Abstract
BackgroundUniversal, high-quality childcare offers a unique opportunity to prevent developmental trajectories leading to mental health problems. Yet, growing evidence has shown that the process quality of Norwegian childcare centers varies considerably, and that research-based models for quality building are significantly lacking.ObjectiveTo examine whether a model for quality building in childcare centers, Thrive by Three, increases the quality of child–caregiver interactions, and promotes child development, well-being, and mental health.MethodsThe Thrive by Three study is a clustered randomized controlled trial involving 187 toddler groups in childcare centers across 7 municipalities within southern and central Norway. Each center is randomly allocated to the intervention or wait-list control group. Data are collected at 4 points: preintervention (T1), midway (T2), postintervention (T3), and 1-year postintervention (T4). Primary outcomes are changes in childcare quality measured by the Classroom Assessment Scoring System toddler version (CLASS), Student–Teacher Relationship Scale, Short Form (STRS-SF), and Life in Early Childhood Programs (LECP), as well as child development and mental health measured by The Brief Infant Toddler Social and Emotional Assessment (BITSEA, parent and teacher report), the Caregiver–Teacher Report Form (C-TRF), and Child Behavior Checklist (parent report) from the Achenbach System of Empirically Based Assessment (ASEBA) from 1.5 to 5 years, and child well-being measured by the Leiden Inventory for Child’s Well-Being in Day Care (LICW-D). Secondary outcomes are child cortisol levels, assessed in a subsample of 372 children.ResultsAs of August 2020, a total of 1531 children and 769 staff from 187 toddler groups were recruited. Because of turnover, the recruitment of staff will be ongoing until August 2020. As of January 2020, the intervention group has been working with Thrive by Three for 1.5 years. Data at T1, T2, and T3 from both the intervention and control groups have been completed and T4 will be completed in August 2020.ConclusionsThis study makes an important contribution to the field of quality building in childcare centers. The results will provide greater insight into how high quality can be obtained and the effects of high-quality early childcare on child mental health. This in turn will be significant for policymakers and to the Norwegian society at large.Trial RegistrationClinicalTrials.gov NCT03879733; https://clinicaltrials.gov/ct2/show/NCT03879733 and Norwegian Research Council 260624/H10; https://prosjektbanken.forskningsradet.no/#/project/NFR/260624/Sprak=enInternational Registered Report Identifier (IRRID)DERR1-10.2196/17726
Highlights
BackgroundMounting evidence supports the notion that high-quality childcare centers promote children’s mental health [1,2]
This study makes an important contribution to the field of quality building in childcare centers
High-quality childcare protects and promotes the underpinnings of mental health in a phase of life when brain plasticity is most pronounced [3,4]; it may prevent the onset of deviant developmental trajectories in toddlers and compensate for insufficient resources at home [5,6]
Summary
Mounting evidence supports the notion that high-quality childcare centers promote children’s mental health [1,2]. Because more than 80% of 1 and 2 year olds in Norway attend childcare, and stay there for long hours [9], interventions targeting caregiver–child interactions may prove an important avenue toward universal prevention of mental health problems. Childcare quality includes elements of both structure (eg, number of staff, staff training and education, group size, child-to-caregiver ratio) and process (eg, caregiver–child relationship, parental involvement) [10]. Process quality in terms of warm, sensitive, and stimulating relationships between caregivers and young children [11] is arguably the most important ingredient of quality as it has long-term effects on children’s mental health, well-being, and development [12]. High-quality childcare offers a unique opportunity to prevent developmental trajectories leading to mental health problems. Parents report on their own background such as their ethnicity, country of origin, marital status, education, and family socioeconomic status through information about parental income.
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