Home-based Child Research Articles

Vaccine coverage and timeliness among children of adolescent mothers: A community-based study in the Eastern Cape, South Africa

BackgroundChildren born to adolescent mothers are more vulnerable to infant mortality and morbidity than those born to adult mothers. HIV-exposed children have lower antibody protection against vaccine-preventable diseases at birth compared to unexposed children. In South Africa, 17 % of adolescent girls aged 15–19 years are mothers, yet vaccination coverage and timeliness among their children is underreported. MethodsThis study estimated age-appropriate vaccination coverage and timeliness among children (n = 1080) of adolescent mothers (n = 1015) in the Eastern Cape, South Africa. Mother-child dyads were recruited through healthcare and community-based sampling strategies. Vaccination data were abstracted from 1013 home-based child health records (2017–2019). Coverage is reported for Diphtheria-Tetanus-Pertussis 3rd dose (DTP3), under-1 vaccination among children over 12 months (n = 613) and measles 2nd dose (MCV2) among children over 24 months (n = 382) using proportions with 95 % confidence intervals (95 %CI). Timeliness is defined as receiving each vaccination within 4 weeks of recommended age. Findings are disaggregated by maternal HIV-status. ResultsOverall, 27.3 % of adolescent mothers were living with HIV. Coverage of DTP3 was 85.6 % (95 %CI: 82.6–88.3 %), under-1 coverage was 53.2 % (95 %CI: 49.1–57.2 %), and MCV2 coverage was 62.3 % (95 %CI: 57.2–67.2 %). Vaccination coverage was lower among children of adolescent mothers living with HIV (AMLHIV) than unexposed children (DTP3 80.3 % vs 88.2 % p-value: 0.01; under-1 46.5 % vs 56.4 % p-value: 0.02; MCV2 55.4 % vs 67.1 % p-value: 0.02). Timeliness of vaccinations declined over time from 98.0 % at birth, 70.7 % at 14 weeks, 71.9 % at 9 months and 37.3 % at 18 months. ConclusionVaccination coverage among children of adolescent mothers in the Eastern Cape are below national targets. Children of AMLHIV had lower coverage than HIV-unexposed children. Further research is needed to identify risk factors associated with incomplete and delayed vaccinations among this group, particularly among HIV-exposed children. Enhanced vaccination campaigns may be required for children of adolescent mothers.

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.

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).

Pragmatic cluster-randomized trial of home-based preventive treatment for TB in Ethiopia and South Africa (CHIP-TB)

BackgroundEach year, 1 million children develop TB resulting in over 200,000 child deaths. TB preventive treatment (TPT) is highly effective in preventing TB but remains poorly implemented for household child contacts. Home-based child contact management and TPT services may improve access to care. In this study, we aim to evaluate the effectiveness and cost-effectiveness of home-based contact management with TPT initiation in two TB high-burden African countries, Ethiopia and South Africa.MethodsThis pragmatic cluster randomized trial compares home-based versus facility-based care delivery models for contact management. Thirty-six clinics with decentralized TB services (18 in Ethiopia and 18 in South Africa) were randomized in a 1:1 ratio to conduct either home-based or facility-based contact management. The study will attempt to enroll all eligible close child contacts of infectious drug-sensitive TB index patients diagnosed and treated for TB by one of the study clinics. Child TB contact management, including contact tracing, child evaluation, and TPT initiation and follow-up, will take place in the child’s home for the intervention arm and at the clinic for the control arm. The primary outcome is the cluster-level ratio of the number of household child contacts less than 15 years of age in Ethiopia and less than 5 years of age in South Africa initiated on TPT per index patient, comparing the intervention to the control arm. Secondary outcomes include child contact identification and the TB prevention continuum of care. Other implementation outcomes include acceptability, feasibility, fidelity, cost, and cost-effectiveness of the intervention.DiscussionThis implementation research trial will determine whether home-based contact management identifies and initiates more household child contacts on TPT than facility-based contact management.Trial registrationNCT04369326. Registered on April 30, 2020.

“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.

Nannies or creche: exploring child carers’ knowledge of the first 1000 days and their perception of the significance of their role as carers

ABSTRACT In South Africa, many infants spend more time with carers other than their parents due to socio-economic demands on mothers. Carers thus play an important role in the infants’ lives. This qualitative study explored child carers’ knowledge and understanding of the ‘first 1000 days’ initiative and their perception of themselves as attachment figures. Seven home-based and nine creche-based carers working in Cape Town, South Africa were included. None of the child carers were aware of the ‘first 1000 days’ initiative. They did, however, describe themselves as being attuned and sensitive to the needs of the infants in their care, placing a high personal value on their work, and acknowledging their role as an attachment figure. Furthermore, these carers felt their role was underestimated by both parents and the broader public. Home-based child carers were particularly vulnerable as all spoke of their needs being overlooked by their employers.

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.

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...

Investigating the Differential Effects of Early Child Care and Education in Reducing Gender and Racial Academic Achievement Gaps From Kindergarten to 8th Grade

We used the generalized propensity score method to estimate the differential effects of five Early Child Care and Education (ECCE) experiences (Prekindergarten, Head Start, Center-based Child Care, Home-based Child Care, and Parental Care) in reducing math and reading achievement gaps between boys versus girls, Latinx versus Whites, and Blacks versus Whites. Findings revealed differential effects of ECCE in reducing gender and racial achievement gaps. However, results indicated that significant gender and racial gaps still exist despite ECCE experiences and that these gaps widen throughout the elementary and middle school years.

Impact of COVID-19 on maternal health and child care behavior: Evidence from a quasi-experimental study of vulnerable communities in Boa Vista, Brazil

BackgroundCOVID-19 related distress has been shown to have negative associations with family well-being. ObjectivesTo determine the immediate impact of acute COVID-19 infection on maternal well-being and parenting practices among Brazilian families. Participants and settingWe studied 2′579 mothers (29′913 observations) of young children from vulnerable neighborhoods in Boa Vista, Brazil over 12 months. MethodsWe monitored family health and caregiving behavior including the incidence of COVID-19 infections in the surveyed households through bi-weekly phone interviews over 50 weeks, from June 2020 to May 2021. Primary outcomes were home-based child stimulation, positive parenting behavior, and parenting stress. We used fixed effects panel regressions to estimate the impact of household COVID-19 infections on parenting outcomes. ResultsOver the study period, 441 participants (17.1%; 831 (3.0%) observations) reported at least 1 positive COVID-19 infection in their household. Household COVID-19 infections significantly reduced home-based stimulation by 0.10 SDs (95%CI: −0.18, −0.01), positive parenting behaviors by 0.14 SDs (−0.21, −0.01), and increased parenting stress by 0.07 SDs (0.02, 0.12). The impact on home-based stimulation was most pronounced when the mother herself had a COVID-19 infection (−0.16; −0.29, −0.04). Parenting stress responded most strongly to mother or child COVID-19 infections. Effects were relatively short-lived, only children's infections' on parental stress was still detectable 2 weeks after initial infection. ConclusionOur findings suggest that COVID-19 infections cause substantial disruptions in children's home environments - additional short-term support for families with acute infections could attenuate the negative impact on children's home environment during the pandemic.

COVID-19 Vaccine Uptake Among US Child Care Providers.

Ensuring high coronavirus disease-2019 (COVID-19) vaccine uptake among US child care providers is crucial to mitigating the public health implications of child-staff and staff-child transmission of severe acute respiratory syndrome coronavirus 2; however, the vaccination rate among this group was previously unknown. To characterize vaccine uptake among US child care providers, we conducted a multistate cross-sectional survey of the child care workforce. Providers were identified through various national databases and state registries. A link to the survey was sent via e-mail between May 26 and June 23, 2021. A 37.8% response yielded 21 663 respondents, with 20 013 satisfying inclusion criteria. Overall COVID-19 vaccine uptake among US child care providers (78.2%, 90% confidence interval: 77.5% to 78.9%) was higher than the US general adult population (65%). Vaccination rates varied between states from 53.5% to 89.4%. Vaccine uptake among respondents differed significantly (P < .01) based on respondent age (70.0% for ages 25-34, 91.6% for ages 75-84), race (70.0% for Black or African Americans, 92.5% for Asian Americans), annual household income (70.8% for <$35 000, 85.1% for >$75 000), and child care setting (73.0% for home-based, 79.7% for center-based). COVID-19 vaccine uptake among US child care providers was higher than the general US adult population. Those who were younger, lower income, Black or African American, resided in states either in the Mountain West or the South, and/or worked in home-based child care programs reported the lowest rates of vaccination. State public health leaders and lawmakers should prioritize these subgroups to realize the largest gains in vaccine uptake among providers.

An Examination of Employee Immunization Policies Among Colorado Child Care Providers.

Child care employee vaccination policies can protect children and adults from vaccine-preventable diseases (VPDs) in child care programs. We aimed to understand the prevalence and characteristics of employee immunization policies at child care facilities and support among child care administrators for statewide employee vaccination regulations. A postal mail survey was distributed to a cross-sectional sample of 300 center-based and 300 home-based child care programs in Colorado. Programs were asked to report whether they had any type of policy requiring employee immunizations and if they would support statewide regulations mandating employee immunizations for influenza, pertussis, and measles. The response rate was 48% (288/600). About 55% of child care programs reported having an employee immunization policy. Child care centers (73%) were more likely than home-based child care programs (30%, P < .001) to report having a policy. Overall, 62% of respondents reported that they would support one or more statewide regulations requiring child care employees to be vaccinated. Home-based programs (71%) were more likely than center-based programs (53%, P = .001) to support one or more statewide child care employee immunization regulations. Our findings demonstrate the variability of employee immunization policies at child care programs across Colorado. These results may be used to inform strategies to increase employee immunization uptake and reduce the incidence of VPDs, including developing comprehensive employee immunization policies at the facility and state level. Future research is needed to understand vaccination knowledge, attitudes, and behaviors among child care employees including their perspectives on employee vaccination policies and regulations.

Effect of Homebased parent child interaction therapy for families having children with disruptive behavior problems at selected community of Khurda, Odisha, India

Background: Disruptive and inappropriate behaviors of children are actions that interfere with the instructional, administrative or service functions of the organization and family or school. In the early lives of children, the significant risk factors for occurrence of antisocial behavior and criminal activity are the presence of oppositional and disruptive behaviors. Related to this concept, current study was conducted with objectives to identify the families having children with disruptive behavior problems, to determine the effect of (parent child interactive therapy) PCIT on disruptive behavior level, to find out the association between disruptive behavior of the children with selected demographic variable. Methods: A quasi –experimental study was carried out with total 40 number of samples by using total enumeration sampling technique. The intervention was carried out under the guidance of guide and experts. Each Individual was exposed to the therapy for duration of 1 hour, twice a week. Child Directed Session 30 MIN and Parent Directed Session 30 mins. Total no. of 5 session was carried out. After completion of intervention, changing behaviour was assessed by eyeberg scale. Conclusion: Result concluded that in experimental group 90% children shown mild disruptive behavior and 10% children found moderate disruptive behavior before giving intervention, and after intervention 10% children did not show any disruptive behavior and, 90% children had mild disruptive behavior.There was significant difference between the scores of pre-test and post -test level of disruptive behavior of the children in experimental group as ’p’ value (0.025*) at 0.05 level of significant. And there was statistically significant association between disruptive behavior of children with type of family, education of father, education of mother.

An in-depth examination of family child care providers and their engagement with outside systems using a mixed methods case study approach

This study extends a previously identified and validated typology of home-based child care providers which used providers’ reports of their beliefs and practices related to caregiving to categorize providers rather than regulatory status. We use a mixed methods case study approach to present findings from 12 licensed family child care providers with a specific focus on exploring differences in perspectives and engagement with outside systems among providers in different profiles. Data come from multiple sources, including state administrative data, provider surveys, an observational measure of program quality, interviews, and field notes. Findings highlight some consistent differences in practices, perspective, and engagement with systems between profiles. The case studies presented highlight and extend what is known about family child care providers’ perspectives on quality improvement initiatives and how their perspectives relate to their practices with children and families. Results can inform the development and refinement of quality improvement initiatives offered to home-based child care providers.

Characteristics of home-based child care providers who offer non-standard hour care

The past decade has seen a dramatic growth of non-standard work schedules in the workforce, leading to increasing demand for non-standard hour child care during evenings, nights, and weekends. Low-income families, less-educated parents, and single parents with young children report greater demand for non-standard hour care. Given the prevalence of non-standard hour care and the importance of quality child care, a better understanding of who provides non-standard hour care and how to support this sector is necessary. Home-based child care (HBCC) providers are the largest caregiving group serving children under age 6 during non-standard hours. Through secondary data analysis of the 2012 National Survey of Early Care and Education on listed home-based child care providers (n = 3476), decision tree analysis was used to predict whether listed HBCC providers offer non-standard hour care. Results indicated those providers who offered non-standard hour care are more likely to receive government subsidies, have lower educational levels, and serve fewer children. The overall accuracy of the decision tree model was 63%. The present study also examined the relationship between providers’ professional engagement and the total number of non-standard working hours (n = 880). The entire model presented a medium effect size. Providers who received home visitors and/or coaching tend to provide more hours of non-standard hour care. To better support HBCC providers in offering non-standard hour care, policy recommendations are presented.

Under the Right Conditions, Center-Based Child Care is an Unlikely COVID-19 Threat to Staff

* Abbreviation: COVID-19 — : coronavirus disease 2019 Research on coronavirus transmission from young children to adults in child care settings is largely based on case reports with limited generalizability,1,2 impeding evidence-based assessment of infection risk to child care providers. Gilliam et al3 address these limitations in their multistate study of 57 335 child care providers reporting on exposures, risk mitigation strategies in the workplace, and coronavirus disease 2019 (COVID-19) infection from March through May 2020. The team solicited child care providers through contact lists provided by national child care organizations and state child care workforce registries, conducted 3 rounds of surveys, and collected data on key variables including exposure to child care (provided child care during the pandemic compared to program closure) and COVID-19 infection based on a positive test result or hospitalization for COVID-19. Respondents who had exposure to child care services from March through May also reported numerous infection prevention strategies, such as class size reduction, masking, and disinfection practices. This exposure was not associated with odds of COVID-19 infection in both unmatched and propensity score matched analyses that accounted for community … Address correspondence to Heather L. Tubbs-Cooley, PhD, RN, FAAN, College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210. E-mail: tubbscooley.1{at}osu.edu

Identifying a Typology of Unlisted Paid Home-Based Child Care Providers Using Latent Profile Analysis

ABSTRACT Research Findings: This study provides a framework for categorizing one subset of the large and heterogeneous group of home-based child care providers, unlisted paid providers. We analyzed data on unlisted paid home-based child care providers (n = 448) from the 2012 National Survey of Early Care and Education conducted in the United States. We used latent profile analysis to explore how providers align into profiles based on key characteristics related to their caregiving beliefs, self-reported instructional practices, professional engagement, and family supportive practices. Findings reveal that unlisted paid home-based providers align into three profiles: Low Instruction, Low Professional Development (51.3%, n = 230); Higher Instruction (35.2%, n = 158); and Engaged with Outside Systems (13.4%, n = 60). Results suggest that there is variation in providers’ instructional practices, family supports, and professional engagement activities among profiles. Additionally, provider age, enrollment characteristics, and neighborhood urban density predicted profile membership. Practice or Policy: Results provide insight into the design and implementation of quality improvement supports for this subset of home-based child care providers. Using this typology can help match unlisted paid home-based providers with supports that align with their beliefs and practices. It also adds to the limited research base about this subset of providers that can be used to guide practices and policies related to home-based child care.

Introduction to the Special Issue on Early Care and Education Professionals’ Social and Emotional Well-being

ABSTRACT Early care and education (ECE) professionals’ social and emotional well-being has emerged as an area of focus for improving program quality. ECE professionals are experiencing increasing levels of stress and burnout, which is threatening the quality of early childhood education and care. This article introduces the special issue devoted to understanding early childhood professionals’ social and emotional competence and well-being and their relationship to program quality and child outcomes. The purposes of this special issue are to (a) describe the nature of ECE professionals’ social and emotional competence and well-being, (b) understand the factors that contribute to ECE professionals’ social and emotional competence and well-being, (c) understand to what extent and how ECE professionals’ social and emotional competence and well-being impacts classroom quality as well as children’s developmental outcomes, and (d) present evidence-based approaches that support ECE professionals’ social and emotional competence and well-being. For the purposes of this issue, ECE professionals include early childhood educators (e.g., teachers or home-based child care providers), practitioners (e.g., home visitors, mental health consultants, specialists, etc.) and early childhood leaders (e.g., directors, principals, or administrators) who serve children from birth to third grade. In this introductory article we conclude with a discussion of implications of this research for future research, policy, and practice.