Nevada – NCCP

Nevada Strategies

IECMH in Part C Early Intervention: Pyramid Model

The Pyramid Model for Promoting Social Competence (Pyramid Model) is a framework that supports early childhood professionals’ use of evidence-based practices to build children’s social-emotional competence and address challenging behaviors. The framework’s three tiers focus on promotion, prevention, and intervention. Tier 1 practices promote social-emotional competence for all children; Tier 2 provides supports for children at risk of challenging behavior, including targeted strategies to promote self-regulation skills and other social-emotional competencies; and Tier 3 offers individualized, intensive interventions for the small number of children with persistent difficulties and their families.

Working with the National Center for Pyramid Model Innovations (NCPMI), Nevada was the first state to implement the Pyramid Model in its Early Intervention (EI), beginning in 2018. Implementation started with three pilot sites, expanded to a second cohort of two sites, and will reach the remaining eight EI sites in a third cohort. A state leadership team (SLT), comprised of EI parents; advocates; local EI program providers; and the state EI office, guides the effort by setting goals for expansion and funding. At monthly meetings the SLT reviews its Benchmarks of Quality (BOQs; see section on evaluation and monitoring below), which are updated every six months, and develops or revises action plans to meet the BOQs.

Each EI site has its own Pyramid leadership team consisting of an administrator, an early interventionist, a professional who facilitates behavior support planning, a Practitioner Coach, an EI family member, and a data coordinator. The following Pyramid-trained staff support the implementation of PM practices within each EI program site.

A Program Coach trains the Practitioner Coaches and coaches them to achieve fidelity to the Pyramid Model through onsite visits and calls. The program coach also helps with collecting and analyzing data to guide the site leadership team’s decision-making. Program coaches are former EI providers who are also part of the state’s EI Quality Assurance (QA) team, a unit within the state division that monitors contracts for EI.
Practitioner Coaches are EI practitioners without existing supervisory responsibilities who are selected by the site leadership team to support other EI practitioners. They typically have a strong interest in promoting infant-toddler social-emotional growth. Trained by a Program Coach in Practice-Based Coaching, Practitioner Coaches work with all the EI practitioners in a program to make sure they are providing EI services to families using Pyramid Model strategies and helping families achieve their Individualized Family Service Plan (IFSP) outcomes. Practitioner Coaches’ work involves home observations (both in-person and video recordings), collecting fidelity data, and coaching. During COVID-19, program coaches and practitioner coaches were able to join EI home visits virtually. With the resumption of in-person services, observations are occurring within home visits and in community settings, such as early care and education programs. NCPMI faculty and Program Coaches support Practitioner Coaches through monthly calls.
The data coordinator. Each site has its own data coordinator, a local EI program employee who offers support in collecting fidelity data with several tools (Benchmarks of Quality, Early Interventionist Pyramid Practices Fidelity Instrument, and Coaching Log; see section on evaluation and monitoring for more information on these tools). This coordinator also brings data to team meetings for discussion and decision-making and organizes data for evaluation reports.

Behavioral therapists or IECMH specialists may be brought in for cases where a child’s needs are beyond what Tier 3 supports can address, often in situations where behavioral and social-emotional challenges are linked to a child’s diagnosis or delay (e.g., autism or severe communication delay).

Nevada’s Pyramid Model aligns well with the state’s other Part C EI efforts to support social-emotional skills and development, which has been the focus of Nevada’s State Systemic Improvement Plan (SSIP). All EI providers are required to take an online social-emotional training module at the time of hire and then once every two years. The module includes referral resources for EI providers working with families in need of mental health supports not provided through EI. All EI providers are required to be trained on one or more of four social-emotional (SE) tools (ASQ:SE, SEAM, DECA, PICCOLO), which are used for screening and assessment. Each child receives an SE screen at EI entry.

Nevada is a large, diverse state, and each Pyramid Model site has tailored implementation to meet the needs of the community it serves. Recruiting parents to serve on site and state leadership teams has been critical to adapting the model for local communities.

Sites in Las Vegas serve a diverse urban population. Prior to COVID, and with anticipated future resumption, EI programs engaged families through community developmental play groups, with EI children joining children with typical development from the community.
At sites in the state’s mountainous frontier communities, EI providers emphasize social supports and addressing isolation for families, which often have one parent engaged in mining shift work, leaving the other parent alone for 3-5 days at a time. Community barbecues for EI families have fostered relationships among providers and families. In Elko County, the EI program’s community developmental playgroups have played an important role in engaging families and children, who had been particularly isolated during the pandemic.
Reno has found success through online parent support groups and its existing strong relationships with the county’s mental health system.
Among the state’s large military population, Pyramid Model’s implementation has helped address stigma around developmental delays and disability, which can impact family eligibility for overseas deployment.

The state Part C tribal liaison helps to connect indigenous communities to early intervention services, though leaders recognize that more work is needed to engage tribal families through Child Find.

Workforce Development

Initial training for the state leadership team, Program Coaches, and first cohort of EI sites took place at a two-day, in-person training led by the NCPMI. The Program Coaches and the Practitioner Coaches received training on Practiced-Based Coaching at this time. The Program Coaches also received train-the-trainer training to allow them to train future cohorts of Practitioner Coaches on Practice-Based Coaching. Site implementation leadership teams receive a web-based orientation and there is an additional training for site data coordinators.

Training on Pyramid Model practices occurs over three days: two days on basic practices and tiers 1 and 2, and one day on the third tier, called Prevent, Teach, Reinforce for Families. Nevada has arranged access to Pyramid Model practices training e-modules for all EI providers for seven years. This will allow existing staff in future EI sites that will implement PM and newly hired staff to take trainings on their own, which is more convenient and less expensive than quarterly or annual in-person trainings. The trainings count as Continuing Education Units (CEUs), which EI providers need to maintain their licenses.

Because of Covid-related turnover and retirements, maintaining a full complement of coaches and providers trained on the Pyramid Model has been a challenge, requiring EI sites from earlier cohorts to have additional Practitioner Coaches participate in trainings with new cohort sites.

Financing

For the initial training, NCPMI paid for its own travel and training costs, including the ongoing monthly calls with Program and Practitioner Coaches. The state used its federal Part C funds to cover the costs to bring the first cohort of EI sites and state leadership team to the initial in-person training. Ongoing funding for Pyramid Model implementation comes from the state’s federal Part C funds. Because Program and Practitioner Coaches are already employed by state and local Part C programs, their Pyramid Model work is supported by these federal Part C funds; the SLT and local sites recognize and manage the reduced caseloads of the Practitioner Coaches.

The state leadership team continues to look for additional sources of ongoing funding for Pyramid Model efforts; currently, the seven-year access to the Pyramid Model e-modules is funded with American Rescue Plan Act funds.

Evaluation and monitoring

Pyramid Model implementation involves collecting data for a range of monitoring purposes. The state and each site establish their own Benchmarks of Quality, which help to inform and refine Action Plan goals. Examples of benchmarks include increasing parent representation on leadership teams and accessing additional sources of funding beyond federal Part C.

Practitioner Coaches use the observational Early Intervention Pyramid Practices Fidelity Instrument (EIPPFI) to monitor EI providers’ fidelity to Pyramid Model practice standards (e.g., focusing on the parent-child dyad, conducting SE assessments, addressing family needs). Practitioner Coaches and EI service providers use the EIPPFI to identify and monitor Pyramid Model goals that a service provider can strengthen.

For each observation cycle with practitioners, Practitioner Coaches also complete logs, which collect more granular data on the content of the coach’s direct coaching activities with providers and on reflection time with providers afterwards. Coaching logs usually document twice-monthly observations and monthly reflections.

For Annual Performance Report (APR) and State Systemic Improvement Plan (SSIP) reports submitted to the federal government, the state Part C program collects data from programs on children’s social-emotional outcomes. Additionally, the state collects social-emotional data during its annual statewide family survey offered during spring. For the 2020 fiscal year APR/SSIP reports submitted to the federal government in April 2022, Nevada exceeded its target of children displaying progress in their SE development at time of exit from EI (68 percent was the target and 74 percent was achieved).

Special thanks to the following individuals in the Nevada Department of Health and Human Services, IDEA Part C Office, for providing information for and reviewing this profile: Shari Fyfe, Edie King, Lori Ann Malina Lovell, and Melissa Slayden.

Last updated June 2022