Use Of Child Care Research Articles

Medicaid Accountable Care Organizations and Disparities in Pediatric Asthma Care

Nearly 6 million children in the US have asthma, and over one-third of US children are insured by Medicaid. Although 23 state Medicaid programs have experimented with accountable care organizations (ACOs), little is known about ACOs' effects on longstanding insurance-based disparities in pediatric asthma care and outcomes. To determine associations between Massachusetts Medicaid ACO implementation in March 2018 and changes in care quality and use for children with asthma. Using data from the Massachusetts All Payer Claims Database from January 1, 2014, to December 31, 2020, we determined child-years with asthma and used difference-in-differences (DiD) estimates to compare asthma quality of care and emergency department (ED) or hospital use for child-years with Medicaid vs private insurance for 3 year periods before and after ACO implementation for children aged 2 to 17 years. Regression models accounted for demographic and community characteristics and health status. Data analysis was conducted between January 2022 and June 2024. Massachusetts Medicaid ACO implementation. Primary outcomes were binary measures in a calendar year of (1) any routine outpatient asthma visit, (2) asthma medication ratio (AMR) greater than 0.5, and (3) any ED or hospital use with asthma. To determine the statistical significance of differences in descriptive statistics between groups, χ2 and t tests were used. Among 376 509 child-year observations, 268 338 (71.27%) were insured by Medicaid and 73 633 (19.56%) had persistent asthma. There was no significant change in rates of routine asthma visits for Medicaid-insured child-years vs privately insured child-years post-ACO implementation (DiD, -0.4 percentage points [pp]; 95% CI, -1.4 to 0.6 pp). There was an increase in the proportion with AMR greater than 0.5 for Medicaid-insured child-years vs privately insured in the postimplementation period (DiD, 3.7 pp; 95% CI, 2.0-5.4 pp), with absolute declines in both groups postimplementation. There was an increase in any ED or hospital use for Medicaid-insured child-years vs privately insured postimplementation (DiD, 2.1 pp; 95% CI, 1.2-3.0 pp), an 8% increase from the preperiod Medicaid use rate. Introduction of Massachusetts Medicaid ACOs was associated with persistent insurance-based disparities in routine asthma visit rates; a narrowing in disparities in appropriate AMR rates due to reductions in appropriate rates among those with private insurance; and worsening disparities in any ED or hospital use for Medicaid-insured children with asthma compared to children with private insurance. Continued study of changes in pediatric asthma care delivery is warranted in relation to major Medicaid financing and delivery system reforms.

His unemployment, her response, and the moderating role of welfare policies in European countries. Results from a preregistered study.

Recent changes in labour markets have increased employment instability. Under these conditions, in male breadwinner families women might increase their labour supply when their male partners become unemployed. Previous studies have extensively investigated the role played by household and individual characteristics in explaining such increases in the labour supply of women. However, studies which examine the moderating role of specific welfare policies are missing. Our study contributes to the literature by investigating the moderating effect of childcare and tax-benefit policies for the labour supply response of women following the unemployment of their partner. We focus on a sample of 24 EU member states and the UK, during the period 2009-2019, combining longitudinal microdata from EU-SILC with country-period specific policy indicators generated with the use of the tax-benefit simulation model EUROMOD, UKMOD and country-period specific indicators of childcare use. We find that women indeed respond to men's unemployment by increasing their labour supply though the response is fairly weak. We also find the response is not restricted by having children at home or availability of public childcare and does not depend on the generosity of unemployment benefits. It is, however, negatively affected by marginal tax rates.

Childcare use and the social-emotional and behavioural outcomes of late-preterm and early-term born children at age 5: An analysis of the All Our Families longitudinal cohort.

Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37weeks) and early term (≥ 37 and < 39weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioural problems among children born between ≥ 34 and < 41weeks gestation, determine whether this association was modified by childcare use, and describe the relationship between childcare and behavioural and social-emotional functioning at age 5. Using data from the All Our Families cohort (n = 1324), logistic regression models were used to model the association between GA and social-emotional/behavioural problems (BASC-2 composite scales at age 5). Models were fit with interaction terms between GA and childcare variables (amount, multiplicity, and type of childcare at age 3) to assess effect modification. GA showed no significant associations with social-emotional/behavioural problems at age 5, though the type of childcare significantly modified the association between GA and externalizing and internalizing problems. Neither the number of hours spent in childcare (amount) nor the number of childcare arrangements used (multiplicity) modified the association between GA and social-emotional/behavioural problems. However, multiplicity was associated with externalizing behavioural problems (aOR = 2.09, 95% CI 1.14‒3.83). This study found no significant association between GA and social-emotional/behavioural problems at age 5, though childcare type modified this association. Factors such as using multiple childcare arrangements to meet families' childcare needs have the potential to influence a child's social-emotional and behavioural functioning at age 5.

Unconditional Cash and Breastfeeding, Child Care, and Maternal Employment among Families with Young Children Residing in Poverty.

Poverty interferes with parents' breastfeeding, child-care, and employment options and ability to meet their parenting goals. This study-the first randomized controlled trial of early childhood poverty reduction in the United States-investigates how increased economic resources affect 1,000 low-income US mothers' breastfeeding, child-care, and employment practices and the ability to meet their intentions for these practices in the first year of their infant's life. The likelihood and length of breastfeeding, use of nonparental child care, and maternal employment did not statistically differ among mothers who received a high ($333) or low ($20) monthly unconditional cash gift. The higher monthly cash gift, however, delayed the starting age of child care by almost 1 month and increased mothers' ability to meet their breastfeeding intentions reported at birth.

The Effects of the Child and Dependent Care Tax Credit (CDCTC) on Child-Care Use and Maternal Labor Supply

The Effects of the Child and Dependent Care Tax Credit (CDCTC) on Child-Care Use and Maternal Labor Supply

Who Uses Childcare Centers? Evidence from Burkina Faso

What determines childcare center use for low-income urban households? And how does subsidizing provision change access to childcare services? We study these questions using data from a randomized evaluation that subsidized childcare center use for women participating in a public works program in Burkina Faso. One quarter of eligible women use these childcare services, tripling childcare center use for zero-to six-year-olds in our sample. Household wealth significantly predicts childcare center use. However, the public works childcare centers increased access for disadvantaged households and young children. Women employed as childcare providers were also more likely to use the childcare centers.

Labour market gender gaps and childcare policies in countries with different social investment strategies

AbstractWe study the role of formal and informal childcare within the ECEC policies for gender employment and pay gaps, considering the life course stages distinctive for childcare tasks. The ECEC policies are framed within the types of social investment strategies identified in the EU countries to picture developments in social investments after 2005. The aggregated EU‐SILC data from 2005 to 2019 for 27 European countries have been used in the panel regression models to uncover how the caring arrangements influence labour market gendered outcomes of women at different ages (15–24, 25–49, 50–65). We find that better provision and use of early education and childcare not only contribute to early investment in human capital but it also facilitates mothers' employment and thus contributes to lowering gender employment and pay gaps. However, better coverage of care for children older than 3 years old results in negative employment effects for grandmothers. These effects vary also across countries, depending on their overall institutional setting depicted by the types of social investment strategies distinguished. Consequently, the ECEC agenda should be extended by addressing the employment of women at the pre‐retirement age. It is crucial not only for reducing gender gap in employment and pay but also in the light of challenges generated by demographic developments—the labour force shrinking and the population ageing processes.

Charting the 21st Century Rise of For-Profit Residential Child Care

This article explores the increasing prevalence of for-profit residential care, with a particular focus on Great Britain, while also drawing on the international evidence from the Global North. Comprising a critical review of the published evidence (both academic and grey literature), the article seeks to examine what might explain the rising prevalence of and the possible associated impacts of the increase in for-profit provision. The findings indicate that the rise of for profit-companies among residential child care providers appears to have occurred by default, rather than explicit policy design. Our analysis also highlights gaps in the knowledge base about the quality of care and whether better quality is associated with the type of provider. Furthermore, the relationships between provider, quality, cost and outcomes are unclear. There are inconsistencies in the evidence base, with different conclusions being reached. However, available evidence tends to suggest the increased prevalence of for-profit residential child care providers has had an overall negative, rather than positive, effect. The best case in favour of the continued use of for-profit residential care is currently a non-moral pragmatic one: that in countries with medium and high prevalence of the use of residential child care, it would be hard to sustain care systems if for-profit providers were to suddenly withdraw or be withdrawn.

Acute health care use among children during the first 2.5 years of the COVID-19 pandemic in Ontario, Canada: a population-based repeated cross-sectional study.

The effects of the decline in health care use at the start of the COVID-19 pandemic on the health of children are unclear. We sought to estimate changes in rates of severe and potentially preventable health outcomes among children during the pandemic. We conducted a repeated cross-sectional study of children aged 0-17 years using linked population health administrative and disease registry data from January 2017 through August 2022 in Ontario, Canada. We compared observed rates of emergency department visits and hospital admissions during the pandemic to predicted rates based on the 3 years preceding the pandemic. We evaluated outcomes among children and neonates overall, among children with chronic health conditions and among children with specific diseases sensitive to delays in care. All acute care use for children decreased immediately at the onset of the pandemic, reaching its lowest rate in April 2020 for emergency department visits (adjusted relative rate [RR] 0.28, 95% confidence interval [CI] 0.28-0.29) and hospital admissions (adjusted RR 0.43, 95% CI 0.42-0.44). These decreases were sustained until September 2021 and May 2022, respectively. During the pandemic overall, rates of all-cause mortality, admissions for ambulatory care-sensitive conditions, newborn readmissions or emergency department visits or hospital admissions among children with chronic health conditions did not exceed predicted rates. However, after declining significantly between March and May 2020, new presentations of diabetes mellitus increased significantly during most of 2021 (peak adjusted RR 1.49, 95% CI 1.28-1.74 in July 2021) and much of 2022. Among these children, presentations for diabetic ketoacidosis were significantly higher than expected during the pandemic overall (adjusted RR 1.14, 95% CI 1.00-1.30). We observed similar time trends for new presentations of cancer, but we observed no excess presentations of severe cancer overall (adjusted RR 0.91, 95% CI 0.62-1.34). In the first 30 months of the pandemic, disruptions to care were associated with important delays in new diagnoses of diabetes but not with other acute presentations of select preventable conditions or with mortality. Mitigation strategies in future pandemics or other health system disruptions should include education campaigns around important symptoms in children that require medical attention.

Child care participation among Indigenous children in Canada

The release of a Canadian Indigenous Early Learning and Child Care Framework highlights the importance of recent, Indigenous-specific information to describe the landscape of child care among Indigenous children in Canada; however, there has been a gap in identity-specific, national data on child care for Indigenous children. The purpose of the current study was to address data gaps on participation in child care for First Nations children living off reserve, Métis, and Inuit children. Furthermore, two years of data are examined which provide information on child care use both prior to and during the first year of the COVID-19 pandemic. In 2019, First Nations children living off reserve (49%) and Inuit children (42E %)1 were significantly less likely to participate in child care compared with non-Indigenous children (60%), although Métis children (60%) were equally likely to participate in child care compared with non-Indigenous children. Only First Nations children living off reserve (40%) were significantly less likely than non-Indigenous children (53%) to participate in child care in 2020. In terms of the type of child care used, Inuit children were more likely to be in a daycare centre (70%) compared with non-Indigenous children (52%) in 2019, although Inuit children’s participation in a daycare centre dropped to 46E% in 2020. This is likely due to public health restrictions which closed many child care centres during the pandemic, as over one-third of child care in the territories is centre-based. The findings provide important information about patterns of child care use for Indigenous children both before and during the pandemic.

Decisions & distance: The relationship between child care access and child care travel

Child care is essential infrastructure. Without child care—or without adequate access to child care—parents and household caregivers are unable to work or conduct other critical activities, which can adversely affect their outcomes. In the U.S., child care supply has long fallen short of demand, with variations across neighborhoods that differ by income, race, and ethnicity. Yet there is relatively little research on child care access, use, and travel. In this study, we test the relationship between formal child care supply and households' use of formal care and home-to-child-care travel distances in California. Using a two-step floating catchment area method, we develop a time-weighted spatial measure of child care access and apply this measure in statistical models to predict two outcome measures: the likelihood of making a home-to-child-care trip and travel distance to the child care center, controlling for other factors. We find that child care access is associated with an increased likelihood of using formal child care—and among households that use such care, access is associated with shorter travel distances. Our analysis underscores the importance of policies to address spatial barriers to child care, particularly in neighborhoods—low-income, Latinx, non-urban—where child care supply is limited.

Migrants' choices pertaining to informal childcare in Italy and France: A complex relationship between the origin and destination countries

AbstractChildcare is a need that inevitably emerges once migrants establish themselves and their families in their destination country. However, migrants' use of informal childcare still constitutes an under‐researched phenomenon. Using data from the ‘Social Condition and Integration of Foreign Citizens’ survey (2011–2012) for Italy and the ‘Trajectoires et Origines’ survey (2008–2009) for France, this paper examines differences between migrants living in the two countries in terms of their use of informal childcare and, more specifically, their informal childcare arrangements. We employ a comparative analysis because we hypothesised that parental choices would depend on the migrants' region of origin, the institutional context of their destination country and the interplay between these two elements. The results suggest that migrants' choices stem from a complex relationship between the norms and beliefs of the country of origin and those in the destination country, which are generally characterised by different family policies and levels of childcare availability. We show that the use of informal childcare is higher among migrants in Italy than it is among those in France, even among migrants from the same region of origin. The results also suggest that the use of particular informal childcare arrangements varies by region of origin regardless of destination country, supporting the hypothesis that migrants' cultural values and beliefs play a critical role in determining childcare arrangements. Finally, we demonstrate that household composition and parents' occupational status strongly influence migrants' childcare choices.

Influences of women empowerment indices on demand for childcare services: Evidence from the Nigeria Demographic and Health Surveys.

This study examined the effect of various dimensions of women's empowerment on childcare use in Nigeria, utilizing information from five rounds of the National Demographic and Health Surveys. The analysis made use of both binary and multinomial logistic regression. The findings show that women who share household choices with their spouses were more likely to undertake postnatal care for their babies in either private or public hospitals compared to self-medication/others/traditional. Also, women who owned houses and those who participate in economic activities are significantly more inclined to use postnatal services for babies in health facilities. By implication, women empowerment is a significant factor to consider in improving childcare services in Nigeria. This suggests that in order to improve the health of children, women's inputs in household decision-making should be accommodated, while efforts should be made to enhance household socioeconomic position, and support mothers to have formal education. The findings also suggest that promoting women's empowerment can play a crucial role in increasing the demand for formal childcare services.

‘Unprecedented injustice’: Digitalisation and the perceived accessibility of childcare benefits

Abstract The Netherlands recently experienced a crisis in childcare benefits, leading to ‘unprecedented injustice’ for many parents falsely accused of defrauding the childcare benefit system. This crisis highlights multiple barriers in parents’ ability to access childcare already evident prior to the crisis, including the far-reaching digitalisation of social policies and childcare benefits in particular. Digitalisation can make parents feel childcare services are less accessible, thereby creating or exacerbating existing inequalities in childcare use. Parents may also lack the skills needed to navigate complex application procedures, which can affect their perceived access to childcare benefits, particularly in market-led systems with greater reliance on government benefits to cover the high costs of childcare. Extending recent research on childcare capabilities, we investigate the extent to which digital and functional literacy affect parents’ perceived access to childcare benefits in the Netherlands. The results from our exploratory quantitative analysis provide a starting point for understanding the understudied relationships between digitalisation, parents’ abilities to navigate complex childcare or other policy systems, and their (perceived) ability to access childcare benefits. We use these findings to develop multiple future research recommendations in the childcare policy literature.

Maternal Employment and Childcare Use from an Intersectional Perspective: Stratification along Class, Contractual and Gender Lines in Denmark, France, Germany, Italy, Sweden and the UK

Abstract Connecting streams of feminist and comparative social policy literature, this article investigates stratification in maternal employment and childcare use along class, contractual, and gender lines across six countries (Denmark, France, Germany, Italy, Sweden, and the United Kingdom) and five family policy models. Detailing the different stratifying factors that intervene in the relation between maternal employment and childcare use offers a concrete analysis of the complex link between social reproduction and work. Employing multivariate regressions and EU-SILC (2007–2018) data, it provides an intersectional perspective to the literature. First, we observe a process of formalization in childcare use with a parallel reduction of nonformal care for couples; this process is slower for single mothers. Second, we document a paradox in relation to the social investment approach: the relation between childcare use and maternal employment is stronger in countries that recently expanded childcare to modify their male-breadwinner orientation, but in these countries childcare use is more stratified along class/contract types, a concern for the outcomes of social investment strategies outside of Scandinavia. Being out of work, being in a lower social class, fulfilling domestic tasks and/or care activities, and having an atypical contract negatively correlates with childcare use in most countries. Third, households where partners have more similar earning levels use childcare to a greater extent. The article also provides models employing different dependent and independent variables, alternative family structures, full and part-time work, formal and nonformal childcare, and rich country details.

Informal childcare arrangements: a comparison between Italians and migrants

As migrants settle in their destination country, for those who reunited the family or after childbirth childcare becomes a priority. Most studies on migrants’ childcare arrangements have focused on parental use of formal childcare rather than on different informal childcare solutions by analysing only families with preschool-age children. Italy poses an interesting case study because its welfare system is characterised by a familistic model of care, based on solidarity between generations. In familistic countries, migrants’ childcare solutions are more constrained. In this study, we analysed differences in informal childcare needs and arrangements for children younger than 14 between Italians and migrants from different countries of origin. We merged two surveys conducted by the Italian National Statistics Institute in 2011–2012: ‘Social Condition and Integration of Foreign Citizens’, a sample of households with at least one migrant with foreign citizenship, and ‘Multiscopo—Aspects of Daily Life’, a sample of households in Italy. We found that household composition and parents’ employment status play an important role in shaping informal childcare arrangements. Overall, migrants are less likely to use informal childcare, especially grandparents, than Italians but when they do, they rely more on other relatives and non-relatives than Italians. Moreover, differences emerge across migrant subgroups. This study is the first in Italy to contribute to an understanding of the role of migrant status in determining parents’ childcare arrangements for children up to 13 years.

Childcare in Italy among migrants and natives: who uses which type and why?

The Italian welfare state is characterised by a preference for income transfers over transfers in kind and the marginal role of policies aimed directly at supporting the family. Despite the growing participation of women in the labour market, the Italian welfare system still assumes the family, with its unbalanced gender division of housework and its intergenerational solidarity, to be the primary provider of protection and support. As a result, in Italy in 2019 only 26.9% of children under 3 years of age were enrolled in formal childcare, which is below the European average. In this context, births from at least one foreign parent had increased over time, and foreign national children accounted for 14.0% of all children aged 0–3 in 2019. Despite this, migrants are still seen as ‘suppliers’ rather than citizens who, as parents, are potential consumers of childcare services. Aspects related to the use of childcare by migrants and differences compared to natives in Italy are currently understudied. We use the 2012 Birth Sample Survey by the Italian National Institute of Statistics to fill this gap. Mothers were interviewed about 18–21 months after having given birth: information on sociodemographic characteristics of both parents was collected, including their use of childcare services, their reasons for not using them, their unmet need for childcare services, and the lack of access to the job market due to care work. Our study aims to understand childcare patterns among migrants and the differences between them and those of the native-born population. We found that Italian mothers use informal care more than migrants. Unlike the evidence from other international studies, our results show that migrant mothers use daycare for children aged 0–3 more than native-born mothers. However, we found that the migrants who had arrived as children show patterns more similar to natives. This finding might be associated with a better knowledge of the system and a more extensive network (including grandparents) in Italy. Similarly, we found that migrant mothers who co-parent with an Italian father use more informal care and experience lower logistical barriers to accessing daycare. In addition, we observed that obstacles to children’s enrolment resulting in an unmet need for daycare are also related to migrant background.

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.

Reconciling work-family balance among Moroccan immigrant women in Spain: Socioeducational aspects

In Spain, Moroccan immigrant women constitute one of the largest and most important migrant groups. They face a series of obstacles when trying to balance family and work. This research aims to discover the perceptions of economically active and inactive Moroccan immigrant women concerning work-family and gender balance, childcare in the home, and the use of childcare and early education centres in Spain. A quantitative methodology was employed. A questionnaire was administered to a sample of 388 Moroccan immigrant women in Spain. SPSS v. 27 was used for descriptive and inferential statistics. Most of employed respondents are dissatisfied with their work-life balance. Mothers (employed and non-employed) are mainly responsible for the care of their children. Non-believers and those of a higher socio-economic status are more in favour of gender equality in the family and workplace. Childcare support policies are needed that guarantee appropriate personal, family, work, and gender balance.

Who’s Caring for the Kids? The Earned Income Tax Credit and Childcare Arrangements

Labor force participation among mothers in the U.S. has increased dramatically over the past several decades, driven in part by social policies that provide benefits that are contingent upon paid work. Little is known, however, about how these work-contingent social policies affect childcare arrangements. We study the effect of the Earned Income Tax Credit (EITC)—one of the largest work-contingent cash transfer programs in the U.S.—on childcare arrangements, using data from the Survey of Income and Program Participation. Our findings suggest that, for children under three, the EITC increased the use of childcare, the number of hours children spent in care, the likelihood of parents paying for care, and the use of multiple care arrangements. It seems to have little effect on childcare arrangements for older children.