Enhance Child Development Research Articles

Concentrated affluence, concentrated disadvantage, and children's readiness for school: A population-based, multi-level investigation

A number of studies demonstrates a relationship between neighbourhood concentration of affluence and disadvantage and the health and development of its residents. We contribute to this literature by testing hypotheses about the relationship between neighbourhood-level concentrated affluence/disadvantage and child-level developmental outcomes in a study population of 37,798 Kindergarten children residing in 433 neighbourhoods throughout the province of British Columbia, Canada. We utilise a previously-validated measure of neighbourhood socioeconomic composition--the Index of Concentration at the Extremes (ICE)--which not only allows for more precise estimation of the competing influences of concentrated affluence and disadvantage, but also facilitates examination of the potential impact of neighbourhood-level income inequality. Our findings show that increases in neighbourhood affluence are associated with increases in children's scores on the Early Development Instrument (EDI), a holistic measure of Kindergarteners' readiness for school. Particularly noteworthy is that, for four of the five EDI scales (physical, social, emotional, and communication) and the total score, results indicate a significant curvilinear relationship--whereby the highest average child-level outcomes are not found in locations with the highest concentrations of affluence, but rather in locations with relatively equal proportions of affluent and disadvantaged families. This finding suggests, first, that concentrated affluence may have diminishing rates of return on contributing to enhanced child development, and, second, that children residing in mixed-income neighbourhoods may benefit both from the presence of affluent residents and from the presence of services and institutions aimed at assisting lower-income residents. Implications and future directions are discussed.

Primary care pediatrics: 2004 and beyond.

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

The National Evaluation of Sure Start Local Programmes in England

In the latter part of the 20th century evidence was accumulating about the effectiveness of various intervention programmes for young children in disadvantaged families. Some small-scale interventions were evaluated by randomised control trials as in the case of the Abecedarian project (Ramey et al., 2000), the High/ Scope Perry Preschool Project (Schweinhart, Barnes, & Weikart, 1993) and evaluations of home visiting (e.g. Olds, 1997). Others were evaluated by quasi-experimental methods as with the large-scale Head Start project (e.g. Barnett, 1995; Kresh, 1998). Despite some weaknesses in the evidence for large-scale interventions, the accumulating evidence of the benefits of early intervention was very influential in the planning and launch of the Sure Start programme (Glass, 2003), now known as Sure Start local programmes. Sure Start local programmes are central to the UK government’s policy for combating the adverse effects of poverty and disadvantage on young children and their families. Hence they have potentially great importance in the lives of hundreds of thousands of families and young children. By 2004 there will be 524 Sure Start local programmes in disadvantaged areas in England that will be serving over 300,000 children and their families. Scotland, Wales and Northern Ireland have their own Sure Start programmes. This initiative represents a unique approach to early intervention for children aged 0–4, their families, and communities. The aim of Sure Start is: To work with parents-to-be, parents and children, to promote the physical, intellectual and social development of babies and young children – particularly those who are disadvantaged – so that they can flourish at home and when they get to school, and thereby break the cycle of disadvantage for the current generation of young children. Sure Start local programmes are designed to be comprehensive, community-based projects adapted to local needs, and making maximal use of local expertise and enthusiasms. Such a focus on local autonomy may capitalise on shared concerns of people for their community (Oliver, Smith, & Barker, 1998). The issue of whether preventative interventions should be targeted or universal in application is dealt with by Sure Start by targeting distinct areas of disadvantage and making the services universal within those areas. In this way there are the advantages of economy associated with targeted interventions and also the stigma-free advantage of universal provision. While some research has reliably documented the benefits of early intervention, there has been much prevention work that has either not been evaluated or where evaluations are so flawed as to preclude meaningful conclusions (see Mrazek & Brown, 2002; WebsterStratton & Taylor, 2001). The Sure Start programme recognised the need for rigorous evaluation and after a competitive commissioning process the National Evaluation of Sure Start (NESS) was initiated. Rather than providing a specific service, Sure Start local programmes involve changes to existing services. Improved services and community functioning are presumed to lead to enhanced family and community functioning that in turn enhance child development. This approach raises the following questions for NESS. 1. Do existing services change? (How and, if so, for which populations and under what conditions?) 2. Are delivered services improved? (How, and if so, for which populations and under what conditions?) 3. Do children, families, and communities benefit? (How, and if so, for which populations and under what conditions?) This journal article is available at Research Online: http://ro.uow.edu.au/sspapers/1975 NESS addresses these questions through four core research components: (1) implementation evaluation that considers how programmes are operating and changing; (2) impact evaluation that considers effects of Sure Start local programmes upon children and families; (3) local context analysis that considers communities as units of analysis and how they function and change over time; and (4) cost-effectiveness analysis that examines economic return on investment of the Sure Start local programmes. The NESS team also provides technical support to smaller scale evaluations being conducted by local Sure Start programmes themselves. The four core research modules of the evaluation are described in turn.

Linking Research to Practice

While most agree on the need for empirical evidence in determining best practice standards, little consensus exists on how best to build an effective, ongoing linkage between research and practice. This article examines how one prevention effort has sought to better integrate research and practice through the promotion of diversified research methodologies and structures designed to insure the ongoing exchange of empirical evidence and clinical practice. Healthy Families America (HFA) is a national initiative to develop the infrastructure necessary to sustain a universal support system for all new parents. Initiated in 1992 by the National Committee to Prevent Child Abuse (NCPCA), the program is grounded in a belief that the most effective prevention efforts are those which are shaped by empirical realities and an ongoing commitment to using research to shape program development. The article begins with an overall discussion of HFA's theoretical framework and the role of research in its initial conceptualization. It then reviews emerging research on HFA's home visitation component and how these findings compare to other evaluation efforts examining programs and policies designed to enhance child development and parental capacity. The article concludes with the implications of both the findings and the HFA planning approach on developing empirically sound and clinically effective future prevention initiatives.

Child care licensing regulations and child care quality in four states

This study analyzed the child care rules and regulations from the four states that had previously been reviewed under the Child Care, Cost & Quality study. Child day care regulations for each of the states were analyzed through rubrics designed by the investigators in the domains of structure, operations, personnel, and context. A separate analysis was done comparing regulations for protecting the child versus regulations for enhancing child development. The four states were in general agreement in setting higher standards for child protection than for the enhancement of development. Such regulations support the image of child care programs being a “safe haven” rather than a “development enhancer.” The limited requirements for child care personnel and for community interaction also encourage that image. These minimum standards departed substantially from professional judgments about what is needed in child care settings. The authors proposed higher personnel standards, greater explicit emphasis on developmental enhancement, and more required interaction with parents and community contact.

Market Child Care Versus Care by Relatives

We study the determinants of whether mothers of preschool-aged children use market child care versus care by relatives to assess the importance of economics versus preferences. The evidence suggests that employed mothers turn to relatives for child care partly out of preference, not just because relatives are inexpensive. Public policies that encourage the use of relatives for child care might therefore increase parental satisfaction and quality of care. The analysis finds substantially similar results for African American and other women, but the results for employed mothers differ from those for nonemployed women, who appear to use child care primarily to enhance child development.

Early childhood intervention. A promising preventative for juvenile delinquency.

Programs to reduce or prevent juvenile delinquency have been generally unsuccessful. Apparently the risk factors that make a child prone to delinquency are based in too many systems--including the individual, the family, and community networks--to make isolated treatment methods effective. Surprisingly, longitudinal studies of some early childhood intervention programs suggest they may help to reduce future delinquency. These programs take an ecological approach to enhancing child development by attempting to promote overall social competence in the many systems impacting on children. Not engaging in criminal acts is one indicator of competence that is related to others, such as being successful in school and in personal relationships. Evaluators must gather more data to confirm this unanticipated benefit of comprehensive interventions.

Chapter 12: The Role of Humor in Enhancing Children's Development and Adjustment

Chapter 12: The Role of Humor in Enhancing Children's Development and Adjustment