Contribution of a MISC-CAB model workshop to the interaction between staff and toddlers with developmental delay, and to the staff's attitudes, beliefs, and psychological capital (Hebrew)

The main aim of the current study was to examine the contribution of a workshop based on the MISC-CAB approach to the quality of mediated interaction between multidisciplinary staff and toddlers with developmental delay, as well as to the staff’s attitudes toward the toddlers’ cognitive modifiability, their beliefs regarding the toddlers’ development, and their psychological capital.

Studies have shown that staff-child interactions in educational settings play a crucial role supporting children’s development (Ansari et al., 2020; Baardstu et al., 2021; Egert et al., 2020). In most cases, intervention programs aimed at improving interaction have focused on only one dimension: emotional, cognitive, or behavioral (Davis et al., 2023; Dolev et al., 2023; Engevik et al., 2015). The present study is based on the MISC-CAB model (Klein, 2003; Lifshitz, 2020), a holistic framework addressing mediated interaction, with a multidimensional consideration of the three CAB dimensions: Cognition, Affect, and Behavior. The model is based on the MISC approach – Mediational Intervention for Sensitizing Caregivers (Klein, 2003), which has been found effective in improving interaction between parents and toddlers/ children with non-typical development (Barnes Balanga, 2006; Jaegermann, 2005; Neeman, 2011; Sobleman-Rosenthal & Klein, 2003). Among staff, the model was implemented and found to be effective in a daycare for adults with intellectual disabilities (Lifshitz et al., 2010). 

            Intervention programs among teaching staff in schools for students with intellectual disabilities have led to improvements both in staff attitudes toward the cognitive and emotional modifiability of individuals with intellectual disabilities and in the staff’s psychological capital (Levy, 2024; Sapir, 2016; Akiva, 2024). The uniqueness of the present study lies in examining the attitudes and psychological capital of education and health professions staff in rehabilitation daycares for toddlers, before and after a workshop based on the MISC-CAB model.

            The study was conducted in two rehabilitation daycares, with one serving as the experimental group (N = 15) and the other as the control group (N = 16), for a total of 31 staff participants. The study comprised three stages: During the pre-test stage, background variables of the staff, their attitudes toward toddlers’ cognitive modifiability, their beliefs regarding toddlers’ development, and their psychological capital (hope, optimism, and self-efficacy) were assessed using a battery of questionnaires. In addition, the mediated interaction between the staff and toddlers was assessed through video analysis using the OMI method. During the intervention stage, the experimental group participated in a workshop based on the MISC-CAB model. In the post-test stage, all research variables were re-examined.

The results of the study will be presented in relation to its aims, according to its three parts:

Part A: Differences between the experimental group and the control group in the MISC-CAB mediation measures, in attitudes toward cognitive modifiability, in beliefs regarding the development of toddlers with developmental delay, and in psychological capital before and after the workshop.

            Consistent with our hypothesis, a significant improvement was found in the experimental group after the workshop across all mediation measures, except for choosing and regulating. In addition, significant differences were found in the degree of improvement between the experimental and control groups in the mediation measures of focusing, expanding, affecting, encouraging, and the overall measure of interaction quality. These findings are consistent with the principles of Feuerstein’s “Active-Modification” approach (Alony, 2024; Feuerstein, 1970; Feuerstein, 2003), which emphasizes every person’s cognitive modifiability and the central role of mediation in this process. Contrary to our hypothesis, no improvement occurred in attitudes, beliefs, or psychological capital following the workshop. One possible explanation is that, even before the intervention, the scores on these measures were already high in both groups. We interpreted this finding according to two perspectives: the critical approach and the realistic approach. It is important to note that this was a pioneering study conducted with a small sample and over a limited period, and further large-scale studies are needed to substantiate these findings.

Part B: Correlations between the research variables

            Consistent with our hypothesis, several statistically significant positive correlations were found, indicating that the more positive the caregiver’s psychological capital, attitudes, and beliefs were, the greater their use of cognitive and emotional mediation measures. Our findings are consistent with studies showing that the attitudes of individuals working with people with disabilities have a considerable influence on their behavior toward them (Shavit & Reiter, 2016; Chimhenga, 2016; Hecht et al., 2017; Klibthong & Agbenyega, 2018), as well as with theories suggesting that individuals with high psychological capital tend to activate more cognitive and emotional resources in their work, leading to higher performance effectiveness (Bandura, 1997; Luthans & Youssef-Morgan, 2017). In addition, we found that the more positive the caregiver’s attitudes toward toddlers’ cognitive modifiability were, and the lower their optimism score was at baseline, the more they used mediation measures at the second measurement. This suggests that basic beliefs and attitudes are meaningful in determining the extent to which individuals benefit from an intervention program.  

Part C: The contribution of background variables, psychological capital, attitudes, and beliefs of the staff members regarding the toddler with developmental delay, as well as the intervention, to the dependent variables of the study.

            The results of hierarchical regression analyses, conducted in a stepwise manner, showed that for the three mediation measures in which significant improvement was found (the overall interaction measure, focusing, affecting), all research variables combined with the workshop explained the significant improvement in interaction quality. Conversely, for the mediation measures of expanding and encouraging, the workshop itself emerged as the primary contributor. Moreover, after controlling for the staff’s background characteristics, psychological capital, and attitudes, a statistically significant unique contribution of the research group affiliation was found in all regression models. In other words, the workshop contributed to the improvement beyond the other variables.

            Theoretical Contribution: The model suggesting that an environmental intervention, specifically a workshop based on the MISC-CAB model, may contribute to improving the quality of interaction between multidisciplinary staff and toddlers with developmental delay, was confirmed. In addition, background variables (education, gender, years of experience in the daycare, rehabilitation/autism class), the optimism measure, and attitudes toward cognitive modifiability in daily functioning also contributed to the improvement in the quality of mediated interaction.

            Practical Contribution: According to the study’s findings, it is recommended to implement the MISC-CAB model in rehabilitation daycares to enhance and retain staff, particularly in view of the growing shortage of educational and professional personnel within these settings (Knesset Education, Culture and Sports Committee, 2023; Rabinowitz, 2023).