Implementation of an Integrated Training for Parents and Teachers in Early Head Start: A Research to Practice Summary

This qualitative study documented perspectives of professionals and parents who were involved in the implementation of an attachment-based training for parents and teachers in Early Head Start (EHS). Eight university-based facilitators, 20 EHS teachers, and 13 parents participated in focus groups to better understand the appropriateness, acceptability, and feasibility of Hearts and Minds on Babies (HMB); a group-based, multi-session training with the goal of supporting social emotional development in young children through promotion of reflective functioning and mindfulness strategies for teachers and parents. Data suggest that a small group format and a facilitator stance of openness, curiosity, and cultural humility promoted teachers’ and parents’ positive perspectives of HMB concepts. Participants in this study also helped us to understand challenges to HMB’s feasibility, including logistical challenges that need to be considered for successful implementation in other EHS sites.


INTRODUCTION
Sensitive and responsive caregiver-child interactions for infants and toddlers across home and early care and education (ECE) contexts support optimal development and school readiness (e.g., Halle et al., 2011;Tamis-LeMonda et al., 2014).High quality experiences cannot be fully achieved for infants and toddlers without cooperation and communication among the caregivers across these care settings (Elicker et al., 1997): parents or other family members at home (referred to here as "parents") and educators (referred to here as "teachers").National efforts have been made to provide resources and support to define and assess effective parent-teacher relationships (Porter, et al., 2012), and the competencies needed by ECE practitioners to develop, maintain, and utilize effective partnerships with families (U.S. DHHS, 2018b; 2018c).However, while ECE programs understand the importance of and prioritize relationships, the focus of interventions is on dyadic relationships in the home or in the classroom, rather than the integration of these relationship systems.Thus far, training and interventions have not adequately addressed the development of content and relationships that can bridge the gap between the classroom and the home environment.Integrated training that promotes the provision of sensitive and responsive care in the classroom and provides the resources and skills to parents supports the parent-teacher relationship and the parent-child relationship (Landry et al., 2017;Sheridan et al., 2020).
Hearts and Minds on Babies (HMB) is an attachment-and mindfulness-based multilevel training curriculum that incorporates shared training components for administrators (HMB+A), teachers (HMB+T), and parents (HMB+P).The program aims to reduce caregiver (i.e., teacher and parent) stress through mindfulness practice and improve reflective functioning and responsive caregiving through understanding of and reflection upon infants' and toddlers' attachment needs.In all three HMB program variants (A, T, and P), HMB concepts are shared through semi-structured, manualized content and relationship-based and culturally responsive interactions; thus, presenting content in ways that attend to the unique emotional needs and racial, cultural, and ethnic values of the training participants (see Stacks et al., 2023 for a description of HMB concepts and development).This study focuses on HMB+P which provides teachers with 8 hours of training over four monthly sessions to support their ability to share HMB content with parents at three 90minute parent meetings offered to parents monthly; and at drop-off and pick-up times.
This study was guided by implementation science.Implementation science involves the use of scientific methods and strategies to investigate feasibility of interventions when they are moved from more controlled settings to the community setting (Durlak, 2015).Defined by Proctor and colleagues (2011), appropriateness of the HMB+P training refers to the perceived fit of the content of the curriculum within EHS, the relevance of the topics for EHS parents and teachers, and whether it is useful and practical within their lived experiences.Acceptability calls attention to whether participants are satisfied with the content, format, and delivery of HMB+P in an EHS context.Lastly.feasibility is assessed by asking providers or organizational settings whether the intervention can be delivered as intended, that is, whether programs can adhere to the recommended facilitator training and supervision, HMB delivery format, schedule, and ongoing use of the concepts.

CURRENT STUDY
The current qualitative study explored stakeholder experiences of the integrated parent-teacher HMB+P training.Guided by implementation science, research questions focused on understanding of HMB+P's appropriateness, acceptability, and feasibility within an Early Head Start (EHS) setting: 1. What is the appropriateness of HMB+P for EHS? 2. How do stakeholders describe the acceptability of the HMB+P format and content? 3. Is it feasible for teachers to deliver HMB+P?
To answer these questions, we conducted a total of ten focus groups across four EHS sites: four teacher groups; four parent groups; and two university-based trainer groups.These groups were held in person and led by members of the research team.Our study sample included eight HMB university-based trainers; 20 EHS teachers; and 13 EHS parents.Participants were predominantly Black (83%) and female (93%).The distribution of race and education varied in each group.Focus groups were run using a semi-structured interview protocol and were audio recorded and transcribed verbatim.The research coding team used inductive thematic coding strategies to discern and capture the experiences of the participants.That is, we used participant words to identify, interpret, and categorize themes related to the research questions.

KEY FINDINGS
This study's purpose was to understand participant experiences of HMB+P.First, three main categories emerged from the parents, teachers and university-based facilitators related to the appropriateness of the HMB+P training: (a) cultural relevance of concepts; (b) promotion of parenting skills; and (c) promotion of parent-teacher relationships.While participants found the content and concepts of the training relevant and useful in their lives, some concepts challenged cultural values, beliefs, and experiences that teachers and parents hold.In addition, participation in the group offered developmental knowledge and promoted parenting efficacy for parents; while the shared language and experiences within the group offered teachers and parents an opportunity to develop new perspectives of each other.
Two main categories emerged from the data related to the acceptability of HMB+P in EHS.That is, how do participants describe their satisfaction with the content, format, and delivery of HMB+P in an EHS context.Again, cultural and racial experiences were highlighted.Participants helped us understand that these experiences need to be considered when presenting content that has the potential to challenge beliefs and values.Participants noted that the structure of the training supported ongoing learning and reflection and an understanding that learning and using these concepts may take time.However, participants also noted that a person's motivation to participate in HMB+P was important in learning, reflecting upon, and using the HMB concepts in their daily lives.
Lastly, data from this study suggest two main categories related to the feasibility of HMB+P implementation.Participants noted that the reality of the classroom environment, including classroom responsibilities and parent availability often interfered with the teacher's facilitation of, and parent attendance at, the HMB+P groups.The sharing of HMB concepts at drop off and pick up was also challenging.Data also suggest that the elements needed to use and share HMB concepts are important to consider when assessing its feasibility.Participants in this study noted that three elements need to be in place if an EHS setting would like to offer HMB+P.First, a supportive learning environment that includes the EHS program's organizational and leadership supports.When leadership was supportive, teachers found it easier to be involved and use the HMB concepts in their work.In addition, intrinsic dispositions such as being open-minded, patient, and curious were also important for an HMB+P facilitator to share and use the concepts.Lastly, it was important to participants in this study that HMB+P facilitators should have knowledge of early childhood and the HMB concepts, skills in group facilitation, and skills in engaging parents.It would be important for program decision makers to reflect upon whether they have these elements in place when planning to implement HMB+P.

SUMMARY
Findings suggest that HMB+P was beneficial to teachers and parents who were able to participate in the group sessions and that teachers had the knowledge and skill to facilitate HMB+P, yet feasibility remained a problem due in part to organizational capacity.Overall, the parent group training sessions were acceptable for parents who were able to attend during the day, and parents were able to use the HMB concepts within their daily lives, suggesting the content was appropriate.It was critical that HMB facilitators were curious about how concepts fit with different cultural values and beliefs and allow time for these discussions in the HMB+P groupswith teachers and parents.Findings from this study offer insights into the importance of supporting cultural humility in group facilitators and ways to integrate parent training and engagement in ECE settings that enhances the parent-teacher relationship and caregiving quality.We learned that HMB+P participants benefit when concepts are taught in a way that they could be reflected upon (i.e., presented with a stance of cultural humility); and integrated into existing cultural experiences (i.e., considering current and historical sociocultural context).
HMB+P is a unique integrated training model in which the format and delivery supports the learning and integration of relationship-and attachment-based content.The ECE setting is a complex array of relationships that are critical to the social-emotional development of young children, and the sense of efficacy among teachers and parents.This study reflects the perspectives of stakeholders who would benefit from the HMB+P training, provides important considerations for future iterations of the HMB+P curriculum, and offers insights that could support development and implementation of this type of training model within other early child education settings.