*5.5. Framework Regarding Evidence, Policy, and Implementation*

The role of the government, through policies or legislation, in early intervention varies greatly. In most countries, its primary concern has been the provision of services, ensuring services are available to young children with disabilities. Not all governments have been involved with the quality of services. The United States has provisions built in, such as the requirement that services be provided in natural or least restrictive environments. Different state systems of early intervention or preschool special education have varying levels of interest in the quality of services. Some, such as Alabama and Maine, have invested heavily in improving and maintaining high quality services. Outside the U.S., Portuguese law deals with the establishment of the system for managing early intervention, with a nod to quality by requiring the International Classification of Functioning, Health, and Disability be used in assessment [22,59]. In Australia, the government has established the National Disability Insurance Scheme, ostensibly to provide consumer choice, yet the scheme challenges family-centered practices and promotes a multidisciplinary approach to early childhood intervention [60].

As shown in Figure 3, the provision of services comes largely from the impetus of government policies and from legislation. To some extent, we have seen that the face value of RBM practices and the theories underpinning it have had some impact on systems. Those systems concerned about the quality of services have invested in training on, for example, the RBM. New Zealand's Ministry of Education adopted the RBI initially in one region, then spread it to the other three regions, and now uses other aspects of the RBM. They, like Australia, had a leg up because they were already using keyworkers, who are like primary service providers in the RBM. We see that the common sense of the RBM, the family-centered principles, and the theories about child functioning have had more impact on impact by agencies and governmental agencies than has the empirical evidence. However, the RBM's face value has credibility because of its basis in evidence-based practices.

**Figure 3.** Relationships among government, evidence, and implementation. AL: Alabama: ME: Maine, NZ: New Zealand. RBM: Routines-Based Interview.

Agencies in various international implementation sites have had a key role. To some extent, they might influence governmental agencies, and, certainly, they are influenced by the governments (i.e., they usually exist within the constraints of governmental regulations). In Australia, we have see Noah's Ark, in Melbourne and Canberra, embrace high-quality supports to children and families-not only with the RBM but also other philosophically and empirically sound models. They have been vocal in warning the National Disability Insurance Scheme about challenges to quality. In Poland, the implementation site for the Engagement Classroom Model, Słonezna Kraina, repudiated the traditional Polish concepts of quality early intervention approaches and boldly adopted the RBM. Teletón Paraguay, similarly, broke with cultural traditions to reimagine quality, moving from a rehabilitation approach to a functional, family-centered approach. These agencies and others were influenced primarily by the logic and values of the RBM.

An interest in quality, therefore, has been the driving force behind implementation of best practices. Circling back to governmental input, we have seen that some actions by governmental agencies have enhanced implementation of the RBM. For example, in the U.S., 24% of the states have included practices from the RBM in their state systemic improvement plans, which are required, annually [61]. In these improvement plans, most often states have included the RBI in their assessment procedures. Finally, governmental agencies have invested in training in the RBM. For example, various U.S. states such as Alabama, Kentucky, Maine, Mississippi, Montana, and Nebraska have funded professional development in the RBM. Outside the U.S., governmental investment has been restricted largely to New Zealand. In Spain, some states (comunidades autónomas), such as Castilla la Mancha, have funded training in the model.

The interaction among governmental interest, research, and implementation is, therefore, a complicated and fascinating one. Pragmatists would like to find the perfect solution. Descriptivists, however, are content with admiring the phenomenon.

We end with three inferences. First, working with implementers in a caring, respectful, and honest way leads to appropriate modifications of the model. Second, sustaining an innovation is harder than implementing it: things change (funding mechanism, geographical organization, leadership), and carrying out the innovation with fidelity to the model is shaken. Third, some practices are good for young children with disabilities and their families, wherever they are. These practices might be that early intervention and parenting should help children participate in their lives meaningfully, that early intervention should support families to be the caregivers they want to be, and that early intervention professionals should know what they are doing. International implementation of the RBM has, therefore, provided a prototype for how to work across cultures, countries, and customs.

**Author Contributions:** Conceptualization, R.A.M.; methodology, R.A.M.; writing—original draft preparation, R.A.M.; investigation, resources and writing—review and editing: R.A.M., T.B., K.B., M.C., A.-W.H., N.J., H.H.L., M.P., T.S., J.W.; visualization, R.A.M.; supervision, R.A.M.; project administration, R.A.M. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** We acknowledge, with gratitude, contributions from Stacey Hodgson, Becky Hoo, Iris Lin, Low Hwee San, Agatha Tan, Tan Peng Chian, Sze Wee Tan, and Marla Teicher.

**Conflicts of Interest:** Authors declare no conflict of interest.

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