*2.4. How the Model Became of Interest, Internationally*

The profile of implementation of the RBM, globally, is shown in Table 1. Each country has had its experiences with the exploration stage of implementation, the installation stage, the extent of implementation, systemic or cultural barriers or enhancers, and leadership.


**Table**




When we talk about global implementation, we need to remember that U.S. implementation counts too. The RBM is implemented, to one extent or another, in many places in the U.S. The RBI specifically or the RBM as a whole are the most frequently cited strategies for improving federal child or family outcomes in state systemic improvement plans (SSIPs) [13]. Some states, such as Alabama, Maine, and Mississippi, have adopted the model and are at different stages of implementation. Other states—four that we know of—were strong implementers but have waned in recent years, which is a lesson in implementation, specifically sustainability. Siskin Children's Institute, where McWilliam used to work, still demonstrates most of both the home- and community-based components of the model as well as the Engagement Classroom Model, under the leadership of Deidra Love (director of the home- and community-based early intervention program) and Julie Mickel (director of the classroom programs), respectively. Community-based components are visits to children's child care centers or preschools. In addition, the Multnomah Early Childhood Program (MECP) in Portland, Oregon, is adopting the needs assessment, intervention planning, and home- and community-based practices in a large metropolitan environment, under the leadership of Cami Stevenson (assistant administrator). MECP is the mothership demonstration site of the model.

Implementation data have come from leaders in each of the implementation countries. [FIRST AUTHOR] has collected data from individual states and ECTA. Key informants from U.S. states and other countries have been participants in the action research involved in this implementation science. These key informants are the authors and their colleagues. Data collection has ranged from anecdotal reports to checklist data on individual practitioners.

The first non-U.S. country to show an interest in implementation of the RBM was Portugal, because McWilliam had been working intensively with the University of Porto (under the leadership of Professor Joaquim Bairrão, psychology professor) [14,15]. Eventually, the national association for early intervention adopted the model, wrote a manual, and provided sporadic training around the country [16]. Meanwhile, students McWilliam had worked with, such as Cecília Aguiar and Tânia Boavida (faculty members at ISCTE), began their own leadership in Lisbon.

Spain followed suit, when Marga Cañadas (director of an early intervention program at the Catholic University of Valencia, UCV) became an indefatigable ambassador for the approach. Within countries, the spread of the model is something that we try to keep track of. In Spain, for example, implementation sites are gradually growing and, even within *comunidades autónomas* (states) such as Castilla-La Mancha, officials are documenting the extent to which the RBM is being adopted. Currently, Pau García Grau, also on the faculty of UCV, is training professionals there on the RBI, and Catalina Morales Murillo (on faculty at La Universidad de la Rioja) has also trained Manchegos and Manchegas in RBM practices. Some Canadians were interested, in particular Kamal Haffar, who worked to spread the word in Ontario. In Taiwan, Ai-Wen Hwang went about conducting research on the model in Taiwan, and she has produced the only randomized control trial on the RBM [17]. This study showed that the RBM (called Routines-Based Early Intervention then) group had a faster progress rate in self-care functions and independence in social functions in the first 3 months of intervention and at the 6 month follow up than the traditional home-visiting group. Traditional home visiting was not more effective on any outcomes measured.

In Singapore, Lim Hong Huay led Project ECHO, which used the model for classroom practices. In New Zealand, Julia Woodward and colleagues at the Ministry of Education decided that all children and families receiving early intervention through their system would receive practices under the RBM. In Australia, a program in Victoria and Canberra, Noah's Ark, under the leadership of John Forster and his lieutenant, Kerry Bull, implemented the model. Meanwhile, in Western Australia, Denise Luscombe was also using many of the model's practices in her training and consultation to others in the Perth area. Through connections Cañadas had made, a large agency serving children with physical disabilities, Teletón Paraguay, adopted the model. This agency is one of a number in Oritel, a federation of Teletones, meaning that we might have the opportunity for implementation throughout Central and South America. The most recent implementer has been an agency in Silesia, in Poland, which has

constructed classrooms expressly designed to implement the Engagement Classroom Model, under the leadership of Krystian Kroczek, Lucyna Legierska, Sylwia Wrona, and, formerly, Natalia Józefacka.
