Child Care Providers Research Articles

Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya.

Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya. This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted. In total, 129 childcare centers were identified -55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention. Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

‘Vulnerable and abandoned’—The impact of the COVID‐19 pandemic on education, health and social care provision for children with SEND: Children and parents' perspectives

AbstractThis study aimed to understand children with special educational needs and disabilities' (SEND) and their parents/carers' experiences of the pandemic in the UK, using mixed‐method surveys (n = 893 parents, 55 children) and qualitative interviews (n = 10 parents, 4 children). Descriptive statistical analyses and thematic analysis were utilised. Findings suggest that the needs and rights of children with SEND were not given due consideration during the pandemic, resulting in a decline in mental health, and their social, emotional, academic and physical development. Restrictions were reported as compounding and exacerbating the existing challenges faced by children with SEND in gaining equitable access to services.

Trauma rates in children in Saint Petersburg and inpatient trauma care

BACKGROUND:Increasing rates of childhood trauma, poisoning, and sequelae of environmental exposure not only reduce the quality of life of children and their families but also lead to disability and death. Statistical analysis of childhood trauma data makes it possible to define risk age groups among children and adolescents, identify the causes of the decrease or increase in the rates, estimate the level of medical care, and make necessary management decisions.
 AIM:To assess the state of childhood trauma in St. Petersburg and its changes in 5 years (20162020) and the provision of inpatient trauma care.
 MATERIALS AND METHODS:Data on childhood trauma in St. Petersburg were analyzed based on the analysis of Federal statistical observation forms submitted by the St. Petersburg State Budgetary Institution Medical Center for Information and Analysis, collections of N.N. Priorov National Medical Research Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation Trauma, orthopedic morbidity, the state of trauma and orthopedic care for the population, edited by Acad. S.P. Mironov, RAS, and data from the Federal State Statistics Service.
 RESULTS:From 2016 to 2019, the frequency of trauma, poisoning, and sequelae of environmental exposure in children of St. Petersburg slightly increased. In 2020, owing to the COVID-19 pandemic, childhood trauma rates decreased, and the most significant decrease in trauma rates was recorded at 32%36% in adolescents aged 1517 years. Despite the overall decrease in childhood trauma in 2020, the structure of trauma due to environmental exposure revealedan81% increase in transport accidents, compared with previous years, anda39% increase in trauma due to injuries with undetermined intentions. For 5 years, the number of beds was reduced, and by 2020, the provision of trauma, and orthopedic beds for children in St. Petersburg was 1.4 beds per 10 thousand children, which corresponds to the data for Russia.
 CONCLUSIONS:The incidence of traumatic injuries slightly increased in children in St. Petersburg, mostly in children aged 04 years, and mortality from environmental exposure also increased in adolescence.Acorrelation was found between the COVID-19 pandemic andadecrease in the number of visits and hospital admissions of children with trauma to medical institutions. Moreover, the incidence of severe, high-energy injuries that require more serious treatment approaches also increased, as evidenced by the annual increase in the number of surgical interventions in children with traumatic injuries. The new form of statistical reporting does not allow us to determine all causes of trauma. The provision of trauma care for children in St. Petersburg remains atanappropriate level.

Provision of care for children with medical complexity in tertiary hospitals in England: qualitative interviews with health professionals

BackgroundDue to medical and technological advancements, children with medical complexity are a growing population. Although previous research has identified models of care and experiences when caring for this population, the...

Psychosocial support during the COVID-19 pandemic in informal settlements: A Case of Childcare Providers in Nairobi, Kenya

BackgroundThe Covid-19 pandemic has placed a significant burden on psychosocial health and wellbeing of childcare providers. The need to support childcare managers has been recognized. However, there is to date little research specifically on how best to support the mental health needs of childcare providers, and no studies on their own experiences and views about what might be most helpful. We set out to address this research gap by qualitatively exploring the psychosocial experiences of childcare providers in Korogocho and Viwandani informal settlements in Nairobi, Kenya. MethodsWe collected data through key informant interviews with thirty-two childcare providers who were recruited purposively from Korogocho and Viwandani informal settlements. We analysed the data using framework analysis. ResultsWe organized the results into six psychosocial support domains derived from themes identified during coding and analysis. As such, experiences and views about psychosocial support were diverse, ranging from self or individual; family and friends; colleagues, peers and teams; organizational; media and the wider public to specialized psychological support services. Colleagues and teams were most childcare centres' first line of support. Notably, like psychosocial support from self, family, organization, media and specialized support services, there were several caveats. Particularly, peer support was described to be a burden to other childcare providers. ConclusionsThere is a need to strengthen psychosocial support from colleagues and teams, as it was the most preferred support. Further, there is a need for preparedness and response plans concerning the psychosocial consequences in an outbreak. As such, organisations, governments and other health and wellbeing actors ought to put measures in place to curb not only the physical health of individuals but also their psychosocial wellbeing as well. We recommend that psychosocial support structures of all nature by key actors in organisations should be kept operating during and beyond a crisis. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support during and beyond a pandemic.

P12-012-23 CACFP Participating Family Child Care Providers and COVID-19: Implications for Child Nutrition

P12-012-23 CACFP Participating Family Child Care Providers and COVID-19: Implications for Child Nutrition

Women’s market work and childcare policies in Colombia: policy simulations using a computable general equilibrium model

In recent decades, Colombia has made significant progress towards achieving gender equality in its labor market. However, persistent inequalities in unpaid care work remain a significant challenge, resulting in heavy care workload for women. This study evaluates the impact of three government policy options that can help reduce women's unpaid work: subsidy for childcare services provided by the market, an increase in public provision of childcare services, and cash transfers to households with children using a care-extended computable general equilibrium model (CGE) calibrated to Colombian data. The results show that while all policies improve family economic situations by increasing private consumption, childcare provision, whether through subsidies or as a public good, has a more significant impact on increasing female market work while cash transfers increase unpaid work performed inside the home. These findings underscore the importance of policy design and their analysis regarding their impact on gender inequalities, labor supply, and economic growth.

Exploring School Professionals' Definitions of Childhood Trauma.

Little is known about school professionals' definitions of trauma outside of the context of trauma-informed school trainings. The present study used thematic analysis to explore school professionals' open-ended definitions of childhood trauma (N = 1271). Follow-up chi-square tests of independence were used to investigate differences in professionals' definitions based on their professional role and education. Five themes were identified: effects of trauma, events of trauma, solutions to trauma, emotional responses, and no knowledge. Effects of trauma and events of trauma contained ten and five subthemes, respectively. School professionals who identified long-term effects of trauma on students most commonly listed general negative effects (e.g., "An experience or event that can negatively impact that child") instead of effects on specific domains such as behavior or emotions (e.g., "An experience that negatively impacted a child emotionally"). School professionals who identified an event of trauma most commonly provided examples of trauma (e.g., child maltreatment) or a general definition of trauma. School professionals' roles and education were somewhat related to their definitions of childhood trauma. Findings suggest that childcare providers and professionals without a bachelor's degree have gaps in their knowledge of child trauma. These results suggest school professionals have some foundational knowledge about trauma, but it is not universal. To best serve school professionals working with this vulnerable population of students, researchers and practitioners should design future trauma-informed professional development opportunities around school professionals' prior knowledge and understanding of trauma as well as their potential misunderstandings of trauma.

Systematic review and thematic synthesis of the barriers and facilitators to physical activity for women after gestational diabetes: a socio-ecological approach

Physical activity can reduce risk of type 2 diabetes (T2DM) after gestational diabetes. Understanding barriers and facilitators to physical activity, using a socio-ecological approach, could better direct multi-level interventions. The present review aimed to synthesise barriers and facilitators to physical activity, and to develop an understanding of where, across the socio-ecological model, these factors exist and/or are interrelated. Eligible studies included women with a history of gestational diabetes and a discussion around physical activity. A systematic search of MEDLINE, the Cochrane Library, Web of Science, CINAHL Complete and Scopus was conducted in October 2022. Barriers and facilitators to physical activity were thematically analysed and themes organised according to the socio-ecological model. Twenty-nine studies were included. Barriers pertained to leisure time physical activity, while other types of activity including housework and transport were overlooked, despite being routine. Partner and family support were vital for engagement with activity, whether emotional support or provision of childcare. Most barriers and facilitators at the social and organisational levels were interrelated with those at the individual level. These findings suggest that multi-level physical activity interventions after gestational diabetes could be most effective.

Equalizing or not? Public childcare and women’s labour market participation

Within the scientific literature and debate on social investment, public childcare provision plays a pivotal role. At the same time, critics have argued that social investment is often unable to reduce social inequalities and, to the contrary, tends to reproduce them (the so-called ‘Matthew effect’). The article focuses on a specific facet of social investment policies: their capacity to support mothers’ employment and its effect on social inequality, by investigating empirically to what extent an expansion of public childcare can help to increase women’s labour market participation and how this eventual support is homogenously distributed among different mothers’ profiles. To give a convincing answer to such a question requires careful attention to methodology, in order to avoid drawing the wrong conclusions. Whereas existing research has predominately focused on cross-national variation and has often been static in nature, the present study assesses the effects of public childcare expansion on women’s labour market participation and employment by examining region-specific within-variation over time of public childcare coverage. The study relies on data from the European Social Survey (2002–2018) that were integrated with an original collection of regional-level information on public childcare. It finds a positive association between increases in public childcare coverage and mothers’ labour market participation. Furthermore, it shows that public childcare helps to fight social inequalities among households with young children. Low-educated mothers are the ones who profit most from an increase in public childcare, and positive employment effects are most pronounced at lower levels of childcare coverage. Therefore, this contribution highlights the importance of public childcare policies as an equalizer in society, especially in contexts in which an intervention is most needed, because expanding childcare fosters mothers’ labour market participation

State of the Service: Pediatric Palliative and Hospice Community-Based Service Coverage in the United States.

Background: The pediatric literature describes reliance on community-based organizations for home-based palliative and hospice care for children. Objective: To quantify and describe the inclusion of children in services, staffing, and care scope offered by community-based hospice organizations in the United States. Design and Subjects: This study utilized an online survey distributed to organizational members of the National Hospice and Palliative Care Organization (NHPCO) in the United States. Results: A total of 481 hospice organizations from 50 states, Washington DC, and Puerto Rico responded. Twenty percent do not provide services for children. Nonmetro geographies are less likely to provide services for children. Pediatric services provided include home-based pediatric hospice (57%), home-based palliative care (31%), inpatient pediatric hospice (23%), and inpatient pediatric palliative care (14%). Hospice annual pediatric census is an average of 16.5 children, while palliative care annual census is an average of 36. Less than half (48%) of responding agencies have a team that is dedicated to only pediatric care. Medicaid and the Children's Health Insurance Program are the most common forms of reimbursement, with 13% depicting "no reimbursement" for provision of care for children and many relying on philanthropy coverage. Lack of trained personnel, discomfort, and competing priorities were depicted as the most common barriers. Conclusions: Children remain underrepresented in the extension of care offered through community-based hospice organizations in the United States particularly in nonmetro settings. Further research into strong training, staffing, and reimbursement models is warranted.

How Does Learning Happen? Ontario’s Pedagogy of Oppression?: A Critical Discourse Analysis of Ontario’s Early Years Pedagogical Framework

As Canada begins to establish universal childcare, the market-based neoliberalism of the early learning and care system continues to undervalue, underpay, overwork, and overpolice early childhood educators (ECEs). Ontario’s resource How Does Learning Happen? (HDLH) has been celebrated for its sociocultural stance and identified as transformative and central to the modernization of Ontario’s childcare system. Critical discourse analysis reveals how HDLH and the Ontario Ministry of Education continue to oppress ECEs. The implementation of universal childcare provides an opportunity for the government to include ECEs to make real changes in working conditions, wages, and the provision of quality childcare.

Maternal and Childcare Provider Views of Lactation Support in Childcare Centers

Maternal and Childcare Provider Views of Lactation Support in Childcare Centers

Associations of formal childcare use with health and human capital development for adolescent mothers and their children in South Africa: A cross-sectional study.

This study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers. Forty percent of adolescent girls in Africa are mothers. Increasing evidence shows positive impacts of formal childcare use for adult women, but no known studies in the Global South examine associations for adolescent mothers and their children. We interviewed 1046 adolescent mothers and completed developmental assessments with their children (n= 1139) in South Africa's Eastern Cape between 2017 and 2019. Questionnaires measured childcare use, maternal and child outcomes and socio-demographic background variables. Using cross-sectional data, associations between formal childcare use and outcomes were estimated in multivariate multi-level analyses that accounted for individual-level and family-level clustering. Childcare use was associated with higher odds of being in education or employment (AOR: 4.01, 95% CIs: 2.59-6.21, p< .001), grade promotion (AOR: 2.08, 95% CIs: 1.42-3.05, p< .001) and positive future ideation (AOR: 1.58, 95% CIs: 1.01-2.49, p= .047) but no differences in mental health. Childcare use was also associated with better parenting on all measures: positive parenting (AOR: 1.66, 95% CIs: 1.16-2.38, p= .006), better parental limit-setting (AOR: 2.00, 95% CIs: 1.37-2.93, p< .001) and better positive discipline (AOR: 1.77, 95% CIs: 1.21-2.59, p= .003). For the children, there were no differences in temperament or illness, but a significant interaction showed stronger associations between childcare use and better cognitive, language and motor scores with increasing child age (AOR: 5.04, 95% CIs: 1.59-15.96, p= .006). Adolescent mothers might benefit substantially from formal childcare, but causal links need to be explored further. Childcare use was also associated with improved parenting and better child development over time, suggesting positive pathways for children. At an average of $9 per month, childcare provisions for adolescent mothers may offer low-cost opportunities to achieve high returns on health and human capital outcomes in Sub-Saharan African contexts.

A Qualitative Study of Military Connected parents’ Perceptions on Establishing and Maintaining Child Behavioral Health Services

Few studies have examined U.S. military parents’ perspectives in establishing, maintaining, and reestablishing child behavioral health services within the context of military life. This qualitative study focused on the experiences of military-connected parents raising children who were receiving non-psychiatric outpatient behavioral health services for a range of behavioral or emotional challenges. The purposes of the qualitative study were to understand parents’ perspectives on the unique challenges military families face while seeking treatment and to understand facilitators or barriers to treatment. Twenty-two parents across the branches of the U.S. military participated in semi-structured interviews. Data were analyzed using a grounded theory approach. Primary themes identified were difficulties reestablishing social and healthcare support networks when moving. When accessing behavioral health services, stigma, difficulty obtaining referrals, and family logistics were noted barriers. Facilitators included parental advocacy on behalf of their child and primary care providers providing quick referrals to specialized behavioral health services.

Supporting service children in early years education

In the last of this three-part series, Debra Barton, early years specialist lead for the Ministry of Defence (MOD) Armed Forces Families &amp; Safeguarding (AFFS) team, gives an overview of the challenges service families face when trying to access childcare, and how early childhood education and childcare providers can help with this process. Barton also shares ideas of how providers can reflect on and improve their offering to young service children.

Development of a Rural Childcare Professionals Advisory Board Focused on Mental and Physical Well-being.

Childcare providers have high rates of stress and obesity, which can have an impact on the care they provide for children. Limited research has described strategies for including childcare providers in the development of well-being initiatives, especially in rural areas. To describe the creation and acceptability of a rural childcare advisory board focused on childcare providers' well-being as well as the acceptability of a well-being summit implemented by the board. A collaborative model guided the actions of the advisory board. Acceptability of the board and the summit were assessed via surveys. Key factors contributing to the success of the advisory board included flexibility around the COVID-19 pandemic, evening meetings, and group text messaging. Both the advisory board and well-being summit were deemed acceptable. Future efforts are focused on offering an annual statewide well-being summit and other interventions. Work is needed to identify sustainable funding sources.

Feasibility trial of child care as a therapeutic intervention.

e24196 Background: The incidence rate of cancer among young adults (ages 20-44) has steadily increased over the past decade. Among them, approximately 18% are parents within two years of initial diagnosis. Work as part of our Young Women Surviving support group identified childcare support as an unmet need. We therefore sought to determine the impact of childcare provision on the timeliness of care among young women undergoing chemotherapy for cancer. Methods: We conducted a pilot feasibility study that enrolled a convenience sample inclusive of parents with histologically confirmed invasive breast or gynecologic cancer receiving system chemotherapy and were caring for children 16 years or younger. Following consent, funds were reimbursed for costs related to their preferred childcare resource, including for travel and infusion time. Therapy assessments and an abridged version of the NCCN Distress Thermometer (score ranging from 0-10 with 0 indicating no distress) were administered at each infusion appointment. Feasibility was measured by acceptance of childcare services by &gt; 25% of patients identified as eligible. Results: This study was offered to 26 eligible patients, of which 23 enrolled (88.5%) and 20 have follow-up data. Among study volunteers, 80% were white, 15% were black; Five percent identified as Hispanic or Latino. The median age was 39 years old (range, 31 to 79). The majority of patients (85%) had breast malignancy, while the remaining 15% had gynecological cancers. The median number of treatment events for which babysitting services were paid for were 6 (range, 2-18). Of 19 patients with distress scores, 4 (21%) reported childcare as a stress for them. The median distress score decreased over time, from 5 at first treatment event to a median score of 3 at the eighth event. All participants who completed end of study surveys (16 patients) reported they “agree” or “strongly agree” with the statements “I would participate in child care again” and “Babysitting allowed you to get to your treatment on time.” Over the duration of study, 95% of this cohort did not have any delays in their cancer-directed therapy due to childcare. Conclusions: This is early evidence to suggest providing childcare to patients who are also undergoing chemotherapy is feasible and may be beneficial in improving impact on cancer outcomes and psychological distress. Further studies should include a comparator arm to better clarify the significant of this supportive measure. It is important to continue investigating the impact of supportive services on the quality of life and of care for this unique cohort.

Book Review: Childcare Provision in Neoliberal Times: The marketization of Care by Aisling Gallagher

Book Review: <i>Childcare Provision in Neoliberal Times: The marketization of Care</i> by Aisling Gallagher

Screen time and preschool children: Promoting health and development in a digital world.

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.