Center-based Care Research Articles

Effects of formal center-based care and positive parenting practices on children in foster care

BackgroundThe current study examined whether children in foster care have better cognitive and social-emotional outcomes at kindergarten age when they enroll in formal center-based care and when they receive positive parenting practices at home. ObjectiveTwo primary questions were addressed: (1) Do children in foster care who attended formal center-based care (including Head Start) have higher cognitive and socio-emotional outcomes than children in foster care who did not attend formal center-based care? (2) Does positive parenting practice promote better cognitive and socio-emotional outcomes? Participants and settingBased on the Early Childhood Longitudinal Study-K: 2011 data, 299 children in foster care were selected. MethodsRegression analyses were conducted on children's cognitive and social-emotional scores by types of children's childcare arrangements (formal vs informal care) and positive parenting practices. Active parental involvement was measured based on how frequently parents read books with their children, and authoritarian parenting discipline was measured based on whether parents spanked their children. ResultsChildren in foster care who enrolled in formal center-based childcare at pre-school age have higher cognitive and socio-emotional scores at kindergarten age. Positive parenting practice also promotes children's outcomes. Children in foster care who are both enrolled in formal center-based care and experience positive parenting practice had the most positive outcomes. Conclusions.Parents raising children in foster care should be informed about the positive impacts of certain parenting practices on their children. Foster parents should be connected to available community resources, including formal-center-based preschool programs and required to continuously attend parenting classes to sustain positive impact of parenting practice on foster children.

Survival of people with cystic fibrosis in Australia

Survival statistics, estimated using data from national cystic fibrosis (CF) registries, inform the CF community and monitor disease progression. This study aimed to estimate survival among people with CF in Australia and to identify factors associated with survival. This population-based cohort study used prospectively collected data from 23 Australian CF centres participating in the Australian CF Data Registry (ACFDR) from 2005–2020. Period survival analysis was used to calculate median age of survival estimates for each 5-year window from 2005–2009 until 2016–2020. The overall median survival was estimated using the Kaplan–Meier method. Between 2005–2020 the ACFDR followed 4,601 people with CF, noting 516 (11.2%) deaths including 195 following lung transplantation. Out of the total sample, more than half (52.5%) were male and 395 (8.6%) had undergone lung transplantation. Two thirds of people with CF (66.1%) were diagnosed before six weeks of age or by newborn/prenatal screening. The overall median age of survival was estimated as 54.0 years (95% CI: 51.0–57.04). Estimated median survival increased from 48.9 years (95% CI: 44.7–53.5) for people with CF born in 2005–2009, to 56.3 years (95% CI: 51.2–60.4) for those born in 2016–2020. Factors independently associated with reduced survival include receiving a lung transplant, having low FEV1pp and BMI. Median survival estimates are increasing in CF in Australia. This likely reflects multiple factors, including newborn screening, improvement in diagnosis, refinements in CF management and centre-based multidisciplinary care.

Do more hours in center-based care cause more externalizing problems? A cross-national replication study.

Whether high quantities of center-based care cause behavior problems is a controversial question. Studies using covariate adjustment for selection factors have detected relations between center care and behavior problems, but studies with stronger internal validity less often find such evidence. We examined whether within-child changes in hours in center-based care predicted changes in externalizing problems in toddlers and preschoolers (N=10,105; 49% female; data collection 1993-2012) in seven studies, including from Germany, Netherlands, Norway, two from Canada and two from the U.S. Race/ethnicity data were only collected in the United States (57% and 80% White; 42% and 13% African-American; 1.2% and 5% Latinx). Meta-analyses showed no association (r=.00, p=.88) between hours in center-based care and externalizing problems.

Assessment of Early Childhood Mental Health in Immigrant and Local Children in Chile

Little is known about mental health during early childhood and differences in mental health problems between migrant and local preschool children in Chile. This research aimed to study the early mental health of children and disparities in mental health indicators between immigrant and local children in the context of a middle-income country. Parents and teachers assessed immigrant (n = 120) and non-immigrant (n = 383) children between 3 and 4 years old with the Sistema de Evaluación de Niños y Adolescentes (Child and Adolescent Evaluation System, SENA). A multivariate analysis of covariance (MANCOVA) was used to study both main and interaction effects while controlling for the clustering of children on center-based care. Results show that immigrant parents tended to report more internalizing problems than locals’ parents did in terms of depression, anxiety, and somatic complaints. Also, they reported more attention problems, developmental delay, unusual behavior, rigidity, and isolation in immigrant children. However, teachers’ assessments regarding immigrant children were similar to non-immigrant children’s evaluations in many cases. Finally, girls presented fewer emotional and behavioral problems than boys. Our study shows the importance of assessing mental health during early childhood, especially in immigrant children, and the difficulty of carrying out this evaluation through different information sources from parents and early childhood teachers.

89 Centre-based child care attendance in early childhood and adiposity in later childhood: a prospective cohort study

Abstract Background One in three children are living with overweight or obesity in North America. The burden of childhood obesity is disproportionately experienced by children from low-income families, who are more likely to have obesity. Centre-based child care attendance may influence important adiposity risk factors such as dietary intake, eating behaviour, and physical activity, but its impact on childhood obesity is unclear. Objectives The primary objective was to evaluate the relationship between the intensity of centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny’s). The secondary objective was to explore if family income modified the relationship. Design/Methods A prospective cohort study of children 1 to 10 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was intensity of centre-based child care attendance (hours/week). The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Interaction terms for child age and family income were explored. A linear mixed effects model and logistic generalized estimating equations were used to determine the association between centre-based child care attendance and child zBMI. Results 3,503 children were included (mean age: 2.7 years). Children who attended centre-based child care full time (40 hours/week) had a 0.11 lower zBMI at 4 years (95% CI -0.19, -0.03; p=0.005) and lower odds of obesity (zBMI > 2) at 4 (OR 0.58; 95% CI 0.34, 0.99; p=0.04) and 10 years of age (OR 0.52; 95% CI 0.29, 0.90; p=0.02) relative to children who attended non-centre-based child care. The relationship was modified by family income such that, children from families with an income of <$50,000CDN who attended centre-based child care full time had a 0.35 (95% CI -0.56, -0.15; p=0.001), 0.34 (95% CI -0.54, -0.13, p=0.001) and 0.29 (95% CI -0.50, -0.07, p=0.009) lower zBMI at 4, 7 and 10 years of age, respectively, relative to children who attended non-centre-based child care. Conclusion Centre-based child care attendance in early childhood was associated with lower adiposity and odds of obesity in later childhood. This relationship was stronger for children who were from lower income families. Centre-based child care may be an effective early intervention to prevent childhood obesity.

Demographic and Family Differences in Use of Early Childhood Care and Education in Pennsylvania

Studies show that Pennsylvania ranks below the national average in the percentage of preschool children enrolled in center-based programs. This is important because center-based care has been shown to better prepare children for entry into school. In 2002, we examined demographic and family influences in the use of early childhood care and education (ECCE) in a statewide random sample of 1005 Pennsylvania families with children under 6 years of age, providing a baseline of ECCE in Pennsylvania during a time when the state offered no public funding specifically for preschool. Our findings suggest that Pennsylvania children, particularly those from less educated and lower income families, may not have been well prepared to enter school in 2002. Policy changes since 2002 are described, and the likelihood of these policies to better prepare Pennsylvania's children to enter school ready to learn are considered.

Types of Community Support Services and Self-Efficacy for Continuous Community Living among Individuals with Disabilities and Caregivers.

This study explored the impacts of five types of community support services (i.e., center-based care, home-based care, respite care, caregiver assistance, and financial subsidies) on self-efficacy for continuous community living among individuals with disabilities and caregivers. Design: Cross-sectional. Method: The sample consisted of a group of individuals with disabilities (n = 948) and a group of caregivers (n = 522). A mixed ANOVA was applied to explore the differences in the perceived importance of improvements to community support services between the groups. Logistic regression analyses were conducted to examine the perceived importance of improvements to types of community support services for self-efficacy for continuous community living. Results: Caregivers perceived higher levels of importance for improvements to community support services than individuals with disabilities. Both groups reported that financial subsidies were the most important area for improvement. The greater importance of improvements to financial subsidies reported by caregivers predicted greater odds for self-efficacy for continuous community living. The greater importance of improvements to center-based services reported by individuals with disabilities predicted greater odds for self-efficacy for continuous community living. Conclusions: The findings suggested that financial subsidies for caregivers and center-based services for individuals with disabilities could improve self-efficacy for continuous community living.

Explaining gaps by parental education in children’s early language and social outcomes at age 3–4 years: evidence from harmonised data from three countries

Child outcomes vary by family’s socioeconomic status (SES). Research on explanatory factors underlying early SES-related disparities has mainly focused on specific child outcomes (e.g., language skills) and selected influencing factors in single countries often with a focus on individual differences but not explicitly on early SES-related gaps. This study uses harmonised data from longitudinal large-scale studies conducted in the United Kingdom, United States, and Germany to examine parental education-related gaps in early child language and social skills. Twelve theoretically proposed family-, child-, and childcare-related factors were systematically evaluated as explanatory factors. In all countries, parental education-related gaps were particularly pronounced for early child language compared to social skills. In the decomposition analyses, the home learning environment was the only measure that significantly explained gaps in all child outcomes across all countries. Early centre-based care attendance, family income, and maternal age at childbirth contributed to gaps in child outcomes with the specific pattern of results varying across outcomes and countries. Maternal depressive feelings significantly contributed only to explaining gaps in children’s social skills. Thus, while some mechanisms found to underpin early parental education-related gaps can be generalized from single-country, single-domain studies, others are outcome- and context-specific.

Comparing center-based with home-based child care: type of care moderates the association between process quality and child functioning

This study compares process quality and child functioning in Dutch center-based care and home-based care and explores the role of the dyadic caregiver-child relationship. Participants in this study included 228 children from 74 locations (154 attending center-based child care, 74 home-based child care; mean age 2.5 years). The level of emotional and behavioral support and caregiver-child closeness was higher in home-based care than center-based care, whereas quality of the physical environment was higher in center-based child care. Children's well-being was higher and levels of problem behavior were lower in home-based care compared to center-based care. The caregiver-child relationship was related to a higher level of well-being and less problem behavior. Process quality was more strongly related to children's functioning in home-based child care compared to center-based child care. The dyadic relationship quality is an important element of the care ecology of preschool children and predicts child functioning in both home-based and center-based care.

Head Start in Low-Wealth, Rural Communities: Evidence from the Family Life Project

ABSTRACT This study utilized data from the Family Life Project (FLP) to examine Head Start children’s school readiness skills at the end of preschool in comparison to two other care groups: home-based care and other center-based care. The FLP study enrolled a birth-cohort of 1,292 children born in two historically low-wealth, rural regions of the U.S., with oversampling of children from low-wealth families and African American families. Propensity score weighting adjusted for differences in baseline child and family characteristics between the Head Start participants and children in the two alternative care groups. Research Findings: The results indicated that the Head Start group had higher literacy skills at the end of preschool in comparison to the home-based care group (β = 0.36), but no other reliable differences emerged between these groups in school readiness skills. No reliable differences emerged between the Head Start and other center-based care groups in school readiness skills. Practice and Policy: Implications for educational practice and policy were discussed in relation to Head Start programming in rural America, including potential targets for program improvement and strategies for program expansion.

Centre-Based Child Care Attendance in Early Childhood and Growth in Later Childhood: A Prospective Cohort Study

ObjectivesAttending centre-based child care in early childhood may influence important health behaviours including nutrition, physical activity and routines related to child growth and weight status. The primary objective was to evaluate the relationship between centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny's). The secondary objective was to explore if family income and child age modified the relationship.MethodsA prospective cohort study of children aged 1 to 10 years was conducted through the TARGet Kids! primary care research network. The exposure was centre-based child care attendance (hours/week). Outcomes were zBMI and odds of overweight and obesity (zBMI > 1). Interaction terms for child age and family income were explored. Linear mixed effect models and logistic generalized estimating equations were used.Results3,503 children who attended child care were included (mean age: 2.7 years at baseline). Children who attended centre-based care full-time (40 hours/week) had a 0.11 (95% CI: −0.19, −0.03; p = 0.01) lower zBMI at 4 and 7 years of age and lower odds of overweight/obesity at 4 years of age (OR 0.78; 95% CI 0.62, 0.97; p = 0.03) relative to children who attended non-centre-based care. Children from families with income < $50,000CDN who attended centre-based care full time had a 0.32 (95% CI: −0.50, −0.14; p = 0.001) lower zBMI and lower odds of overweight/obesity (OR 0.52; 95% CI: 0.28, 0.99; p = 0.05) at 10 years of age relative to children who attended non-centre-based care.ConclusionsAttending centre-based child care in early childhood was associated with a lower zBMI and lower odds of overweight/obesity in later childhood, and associations were stronger for children from lower income families. Centre-based child care may be an effective early intervention for the prevention of childhood obesity.Funding SourcesCanadian Institutes of Health Research (CIHR).

The impact of time of entrance to center-based care on children’s general, language, and behavioral development

There are contrasting results of the association between center-based care attendance and child development, mainly related to how the time of entry and permanence in the program relates to developmental outcomes. Using latent class analysis in a nationally representative sample of Chilean children between 6 and 35 months old (n = 3,992), and controlling for the child’s age, maternal education, mother’s marital status, and household income, we identify three different timings of entrance in center-based care programs. The three timings of entrance were defined as early-entry (16%), those children who are more likely to enter before they are 6 months old; middle-entry (16%), those who are more likely to enter when they are between 6 and 18 months old; and late-entry (68%), those children with a low probability of enrollment any time before they are 35 months old. We found that children from the early- and middle-entry classes had higher language development when compared with children from the late-entry class. Still, only those from the middle-entry class showed higher general development in the Battelle test. In contrast, children in the early- and middle-entry classes presented higher scores in the Child Behavior Checklist’s externalizing behavior scale than children in the late-entry class. Our findings highlight the existence of a likely linkage between the timing of entry to center-based care and child development. It is essential to understand the potential advantages of center-based care in younger children, especially in enhancing their vocabulary and general development, and the potential negative association of early-entry with problematic behavior.

A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation

BackgroundThis article provides a generalizable method, rooted in co-design and stakeholder engagement, to identify, specify, and prioritize implementation strategies. To illustrate this method, we present a case example focused on identifying strategies to promote pediatric hypertension (pHTN) Clinical Practice Guideline (CPG) implementation in community health center-based primary care practices that involved meaningful engagement of pediatric clinicians, clinic staff, and patients/caregivers. This example was chosen based on the difficulty clinicians and organizations experience in implementing the pHTN CPG, as evidenced by low rates of guideline-adherent pHTN diagnosis and treatment.MethodsWe convened a Stakeholder Advisory Panel (SAP), comprising 6 pediatricians and 5 academic partners, for 8 meetings (~12 h total) to rigorously identify determinants of pHTN CPG adherence and to ultimately develop a testable multilevel, multicomponent implementation strategy. Our approach expanded upon the Expert Recommendations for Implementation Change (ERIC) protocol by incorporating a modified Delphi approach, user-centered design methods, and the Implementation Research Logic Model (IRLM). At the recommendation of our SAP, we gathered further input from youth with or at-risk for pHTN and their caregivers, as well as clinic staff who would be responsible for carrying out facets of the implementation strategy.ResultsFirst, the SAP identified 17 determinants, and 18 discrete strategies were prioritized for inclusion. The strategies primarily targeted determinants in the domains of intervention characteristics, inner setting, and characteristics of the implementers. Based on SAP ratings of strategy effectiveness, feasibility, and priority, three tiers of strategies emerged, with 7 strategies comprising the top tier implementation strategy package. Next, input from caregivers and clinic staff confirmed the feasibility and acceptability of the implementation strategies and provided further detail in the definition and specification of those strategies.ConclusionsThis method—an adaptation of the ERIC protocol—provided a pragmatic structure to work with stakeholders to efficiently identify implementation strategies, particularly when supplemented with user-centered design activities and the intuitive organizing framework of the IRLM. This generalizable method can help researchers identify and prioritize strategies that align with the implementation context with an increased likelihood of adoption and sustained use.

A culturally adapted, social support-based, diabetes group visit model for Bangladeshi adults in the USA: a feasibility study

BackgroundInterventions focused on weight loss can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs for this community in the USA. The aim of this project was to develop and test the feasibility of a tailored group visit model for Bangladeshis with type 2 diabetes (T2D) or prediabetes based in primary care.DesignMixed-methods single-arm feasibility study.SettingAn academic health center-based primary care clinic in Atlanta, Georgia.ParticipantsBangladeshi adults > 18 years old with T2D or prediabetesMethodsIn conjunction with a community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable intervention. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. The primary feasibility outcomes were number of sessions attended and participant satisfaction with the intervention. Weight, blood pressure, cholesterol, and HbA1C were measured at beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed paired t tests were used to test significance of pre-post changes in outcomes.ResultsKey themes from the formative focus groups (n = 50) were closely tied to sociocultural beliefs and included: dietary patterns, physical activity perceptions, and healthcare access concerns. In the intervention, 10 of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (− 2%, 95%CI: − 3.1, 0.2 kg), systolic/diastolic blood pressure (− 12.7 mmHg [95%CI: − 23.2, − 2.2]/− 3.7 mmHg [95%CI: − 7.6, − 0.1], respectively), and triglycerides (− 62.6 mg/dl, 95%CI: − 123.1, − 2.0) were noted. Overall, participants reported high levels of satisfaction with the program.ConclusionA lifestyle program based in primary care is feasible and acceptable for Bangladeshi immigrants. Larger studies testing the effectiveness of group programs, in primary care, to improve cardiometabolic factors are important.Trials registrationClinicalTrials.gov; NCT03861546. Registered 28 February 2019.

Center-Based Care and Parenting Activities

We estimate effects of center-based care on parenting activities using time use data for Germany. Our estimates imply that center-based care reduces the overall time that parents spend with the enrolled child, but has only small negative effects on time spent doing activities together. Correspondingly, center-based care increases activities as a share of the time spent together with the child. The overall effect is driven by households with lower maternal education. Our findings imply that child development effects of center-based care may be explained, not just by the institutional environment, but also by changes that occur within the home environment.

“Not everyone can do this”: childcare context and the practice of skill in emotional labor

Scholarship remains divided about whether emotional labor is ‘skilled’. Interrogating gendered skill constructs that render emotions in work invisible, I examine two organizational contexts in the Early Childhood Education and Care (ECEC) sector: family and center-based care. I draw from 43 interviews, primarily with Latina and White women workers, reflecting feminized and racialized workplaces. I also draw from ethnographic and observational data. Challenging the particular devaluation of family-based care, findings reveal that the practice of skill in emotional labor is organizationally shaped across less and more institutionalized forms of ECEC. Examining worker critiques of professionalization norms and credential-based skill metrics, autonomy is also identified as a pre-requisite for embodied, tacit and discretionary skills in the emotional labor of ECEC.

Does attending center-based care prior to kindergarten improve Latino children’s academic readiness?

ABSTRACT This study provides estimates for the impact of centre-based care participation during pre-kindergarten on Latino children’s academic readiness skills at kindergarten-entry. Using the ECLS-K:2011 dataset, findings indicate that Latino children who participated in centre-based care during their pre-kindergarten year had significantly higher English oral language (ES = 0.112, p < .05), reading (ES = 0.151, p < .001), and math scores (ES = 0.117, p < .05) than their peers who did not participate in such programmes. Additionally, children from lower SES homes especially benefitted in terms of oral language skills from participating in centre-based care. These results suggest that efforts should be made to increase the participation of Latino children in centre-based preschool, which can play a role in increasing their academic readiness skills.

The Associations between maternal depressive symptoms and parenting practices among low income head start eligible families

ABSTRACT This research examines associations between maternal depressive symptoms and parenting practices among Head Start eligible, low-income families. Among 3,780 mothers, four types of childcare were identified: Head Start (n = 2124), informal care (n = 270), other center-based care (n = 638), and exclusive parental care (n = 748). The study found that mothers with higher depressive symptoms engaging in less positive parenting practices. Mothers whose children were cared for by parents or informal childcare have higher depressive symptoms and more neglectful and unsafe parenting practices than those with children enrolled in Head Start. Low-income families should aim to enroll their children in formal childcare including Head Start.

The Associations Between Child-Care Services During the Preschool Years and High School Graduation: A 20-Year Longitudinal Population-Based Study.

Together with family factors, early care and education (ECE) services were shown to improve school readiness in kindergarten. However, it is not clear whether better school readiness at age 6 years translates into higher rates of high school graduation years later. Our objective was therefore to investigate the long-term associations between the use of ECE and high school graduation while considering the sex of the child and the socioeconomic status of the parents as moderators. Participants were children from the Quebec Longitudinal Study on Child Development (QLSCD) born in 1997 to 1998 (N = 2001). Intensity and type of ECE exposure were measured from age 5 months to 5 years. Administrative records were used to determine whether students had obtained a high school diploma by age 20 years. Factors explaining differences in the profiles of ECE users were controlled using propensity score weights. Twenty-two percent of students did not have a high school diploma by age 20 years. Compared with children never exposed to center-based care, those exposed early (i.e., before toddlerhood) had better odds of graduating from high school (odds ratio = 1.49) after controlling for confounding factors. Late exposure to center-based care was not related to high school graduation rates. Exposure to regulated and center-based ECE on a regular basis from toddlerhood to school entry was associated with higher rates of high school graduation. Regulated center-based ECE at the population level may improve rates of high school graduation.

Preschool Behavioural and Emotional Outcomes Associated with Participation in Early Childhood Education and Care

ABSTRACT Early childhood education and care (ECE) type (e.g., center-based care, home-based care, informal care) and quantity (i.e., time spent in ECE) have been linked to observed behavioral challenges in children. However, there is a dearth of research on this association in New Zealand. Using data from 6,536 children from the Growing Up in New Zealand longitudinal birth cohort, the current study investigated whether the type of ECE and weekly hours of attendance at 24 months of age was associated with behavioral outcomes at 54 months. Behavioral outcomes were measured using the Strengths and Difficulties Questionnaire. Research Findings: Compared to children who did not attend ECE, adjusted analyses showed that children in center-based care and children who spent 20 to <30 hours a week in ECE had a lower odds of mother-rated peer challenges at 54 months. Spending 20 to <30 hours a week in ECE was also protective against the development of later mother-rated emotional challenges. Practice or Policy: Future research should investigate whether structural and process quality contributes to the beneficial impact of ECE in New Zealand, particularly center-based care.