	“In Auditory-Verbal Therapy (AVT) … [coaching] is a collaborative effort between practitioner and parent, helping parents discover their own strengths and enabling them to become confident parents of children with hearing loss” (Rhoades & MacIver-Lux, 2016, p. 328)
Strengths-based	n = 13	Many articles specifically mentioned the utilization of strengths-based coaching in the implementation of LSL services, indicating that building on families’ strengths, rather than remediating deficits, is best practice	“All coaching interactions with family members should acknowledge existing strengths of the parent and the child and offer support to key caregivers” (DesJardin, 2017, p. 686)

D/HH = deaf or hard of hearing; LSL = listening and spoken language.

Caregiver participation

The level of caregiver involvement during the different stages of coaching varied, particularly with regard to choosing goals and activities for the session. Nine articles described caregiver involvement in every stage of the coaching process, including in the planning stage (Blaiser et al., 2012; Brooks, 2017; Daczewitz, 2015; Hamren & Quigley, 2012; Houston, 2020; MacIver-Lux et al., 2020; Morrison, 2017; Rhoades & MacIver-Lux, 2016; Voss & Stredler-Brown, 2017). Three documents described a model in which practitioners did the majority of the planning and goal setting, but adjusted accordingly after discussing and weighing priorities with caregivers (Clark & Watkins, 1985; DesJardin, 2017; Estabrooks et al., 2020). In four of the documents, the authors described models whereby caregiver participation occurred primarily during the session and in-between sessions, when caregivers practiced strategies in the natural environment (Bruce, 1986; Houston, 2011; Martin-Prudent, 2018; Nardine, 1974). In the remaining five articles, it was unclear whether caregivers were involved in planning or goal setting, but active participation in the sessions and the expectation of carryover between sessions was clear (Brown & Nott, 2005; DesJardin et al., 2006; King, 2017; Nevins & Sass-Lehrer, 2015; Stredler-Brown, 2015).

Practitioner reflection

Two categories of practitioner reflection were identified in the literature: reflecting with caregivers and self-reflection. A total of 20 of the 22 articles described reflection as occurring during the application stage, wherein the practitioner guides the caregiver through reflection on the exchange that just occurred. Four articles presented practitioner self-reflection as occurring before or after an intervention session.

Reflecting with Caregivers

Reflection was presented in the literature as a means by which to determine the effectiveness of actions or practices (Stredler-Brown, 2015). Nine articles described practitioners guiding caregivers in reflective practice by asking open-ended questions (DesJardin, 2017; Estabrooks et al., 2020; Hamren & Quigley, 2012; MacIver-Lux et al., 2020; Martin-Prudent, 2018; Morrison, 2017; Nardine, 1974; Rhoades & MacIver-Lux, 2016; Voss & Stredler-Brown, 2017) and three referred to the utilization of active, reflective listening (King, 2017; Martin-Prudent, 2018; Voss & Stredler-Brown, 2017). Four articles outlined the practitioners’ role in reflection: to highlight caregiver strengths and encourage them to identify their own strengths and learning needs (Brooks, 2017; DesJardin, 2017; MacIver-Lux et al., 2020; Rhoades & MacIver-Lux, 2016). Two articles asserted that as caregivers become more efficacious at self-reflection, it builds their confidence (Brooks, 2017; DesJardin, 2017), five indicated growth in caregiver self-awareness or self-analysis skills (Nardine, 1974; Nevins & Sass-Lehrer, 2015; Rhoades & MacIver-Lux, 2016; Voss & Stredler-Brown, 2017), and one author attributed the encouragement of active engagement and accountability of caregivers to reflection (Brooks, 2017). Three authors suggested that ideally caregivers should be encouraged to self-reflect before the coach provides feedback (Brooks, 2017; Nevins & Sass-Lehrer, 2015). In addition to evaluating specific intervention strategies following practice, three authors suggested that reflection may also be used to review the effectiveness of the coaching experience for the caregivers (Brooks, 2017; Hamren & Quigley, 2012). In one study, practitioners reported that incorporating reflection into coaching sessions accelerated the caregivers’ learning beyond external practitioner feedback alone (Brooks, 2017). Taken together, this highlights the variety of ways in which reflection is utilized in caregiver coaching.

Practitioner Self-Reflection

Practitioner self-reflection was presented as a way to continually improve LSL practice in order to achieve better outcomes with children and families. MacIver-Lux et al. (2020) recommended personal evaluation following each intervention session, and Estabrooks et al. (2020) provided open-ended question prompts and a goal-setting form to facilitate this self-reflection. Nevins and Sass-Lehrer (2015) suggested that self-reflective practitioners develop the ability to observe and refine their coaching skills, enabling them to work toward exemplary practice.

Training for Coaching

Caregiver coaching is a central tenet in LSL professional practice (AG Bell Academy, 2017); therefore, an objective of this review was to identify how practitioners learn to coach. The literature contained information in two categories: preservice graduate training and postdegree professional development activities.

Graduate training

Five articles explicitly mentioned graduate training for caregiver coaching, three of which were empirical studies. Stredler-Brown (2015) found that practitioners with graduate training as Speech–Language Pathologists or Audiologists used direct instruction, or teaching skills to caregivers, 2.5 times more often than did practitioners trained as Teachers for the D/HH. The author attributed the limited use of coaching strategies by Teachers for the D/HH to the coursework in their preservice training programs. In King’s (2017) study, almost 18% of Developmental Specialists, who are not trained to work specifically with children who are D/HH, took an entire course on caregiver coaching in their preservice training, compared with 9.1% of Teachers of the D/HH and 7.7% of Speech–Language Pathologists. Consequently, only 37.1% of all participants felt prepared to utilize caregiver coaching with this population upon completion of their graduate programs.

Martin-Prudent (2018) recruited student participants from a program at Illinois State University called AIM to Be Ahead Grant^™ (an interdisciplinary model to offer babies early auditory habilitation, education, and development). This program included specialized instruction in caregiver coaching for graduate students, particularly a four-step parent training model designed to increase parent engagement in intervention sessions. The author investigated the impact of the training on the students’ ability to execute the parent model with fidelity in the home and clinic settings. Results indicated that although the graduate students learned and implemented the strategies, they did not consistently execute all four steps of the coaching model.

Two additional references mentioned preservice training for professionals working with families of children who are D/HH. Blaiser et al. (2012) described the program at Sound Beginnings, which serves as a practicum site for graduate students in Utah State University’s LSL personnel preparation program. One component of Sound Beginnings is to educate students to coach while serving families through telepractice. MacIver-Lux et al. (2020) outlined components of caregiver coaching and suggested that LSL practitioners often learn how to coach “on the job.” As an essential element to LSL practice, the authors advocated for caregiver coaching to be added as a required component in all graduate programs for Speech–Language Pathologists, Teachers of the D/HH, and Audiologists.

Professional development

A total of 11 articles suggested that training for coaching only occurred once professionals began working with families, through job-embedded training or professional development activities. Two authors referred to the AG Bell Association’s LSLS certification process as a means by which practitioners gain coaching skills (Morrison, 2017; Stredler-Brown, 2017). The LSLS certification process requires 3–5 years of postgraduate mentoring, during which practitioners learn the specialized skills needed to work with families of children who are D/HH learning to listen and talk, including caregiver coaching (AG Bell Academy, 2017).

Two articles outlined specific professional development programs created to develop caregiver coaching skills (Brooks, 2017; Nevins & Sass-Lehrer, 2015), whereas two others only briefly mentioned that providers learn to coach on-the-job (Houston, 2020; MacIver-Lux et al., 2020). Three others discussed training related to a specific coaching model, including a researcher-developed model (Roberts, 2019) and an established curriculum for working with families of children who are D/HH (Bruce, 1986; Clark & Watkins, 1985). Two articles specifically addressed telepractice as a means by which practitioners develop and practice caregiver coaching skills. Hamren and Quigley (2012) suggested that telepractice provides an avenue for practitioners to focus specifically on strengthening their coaching skills to better empower families to facilitate LSL skills in their children. Stredler-Brown (2015) found that practitioners who obtained LSLS certification were more experienced using family-centered EI practices, including caregiver coaching via telepractice, suggesting that the certification process is an avenue through which practitioners developed coaching expertise.

The Impact of Coaching

There is a lack of evidence to support caregiver coaching in LSL practice. We identified four studies that investigated the impact of caregiver coaching in the current LSL literature, including a single randomized-controlled trial (RCT), a quantitative descriptive study, a single-case multiple baseline mixed methods study, and one qualitative study with a quantitative secondary objective.

Caregiver application of strategies

Two studies measured caregiver application of strategies following coaching. In an RCT, Roberts (2019) utilized a fidelity checklist to evaluate whether parent-implemented communication treatment (PICT) training resulted in parents’ application of strategies with fidelity. Parents of children who are D/HH (n = 9) participated in a structured PICT training over a 6-month period to learn visual, interactive, responsive, and linguistic communication support strategies to use with their children, and parents of children with normal hearing (n = 10) received no PICT training. The authors reported that across a 6-month period, parents in the treatment group achieved an average of 92% fidelity, with fidelity exceeding 85% in every session, compared with parents in the control group. Parents in the treatment group increased their use of strategies over the parents who did not participate in the training (17% vs. 2%). As a result, children of the parents in the treatment group made significant gains in social and symbolic prelinguistic speech skills. The second study was a case study: Daczewitz (2015) found that virtual training of a highly structured parent-implemented communication strategy (PiCS) led to the successful use of specialized communication strategies by the parent of one child who was D/HH, and the parent reported that the strategies met his goals.

Practitioner application of coaching

Two studies evaluated the process of practitioner coaching by measuring the fidelity of use of coaching strategies (Martin-Prudent, 2018) and examining the perspectives of practitioners and caregivers (Brooks, 2017). In a quantitative descriptive study, Martin-Prudent (2018) measured the fidelity of the use of a four-step parent coaching model by graduate student practitioners following specialized training. Results indicated that overall compliance and use of all four steps of the model with fidelity was only demonstrated in 23.97% of the sessions. Qualitatively, Brooks (2017) explored the application of adult learning principles to real-time embedded coaching with caregivers of children in a school-based EI program. Caregivers and teachers reported that this new approach to intervention resulted in a change in attitudes and behaviors, resulting in increased caregiver engagement and feelings of empowerment by both caregivers and teachers.

Impact of caregiver coaching on child outcomes

Three studies evaluated the effectiveness of caregiver coaching by measuring child outcomes pre- and post-intervention. In the quantitative portion of her study, Brooks (2017) reported that children (n = 5) whose caregivers received coaching showed from 3–5 months more growth in expressive vocabulary on the MacArthur–Bates Communicative Development Inventories (CDI), than children whose caregivers did not participate in coaching. Daczewitz’s (2015) case study reported overall positive child outcomes as the result of caregiver coaching, as indicated by increased raw scores on the CDI and Cottage Acquisition Scales for Listening, Language, and Speech (CASLLS). However, due to developmental delays, the child’s scores could not be reported as percentile rankings, and the author could not attribute the child’s progress directly to the PiCS intervention. Results of Roberts’ (2019) PICT RCT study indicated that children of the parents who received PICT coaching made significant gains in prelinguistic speech skills compared with children in the control group (effect size 1.09 [p = 0.03]).

Discussion

The aim of this scoping review was to gain a better understanding of the current state of the LSL literature regarding caregiver coaching definitions, practices, recommendations, and impact. Our findings indicate that there is a continuum of practices that fall within caregiver coaching in LSL services and the definitions are varied. However, common elements include coaching as a means to equip and empower caregivers to increase and improve language interactions with their children, ultimately resulting in self-efficacy and generalization of LSL intervention strategies into their daily routines.

The findings of this review highlight the lack of a consistent, widely recognized model of coaching being utilized in LSL practice. There are a variety of coaching approaches, including a model that was developed for other populations and adapted for families of children who are D/HH (PiCS) (Daczewitz, 2015). The literature included eight models of coaching (across 15 articles), while two articles described the general philosophy of family-centered intervention and five did not specify a particular model. No dominant approach to coaching was evident, as the models ranged from highly structured curricula, like the SKI-HI and PICT (Bruce, 1986; Clark & Watkins, 1985; Roberts, 2019), to more flexible steps intended to be implemented in a prescribed manner (Martin-Prudent, 2018), and finally to less-defined family-centered EI frameworks intended to be individualized and flexible (Stredler-Brown, 2015; Voss & Stredler-Brown, 2017). Several models were put forth by the authors specific to the context of LSL practice (Brown & Nott, 2005; Estabrooks et al., 2020; Voss & Stredler-Brown, 2017). Most LSL coaching models were informed by caregiver coaching models developed for EI in general, most notably the model developed by Rush and Shelden (Rush et al., 2003; Rush & Shelden, 2011), indicating that authors have sought to adapt and apply established, evidence-based caregiver coaching strategies with families of children who are D/HH.

Best practice guidelines indicate that family/professional partnerships, including involving caregivers as active participants in the intervention process, are critical for family-centered LSL practice (JCIH, 2019; Moeller et al., 2013). Active participation by caregivers was a central theme across the literature, although the amount and type of caregiver participation across the stages of coaching varied. This supports LSL research indicating that caregiver involvement is linked to positive outcomes for children who are D/HH (Allegretti, 2002; DesJardin et al., 2006; Lund, 2018; Nicastri et al., 2020; Spencer, 2004; Zaidman-Zait & Young, 2008), and caregiver involvement is a strong predictor of child language outcomes (Calderon, 2000; Moeller, 2000; Nicastri et al., 2020). Active caregiver participation is a critical component of adult learning, and thereby important to caregiver coaching (Dunst & Trivette, 2009; Trivette et al., 2009). By supporting active caregiver engagement in the LSL intervention process, coaches support caregivers in identifying and working toward intended outcomes for their children. As a capacity-building practice, coaching requires collaborative planning, practice, and reflection with caregivers to work toward goals that are important for their family. The findings of this review support that caregivers should be encouraged to be actively engaged as equal partners in every stage of the LSL intervention process, from planning to implementation, to establish goals and acquire new knowledge and skills that are relevant and applicable to their unique needs.

Recommendations for caregiver coaching drawn from this scoping review of the literature indicate that it should be individualized, context-driven, collaborative, and strengths-based (e.g., DesJardin, 2017; MacIver-Lux et al., 2020; Voss & Stredler-Brown, 2017). Although building on families’ strengths was mentioned less frequently in the LSL literature, these recommendations align with recommended practices. The Division for Early Childhood (DEC) Recommended Practices indicate that EI services for families of children with all disabilities should identify and build on individualized family strengths and capacities because all families are capable of supporting their child’s learning when the right services and supports are in place (Workgroup on Principles and Practices in Natural Environments, 2008; DEC, 2014). In addition, because context is important for children’s learning (DEC, 2014), intervention strategies should be implemented within the context of meaningful family activities, which can be achieved through coaching the caregiver to utilize strategies with their child outside the confines of an intervention session. An international consensus statement of best practices in family-centered EI for children who are D/HH recommends that EI services should comprise a partnership between caregivers and practitioners characterized by reciprocity, mutual trust, honesty, respect, shared responsibility, and open communication (Moeller et al., 2013). These recommendations are echoed in the JCIH Year 2019 Position Statement (JCIH, 2019) and supported by the articles included in this review.

Reflection is another principle of adult learning that plays an important role in caregiver coaching (Dunst & Trivette, 2009; Lorio, Romano, Woods, & Brown, 2020; Nelson, Gotcher, & Smith, 2020; Salisbury et al., 2018; Trivette et al., 2009). Consistent with the broader EI literature, reflection appeared consistently across the included literature as an important component in the coaching process in LSL practice. In the context of coaching, reflection with the caregivers involves engaging them in purposeful thinking to determine the next steps in their learning process, whether that entails repetition to further develop understanding, or setting new learning targets (Dunst & Trivette, 2009; Trivette et al., 2009). Reflection is what differentiates coaching from other types of problem solving and information sharing, as it allows the coach to build on the caregivers’ existing skills and promote continuous improvement by teaching the caregivers to analyze their understanding and practice. EI research suggests that caregivers consider reflection an integral component for learning to confidently and effectively support their child’s learning (Gallacher, 1997; Rush et al., 2003; Salisbury et al., 2018), although it may be challenging for practitioners to implement (Douglas, Meadan, & Kammes, 2019; Meadan, Douglas, Kammes, & Schraml-Block, 2018).

Reflection with the caregivers, for the purpose of evaluating the achievement of goals within a session, appeared more frequently in the literature than did practitioner self-reflection. Where practitioner self-reflection was outlined, it was emphasized as an important component of professional growth and mastery of coaching principles. In the included literature, self-reflection occurred before intervention sessions, during planning, and/or afterwards to evaluate professional performance and consider changes that might be implemented moving forward. However, it is unclear whether practitioners utilize self-reflection within the context of a coaching exchange to evaluate whether the coaching strategies are effective or need to be adjusted to optimize caregiver learning; therefore, this may be an interesting direction for further research.

Although not as prevalent in the literature, studies addressing the impact of caregiver coaching suggest that families of children who are D/HH can effectively learn to implement specialized LSL strategies through coaching. Findings are limited; however, three studies reported that an increase in caregivers’ use of strategies led to benefits in their child’s language skills, indicating that equipping caregivers to increase and improve language interactions with their children through coaching may facilitate spoken language development during early childhood (Brooks, 2017; Daczewitz, 2015; Roberts, 2019). This is consistent with previous research in the general EI literature that indicates that caregivers can successfully learn to implement intervention strategies through coaching (Akamoglu & Meadan, 2018; Brown & Woods, 2016; Meadan, Angell, Stoner, & Daczewitz, 2014; Roberts, Kaiser, Wolfe, Bryant, & Spidalieri, 2014; Woods, Kashinath, & Goldstein, 2004), and caregiver-implemented interventions may lead to positive child outcomes (Heidlage et al., 2020; Roberts & Kaiser, 2011). However, the degree to which caregivers were involved in the coaching process varied across the studies, ranging from active engagement in every part of the process, including goal setting and planning, to caregiver participation. Participation mainly consisted of practicing strategies that were planned and modeled by the practitioner during the intervention session and carrying those strategies over at home. Highly structured models, in which caregiver participation is limited to following the practitioners’ lead, may not be the most effective approach if the goal of coaching is for families to implement strategies in real-life situations. This does not indicate, however, that caregiver coaching is less effective when implemented in a flexible, individualized way to accommodate the needs of each family; in fact, this review identified individualization as an important characteristic of effective coaching practices. Individualized coaching is imperative for the provision of equitable and culturally competent services for all families of children who are D/HH.

Overall, all of the articles that addressed professional training for coaching indicated that it is a specialized skill that practitioners need to master in order to equip and empower caregivers to increase and improve language interactions with their children. However, within the EI literature, no consensus has been reached as to the type or dosage of professional development needed to achieve implementation fidelity of caregiver coaching (Haring Biel et al., 2020; Salisbury et al., 2018), and researchers have identified a need for comprehensive, well-designed, and sufficiently detailed studies to address this (Artman-Meeker, Fettig, Barton, Penney, & Zeng, 2015; Elek & Page, 2018; Haring Biel et al., 2020; Romano & Schnurr, 2020; Salisbury et al., 2018). Of the documents included in our study, few referred to professional training opportunities outside of LSLS certification training, other than to indicate a scarcity of coursework pertaining to caregiver coaching offered in professional preparation programs. This is worth noting, because the LSLS certification process requires 3–5 years of postgraduate training, during which time practitioners are already working with families. In addition, not all LSL practitioners choose to pursue certification, so it is therefore worth considering the inclusion of caregiver coaching in professional training program curricula and the development and expansion of robust postgraduate professional training programs to ensure the acquisition of the requisite skills for coaching caregivers.

The majority of documents included in this review were conceptual papers and professional practice recommendations published in peer-reviewed journals or professional books. The lack of peer-reviewed research related to coaching in LSL services is evidenced by the identification of only one RCT that met the inclusion criteria. Large-scale RCTs are considered the most reliable source of evidence to determine the effectiveness of an intervention, and are therefore necessary to establish an evidence based for clinical practices (Akobeng, 2005). Researchers have highlighted the challenge of designing empirical research that accommodates for the individualization needed to support families receiving EI services (Romano & Schnurr, 2020), which may account for few well-designed studies specific to LSL practice. Studies addressing what types of coaching interventions are effective and in what settings are just beginning to emerge in the LSL literature, and more well-designed research is needed to determine the effectiveness of specific coaching practices and the circumstances under which they are effective (Akamoglu & Meadan, 2018; King & Xu, 2019). We identified only four studies investigating the impact or fidelity of use of caregiver coaching, and the sample sizes of the included studies were generally small. Recent research has emerged that examines the perspectives of caregivers receiving EI services, which may include coaching, for their children who are D/HH (Ambrose, Appenzeller, Mai, & Des Jardin, 2020; McCarthy, Leigh, & Arthur-Kelly, 2020; Scarinci, Erbasi, Moore, Ching, & Marnane, 2018; Stewart, Slattery, & McKee, 2020; Ward, Hunting, & Behl, 2019); however, few empirical research studies and small sample sizes indicate a need for ongoing research to establish the evidence base for the effectiveness of caregiver coaching in LSL practice.

Implications for Research and Practice

We integrated the findings of this review to present a potential model of LSL caregiver coaching, as shown in Figure 2. The proposed model includes a synthesis of caregiver coaching steps, coaching recommendations, and the role of caregiver participation and reflection in coaching in LSL practice, and represents commonalities identified across most of the literature. This model was derived from limited empirical evidence and a prevalence of informed professional recommendations; therefore, it requires further investigation to be validated through research and practice.

Figure 2 .

Caregiver coaching in LSL practice. LSL = listening and spoken language.

Three broad stages of the coaching process were identified in the literature: setting the stage, application, and wrap-up, each containing a number of steps. Some of the steps may overlap; for example, caregivers may observe while a practitioner is modeling a strategy, or a practitioner may provide feedback while the caregivers practice a strategy. The steps are not necessarily applied in order, as coaching is individualized to each family, and the process is cyclical, so steps may be repeated several times within a single LSL session. The overarching recommendations are included to represent the application of the coaching model in an individualized, context-driven, collaborative, and strengths-based manner.

Setting the stage represents the beginning of a coaching session. This stage may incorporate practitioner self-reflection, particularly during planning. Setting the stage includes (a) planning for the session, which the practitioner may complete without the caregivers before the session, or in collaboration with the caregivers; (b) initiation, which includes checking in on how things have gone since the previous session; and (c) introducing the listening or language strategy that will be practiced during the session.

In the application stage, caregivers practice strategies during a meaningful routine, often incorporating play. This stage includes (a) observation, both by the practitioner and the caregivers; (b) modeling, during which the practitioner demonstrates a strategy for the caregivers to observe; (c) practice, at which point the caregivers take a turn practicing the strategy with the child; (d) feedback by the practitioner; and sometimes (e) evaluation, which may involve formal assessment of the child’s speech and language skills or informal evaluation of how the coaching process is going for the caregivers.

The final wrap-up stage includes (a) planning for carryover to other routines throughout the week and (b) the final discussion, during which the caregivers have an opportunity to ask questions or discuss concerns.

Active caregiver participation and reflection happen throughout the coaching process. Reflection occurs in two forms: reflection with the caregiver, which may occur at any point during the process, and self-reflection by the practitioner, which generally takes place during planning and/or evaluation.

This scoping review offers insight into the existing literature on caregiver coaching with families of children who are D/HH and highlights gaps that represent opportunities for further research. It is clear that research on the effectiveness of caregiver coaching is needed. Although we identified a few studies that evaluated the impact of coaching in our review, sample sizes were relatively small, and due to study design, the level of evidence is low. Larger scale intervention studies are needed in order to increase the evidence base for the effectiveness of caregiver coaching on family and child outcomes.

Although reflection was identified as an important component of caregiver coaching, further research is warranted to determine whether practitioner self-reflection is more prevalent than the current literature suggests. It would also be beneficial to investigate whether practitioners reflect during the application phase of a session in order to evaluate the effectiveness of their coaching strategies. Gaining a better understanding of how reflection is used in practice would be useful for validating, evaluating, and improving practitioners’ coaching practices with families. Further research in this area may also lead to the development of best practice guidelines for incorporating reflection in caregiver coaching for families of children who are D/HH.

Successful EHDI programs have led to growth in EI programs for children who are D/HH, and it is reasonable to expect that the demand for LSL practitioners who are trained in caregiver coaching will continue to increase. This review highlights the need to evaluate professional training programs in order to ensure that practitioners working with young families learn to implement caregiver coaching. Important directions for future research also include an investigation of how much training is needed to obtain mastery of caregiver coaching skills and the best way for practitioners to acquire those skills. In addition, the development of caregiver coaching competencies and standards would enable consistency of application and provide a framework for future research studies, as well as result in higher quality LSL services for families.

Consistent with the general EI literature (Friedman et al., 2012), there is a lack of consensus on the steps involved in coaching in LSL practice. As presented in our proposed model, caregiver coaching is consistently represented in the literature as involving three stages: setting the stage, application, and wrap-up. Although some variations exist with regard to the specific steps involved in the coaching process, all caregiver coaching involves touching base on what’s new with the family, discussing the goals for the session, learning and applying LSL strategies, and discussing how those strategies can be practiced in-between sessions. This review also provides a greater understanding of how the steps are implemented and recommendations for the implementation of caregiver coaching with families of children who are D/HH.

Limitations

Our search strategy was intentionally broad in scope and no date limitations were set; however, due to the variability of terminology regarding caregiver coaching over time, it is possible that some relevant references were missed. Second, the inclusion of only English articles precluded the representation of potential cultural differences in the implementation of caregiver coaching. Although we did consult with experienced professionals during the identification stage of the review, we did not conclude with a consultation exercise to evaluate the validity of our findings or the resulting model, which might have increased the strength of our results (Arksey & O’Malley, 2005). Only six of the 22 included articles were empirical research studies, indicating a lack of evidence upon which to base practice recommendations. Therefore, our proposed model represents the current state of the literature, but will require further research to refine it for caregiver coaching in LSL practice. In addition, we were unable to retrieve 13 of the 506 full-text articles due to Covid-19 closures. However, all of these items were at least 20 years old and therefore would likely have contributed limited new information to our review.

Conclusion

Caregiver coaching in LSL practice is a means by which caregivers learn to utilize enhanced language interactions to improve their child’s language outcomes, ultimately resulting in self-efficacy and carryover of intervention strategies into their daily routines. The principles and practices of LSL services prioritize caregiver coaching as a means to enable children who are D/HH to develop communication competency (AG Bell Academy, 2017). The LSL research is beginning to address the effectiveness of caregiver coaching, but a lack of consensus on definitions and practices is still evident in the literature, and more research is needed to validate its application in a variety of settings. This scoping review provides a foundational understanding of the current state of the LSL literature with regard to caregiver coaching and may inform future research endeavors that are critical for establishing an evidence base for coaching caregivers of children who are D/HH. Finally, coaching steps found in the literature were synthesized, resulting in a proposed coaching framework that has the potential to improve consistency in terminology, practices, and application of coaching strategies across LSL programs and establishes a foundation for further research. With validation, this model of caregiver coaching may inform the practices of current LSL practitioners, advise the development of training programs for the next generation of LSL practitioners, and ultimately impact the quality of LSL services for families. Most importantly, this new understanding may impact the outcomes of children who are DHH by equipping and empowering their caregivers through coaching.

Funding

E. M. F. is a recipient of a Canadian Institutes of Health Research Foundation (Grant #366311). I. D. G. is a recipient of a Canadian Institutes of Health Research Foundation (Grant #143237).

Conflict of Interest

No conflicts of interest were reported.