**Background:** Infants at high biological risk of neurodevelopmental disability (e.g., preterm infants, those with hypoxic-ischemic encephalopathy) face risks of cerebral palsy, intellectual disability, and autism spectrum disorders. These conditions limit school readiness, especially in low- and middle-income countries (LMICs) where early intervention is often unavailable or inaccessible. Effective early intervention should be family-centered, goal-oriented, home-based, and focused on activity and participation. Coaching approaches like COPCA (Coping with and caring for infants with special needs) empower families to promote their child's development during daily care activities. COPCA has shown positive associations with infant mobility and family empowerment in high-income countries (HICs). This perspective paper describes COPCA's coaching strategies, reports on two pilot implementation studies in Brazil, and argues for COPCA's suitability in LMICs.
**Methods:** The paper first describes COPCA's theoretical framework and coaching strategies (information exchange, active listening, shared observation, provision of hints and suggestions, asking reflective questions, provision of feedback, illustration with example, and joint planning). COPCA coaches complete a professional education course of 3 × 2 days plus two individual coaching sessions of one hour. Two pilot studies were conducted in Brazil. The first was a case series of five Brazilian children: three with cerebral palsy (GMFCS levels III, IV, V), one infant at high biological risk due to perinatal hypoxia/ischemia, and one with psychosocial risk. Four of five families had low income. Children received seven weekly one-hour home visits with COPCA coaching, delivered by physical therapy students supervised by a certified COPCA coach. Outcomes were measured using the Gross Motor Function Measure (GMFM-88) and Alberta Infant Motor Scale (AIMS). The second pilot study, conducted during the COVID-19 pandemic, involved seven preterm infants (gestational age at birth 29–36 weeks; corrected age at start 5–14 months) who received eight weekly COPCA coaching sessions via WhatsApp video-call telemonitoring, supervised by a certified COPCA coach.
**Key Results:** In the first pilot study, the three children with cerebral palsy showed an increase of more than 5% in target areas of the GMFM-88, considered clinically important. The infant at biological risk increased AIMS percentile from <25 to 50 (total score from 15 to 29). The infant at psychosocial risk showed no change in AIMS percentile (remained at 10; total score from 49 to 52). All families reported high satisfaction and felt empowered. In the second pilot study (tele-coaching), all seven preterm infants reached their individually determined goals after eight weeks, and all showed substantial increases in AIMS percentile scores. Caregivers were satisfied and felt supported and empowered.
**Clinical Implications:** COPCA's coaching approach is well-suited to LMICs because it is adapted to each family's strengths, needs, and culture; empowers families; promotes child development; and may improve school readiness. It requires no expensive equipment—only materials available in the home. Tele-coaching eliminates the burden of travel to distant clinics, a known barrier to adherence. COPCA aligns with Brazilian national policies recommending home-based early intervention, though most existing programs target psychosocial rather than biological risk. Potential barriers include parental resistance to the non-directive coaching model (versus traditional hands-on approaches like neurodevelopmental treatment), but experience in HICs suggests families accept coaching once informed. The authors note that larger-scale studies are needed to confirm effectiveness in LMICs, identify implementation barriers, and evaluate which components can be delivered by lay or paraprofessional community health workers versus fully trained COPCA coaches.