Background: Early interventions to support young children’s language development through responsive parent-child interaction have proven efficacy but are not routinely delivered universally. A potential universal delivery platform in England is the Health Visitor (HV) led 2-2½ year old review in England’s Healthy Child Programme. We report intervention development processes, completed between 2019 and 2024 including extensive stakeholder consultation and co-design which aimed to develop an acceptable, feasible and equitable early language intervention for delivery in this context. The Early Language Identification Measure and Intervention (ELIM-I).
Methods: Study1 involved five phases 1) Identification of existing intervention evidence and underpinning theory 2) Qualitative review of intervention studies extracting candidate target behaviours for intervention and intervention techniques. 3) Co-design workshops with parents and practitioners examining acceptability, barriers and enablers to those behaviours and techniques. Particular attention was paid to diverse family circumstances and the range of barriers which might exist. 4) Findings were analysed using behaviour change theory and frameworks and a prototype intervention model designed. 5) Co-design workshops iteratively refined the proposed model. Study 2 involved resource development, and cycles of piloting and refinement in partnership with parents/caregivers, practitioners and BBC Tiny Happy People.
Findings: Practitioners were committed to offering language intervention at the 2-2½ year old review but were not sure precisely how to do so. Parents/caregivers wanted to be proactive and to have agency in supporting their own children, and to do this as soon as possible. For equitable intervention it was essential that the intervention be proportionate, with higher ‘intensity’ for higher levels of disadvantage, and tailored, offering differing approaches considering the specific barriers and enablers, assets and challenges in each family. The importance and potential fragility of alliances between parent/caregiver and practitioner were identified as key and so strategies to engender successful collaborative partnership were also embedded in intervention design. A set of co-designed, paper-based, and online resources together with online practitioner training can enable the delivery of a universal intervention which is acceptable to professionals and parents/caregivers and which supports practitioner implementation, parent/caregiver agency, proportionality and practitioner-parent/caregiver partnership.
