Healthy and Ready to Learn: Effects of a School‐Based Public Health Insurance Outreach Program for Kindergarten‐Aged Children

BACKGROUND

Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school‐based health insurance outreach initiative, “Healthy and Ready to Learn,” aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina.

METHODS

Regression discontinuity design and difference‐in‐differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well‐child visits; secondary outcome). Focus groups and key‐informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment.

RESULTS

The initiative increased enrollment rates by 12.2% points and increased well‐child exam rates by 8.6% points in the RD models, but not differences‐in‐differences, and did not significantly increase well‐child visits.

CONCLUSIONS

Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low‐income parents.     

Förderung der kindlichen Entwicklung durch Frühe Hilfen?

Background

A primary goal of early childhood interventions is to enhance child development through fostering parental competencies in socially disadvantaged mothers.

Method

The preliminary effects of the home visiting program “Pro Kind” were analyzed using a longitudinal randomized control group design. By the end of 2009, 755 high-risk primiparae had been enrolled. Self-rated maternal competencies as well as the cognitive development of the children assessed with the Bayley Scales of Infant Development (BSID)-II were analyzed.

Results

Interim analyses showed first positive treatment effects on self-rated maternal competen­cies as well as on cognitive development in children under 3 years old. However, higher self-ratings of maternal competencies did not explain the better cognitive development of the child.

Conclusion

“Pro Kind” as an early childhood intervention seems to contribute positively to children’s cognitive development in socially disadvantaged families. Clinical and research implications of biased maternal self-perceptions are discussed.     

Child Routines and Self-Regulation Serially Mediate Parenting Practices and Externalizing Problems in Preschool Children

Background

Studies clearly indicate that parenting practices relate to child externalizing behaviors, although the mechanisms underlying this relation are less well understood. There has been limited evaluation of child routines and self-regulation in relation to these variables, and no known studies have evaluated all of these variables simultaneously.

Objective

This study examined child routines and self-regulation as serial mediators of the relations between positive and negative parenting practices (separately) and child externalizing problems among preschool children.

Methods

Participants included 146 maternal caregivers of preschool children who completed measures of their parenting practices and of their child’s daily routines, self-regulation, and externalizing behaviors.

Results

Results demonstrated that both child routines and self-regulation are significant mechanisms through which negative and positive parenting practices relate to externalizing problems in preschoolers, although the temporal sequencing was only upheld with respect to negative parenting. Our findings offer preliminary evidence that child routines may play a critical role in self-regulation development among preschool children, which, in turn, is inversely associated with externalizing behaviors.

Conclusion

Although further study is needed, these findings suggest that child routines and self-regulation development may be key components to incorporate clinically and evaluate empirically among intervention programs designed to prevent early development of behavior problems in preschool children.

     

Care for Child Development: an intervention in support of responsive caregiving and early child development

Background

An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children.

Methods

In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource‐constrained communities.

Results

The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services.

Conclusions

Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale‐up of CCD as part of services for families and children.     

The Pullout Program Day a Week School for Gifted Children: Effects on Social–Emotional and Academic Functioning

Background

Gifted children learn differently compared to their peers in several ways. However, their educational needs are often not met in regular schools, which may result in underachievement and social–emotional and behavioral problems. A pullout program, the “Day a Week School” (DWS), was offered to gifted children in 25 elementary schools from neighborhoods of higher and lower SES in Amsterdam.

Objective

To investigate whether DWS decreases children’s social–emotional and behavior problems and parents’ stress, and improves children’s self-concept, enjoyment at school, and academic achievement.

Methods

Gifted children (grades 3–5) were selected through a standardized identification procedure assessing “out-of-the box”, logical, and creative thinking and motivation (n = 89). Children, as well as both their parents and teachers, completed questionnaires before the start of DWS and after 2,5 months. Results were analyzed for all children and for at-risk children with higher levels of psychopathology before starting DWS.

Results

Analyses on the total group showed small positive effects on children’s self-reported self-concept dimensions, scholastic competence and behavioral conduct, as well as on fathers’ reported child prosocial behavior. In the at-risk group, children reported medium positive effects on scholastic competence and behavioral conduct, and on sleep problems and worry, and small improvements on enjoyment at school. Parents of at-risk children reported decreased child’s somatic complaints and decreased social–emotional and behavioral problems. Finally, teachers reported higher academic achievement and medium positive effects on inattention-hyperactivity in the at-risk group.

Conclusions

Day a Week School appears to be a promising pullout program for gifted children, particularly for children at-risk for psychopathology.     

Active Commuting to School,Physical Activity,and Behavior Problems Among Third‐Grade Children

BACKGROUND

We examined factors associated with active commuting to school and the relationships of active commuting and physical activity to child‐ and teacher‐reported internalizing and externalizing behavior problems in a sample of third graders.

METHODS

The study sample consisted of 13,166 third graders enrolled in the Early Childhood Longitudinal Study Kindergarten Class of 1998‐1999. “Active” commuters were children who walked to school and “passive” commuters were those who took the bus or were driven. Linear analyses evaluated differences in behavior problems by school commute, physical activity, and sports team participation after adjusting for sociodemographic, regional, and neighborhood factors.

RESULTS

Overall, 11% of children actively commuted. Type of commute differed by sociodemographics, region, urbanicity, school type, and neighborhood safety. Active commuters had less general physical activity participation and sports team participation. Commuting type and general physical activity were not associated with behavior problems, but sports team participation was associated with fewer child‐reported internalizing and externalizing behaviors as well as fewer teacher‐reported internalizing behaviors.

CONCLUSIONS

Our findings demonstrate the ongoing need for creating and maintaining physical activity programs (such as sports teams) among school‐aged children to optimize children's overall health and well‐being.

     

Parents' voices: “Our process of advocating for our child with autism.” A meta‐synthesis of parents' perspectives

Background

Advocacy has been described by parents of children with autism as an important coping strategy, enabling them to move forward by redirecting emotions into actions. A key factor in the development of collaborative and constructive partnerships between service providers and parents is having an understanding of how parents engage in advocacy and the support needed to do so. This meta‐synthesis was undertaken to consolidate in‐depth qualitative data from parents' perspectives of the process that they use to advocate for their children with autism.

Methods

A qualitative meta‐synthesis was conducted, whereby 15 databases were systematically searched. Thirty‐one studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesized into themes through the steps of review, meta‐aggregation, integration, and interpretation.

Results

The voices of 1,662 parents are presented describing the process of advocacy in the stages of seeking a diagnosis, seeking self‐education, and taking action. Taking action includes 2 subthemes: seeking, access, and use of support services and community engagement and educating others.

Conclusions

Results highlight the significant impact that positive experiences with first‐line professionals have during the diagnosis process and how these experiences lay the foundation for all future relationships with other service providers. Important implications arise from this meta‐synthesis for service providers in supporting parents' advocacy and hence building constructive relationships with families with a child with autism.     

Scaling up child development centres in Bangladesh

Background

Child Development Centres (CDCs) have been established within government medical college tertiary hospitals across Bangladesh. Services entail a parent–professional partnership in a child and family friendly environment with a focus on assessment, diagnosis, and management of a range of neurodevelopmental disorders in children and adolescents 0–16 years of age. Services are provided by a multidisciplinary team of professionals (child health physician, child psychologist, and developmental therapist) who emphasize quality of services over the numbers of children seen.

Methods

In 2008, Dhaka Shishu (Children's) Hospital was given the mandate by the government to conceptualize, train, and monitor CDCs nationwide. Here, we describe the rationale and processes for the establishment of the national network of CDCs and discuss lessons learned on scaling up early childhood development services in a low resource setting.

Results

Fifteen CDCs were established in major government hospitals across Bangladesh and have recorded 208,866 patient visits. The majority (79%) of children were from the lowest and middle‐income families, and about one third (30%) were < 2 years of age at first presentation. Two thirds of children seen in follow‐up demonstrated improvements in functional skills since their first visit, 77% in their adaptive behaviour (i.e., activities of daily living) and 70% in cognitive functions.

Conclusions

CDCs are expanding coverage for child neurodevelopment services across Bangladesh through a tiered system of home‐based screening, community‐ and clinic‐based functional assessment, and CDC‐based diagnosis, support, and referral. Vulnerable populations—the lowest income groups and younger children—comprised the majority of patients, among whom there is high unmet need for psychological services that is being met for the first time. Innovative human resource development, including a 3‐month training for the multidisciplinary teams, enabled wide coverage for assessment and diagnosis of a range of neurodevelopmental problems. Demand for services is growing, especially among non‐government and private hospitals.     

Scaling up Integrated Early Childhood Development programs: lessons from four countries

Background

There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large‐scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale.

Objectives

The objective of this study is to examine the process of scaling up four major country‐level ECD programmes through the application of a CAS framework.

Methods

Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open‐ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus.

Results

The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale‐free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes.

Conclusions

CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field.     

Implementing a tuberculosis child contact register to quantify children at risk for tuberculosis and HIV in Eldoret,Kenya

Setting:

Tuberculosis (TB) clinic in Eldoret, Kenya.

Objective:

To identify TB exposed children through the implementation of a child contact register (CCR). To assess the demographics of children exposed to TB and the potential for initiation of isoniazid preventive therapy (IPT) in this cohort.

Methods:

A CCR was implemented in routine care with health care workers querying index cases regarding child contacts. Data were retrospectively analyzed.

Results:

In 12 months, the CCR revealed 580 children exposed to TB. Of these, 58% were exposed to smear-positive TB and 30% were aged <5 years. Of those exposed to smear-positive TB, 15% may have qualified for IPT initiation. Only 6 (1%) child contacts were screened for TB disease. More than 50% of the children with human immunodeficiency virus (HIV) positive mothers had not been HIV tested.

Conclusion:

Implementation of a CCR is a possible first step in child contact identification and management, which requires minimal resources and identifies children at risk for TB and HIV. Child contact screening and IPT initiation remain a challenge, and additional strategies are urgently needed.     

An Inquiry of Children’s Social Support Networks Using Eco-Maps

Background

Children receive support for their learning and development from multiple sources and within various developmental contexts. The extant literature investigating children’s social supports has uncovered multiple benefits to positive and complex social support system. However, the measurement of children’s social supports has largely been accomplished through accessing knowledge of either a parent or child. In order to understand children’s support systems, which are embedded within multiple contexts and prejudiced by multiple influences, it is imperative to access all relevant perspectives.

Objective

This exploratory project was undertaken by a preschool teacher-researcher in order to understand the types of information eco-maps provide about children’s social support networks in an effort to support young children’s learning and development.

Methods

Eco-map interviews describing children’s social networks were completed by preschool-age children, their parents and their preschool teacher. Each informant identified the major people in the child’s support network, described relationships, and identified the type and developmental area of support provided by each individual. All the information was graphically represented within an eco-map using shapes and color coding to distinguish variations.

Results

Qualitative analysis of five children’s completed maps revealed three themes: agreement on an inner circle, different perspectives on the kinds of support provided, and children’s unique way of expressing support.

Conclusion

Eco-maps with children, parents, and teachers may contribute to educational research and practice through providing detailed information about children’s social support network through the identification of resources to support the development and learning of young children.     

The INMA—INfancia y Medio Ambiente—(Environment and Childhood) project: More than 10 years contributing to environmental and neuropsychological research

Background

In 2003 the INMA—INfancia y Medio Ambiente (Environment and Childhood) project, a Spanish national network of birth cohorts including more than 3500 participants, was set up with the aim to assess the health impacts of pre- and postnatal environmental exposures on children. The project has published more than 60 papers on maternal and environmental factors related to neuropsychological development in children, one of the main research interests within the project. With the present review, we evaluate the evidence provided by the INMA project on this topic and discuss how the data can contribute to cover the challenges that children’s environmental health research will face in the coming years.

Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy

Background

Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g., reducing risk of hip subluxation, and improving bladder and bowel function), improving activity (e.g., motor abilities) and participation (e.g., interaction with peers), but there is little evidence that they do. We aimed to identify current UK standing frame practice for children with CP and to understand stakeholder views regarding their clinical benefits and challenges to use.

Method

Three populations were sampled: clinicians prescribing standing frames for children with CP (n = 305), professionals (health and education) working with children with CP who use standing frames (n = 155), and parents of children with CP who have used standing frames (n = 91). Questionnaires were developed by the co‐applicant group and piloted with other professionals and parents of children with CP. They were distributed online via clinical and parent networks across the UK.

Results

Prescribing practice was consistent, but achieving the prescribed use was not always possible. Respondents in all groups reported the perceived benefits of frames, which include many domains of the International Classification of Functioning Disability and Health for Children and Youth. Challenges of use are related to physical space and child‐reported pain.

Conclusions

These survey findings provide information from key stakeholders regarding current UK standing frame practice.     

Attachment,Working Models of Parenting,and Expectations for Using Television in Childrearing

This study used attachment theory to understand college students' working models of parenting and expectations for how they would use television in parenting. We found that secure parent‐child attachment histories were related to more positive expectations of parenting and that avoidant and anxious‐ambivalent parent‐child attachment histories were related to more negative expectations of parenting. Avoidant parent‐child attachment history was related to more positive views about television for children and in parenting, especially among adults with insecure adult attachments. In addition, students with more secure attachment histories had healthier views on using television with children. The implications of these results for understanding parents' use of television with their children as well the effects of television on children are discussed.     

How Young Children and Their Mothers Experience Two Different Types of Toys: A Traditional Stuffed Toy Versus an Animated Digital Toy

Background

Despite widespread use of digital toys, research evidence of how a digital toy’s features affect children’s development and the nature of parent–child interactions during play is limited.

Objective

The present study aimed to examine how mother–child dyads experience a traditional stuffed toy and an animated digital toy by comparing children’s conceptions of the toys, their play behaviors, and maternal interactive behaviors. The relationship pattern of how and degree to which children’s conceptions and maternal interactive behaviors are associated with children’s play were explored to examine how the toys’ animated and interactive function affected children’s play level and mother–child interaction.

Method

Forty-eight children (mean age 49.77 months; 32 boys and 16 girls) and their mothers participated in the present study. Mother–child play with the toys was observed, and the children’s conceptions of the toys were obtained through interviews.

Results

Children seemed to perceive that a digital puppy doll had psychological attributes. The mothers showed more interactive behaviors overall when playing with their children using digital toys. However, the associations between maternal interactive behaviors and children’s play in the two different play settings showed that a digital toy changed mother–child interaction owing to its technological features. Both children’s conception and maternal interactive behaviors of pretend play in the two different play contexts independently contributed to children’s pretense level.

Conclusions

The current findings confirmed the facilitating as well as mediating effects of a digital toy on children’s play and the role of parents during play with digital toys.

     

Treating Mental Health Disorders for Children in Child Welfare Care: Evaluating the Outcome Literature

Background

Children involved in the child welfare system (CWS) have a greater need for mental health treatment relative to children in the general population. However, the research on mental health treatment for children in the CWS is sparse with only one known previous review of mental health services with children in the CWS.

Objective

This review reports on an evaluation of the literature examining mental health interventions for children within the CWS.

Methods

The Grades of Recommendation Assessment, Development and Evaluation (GRADE) process was used as the basis of the evaluation.

Results

The results reflect that, while the overall quality of research in this area is low and findings are, at times, inconsistent, detailed, manualized interventions using multiple treatment components that focus on family, child, and school factors showed the most promise in regards to child mental health outcomes and placement stability. These interventions not only report the best quality outcomes for children and families, but they were also most highly recommended within the GRADE analysis.

Conclusions

These findings emphasize the importance of comprehensive intervention efforts that involve the family and community, as well as the child. The inconsistent positive outcomes may be partially explained by the lack of trauma-informed practices incorporated into treatment for these often traumatized children. Recommendations for research in regards to mental health interventions for children in the CWS are discussed.     

A Closer Look at Teacher–Child Relationships and Classroom Emotional Context in Preschool

Background

Children’s early classroom experiences, particularly their interpersonal interactions with teachers, have implications for their academic achievement and classroom behavior. Teacher–child relationships and classroom interactions are both important aspects of children’s early classroom experiences, but they are not typically considered together in studies of early childhood classrooms. The bioecological model suggests that both uniquely impact children’s development.

Objective

The objective of this study was to examine the joint impact of individual teacher–child relationships reported by the teacher and observed classroom interactions to identify associations between these and children’s outcomes.

Methods

Using the Early Childhood Longitudinal Study—Birth cohort, multiple regression was employed to test the hypothesis that teacher–child relationships and classroom interactions are uniquely related to children’s classroom behavior and academic achievement. Further, a moderation model was tested to examine the moderating impact of teacher–child relationships on the association between classroom interactions and children’s outcomes.

Results

Teacher–child relationships were related to children’s concurrent academic achievement and classroom behavior, and to children’s classroom behavior assessed one year later. No main effects of classroom interactions were identified; however, teacher–child relationships moderated the associations between classroom interactions and children’s preschool classroom behavior.

Conclusions

Findings suggest that teacher–child relationships are important for children’s development in classrooms, even after accounting for classroom interactions. Professional development for teachers and measurement in classroom research should address teacher–child relationships in addition to classroom interactions.

     

Significant differences in maternal child‐feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

Background

Nonresponsive maternal child‐feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self‐regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child‐feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child‐feeding style between ethnic groups in the UK , taking into account associated factors such as deprivation and parenting style.

Methods

Six hundred and fifty‐nine UK mothers with a child who was aged 5–11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

Results

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child‐feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

Conclusions

Understanding cultural factors behind maternal child‐feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK .