The role of playgroups as a service for preschool children

This paper uses data from a four-year study of preschool playgroups to analyse the role performed by playgroups in relation to other services for preschool children. It describes the way in which playgroups are used by children in three contrasting geographical areas, including the age at which they start, the length of time they spend in the playgroup, the hours they attend each week and their use of other preschool services. Mothers' reasons for wanting their children to attend a playgroup are analysed, and their satisfaction with various aspects of the service discussed. The paper concludes by considering the implications of the data for the issue of diversity and choice among preschool services.     

The mother–child playgroup as socialisation context: a short‐term longitudinal study of mother–child–peer relationship dynamics

This study employed mother–child playgroups as a context for examining mothers’ supervision of child–peer interactions and children’s adaptation to a new peer‐group setting. Six playgroups, consisting of quartets of mothers and their 24‐ to 54‐month‐old children (n = 23), were observed in ten 90‐minute sessions. All mothers attended the first two days of playgroup; only two mothers were present on each of the remaining days, rotating supervision responsibilities. Ratings were made of mothers’ behaviour toward their own and others’ children and children’s behaviour toward the mothers and peers. Children were oriented mainly toward their own mothers on the first two days of playgroup, but became increasingly involved in cooperative and parallel play with peers over time. Children were more likely to be involved in peer‐oriented play when their own mothers were present, and children of mothers who were judged to be more skilful supervisors were less likely to engage in solitary play. These findings converge with other evidence in supporting the usefulness of playgroup experiences for scaffolding children’s early peer interactions and for facilitating children’s transition between home and more formal educational settings such as preschools and daycare.     

Social interactions among severely handicapped children, non-handicapped children and their mothers in an integrated playgroup

In this study six types of social interaction were observed among a group of severely mentally handicapped children, non-handicapped children and mothers of non-handicapped children in a special integrated playgroup. The study was carried out during free play sessions in a school for children with severe learning difficulties. Eight children with severe handicaps from the nursery class and 15 non-handicapped young children and their mothers participated in the study. The results of ten direct observation sessions with severely handicapped children as the target group revealed three clear patterns: #opa#cp severely handicapped children played alone most of the time; #opb#cp non-handicapped and severely handicapped children played and interacted less frequently with each other; and #opc#cp there was very little social interaction betwen mothers of non-handicapped children and severely handicapped children. The study suggests that without using intervention programmes and structured social interactions between severely handicapped children, non-handicapped children and their mothers, the benefits of integrated playgroups are limited.     

Parents' views about pre‐school immunization: an interview study in southern England

Background National Health Service immunization statistics for England indicate that uptake of the first plus second dose of measles, mumps and rubella (MMR) vaccine, and pre‐school booster against diphtheria, tetanus, polio and pertussis, is lower than for the primary course alone. This qualitative study aimed to explore parents' views about pre‐school immunization and to identify possible reasons for lower pre‐school uptake compared with the primary course. Methods Semi‐structured interviews were conducted with 21 parents of children aged 2–5 years from 19 family units. The parents were recruited from nine playgroups and pre‐schools in three locations in southern England. Data collection and analysis were guided by a modified Grounded Theory approach. Results Although most parents believed pre‐school immunization to be important and most intended to immunise, a minority questioned whether it was necessary based on their understanding of the duration of protection provided by the primary course. Compared with primary immunization, parents typically received no information about pre‐school doses prior to their invitation to attend and had little or no contact with healthcare professionals. Other barriers included minor illness, apprehension about taking an older child for vaccinations and work or childcare commitments. Conclusions Parents reported uncertainties, anxieties and time constraints, all of which may contribute to poor attendance for pre‐school immunization. These findings have important implications for providing parents with timely information about boosters and the two‐dose MMR programme. They indicate the potential value of playgroup or pre‐school involvement and the need for improved communication with children about immunization.     

How can autonomy be achieved in school?

Discussion of the benefits of pre-school provision and the relative merits of the different kinds of institutional provision available -- playgroup, day nursery, nursery class and early school entry -- has tended to focus on the possible cognitive benefits of such provision. It is however possible to draw conclusions, both of a general nature and ones more specifically related to the growth of autonomy in young children. Such conclusions can be used when planning the kinds of experiences we may wish to provide for children upon entry to school. The present paper focusses on the sort of structures that can be created during the early years of children's schooling such that the development of autonomy may be fostered. Consideration is given to the importance of: organisational structures created by the school; tasks and activities in which children engage; relationships within the classroom and school.     

Meeting the Needs of Disabled Children and their Families: Some Messages from the Literature

The present review summarises literature on the needs of disabled children and their families and draws on research identifying promising service provision. The review took 1997 as its starting point to build on two thorough reviews that were written prior to that time. The findings of the current review largely echo earlier work in terms of what is known about the needs of disabled children and their families, but trends in service provision have altered somewhat, primarily through the use of inclusive services and short-break care. Evaluations of services remain over-dependent on user opinion studies, but studies that use basic evaluation or propose theory-based principles for developing effective services are identified.     

Early detection of speech and language delays in the Netherlands. The case for integrating primary and secondary prevention

The early detection of speech and language delays has been an important feature of the child health services in the Netherlands for some 15 years. During this period ideas about both the purpose of screening and the methods themselves have changed considerably. There are four key outstanding issues: What is the best age to identify children? What screening measures are available? How can we detect speech and language delays in multilingual children? Which groups are best able to detect speech and language difficulties: parents, teachers, playgroup leaders, doctors, nurses, or speech and language therapists? These questions are influenced by social, demographic developments and an increase in the understanding of language delay. This article examines the Dutch solutions to these problems. The conclusion reached is that early language screening can only be part of the answer to early detection both because the available measures are not yet sufficiently accurate and because the growing group of multilingual children (e.g. in Amsterdam more than 50% of the children under the age of 4 years are multilingual) makes the application of specific measures at a population level unworkable. An alternative method is suggested, namely primary prevention by giving information and support to parents, playgroup leaders, doctors, etc.     

Effective services to support children in special circumstances

BACKGROUND: Children living in special circumstances, defined as those who are at risk of achieving poorer outcomes than their peers, have a particular need of good quality, accessible services to promote their health and well-being, yet may be least likely to receive them. AIMS: This review considers the evidence for effective services to support children living in five kinds of special circumstances: (1) those at risk of offending; (2) teenage parents; (3) children whose parents have drug, alcohol or mental health problems; (4) children living with domestic violence; and (5) children who have been abused or neglected. In practice, there is often considerable overlap between these groups, and many children face multiple disadvantage. The review also aims to identify effective strategies for making support services more accessible to hard-to-reach groups. METHODS: Relevant literature was identified through searches of databases and websites, and consultation with experts. Given the broad scope of the topic, the aim was to provide an overview of best evidence rather than to undertake a systematic review. RESULTS: Similar themes underpin the most promising approaches to supporting children in special circumstances. These include: (1) a holistic, multi-agency approach addressing the needs of the whole child rather than compartmentalising children's social, educational, health and care needs; (2) the importance of links between adults' and children's services so that children who are in need because of their parents' circumstances can be identified and supported; and (3) the value of providing children in special circumstances with intensive, targeted support within a framework of universal provision. CONCLUSIONS: Overall, there is a lack of well-designed evaluations of the effectiveness of UK services and programmes for children in special circumstances. The existing evidence base would be strengthened by the development of better outcome measures, by exploring the characteristics of effective services from the perspective of different stakeholders (including children and young people themselves) and by extending the current problem-oriented approach to consider the factors that promote resilience and coping.     

Privatization and trade in health services: a review of the evidence.

Health care provision, like other areas of welfare, has increasingly been subject to processes of privatization and contracting out, leading in some cases to an increased involvement of for-profit corporations. Such processes are likely to interact with processes of liberalization at the international level in ways that we would expect to lead to a growth in the international trading of such services. However, health service provision is usually deeply embedded in state structures at the national level, and the form of such structures varies greatly. The degree and type of private involvement allowed for or facilitated by national-level systems defines the scope for the potential development of international trade in health services. The author reviews existing sources of data on the levels of private provision across advanced capitalist countries, countries in transition from Soviet-type systems, and developing countries, and highlights processes of change that are likely to increase such provision. Private provision is growing slowly but steadily in most countries. While levels of international trade in health services are difficult to ascertain, the interaction between national processes of reform and international processes of liberalization is likely to increase such trade.     

Day Care for Children in Need: Universal Provision or a Targeted Service?

This paper is concerned with local authority provision for a particular group of children, those considered to be 'in need' and aged under 5, in the context of the debate about universal versus selective services. It explores the provision of early childhood services, in particular day care, within the framework of welfare policies and the concept of need. After outlining the development of day care policy in Britain the paper considers how, within the current policy of targeting day care on children 'in need', local authorities might attempt to make provision available to a wider range of families, in line with the messages from current research that more emphasis needs to be placed on services to support families at an early stage rather than intervening later only when their needs are acute. It concludes that local authorities need to adopt a strategic and coordinated approach to early childhood services, working with other agencies and local communities, to ensure that a range of services are available to support children and families at different levels of need.     

Involvement of people who use alcohol and other drug services in the development of patient-reported measures of experience: A scoping review

Introduction

Patient-reported measures that assess satisfaction and experience are increasingly utilised in healthcare sectors, including the alcohol and other drug (AOD) sector. This scoping review identifies how and to what extent people accessing AOD services have been involved in the development of satisfaction and experience measures to date.

Methods

PubMed, EMBASE, CINAHL, Scopus, ProQuest, Google and Google Scholar were searched. Included papers described the development and/or implementation of a multiple-item measure of patient-reported experience or satisfaction specifically for people accessing AOD treatment and/or harm reduction programmes. If there was more than one paper, key papers were chosen that described each measure. The method of development, including service user involvement, was assessed against a framework generated for this review. Two reviewers were involved at each stage.

Results

Thirty measures—23 satisfaction and 7 experience—were identified. Sixteen measures reported some level of involvement by people accessing AOD services in their development, although, for most measures, at a relatively low level. This involvement increased over the time span of the review becoming more frequent in later years. Only four measures were developed for use in harm reduction-specific settings, and fewer than half reported undertaking analysis of underlying scale structure and constructs.

Conclusion

Several gaps could be addressed to enhance the measurement of patient-centred care in the AOD sector, including: developing experience measures for use in harm reduction settings and across various AOD settings in a service system; improved reporting of psychometric properties of these measures and increasing commitment to the meaningful involvement of AOD service users in measure development.

Patient or Public Contribution

This scoping review is part of a broader codesign project that involves a partnership between the peak organisation for AOD services and the peer-based AOD consumer organisation in the Australian Capital Territory, Australia. These organisations are working closely together to engage with AOD service users, service providers and policy makers in this codesign project. As such, the Executive Director of the peer-based AOD consumer organisation is involved as a co-author of this scoping review.     

"This does my head in". Ethnographic study of self-management by people with diabetes

Background

Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0?C6?years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.

Methods

We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7?years in Australia (range one month-18?years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.

Results

Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.

Conclusions

Although participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.     

Evaluation of preschool children with Down''s syndrome in Cape Town using the Griffiths Scale of Mental Development

Fifty-five preschool children with Down's syndrome were assessed using the Griffiths Scale of Mental Development. They were all the children with Down's syndrome living in Cape Town who spoke English or Afrikaans as their home language. There was a significant decrease in developmental quotient with increasing age and the hearing and speech subscore was lower than the other subscores. No significant associations were found between maternal age, sex, social class or race of the child and development. There was a negative association between developmental quotient and the number of siblings. The additional stimulation of a playgroup or preschool centre was associated with improved developmental functioning when compared to the children cared for at home during the day.     

Summer holiday respite provision for the families of children and young people with learning disabilities

While the provision of respite care is a relatively recent development in the provision of services to families, it is an area of considerable growth and apparent importance. Most service development and research has focused on the provision of residential or family-based respite care though some studies have commented on the apparent demand for other kinds of relief. This study describes a pilot summer play scheme for children with learning disabilities and the reactions of mothers to its provision. The characteristics of families who used the scheme are described and their felt needs for additional respite care explored. Mothers found the scheme very useful and expressed felt needs for substantially more such provision both during the summer and at other times. The findings are discussed in the context of the importance of developing respite services which meet the varied needs of families.     

Efficiency and quality in the public and private sectors in Senegal

It is often argued that the private sector is more efficient than the public sector in the production of health services, and that government reliance on private provision would help improve the efficiency and equity of public spending in health. A review of the literature, however, shows that there is little evidence to support these statements. A study of government and non-governmental facilities was undertaken in Senegal, taking into account case mix, input prices, and quality of care, to examine relative efficiency in the delivery of health services. The study revealed that private providers are highly heterogeneous, although they tend to offer better quality services. A specific and important group of providers--Catholic health posts--were shown to be significantly more efficient than public and other private facilities in the provision of curative and preventive ambulatory services at high levels of output. Policies to expand the role of the private sector need to take into account variations in types of providers, as well as evidence of both high and low quality among them. In terms of public sector efficiency, findings from the study affirm others that indicate drug policy reform to be one of the most important policy interventions that can simultaneously improve efficiency, quality and effectiveness of care. Relationships that this study identified between quality and efficiency suggest that strategies to improve quality can increase efficiency, raise demand for services, and thereby expand access.     

Conducting research with young children: some ethical considerations

The recent foundation of a ‘Young Children's Perspectives’ special interest group in the European Early Childhood Education Research Association (EECERA) reflects a general move in social research towards the respectful and inclusive involvement of children in the research process. However, established education research guidelines often provide no more than a loose ethical framework, appearing to focus on avoiding poor ethical conduct rather than proposing ways forward for making children's participation in research a positive experience. This short paper draws on my own experiences of conducting ESRC‐funded ethnographic video case studies on the ways four three‐year‐old children express their understandings at home and in a preschool playgroup during their first year of early years education. The paper reflects on the processes of negotiating initial and ongoing consent, problematises the notion of ‘informed’ consent in exploratory research with young children, and considers questions of anonymity when collecting and reporting on visual data. The paper proposes that by adopting a flexible, reflective stance, early years researchers can learn much from children, not only about their perspectives, but also about how to include young children in the research process.     

Black–White Differences in Child Maltreatment Reports and Foster Care Placements: A Statistical Decomposition Using Linked Administrative Data

Introduction Official statistics have confirmed that relative to their presence in the population and relative to white children, black children have consistently higher rates of contact with child protective services (CPS). We used linked administrative data and statistical decomposition techniques to generate new insights into black and white differences in child maltreatment reports and foster care placements. Methods Birth records for all children born in Allegheny County, Pennsylvania, between 2008 and 2010 were linked to administrative service records originating in multiple county data systems. Differences in rates of involvement with child protective services between black and white children by age 4 were decomposed using nonlinear regression techniques. Results Black children had rates of CPS involvement that were 3 times higher than white children. Racial differences were explained solely by parental marital status (i.e., being unmarried) and age at birth (i.e., predominantly teenage mothers). Adding other covariates did not capture any further racial differences in maltreatment reporting or foster care placement rates, they simply shifted differences already explained by marital status and age to these other variables. Discussion Racial differences in rates of maltreatment reports and foster care placements can be explained by a basic model that adjusts only for parental marital status and age at the time of birth. Increasing access to early prevention services for vulnerable families may reduce disparities in child protective service involvement. Using birth records linked to other administrative data sources provides an important means to developing population-based research.     

Effectiveness of surf therapy for children with disabilities

BackgroundFew researchers have examined the effects of surf programs on children with disabilities. Due to previous research findings, surfing is being used, as the focus of physical activity intervention due to its numerous health and therapeutic benefits.Objective/hypothesisThe purpose of this study was to explore the effects of an eight-week surfing intervention on various physical fitness measures in 71 children with disabilities such as autism spectrum disorder, down syndrome, global developmental delays, and cerebral palsy. The study also sought to compare the differences in overall fitness levels between the surf therapy group and an unstructured pool playgroup. Researchers predicted significant differences in the surf therapy group.MethodsThe assessment procedure consisted of pre and post physical fitness measures selected from the Brockport Physical Fitness Test in two groups: surfing (n = 71) and an unstructured aquatic program (n = 20).ResultsThe results demonstrated significant improvements in core strength (p = 0.00), upper body strength (p = 0.00), flexibility (p = 0.01) and cardiorespiratory endurance (p = 0.00) in the surfing group. However, there were no significant differences in overall fitness levels between the surfing and unstructured pool playgroups. Body composition measurements on the surfing group demonstrated a significant reduction in total body fat % (p = 0.016) and fat free mass (p = 0.008) and a significant improvement in bone mineral density (p = 0.004) pre to post surf therapy.ConclusionsThis research demonstrated the effectiveness and physiological benefits of surf therapy for children with selected disabilities.