Providing High-Quality Support Services to Home-Based Child Care: A Conceptual Model and Literature Review

ABSTRACT

Research Findings: Home-based child care accounts for a significant proportion of nonparental child care arrangements for young children in the United States. Yet the early care and education field lacks clear models or pathways for how to improve quality in these settings. The conceptual model presented here articulates the components of high-quality support to child care providers; related factors; and hypothesized provider, family, and child outcomes. The model is based on a literature review of research on home-based child care, home visiting, early childhood mental health consultation, coaching, and family services. We hypothesize that high-quality support to home-based child care that offers relationship-based services focused on quality caregiving (individual home visiting and group supports such as training and networking) and sustainability (materials, equipment, referrals) is most likely to positively impact quality caregiving for children and families. Practice or Policy: Current federal efforts and policy initiatives to increase the supply and quality of infant–toddler child care focus on the development of systems that support home-based providers. The conceptual model of high-quality support described here will inform future program development and research on how to improve quality in home-based child care for the millions of low-income children in these settings.     

Child care effects on the development of toddlers with special needs

Among children with significant developmental delays or with biomedical risk factors for developing delays, those who were in nonmaternal child care (n=80) did not differ from children staying at home with their mothers (n=73) on mental, motor, or adaptive functioning; behavior problems; or attachment security at 30 months of age. An ecological model then was used to predict outcomes for children who had been observed in child care. After accounting for selection effects, child characteristics at 12 months of age, and quality of home caregiving, none of the child-care variables (age of entry, hours, quality) predicted mental or motor development or attachment security among children in nonmaternal care. Older age of entry into child care predicted greater behavioral organization during testing. Higher observed quality of caregiving in child care predicted better adaptive behavior. Additionally, quality of home caregiving predicted mental development, behavioral organization, and secure attachment to mother.     

Day care and family dynamics

Twenty-one dual-earner families whose preschool-aged children entered day care before 6 months of age and 19 dual-earner families whose preschool-aged children entered day care during the second year of life filled out questionnaires on the nature of their children's caregiving environment; their perceptions of the effects of day care on parent-child interaction and children's development; their overall job satisfaction; social support networks; and personal well-being, marital stress, and companionship. Mothers and fathers reported high levels of satisfaction with the caregiving environment and the effects of day care. Parental perceptions of the effects of day care on parent-child interaction and children's development did not differ as a function of time of entry into day care. Parental perceptions of selected parent-child variables were associated with job satisfaction, social support, and the marital measures. Parental perceptions of parent-child interaction were related to their perceptions of the effects of day care on children's social and cognitive skills. Mothers and fathers differed in these perceptions. There was some support for a conceptual link between marital variables and children's functioning in day care.     

Immigrant girls as caregivers to younger siblings: a transnational feminist analysis

This article employs a transnational feminist lens to examine the experiences of racialised immigrant girls who provide care for their younger siblings. The article draws on findings from a participatory action research study in Victoria, British Columbia, Canada to examine the role that immigrant girls’ caregiving practices play in transnational families’ social, economic, and cultural survival. It argues that greater attention should be given to the diverse and complex contexts, consequences, costs, and contributions of immigrant girls’ caregiving labour.     

Der Abbau von Bildungsbenachteiligung durch Kindertagesbetreuung für unter 3-Jährige – zwischen Wunsch und Wirklichkeit

Based on the assumption that children can benefit from early childhood education, the present paper investigates if the admission to day care and the selection of the type of day care (child care centers and home day care) is socially selective. In doing so, the paper analyzes how the socioeconomic and immigrant background of families influences which type of day care is used. For children under the age of three, the social background of families does influence if a child receives day care, but this influences diminishes the older the children get. The type of day care (child care centers and home day care) did not differ according to social background. The paper closes with a discussion of the challenges and potentials for development of educating children under the age of three.     

A Developmental Analysis of Caregiving Modalities Across Infancy in 38 Low‐ and Middle‐Income Countries

Caregiving is requisite to wholesome child development from the beginning of life. A cross‐sectional microgenetic analysis of six caregiving practices across the child's 1st year (0–12 months) in 42,539 families from nationally representative samples in 38 low‐ and middle‐income countries is reported. Rates of caregiving varied tremendously within and across countries. However, caregiving practices followed one of two developmental trajectories: (a) greater proportions of caregivers read, told stories, and named, counted, and drew with each additional month of infant age, and (b) proportions of caregivers who played, sang songs, and took their infants outside increased each month from birth but reached an asymptote at 4–5 months. Rates and growth functions of caregiving have implications for infant care and development.     

Employed mothers and family day-care substitute caregivers: a comparative analysis of infant care

Despite dramatic increases in recent decades in the number of employed mothers with children under 3 years of age and the greater utilization of nonmaternal child-care services (particularly unregulated family day care), little is known about the nature and quality of care provided to these infants by their employed mothers and substitute caregivers. This study was conducted to provide a comparative assessment of maternal and nonmaternal infant caregiving practices in own-home and unregulated family day-care homes, respectively. 30 caregivers (10 employed mothers, 10 substitute caregivers, and 10 nonemployed mothers) were observed in interaction with 5-6-month-old infants using Yarrow, Rubenstein, and Pedersen's Home Environment and Mother-Infant Interaction scales. While no differences were observed in the caregiving of employed and nonemployed mothers, both of these groups exceeded the sitters in socially mediated stimulation, contingent responsiveness, positive affect, and overall level and variety of social stimulation. In addition, employed mothers provided more tactile-kinesthetic, visual, and auditory stimulation to their infants than did the substitute caregivers. However, no differences were found between the infants reared in the home and day-care settings in Bayley Mental and Psychomotor developmental abilities. Evidence implicated group size (total number of children) in the quality of caregiving in family day-care homes. The impact of daily separations and qualitatively different caregiving experiences on infants is discussed.     

Do regulable features of child-care homes affect children’s development?

Data from the NICHD Study of Early Child Care were used to assess whether regulable features of child-care homes affect children’s development. Child-care homes selected were those in which there were at least two children and the care provider received payment for child care (ns=164 when the study children were 15 months old, 172 at 24 months, and 146 at 36 months). Caregivers who were better educated and had received more recent and higher levels of training provided richer learning environments and warmer and more sensitive caregiving. Caregivers who had more child-centered beliefs about how to handle children also provided higher quality caregiving and more stimulating homes. In addition, when settings were in compliance with recommended age-weighted group size cut-offs, caregivers provided more positive caregiving. Quality of care was not related to caregivers’ age, experience, professionalism, or mental health, or to the number of children enrolled in the child-care home or whether the caregivers’ children were present. Children with more educated and trained caregivers performed better on tests of cognitive and language development. Children who received higher quality care, in homes that were more stimulating, with caregivers who were more attentive, responsive, and emotionally supportive, did better on tests of language and cognitive development and also were rated as being more cooperative. These findings make a case for regulating caregivers’ education and training and for requiring that child-care homes not exceed the recommended age-weighted group size.     

Using quality improvement to promote implementation and increase well child visits in home visiting

A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions.     

Multiple determinants of caregiver behavior in child care centers

In this study of the multiple determinants of professional caregiving, 237 caregivers (age range: 18–56 years) from 64 Dutch child care centers were extensively observed during their interactions with the children (0–4 years) in their usual care group. The choice of potential determinants of the caregiving quality was guided by Belsky's [Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55, 83–96] model of the determinants of parenting. Consistent with Belsky's model, quality of caregiving was found to be multiply determined by characteristics of the caregiver, the children and the caregiving context. More specifically, lower-quality care was provided by younger caregivers, to younger children, and by caregivers reporting higher physical occupational workloads. The differences between the participating child care centers proved to explain more variance in the quality of professional caregiving than the differences between the individual caregivers.     

社区居家养老模式实现途径探析

社区居家养老模式是以家庭为载体,社区服务网络为依托,以老年人日常生活照料、医疗保健服务和精神慰藉为主要内容,并以上门服务和社区日托服务为主要形式的一种养老模式。目前,政府已经出台了一些相关政策,社区也在不断完善社区服务,社区建设使社区储备了大量的专业人才,最重要的是社区居家养老模式倡导＂养老不离家＂,使其成为老年人及老年人家庭比较容易接受的养老模式,这些都为社区居家养老模式的实施提供了前提条件。因此,充分发挥政府宏观调控的职能,利用现代社区所具有的优势,并结合血缘和亲情的优势是实现社区居家养老模式的最佳途径。     

The ecology of family day care

The study examined the interrelationships of multiple levels of the family day care system (family, child care, and children) in order to portray the ecology of family day care in a small midwestern city and surrounding rural areas. Fifty-seven children, their mothers, and caregivers (n = 30) participated. Caregiver characteristics, conditions of caregiving, and quality of care in the family day care homes were assessed. Family background information (SES, education, stress, social support, and childrearing preferences) was obtained. Children's cognitive, language, and social development were assessed using static and process measures of each domain. Results revealed that families did not choose caregivers who resembled themselves with respect to SES, childrearing preferences, and stress, nor did they select child care whose quality varied systematically with their characteristics. Family and child care characteristics appeared to have additive effects on children's development.     

Supplementation of urban home visitation with a series of group meetings for parents and infants: results of a "real-world" randomized, controlled trial

OBJECTIVE: Home visitation has been shown to be effective in reducing rates of child maltreatment and in enhancing psychosocial outcomes in children and their parents. Even when available, however, it is underutilized by parents in some urban settings. We tested a supplemental 10-session group intervention for its ability to increase active participation in home visitation, enhance the quality of caregiving behavior of parents, and improve social developmental outcome in children. METHOD: A randomized controlled design was utilized, involving two separate cohorts of parents of 3- to 18-month old infants, totaling 148 parent-child dyads. The intervention focused on practical experience in promoting parent-infant attachment relationships. RESULTS: At 6 months follow-up, there was a substantial increase in the proportion of intervention group parents participating in home visitation, compared to parents in the control group (Fisher's exact p = .008). Parents in the intervention group exhibited a trend for improvement in their capacity to appropriately interpret infants' emotional cues (p = .08), independent of the effects of home visitation itself. Attrition in both the treatment and control groups was inversely associated with income and level of education. CONCLUSIONS: Group meetings may constitute an effective means of engaging stressed urban families in home visitation.     

Providing high quality child care

The trend toward a growing proportion of American women employed outside the home is clear. One- and two-parent families, often out of economic necessity, are seeking alternative care arrangements for their infants and preschool-aged children. As many are experiencing full-day, alternative child care during part or all of their developmentally crucial first five years, there is a need to focus on the quality of day care. Several recent reviews of center-based day care research have portrayed this experience as a relatively benign influence on the development of young children provided that a high level of quality is maintained (Belsky & Steinberg, 1978; Bronfenbrenner, 1979; Etaugh, 1979). What are the implications of this research for child care providers? If it is true that high quality child care has a benign effect on young children's development, what can child care providers do to ensure quality care?     

A Study of Child Rearing Practices Amongst Selected,Sudanese Families in South Australia: Implications for Child Care Service Selection

Child care services in Australia, for example, are largely defined and shaped by the historically dominant Anglo-Australian discourse and norms. The aim of this research was to examine critically and to find meaning in the experiences of recently arrived Sudanese families as they began to settle into their new cultural environment. The cultural values of some 30 Sudanese families were investigated and related to how these affected the selection of child care services. Qualitative research methods including an indigenous approach were used to gather data. Interactions with Sudanese families took place in their home environments. Interviews were conducted in a way that put those people interviewed at ease. Techniques used included narrative interviewing and vignettes.     

Predictors of foster parents’ stress and associations to sensitivity in the first year after placement

In Germany, almost 70 000 children are living in foster families (Statistisches Bundesamt, 2016). Many foster children show mental health problems as they were exposed to an accumulation of risk factors. Hence, foster parents are often faced with challenging parenting situations. The current study focuses on the predictors of foster parents’ stress and examines longitudinally whether parenting stress is associated with foster parents’ sensitivity. The sample consisted of 55 children (aged from 1 to 6 years) and their foster caregivers. Foster parents’ sensitivity was observed during home visits. Caregiver reports were used to assess parenting stress (Parenting Stress Index) as well as foster children’s externalizing behavior problems (Child Behavior Checklist). For main caregivers’ stress at the beginning of placement, regression analyses revealed both, foster children’s externalizing problems as well as partners’ stress as predictive. For main caregivers’ stress one year after, only initial parenting stress and partners’ stress were predictive. Foster parents’ sensitivity was correlated with their parenting stress one year after placement. Regression analyses revealed no longitudinal effects of initial parenting stress on overall sensitivity. However, supportive presence was predicted by initial supportive presence and by the interaction between parenting stress and children’s externalizing problems at placement. The findings highlight the role of the partner in experiencing parenting stress when taking care of a foster child. Furthermore, they emphasize that foster parents who care for children with behavior problems need adequate support that can buffer initial parenting stress and thereby promote sensitive caregiving.     

The viability of pediatric hospices: a case study

This paper identifies the special characteristics needed by hospices caring for terminally ill children. It is based on a feasibility study conducted in 1979 for a pediatric hospital in New York City. From the analysis of statistical data and confidential interviews with health care professionals in the hospital and in the community, the study concludes that the needs of terminally ill children and their families are not being met currently and that the hospice is as appropriate for children as for adults. Three major differences in emphasis are noted, however. First, support of the family suffering the death of a child is of prime importance, because the grief is devastating and long lasting and because the number of family members affected is usually large. Second, the hospice emphasis on home care is even more imperative for children than for adults as it more significantly benefits both child and family; home care can be facilitated through supplementary care components such as day care. Third, there is a major need for both professional and public education in caring for terminally ill children and their families and in coping with childhood death. The author concludes that further research is needed in all aspects of pediatric terminal care.     

Who's minding the kids? Experimental evidence on the demand for child care quality

Despite the well-documented benefits of high-quality child care, many preschool-age children in the U.S. attend low-quality programs. Accordingly, improving the quality of child care is increasingly an explicit goal of government policy. However, accomplishing this goal requires a thorough understanding of the factors that influence parents’ child care decisions. This paper provides the first evidence on the demand for child care characteristics in the market for home-based care. Using a randomized audit design, we study three dimensions of caregiving: affordability (i.e., the hourly price of child care), quality (i.e., caregiver education and experience), and convenience (i.e., caregiver car ownership and availability). We find that while parents are extremely sensitive to the cost of child care, they also have strong preferences for quality, particularly caregivers’ educational attainment. Furthermore, we obtain mixed results on the convenience dimensions of child care, with parents valuing those owning a car but not those with more availability. Finally, we find significant heterogeneity in child care preferences according to families’ age of youngest child, race and ethnicity, and willingness-to-pay. Our findings are consistent with the notion that the problem of low-quality in the U.S. child care market may be explained by lack of affordability or the informational resources to identify high-quality care, rather than an undervaluation of such care by parents.