Home-based Child Care Research Articles

LEGAL REQUIREMENTS OF HOME-BASED CHILDCARE CENTRES IN MALAYSIA; ARE CHILDCARE PROVIDERS AWARE?

Home-based childcare (HBCC) services are among the childcare services available in Malaysia, as ensconsced in the Child Care Centre Act 1984. In Malaysia, HBCC providers are only allowed to care for a minimum of four and a maximum of 10 children. However, this definition does not include small home-based childcare services or childminders who care for less than four children. Employing the qualitative method of content analysis, this study discusses the laws and regulations governing HBCC in Malaysia, particularly the legal requirements that need to be fulfilled. This is further supported by interviews conducted with childcare providers who look after children at their home to examine their level of understanding of the legal requirements under Malaysian childcare laws and regulations. Findings indicate, among others, that the HBCC operators are unaware of the need to register with the Social Welfare Department. The adherence to the legal requirements for this HBCC should not be taken lightly, as it is crucial to ensure the safety and well-being of children. Consequently, greater efforts are required to ensure the children's health and safety because the current procedures rely solely on the experience and expertise of the childcare providers. This paper contributes to the extent of knowledge of HBCC in Malaysia especially towards policy makers, child care operators and parents by exploring the experiences of HBCC childcare providers. It is proposed that continuous improvements need to be made to the laws and regulations on HBCC in ensuring high quality services of HBCC.

Site and Provider Characteristics Associated with the Use of Exclusionary Discipline in Minnesota Early Care and Education Sites

ABSTRACT Research Findings: The present study examined site and provider characteristics that may be associated with use of exclusionary discipline in center- and home-based childcare sites (N = 320). Higher numbers of suspensions and expulsions occurred at center-based sites and at sites with greater percentages of children of color. Furthermore, sites that received professional support services expelled more children. At the provider level, expulsions were higher among providers who had fewer years of experience, endorsed elevated levels of burnout, and received professional support services. Classroom suspensions were higher among providers who had earned an associate degree or higher and who rated developmentally appropriate and culturally inclusive practices as less important. Practice or Policy: Organizational, state, and federal policies that limit and regulate exclusionary discipline practices may reduce inequities affecting young children of color. Furthermore, it is important to increase access to training that will enhance providers’ knowledge of developmentally appropriate and inclusive practices and reduce burnout, particularly for less experienced providers and providers at center-based sites. Increased monitoring of early childhood suspensions (rather than only expulsions) can help align resources with childcare sites in need. Longitudinal studies evaluating the effects of policies and interventions that reduce suspensions and expulsions are needed.

Children’s involvement in home-based childcare: are boys more susceptible to caregiver sensitivity than girls?

Children’s involvement in home-based childcare: are boys more susceptible to caregiver sensitivity than girls?

Efficiency of the Technology-Based “HomeCARE-Family EmPow” for Children with Cancer and Their Parents: A Study Protocol for a Randomized Controlled Trial

ObjectivesHome-based pediatric cancer care requires addressing both physical and psychosocial care needs for children and their parents Currently, there is a notable gap in intervention programs that evaluate technology-based psychosocial empowerment for children and parents in home-based pediatric cancer care. The study protocol was to assess the efficiency of a technology-based psychosocial empowerment intervention for home-based care for children with cancer and their parents. MethodsThis study was planned as a single-blinded parallel-group randomized controlled experimental design. The study was intended to include sixty-four children and parents in the research sample. The HomeCare-Family EmPow is a technology-based intervention based on the Psychological Empowerment Theory. This 4-week program, delivered via the website, consists of four modules for parents and two for children. The descriptive form, Self-Efficacy Scale- for children and adolescents with cancer, State-Trait Anxiety Inventory, and Pediatric Cancer Coping Scale will be used in the data collection for children. The descriptive form, Self-Efficacy Scale, Problem-Solving Inventory, and Psychological Resilience Scale will be used for parents. Repeated measures analysis of variance and linear mixed-effects models will be applied for intra-group and inter-group comparisons. Outcome measures will be assessed before randomization, one week after the intervention, and one month after. ResultsThe possible differences between the intervention and control groups will be evaluated after the implementation of the intervention. Our proposed hypotheses will report the findings. ConclusionsThis research may provide a more comprehensive and evidence-based approach to pediatric cancer management at home-based pediatric cancer management by improving children's and parents' self-efficacy and coping by providing feasible, accessible, and innovative support. Implications for Nursing PracticeThe study outcomes are expected to enrich the understanding and management of the psychosocial well-being of children and their parents and empower them to cope with the treatment process more effectively during home-based care.

Facilitators and barriers to the transition from outpatient clinic visits to home-based check-ups for children being treated with growth hormone: a mixed-methods study

Although the coronavirus disease 2019 (COVID-19) pandemic accelerated the adoption and expansion of telemedicine worldwide, little is known about the transition to home-based care for children. This study aims to investigate the facilitators and barriers to the transition from outpatient clinic visits to home-based check-ups (HBCU), for children being treated with growth hormone. A mixed-methods study was performed at Amalia Children’s Hospital (Radboud University Medical Centre, Nijmegen), consisting of questionnaires and semi-structured and focus group interviews. For the quantitative part, the Measurement Instrument for Determinants of Innovation (MIDI) was utilised to investigate the facilitators and barriers for the 81 participants regarding the transition to HBCU. The MIDI questionnaire is comprised of four domains: the innovation-, user-, organisation-, and the socio-political scale. Descriptive statistics were performed for analysing the questionnaires. For the qualitative part, interviews with 10 participants derived from the questionnaire and the two focus group interviews were conducted, to gain more in-depth information about the research topic, until data saturation was reached. The interviews were analysed by using the reflective thematic approach, starting with deductive coding and followed by inductive coding. Several facilitators were recognised in our study: procedural clarity, self-efficacy, convenience, patient-centred care, increased accuracy in height measurements, social support, client/patient satisfaction/cooperation, patient-centred care, the flexibility and adaptivity of HBCU, physical start-up period of HBCU, and a potential decrease in healthcare costs. However, several barriers were also noted in our study: poor compatibility with current practice, lack of consultation within the team, feeling of being less controlled by physicians, unsettledness of the organisation, an increased workload for the staff, and insufficient information communication technology (ICT) facilities.Conclusion: This study revealed that HBCU have considerable benefits for both patients and healthcare professionals, from the standpoint of innovation, user, and socio-political points of view. The identified facilitators and barriers to HBCU should be taken into account when further steps of implementing HBCU are considered.What is Known:• The Corona-Virus-Disease 2019 (COVID-19) pandemic has had an immense impact on health care worldwide. A substantial amount of the outpatient clinic visits for children treated with growth hormone was, as a result of the pandemic, transferred to online consultation. Transitioning paediatric growth hormone treatment to the home setting may be favorable for children and their parents/caregivers) as well for healthcare professionals.• Insights regarding facilitators and barriers is vital for the successful implementation and adoption of home-care technologies.What is New:• To our knowledge, we are first to report on and explicit the facilitators and barriers of the transition to home-based check-ups, via online consultation for children being treated with growth hormone.• Both children and healthcare professionals reported major facilitators and some minor barriers to the transition to home-based check-ups, illustrating their potential value. These facilitators and barriers should be considered while working towards implementation of home-based check-ups.

Factors Related to Caregiver Burden of Children with Chronic Respiratory Failure with Tracheostomy at Home

Introduction Chronic respiratory failure in children is a significant health problem leading to tracheostomy at home following hospital discharge. Providing long-term care for children at home becomes challenging when they require complex medical treatments, placing a burden on caregivers. Objectives 1) To describe caregiver burden of children with chronic respiratory failure with tracheostomy at home, and 2) To examine the relationships between caregiving self-efficacy, social support, coping, and caregiver burden of children with chronic respiratory failure with tracheostomy at home. Design A descriptive correlational design employing Chou’s caregiver burden as the conceptual framework Methodology Through purposive sampling with inclusion criteria, the sample included 85 caregivers of children aged three months to 15 years old with tracheostomy at home, who were receiving care at a super tertiary hospital in Bangkok metropolitan area and a tertiary hospital in a northern province of Thailand from May 2022 to January 2023. The instruments used for data collection comprised the following: the personal information of caregiver and children questionnaire, the caregiver burden questionnaire, the caregiving self-efficacy questionnaire, the social support questionnaire, and the coping questionnaire. These instruments revealed content validity indices of .86, .97, .92 and .97, respectively and internal consistency reliability, with Cronbach’s alpha coefficients of .90, .95, .95 and .92, respectively. Data were analyzed using descriptive statistics and Pearson’s product-moment correlation. Results The overall caregiver burden score averaged at a moderate level (M = 2.57, SD = 0.10). Furthermore, caregivers perceived a moderate level of burden across all subscales, including physical, emotional, social, and financial burdens (M = 2.51, 2.42, 3.00 and 3.00, with SD = 0.98, 1.01, 1.15 and 1.15, respectively). Social support was at a high level (M =2.83, SD = 0.07) and revealed a significant negative correlation with caregiver burden (r = -.292, p = .007). Caregiving self-efficacy was high, while coping was at a moderate level; however, there was no significant correlation between these factors and caregiver burden (r = -.182, p = .097, and r = -.139, p = .203, respectively). Recommendation The results from this study highlighted the burden experienced by caregivers of children with chronic respiratory failure requiring tracheostomy care at home, as well as the factor related to this burden. It is necessary for healthcare providers to provide targeted training programs aimed at enhancing caregivers’ knowledge and skills in home-based child care. Additionally, offering informational and emotional support, along with providing necessary medical equipment, should be considered to alleviate caregiver burden.

State Regulations Set the Stage for Child and Adult Care Food Program (CACFP) Participation in Home-Based Childcare.

State Regulations Set the Stage for Child and Adult Care Food Program (CACFP) Participation in Home-Based Childcare.

Perspectives of Home-Based Child Care Providers in New Mexico on Barriers and Facilitators to Participating in the Child and Adult Care Food Program, 2021-2022.

This study examined New Mexico home-based child care provider perspectives (n = 75) on barriers to and facilitators of Child and Adult Care Food Program (CACFP) participation. Two thirds of the sample were Spanish speakers. Providers reported that CACFP reimbursement does not cover actual food costs and the time-and-effort costs of obtaining qualifying foods and completing required documentation. They noted that additional reimbursed meals are needed for children in care for extended hours and that linguistically competent CACFP sponsor staff facilitated their participation. (Am J Public Health. 2023;113(S3):S215-S219. https://doi.org/10.2105/AJPH.2023.307402).

International Experience of Home-based Childcare in the Context of Comprehensive Three-child Education and Practical Analysis in Zhejiang

International Experience of Home-based Childcare in the Context of Comprehensive Three-child Education and Practical Analysis in Zhejiang

The educational and parenting test for home-based childcare: a socially valid self-rating instrument

IntroductionHome-based childcare is increasingly becoming the focus of research, policy and public interest. Self-assessment of quality can increase the social validity of quality improvement efforts among stakeholders. A new online self-assessment tool for parents and non-relative providers of home-based childcare is introduced that has been developed in Germany, the Educational and Parenting Test for Home-Based Childcare (EPT; in German: ‚Bildungs- und Erziehungstest für TagesElternBetreuung BET‘).MethodsIn two studies, the social validity of the EPT was investigated: a stakeholder study with 45 parents and 12 non-relative caregivers, and an expert study with nine experts of child pedagogy. The stakeholders rated the EPT survey (N = 57) and the subsequent report of test results (n = 22). The experts evaluated the survey and the feedback report based on vignettes of three fictitious test results (i.e., below average, average, and above average quality). Criteria included face validity, measurement quality, controllability (i.e., comprehensiveness), freedom of response, freedom of pressure, counseling quality, usefulness, control of bias, and privacy protection.ResultsMost aspects of social validity achieved good to very good ratings. All three samples graded the EPT survey as “good.” If the stakeholders felt that their educational quality was undervalued, they rated the report of test results worse (rs(20) = 0.52, p = 0.02). Five of seven experts would recommend the EPT to others.DiscussionBased on participants’ comments, the instrument was thoroughly revised. The EPT is a socially valid instrument for assessing and developing quality in home-based childcare.

Assessment of a new home-based care pathway for children newly diagnosed with type 1 diabetes

AimTo compare the outcomes of home-based and conventional hospital-based care for children newly diagnosed with type 1 diabetes mellitus. MethodsA descriptive study was conducted of all children newly diagnosed with diabetes mellitus at the Timone Hospital in Marseille, France, between November 2017 and July 2019. The patients received either home-based or in-patient hospital care. The primary outcome was the length of initial hospital stay. The secondary outcome measures were glycemic control in the first year of treatment, families’ diabetes knowledge, the effect of diabetes on quality of life, and overall quality of care. ResultsA total of 85 patients were included, 37 in the home-based care group and 48 in the in-patient care group. The initial length of hospital stay was 6 days in the home-based care group versus 9 days in the in-patient care group. Levels of glycemic control, diabetes knowledge and quality of care were comparable in the two groups despite a higher rate of socioeconomic deprivation in the home-based care group. ConclusionHome-based care for children with diabetes is safe and effective. This new healthcare pathway provides good overall social care, especially for socioeconomically deprived families.

From Hospital to Home: Referrals to Pediatric Hospice and Home-based Palliative Care.

Hospital-based pediatric palliative care (PPC) may help optimize referrals to community-based hospice and home-based palliative care (HBPC) for children with serious illness, yet little is known about their referral practices. To describe community-based program referrals from a PPC team, identifying factors associated with referral type, and potential misalignment between patient needs and referral received. Chart abstraction of patients seen in 2017 by the PPC team of a large, urban children's hospital, followed for at least 6 months or until death, including clinical and demographic characteristics, and referrals to hospice and HBPC. Of the 302 study-eligible patients, 25% died during the hospitalization of the first 2017 visit. Of the remaining 228 patients, 42 (18.4%) were referred to HBPC and 58 (25.4%) to hospice. Excluding patients referred to hospice care, only one-third with demographic eligibility were referred to HBPC; those seen in the ICU were least likely to be referred. Over half of the 58 patients referred to hospice died within the study period (n=34, 58.6%); descendants were more likely to have cancer (P=0.002) and less likely to have a neurologic (P=0.021) diagnosis. Despite demographic eligibility, a minority of patients seen by a hospital-based PPC team received referrals for hospice or HBPC. Children discharged from an ICU and those with neurologic conditions may be at higher risk of missing referrals best aligned with their needs. Future research should identify and address causes of referral misalignment. Advocacy for programs adaptable to patients' changing needs may also be needed.

“We are that resilience”: Building cultural capital through family child care

Family child care professionals are a critical sector of the early care and education workforce. Utilizing critical race theory and Yosso’s Community Cultural Wealth model, the current study seeks to examine the strengths and assets that family child care professionals of color bring to their early care and education work and to the children and families in their programs. The authors identified evidence of four types of cultural capital (aspirational, familial, navigational, and resistant) in the focus group narratives of family child care professionals of color across four regions in the USA. Their narratives describe an orientation to caring for children and families that counters exclusionary and biased systems. The family child care professionals of color envision themselves as educators and supporters of community advancement in opposition to racialized stereotypes of home-based child care work as babysitting (aspirational capital); they leverage the home as a place for racial healing and sustain intergenerational connections with families through practices of othermothering and an ethic of love (familial capital). The family child care professionals of color describe the ways they enact navigational and resistant capital in their perseverance and participation in licensing and quality systems, despite inequities. The family child care professionals’ counternarratives of family child care work suggest their essential role in societal functioning and well-being. The study’s findings hold implications for (re)defining early care and education quality and (re)designing systems that celebrate and recognize the strengths, resilience, and capacity of family child care professionals of color to support equitable futures for children, families, and communities.

Home visiting in home-based child care: Staff and provider experiences

States and localities face challenges around how to deliver support to home-based child care (HBCC) providers in meaningful ways that improve quality for children and families and meet the needs of providers. While most support organizations deliver services to HBCC providers through home visits, there is limited research on how these visits are implemented. HBCC networks are a common delivery mechanism for support that are often funded through child care licensing, child care subsidy, and quality rating and improvement systems which may dictate the content and purpose of services delivered. This study sought to understand 1) the experiences of network staff who deliver home visits; 2) the range of home visiting implementation practices across HBCC networks; and 3) variation in home visiting implementation practices across networks with different policy roles. We surveyed 106 HBCC network staff who conducted home visits and 144 HBCC providers who received home visits from 35 HBCC networks across 19 states. The survey included closed-ended questions designed to examine aspects and dimensions of home visiting implementation including logistics, content, and relationship-based approaches to support from both staff and provider perspectives. We describe these implementation drivers for the entire sample and use Chi-square tests and two-sample t-tests to examine differences by the network’s policy role (enforcement vs. support). Findings suggest that HBCC network staff are committed to their work despite low wages and lack of benefits. Staff and providers report respectful positive relationships with each other during home visits. While home visiting is a widely used approach to supporting HBCC providers, the policy role of HBCC networks may be a factor in how networks implement home visits. Compared to network staff responsible for monitoring compliance to regulations, network staff whose role was around supporting providers reported taking a more provider-focused, responsive approach to service delivery and focused visits on working with children. Providers at HBCC networks that were focused on compliance and enforcement reported less comfort with visits and visits focused more on regulatory and administrative tasks. The results of this study suggest that ECE systems seeking to improve quality in HBCC should consider the role of relationship-based approaches to engaging and supporting HBCC providers.

A Disruption, Not an Interruption: The Impact of COVID-19 on Child Care in Iowa.

In March 2020, when public health stay home orders began in order to halt the spread of COVID-19, child care as an industry was drastically and abruptly impacted. This public health emergency highlighted the weaknesses in the child care system in the United States. This study investigated the changes in operations cost, child enrollment and attendance, and state and federal support that occurred during the first year of the COVID-19 pandemic among both center-based and home-based child care programs. A total of 196 licensed centers and 283 home-based programs across Iowa participated in an online survey as a part of the 2020 Iowa Narrow Costs Analysis. This mixed method study utilizes qualitative analysis of response as well as descriptive statistics and pre- post comparison testing. Analysis of qualitative and quantitative data revealed that the COVID-19 pandemic had a marked impact on child care enrollment, the operational cost of child care, the availability of child care, and a variety of other areas including staff workload and mental health. In many instances, participants shared that state and federal COVID-19 relief funds were critical. Although state and federal COVID-19 relief funds were critical for child care providers in Iowa during the pandemic, results suggest similar financial support will be necessary beyond the pandemic to sustain the workforce. Policy suggestions are made for how to continue to support the child care workforce in the future.

Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya

Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. Among formally employed mothers (n=564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P=0.030) and 14 wk (60.6% compared with 22.2%, P<0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P=0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6%compared with 55.6%, P=0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers.

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.

Home-Based Care for Children with Serious Illness: Ecological Framework and Research Implications.

Care for U.S. children living with serious illness and their families at home is a complex and patchwork system. Improving home-based care for children and families requires a comprehensive, multilevel approach that accounts for and examines relationships across home environments, communities, and social contexts in which children and families live and receive care. We propose a multilevel conceptual framework, guided by Bronfenbrenner’s ecological model, that conceptualizes the complex system of home-based care into five levels. Levels 1 and 2 contain patient and family characteristics. Level 3 contains factors that influence family health, well-being, and experience with care in the home. Level 4 includes the community, including community groups, schools, and providers. Level 5 includes the broader regional system of care that impacts the care of children and families across communities. Finally, care coordination and care disparities transcend levels, impacting care at each level. A multilevel ecological framework of home-based care for children with serious illness and families can be used in future multilevel research to describe and test hypotheses about aspects of this system of care, as well as to inform interventions across levels to improve patient and family outcomes.

Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial

BackgroundMelghat, an impoverished rural area in Maharashtra state, India; has scarce hospital services and low health-seeking behaviour. At baseline (2004) the under-five mortality rate (U5MR) (number of deaths in children...

A drive for professional development

Chloe Webster, childminder at Pebbles Childcare, shares her journey with us, from working in a private nursery to transitioning into home-based childcare. Chloe discusses what this has enabled her to do and how she has continued to progress in her professional development.