Who gets coached? A qualitative inquiry into community clinicians' decisions to use caregiver coaching.
Liza Tomczuk, Rebecca E Stewart, Rinad S Beidas and 2 others
PMID 34866429WHAT IT FOUND
Clinicians reported deciding against caregiver coaching for families facing poverty, competing priorities, or cultural barriers.
They often attributed these decisions to family deficits rather than systemic constraints, potentially widening disparities in access to evidence-based early intervention.
Key findings
01Clinicians identified four main themes influencing their decision to use or avoid caregiver coaching: low socio-economic status, competing priorities, caregiver/family system characteristics, and culture.
02Providers frequently described families from marginalized backgrounds as a 'bad fit' for coaching due to perceived lack of resources, time, or understanding, rather than their own skill limitations.
03Clinicians used deficit-based language to describe barriers, such as labeling caregivers as 'clueless' or 'lazy', which reflects implicit biases that may hinder equitable service delivery.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample was skewed towards White, female clinicians, which may not reflect the diversity of the broader workforce or the families they serve. Interviews were conducted before and during the pandemic, and the mix of in-person and remote data collection may have influenced the depth and consistency of responses. The study relies on self-reported beliefs and decisions, which may not fully capture actual clinical practice or the complexity of real-world interactions. Participants were from specific geographic regions, so findings may not generalize to other early intervention systems.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institute of Health (Extramural) and the U.S. Government (Non-P.H.S.).
The easy way to misread this
Do not interpret these findings as evidence that caregiver coaching is ineffective for marginalized families. The study reports clinicians' perceptions and biases, not the actual outcomes of coaching. The barriers identified are often systemic or related to clinician bias, not inherent family deficits.