Maternal and Child Health Journal

, Volume 22, Issue 5, pp 745–752 | Cite as

The Role of Mentors in Early Intervention Referrals: Overlooked Views of Pediatric Residency Training Directors

  • Nicole Megan Edwards


Objectives There continues to be a pressing need to increase referrals to family-centered early intervention (EI) for more eligible infants and toddlers with inadequate consideration for the role of senior, mentoring professionals. Methods To address a dearth in our understanding, a subset of Pediatric Residency Training Directors shared views on EI, referral, and relevant training efforts. Results Participating directors primarily reported limited understanding of EI. Greater knowledge of family-focused EI correlated with its perceived helpfulness (r = .420; p = .021), which positively correlated with referring a child to EI. Despite 67% of the sample viewing pediatricians as ‘most important’ in screenings and EI referrals, residents were perceived as only somewhat aware of EI referral and services, and only somewhat aware of differences between clinic options and Part C EI. Although nearly all respondents noted minimal EI exposure during training, only 43% felt this amount was ‘inadequate/insufficient’. The sample was fairly evenly divided in being ‘extremely’ or ‘somewhat’ interested in communicating with state EI leaders. Conclusions for Practice This preliminary analysis describes perceptions among senior medical professionals who may influence referrals via mentoring, training, and interdisciplinary collaboration. Findings inform next steps in terms of research, improving education for directors and residents, and collaborative information-sharing to bolster family-centered EI referrals to improve child and family outcomes.


Early intervention Referral Family-centered service Pediatric Residency Training Directors Child Find 



Special thanks to Dr. Kathryn Wolff Heller, Dr. James E. Coyle, Dr. Moshe Markowitz, and Dr. Kevin Marks for their thoughtful and detailed feedback on the survey questions. Much appreciation is extended to the Pediatric Residency Training Directors who participated in this study.

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. Aakre, K. J., Paul, K., & Barry, S. (2010). Developmental screening ‘Preferred Tool List’ for children birth to three years. Retrieved January, 2017, from
  2. Bagnato, S. J. (2005). The authentic alternative for assessment in early intervention: An emerging evidence-based practice. Journal of Early Intervention, 28(1), 17–22.CrossRefGoogle Scholar
  3. Baker, J. N., Torkildson, C., Baillargeon, J. G., Olney, C. A., & Kane, J. R. (2007). National survey of pediatric residency program directors and residents regarding education in palliative medicine and end-of-life care. Journal of Palliative Medicine, 10(2), 420–429.CrossRefPubMedGoogle Scholar
  4. Barger, B., Rice, C., Simmons, C. A., & Wolf, R. (2016). A systematic review of Part C early identification studies. Topics in Early Childhood Special Education. Scholar
  5. Boreman, C. D., Thomasgard, M. C., Fernandez, S. A., & Coury, D. L. (2007). Resident training in developmental/behavioral pediatrics: Where do we stand? Clinical Pediatrics, 46(2), 135–145.CrossRefPubMedGoogle Scholar
  6. Bronfenbrenner, U. (2001). Bioecological perspectives on human development. In N. J. Smelser & P. B. Baltes (Eds.), International encyclopedia of the social and behavioral sciences (Vol. 10, pp. 6963–6970). New York: ElsevierCrossRefGoogle Scholar
  7. Carraccio, C., Englander, R., Gilhooly, J., Mink, R., Hofkosh, D., Barone, M. A., & Holmboe, E. S. (2016). Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Academic Medicine: Journal of the Association of American Medical Colleges. Google Scholar
  8. Dosreis, S., Weiner, C. L., Johnson, L., & Newschaffer, C. J. (2006). Autism spectrum disorder screening and management practices among general pediatric providers. Journal of Developmental & Behavioral Pediatrics, 27(2), S88–S94.CrossRefGoogle Scholar
  9. Duncan, P. M., Shaw, J. S., & Hagan, J. F. (2008). In: J. F. Hagan, J. S. Shaw & P. M. Duncan (Eds.), Bright futures: Guidelines for health supervision of infants, children, and adolescents. Elk Grove Village: American Academy of Pediatrics.Google Scholar
  10. Dunsmore, J. C., & Halberstadt, A. G. (1997). How does family emotional expressiveness affect children’s schemas? New Directions for Child and Adolescent Development, 1997(77), 45–68.CrossRefGoogle Scholar
  11. Dunsmore, J. C., & Karn, M. A. (2001). Mothers’ beliefs about feelings and children’s emotional understanding. Early Education and Development, 12(1), 117–138.CrossRefGoogle Scholar
  12. Dunst, C. J. (2005). Repeated visits to primary referral sources are likely to be more successful than one-time contacts. Endpoints, 1(1), 1–2.Google Scholar
  13. Dunst, C. J. (2006). Providing regular feedback to primary referral sources is more likely to result in sustained referrals. Endpoints, 2(1), 1–2.
  14. Dunst, C. J., & Bruder, M. B. (2002). Valued outcomes of service coordination, early intervention, and natural environments. Exceptional Children, 68, 361–375.CrossRefGoogle Scholar
  15. Dunst, C. J., & Trivette, C. M. (2004). Toward a categorization scheme of child find, referral, early identification and eligibility determination practices. Tracelines, 1(2), 1–17.Google Scholar
  16. Dunst, C. J., & Trivette, C. M. (2009). Capacity-building family-systems intervention practices. Journal of Family Social Work, 12(2), 119–143.CrossRefGoogle Scholar
  17. Edwards, N. M., Gallagher, P. A., & Green, K. B. (2013). Existing and proposed child find initiatives in one state’s Part C program. Rural Special Education Quarterly, 32(1), 11–19.Google Scholar
  18. Emans, S. J., Bravender, T., Knight, J., Frazer, C., Luoni, M., Berkowitz, C., … & Goodman, E. (1998). Adolescent medicine training in pediatric residency programs: Are we doing good job? Pediatrics, 102(3), 588–595.CrossRefPubMedGoogle Scholar
  19. Feinberg, E., Silverstein, M., Donahue, S., & Bliss, R. (2011). The impact of race o participation in Part C Early intervention services. Journal of Developmental and Behavioral Pediatrics, 32(4), 1–8.CrossRefGoogle Scholar
  20. Fujiura, G. T., & Yamaki, K. (2000). Trends in demography of childhood poverty and disability. Exceptional Children, 66(2), 187–199.CrossRefGoogle Scholar
  21. Gamble, W. C., Ramakumar, S., & Diaz, A. (2007). Maternal and paternal similarities and differences in parenting: An examination of Mexican-American parents of youn children. Early Childhood Research Quarterly, 22(1), 72–88.CrossRefGoogle Scholar
  22. Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2007). Bright futures. Elk Grove Village: American Academy of Pediatrics.Google Scholar
  23. Hanft, B. E., & Pilkington, K. O. (2000). Therapy in natural environments: The means or end goal for early intervention? Infants & Young Children, 12(4), 1–13.CrossRefGoogle Scholar
  24. Heppner, P. P., & Handley, P. G. (1981). A study of the interpersonal influence process in supervision. Journal of Counseling Psychology, 28(5), 437.CrossRefGoogle Scholar
  25. Hoffman, B. D., Barnes, M., Ferrell, C., Gellin, C., Lichtenstein, C., & Donnelly, J. … & CHAMP Study Group. (2016). The community health and advocacy milestones profile: A novel tool linking community pediatrics and advocacy training to assessment of milestones-based competence in pediatric residency training. Academic Pediatrics, 16(4), 309–313.CrossRefPubMedGoogle Scholar
  26. Hymowitz, N., Schwab, J., & Eckholdt, H. (2001). Pediatric residency training on tobacco: Training director tobacco survey. Preventive Medicine, 33(6), 688–698.CrossRefPubMedGoogle Scholar
  27. Individuals with Disabilities Education Act (IDEA) (2007). 20 U.S.C. § 1400.Google Scholar
  28. Jensen, R. E., Chan, K. S., Weiner, J. P., Fowles, J. B., & Neale, S. M. (2009). Implementing electronic health record-based quality measures for developmental screening. Pediatrics, 124(4), e648–e654.CrossRefPubMedGoogle Scholar
  29. Kilminster, S. M., & Jolly, B. C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34(10), 827–840.CrossRefPubMedGoogle Scholar
  30. King, S., Teplicky, R., King, G., & Rosenbaum, P. (2004). Family-centered service for children with cerebral palsy and their families: A review of the literature. Seminars in Pediatric Neurology, 11, 78–86.CrossRefPubMedGoogle Scholar
  31. Levey, R. E. (2001). Sources of stress for residents and recommendations for programs to assist them. Academic Medicine, 76(2), 142–150.CrossRefPubMedGoogle Scholar
  32. MacArdy, A. L. (2008). Jamie S. v. Milwaukee public schools: Urban challenges cause systemic violations of the IDEA. Marquette Law Review, 92, 857. Retrieved January, 2017, from
  33. Markus, H. (1977). Self-schemata and processing information about the self. Journal of Personality and Social Psychology, 35(2), 63–78.CrossRefGoogle Scholar
  34. Nalven, L. M., Hofkosh, D., Feldman, H., & Kelleher, K. (1997). Teaching pediatric residents about early intervention and special education. Journal of Developmental & Behavioral Pediatrics, 18(6), 371–376.CrossRefGoogle Scholar
  35. Nwokah, E. (2009). The toy bag: An examination of its history and use in early intervention for infants and toddlers with special needs. Transactions at Play, 9, 166.Google Scholar
  36. Raab, M., & Dunst, C. J. (2004). Early intervention practitioner approaches to natural environment interventions. Journal of Early Intervention, 27(1), 15–26.CrossRefGoogle Scholar
  37. Radecki, L., Sand-Loud, N., O’Connor, K. G., Sharp, S., & Olson, L. M. (2011). Trends in the use of standardized tools for developmental screening in early childhood: 2002–2009. Pediatrics, 128(1), 14–19.CrossRefPubMedGoogle Scholar
  38. Raspa, M., Bailey, D. B., & Olmsted, M. G. (2010). Measuring family outcomes in early intervention: Findings from a large-scale assessment. Exceptional Children, 76(4), 496–510.CrossRefGoogle Scholar
  39. Renk, K., Roddenberry, A., Oliveros, A., & Sieger, K. (2007). The relationship of maternal characteristics and perceptions of children to children’s emotional and behavioral problems. Child & Family Behavior Therapy, 29(1), 37–57.CrossRefGoogle Scholar
  40. Roberts, H., Needelman, H., Jackson, B., McMorris, C., & Munyon, A. (2013). Effect of community size on eligibility for early intervention for infants with a neonatal intensive care experience. The Journal of Rural Health, 30(3), 259–264.CrossRefPubMedGoogle Scholar
  41. Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.CrossRefPubMedGoogle Scholar
  42. Rosenberg, A. A., Lockspeiser, T., Lane, J. L., Nomura, Y., Schmitter, P., Urban, K., … & Hanson, J. (2013). A longitudinal career-focused block for third-year pediatrics residents. Journal of Graduate Medical Education, 5(4), 639–645.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Rosenberg, S. A., Zhang, D., & Robinson, C. C. (2008). Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics, 121(6), e1503–e1509.CrossRefPubMedGoogle Scholar
  44. Rush, D. D., Shelden, M. L., & Hanft, B. E. (2003). Coaching families and colleagues: A process for collaboration in natural settings. Infants & Young Children, 16(1), 33–47.CrossRefGoogle Scholar
  45. Scott, F. G., Lingaraju, S., Kilgo, J. L., Kregel, J., & Lazzari, A. (1993). A survey of pediatricians on early identification and early intervention services. Journal of Early Intervention, 17(2), 129–138.CrossRefGoogle Scholar
  46. Shaw, J. S., Norlin, C., Gillespie, R. J., Weissman, M., & McGrath, J. (2013). The national improvement partnership network: State-based partnerships that improve primary care quality. Academic Pediatrics, 13(6), S84-S94.CrossRefGoogle Scholar
  47. Talmi, A., Bunik, M., Asherin, R., Rannie, M., Watlington, T., Beaty, B., & Berman, S. (2014). Improving developmental screening documentation and referral completion. Pediatrics, 134(4), e1181–e1188CrossRefPubMedGoogle Scholar
  48. Williams, M. E., Perrigo, J. L., Banda, T. Y., Matic, T., & Goldfarb, F. D. (2013). Barriers to accessing services for young children. Journal of Early Intervention, 35, 61–74.CrossRefGoogle Scholar
  49. Yao, D. C., & Wright, S. M. (2000). National survey of internal medicine residency program directors regarding problem residents. JAMA, 284(9), 1099–1104.CrossRefPubMedGoogle Scholar
  50. Yoshinaga-Itano, C., Sedy, A., Coulter, D., et al (1998). Language of early and later-identified children with hearing loss. Pediatrics, 102(5), 1161–1171.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Interdisciplinary and Inclusive Education, College of EducationRowan UniversityGlassboroUSA

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