Family Benefits of Early Intervention: A Scoping Review

ABSTRACT Early Intervention (EI) is aimed at children with developmental delays through actions that include families and their context. The objective of this study was to conduct a scoping review based on The Protocols of the Joanna Briggs Institute and PRISMA-Scr, answering the question: How do families of children with special needs understand the benefits (support or assistance received) of Early Intervention Services? 54 articles were found and analyzed, and four different nuclei were organized: EI team, skills, and collaborative practices; Family empowerment and self-efficacy; Participation, personal needs, and Quality of Family Life; Access to information and services. We concluded that family benefits are indicators of the effectiveness of early intervention.

Early Intervention (EI) is an important multi-professional area aimed at the early years of children with special educational needs (SEN), developmental delays, or atrisk, and their families.Currently, with the advent of the expanded and systemic look at human development, the importance of children's relations with the various factors that surround them, such as their community, their family, and the availability of resources is considered (Franco, 2015).In family-centered practices in EI, the family context is seen as the main environment for their development, and its approach consists in valuing their competences and respecting their choices, to better fulfill the needs of the involved individuals, in creating opportunities to encourage the development of children based on their families active participation, providing the necessary support and resources that they need to learn and to engage in that process (Dunst et al., 2014;Dunst & Espe-Sherwindt, 2016;Machado et al., 2017;Serrano & Pereira, 2010).
In recent years, family-centered practices have been highlighted as the model predominantly recommended by the literature and research to provide better results and benefits for supported families (Bruder, 2012;HughesScholes & GavidiaPayne, 2019;Leite & Pereira, 2020).Recent studies, in addition to highlighting the effectiveness of their

METHOD
This study followed the scoping review protocol systematically, according to the literature guidelines, namely the guidelines of the Joanna Briggs Institute (Peters et al., 2015).Thus, the following predefined phases were respected: (1) identifying the review questions, (2) identifying the relevant studies, (3) selecting the studies, (4) mapping the data, and (5) grouping, summarizing, and reporting the results (Pham et al., 2014).Besides, the PRISMA-ScR checklist of the Joanna Briggs Institute (Tricco et al., 2018), along with the Enhancing the Quality and Transparency of Health Research (EQUATOR), was conducted.To identify the key topics of our research, we used the population, concept, and context (PCC) strategy.With this, the main question that this review was: How do families of children with SEN or at risk understand the benefits (support or care) of EI Services?

Inclusion and Exclusion Criteria
We included the papers that targeted families of children with SEN or at-risk aged between 0 and 6 years in Early Intervention services.In addition, the selected papers should address family-centered EI practices and portray EI outcomes in the areas of knowledge and information, skills development, well-being, and of quality of life.Other concepts related to the purpose of this kind of intervention, such as benefits, support, or care provided by EI services, were considered in searching for papers in our review.
We included studies conducted between 2007 and 2020, considering the publications based on the theory that was used by us as a reference for our research, the third generation of EI services, including the family-centered paradigm by Dunst (2000), and the publication of meta-analysis research of the literature produced until the year 2007 by Dunst et al. (2007).Furthermore, we included the quantitative and/ or qualitative research available.To preserve the reliability of the mapped data, we included only peer-reviewed papers published in scientific journals.In addition, for technical reasons, we only included papers available in Portuguese, English, or Spanish.

Search strategy
Search terms were the combined descriptors ("Familycentered" OR "Family involvement" OR "Family needs" OR "Family relationship" OR "family program") AND ("early intervention") AND ("children").We searched multidisciplinary databases and literature of specific field databases (PubMed, Eric, Embase, PsycINFO, Lilacs, and Cinhal).Finally, we searched for the bibliographic references of the papers that were included in our review, to find possible studies that we do not find through the search strategies.In addition to these, we added other papers written by researchers that were not identified using our searches, which satisfied the inclusion criteria, as material for data collection.The search process was conducted and cross-checked by two reviewers independently.

Selection of Studies
The eligibility assessment was applied by screening the titles and abstracts before checking the full text.

Data Collection
The information obtained in the papers to collect data was as follows: author, year of publication, country of origin, scientific journal, population and intervention, method (research design, approach, and kind of instrument), main results, and limitations.In addition, we conducted a thematic analysis, which identified themes or repeated patterns of meaning in the data to describe in detail a particular aspect (Braun & Clarke, 2006).

RESULTS AND DISCUSSION
We found 2647 papers through our search strategy.After finishing the process of removing the duplicates, 2040 papers remained.After applying the inclusion and exclusion criteria, we ended up with 54 papers, which constituted the sample that we used to synthesize content.A detailed description of this process can be found in the PRISMA-ScR flow diagram (Figure 1).The 54 papers included in our review are shown in Table 1 and identified with asterisk *.It is possible to see that there has been an increase in the production of papers on the benefits of EI according to the perspective of families of children with special needs in the last few years, with 39 of the scientific papers in the area (72.2%) referring to the period comprehended between 2011 and 2020.Most of the published studies were conducted by researchers from the United States, with 21 papers (38.8%), followed by Australia, with 8 papers (14.8%), and Spain, with 5 papers (9.25).Among the other countries where research in this area was conducted, we verified that in Canada and Ireland 3, publications were produced (5.6%); that in Portugal, Switzerland, China, South Africa, and the United Kingdom 2 publications were realized (3.7%); also, in New Zealand, Saudi Arabia, India, and Malawi, we found 1 publication (1.9%).
The researchers resorted to the quantitative method in 34 studies (63%).In addition, they undertook correlational analyses (55,7%) and exploratory research (31,4%).Regarding the instruments, many researchers used more than one method to analyze the benefits of EI.The researchers adopted especially questionnaires (55,7%), followed by scales (40,7%).The most used instrument by the researchers was the Measure of Processes of Care-56 (MPOC-56) (11 studies, 20.4%).This instrument was designed to evaluate the perception of family members on the family-centered practices they benefit, considering the items: availability and partnership of the team, access to general information and specific information about the child, coordinated and integral attention to the child and the family, as well as respectful and supportive care (King et al., 1995).Furthermore, the Family Outcomes Survey Revised (FOS-R), which evaluates the main benefits for the family and its perception of the usefulness of the intervention (Bailey et al., 2011), was present in 8 studies (14.8%), followed by the Family Quality of Life Scale, which evaluates the quality of family life in the domains of family interaction, relationships between parents and children, emotional well-being, physical/material well-being, and disability-related support (Hoffman et al., 2006) was resorted to in 7 papers (13%).It is noteworthy that, aside from other forms of data collection, interviews were conducted in 16 papers (29.6%).Qualitative method -exploratory design Semi-structured interviews were used.

BBR Valverde, APS Jurdi, & APS Pereira
To observe how families of children with special needs perceive the benefits and support received by EI services and their teams, four different nuclei of scientific production were identified, namely: EI team, skills, and collaborative practices; Family empowerment and self-efficacy; Participation, personal needs and Quality of Family Life; Access to information and services.
Professional competence was positively perceived (Coogle et al., 2013;James & Chard, 2010), as well as individualized intervention plans (Alotaibi & Almalki, 2016).Families also mentioned the greater support received, the flexibility, and the communication conveyed when attended by a single reference professional (Fitzgerald et al., 2015).A few studies indicate that the perception of the support received by families increased over time involvement in EI (Gascon-Ramos et al., 2010;Leite & Pereira, 2013;Raspa et al., 2010).In some studies, the kind of disability or developmental delay does not interfere with the perception of the benefits of EI (Epley et al., 2011), while in others the satisfaction is greater when children present motor and sensory alterations than when they have communicative, social and behavioral difficulties (Favez et al., 2008).The greater perception of the received support by families is related to the lower education levels of family members (Leite & Pereira, 2013).
If, on the one hand, collaborative practices appear to be related to lower levels of stress and higher levels of parental competence (Broggi & Sabatelli, 2010), on the other hand, it is considered that not all families feel comfortable with the responsibility of participating in the support intervention or be at ease regarding control of decision-making processes in EI (Broggi & Sabatelli, 2010;Hurtubise & Carpenter, 2011;Lee, 2015).
The term self-efficacy is also used to describe the benefits provided by EI support, defined as the families' sense of competence and confidence in their abilities (Boyce et al., 2017).The studies describe families' perception of the improvement of their efficacy, strengthening them, giving them greater self-confidence, and an increased appreciation of their competencies (Boyce et al., 2017;HughesScholes & GavidiaPayne, 2019;Raspa et al., 2010;Swafford et al., 2015), relating it to the degree of involvement of their members in EI actions (Popp & You, 2014).
Besides personal needs, the quality of family life (QFL) is indicated in the literature as one of the most important outcomes of EI, being considered indicative of the quality of the service provided (Balcells-Balcells et al., 2019).QFL considers family relationships, physical or material well-being, emotional well-being, and disability-related support (Epley et al., 2011).Some families mention greater satisfaction with QFL when supported by a case coordinator professional (García-Grau et al., 2018).Families of younger children (between 0 and 2 years old) and of children diagnosed with autism spectrum disorder (ASD) describe a lower QFL than the others, showing a relation between family perception and the degree of functionality of the child (García-Grau et al., 2018).Another aspect indicated in the research is family income, with a significant relation between higher socio-economic levels and better perceptions of QFL (Davis & Gavidia-Payne, 2009;Mas et al., 2016).

Access to information and services
Another relevant topic in the papers reviewed is related to access to information on community services, rights, and resources.This factor is an important benefit provided by EI since it is associated with the promotion of timely spaces of family co-responsibility in this process.In the studies found, the importance of this benefit is clear, with access to information being described as EI support that enables an articulation between children's and families' needs with the possibilities of services and support that aim at their development (Pighini et al., 2014).Thus, some studies indicate that families feel satisfaction with the access to information and the understanding of their rights (Epley et al., 2011;Behl et al., 2017), as well as with the access to available services (HughesScholes & GavidiaPayne, 2019).Also, some families perceive positively a connection with other families in the community (Edwards & Gallagher, 2014), highlighting the importance of the support that allows them to mobilize formal and informal social support (Trute & Hiebert-Murphy, 2007).
While it is important to note the prominence of this benefit, the majority of the studies described low levels of satisfaction of the families regarding the provision of services and resources (Chauhan et al., 2017;Fordham et al., 2011;James & Chard, 2010;McManus et al., 2020;Rodger et al., 2008;Summers et al., 2007;Wilkins et al., 2010;Zheng et al., 2016).As regards informal social support, studies show little family satisfaction with access to this network, indicating the need to encourage possibilities of contact with other families and parent associations (Favez et al., 2008;Gavidia-Payne et al., 2015;Noyes-Grosser et al., 2018;Raspa et al., 2010;Zheng et al., 2016).Regarding a macrosystemic level for the promotion of this access to information and services, it is also possible to observe the need to encourage political actions and government support (Fordham et al., 2011;Alotaibi & Almalki, 2016).

CONCLUSION
Our research allows us to understand that the evaluation of the benefits provided by support is a complex process but simultaneously a fundamental indicator of the effectiveness of support in EI.It also refers to the need for a continuous reflection on the quality of policies and practices implemented in the support of families with children with special needs.The present study´s findings highlight the importance of collaborative practices in the functioning of the EI support team and the effective participation of the family as an indicator of the effectiveness and quality of life.Studies have described the comprehensive relationship with the professionals as a great benefit, pointing to family satisfaction with the provided services and with the received support, which enables their participation, active listening, and appreciation, leading to a strengthening of the family network and greater confidence in the skills and competencies of the members of the families.
Regarding practice, we recommend that professionals should pay attention to the family's perception of EI and their needs, presented in this study, so they can serve as a starting point for improving practices, namely a case coordinator professional of the service and better access to information and informal social support.We also highlight the need to encourage political actions favoring this access to information about services, rights, and resources, because of the relation between this benefit and the promotion of family co-responsibility, which will enable the benefits of EI to extend beyond the period of intervention of the professionals.
On the other hand, we suggest a series of other studies that involve overcoming some of the limitations of our research, namely studies that focus mainly on the participation of mothers in EI, which reflect, almost exclusively, on the perception of the benefits according to this perspective.Also, the socio-demographic characteristics of the population under study are homogeneous in most articles, not being representative of all realities.Furthermore, considering that the predominance of quantitative research and the use of instruments limits the scope of studies, it would be interesting to include the synchronous use of qualitative research strategies to assist in obtaining further information and in exploring data analysis, contributing to a broader understanding of the perspective of family members on the benefits of EI in different contexts and realities.

Table 1 Articles Included in Qualitative Synthesis Title Year of publication Sample Research design, approach, and kind of instrument
Qualitative method -ethnographic research design Focus groups, interviews, and text reviews were used.Parental Perceptions of the Parent-Therapist Relationship: Effects on Outcomes of Early Intervention.Authors: Broggi; Sabatelli.201039parents of children from 9 months to 4 years with motor delays.Quantitative method -correlational design Application of instruments: The Parenting Stress Index (PSI), MPOC-56, Family Resources Scale (FRS), demographic questionnaire, percentage of goals achieved in the family therapeutic plan, and satisfaction questionnaire with the service elaborated by the researchers.Quantitative method -correlational design with two groups (face-to-face and teleservice).Application of instruments: The Monthly Time and Activity Form, FOS-R, The Home Visit Rating Scales-Adapted and Extended.Index, The Center for Epidemiological Studies-Depression Scale, and The Early Intervention Parenting Self Efficacy Scale.Flexibility of Programme Delivery in ProvidingEffective Family-Centred Intervention for Remote Families.Authors: Brown; Remine.200824families of an IE service for the deaf.Quantitative method -exploratory design Application of instrument: questionnaire adapted by the authors.Psic.: Teor.e Pesq.,Brasília, 2023, v. 39, e39303