Improving inexperienced raters' evaluations of day care quality through the use of a guide

The present study demonstrates that inexperienced female raters provided with a Parent Guide to Quality Day Care Centers (experimental group) made more discriminating judgments of day care center quality than did a similar group of female raters who were not provided with the guide until several days after visiting the same centers (control group). The indices of quality included a global nine-point rating scale and the number of items from the guide that were observed in the centers. The experimental group made global ratings of quality (on the nine-point ratings scale) that were highly similar to those made on the same centers by a group of local day care professionals. Finally, as compared to the professionals' judgments, the raters, particularly those in the control group, overestimated the quality of a subset of centers that served primarily black clientele.Reprints and an extended version of this paper can be obtained from Marilyn R. Bradbard, Department of Child and Family Development, Auburn University, Auburn, Alabama 36830.     

Increasing quality in early care and learning environments

High‐quality care is essential to the optimal development of young children. While many children attend childcare away from the home for an average of six hours per day, the environment is not necessarily of the highest quality. An assessment of the indoor and outdoor space, curriculum and activities, teacher and child interactions, materials, equipment, nutrition and health factors can yield critical information for parents and center administrators, teachers and staff. This study provides outcome information in regard to a state‐funded Enhancement Grant project in which childcare facilities' personnel were provided with professional development activities to assist them in evaluating their early care and learning programs, and planning and implementing enhancement activities. After three years, a significant improvement resulted in several areas critical to high‐quality care for young children.     

Increasing quality in early care and learning environments

High-quality care is essential to the optimal development of young children. While many children attend childcare away from the home for an average of six hours per day, the environment is not necessarily of the highest quality. An assessment of the indoor and outdoor space, curriculum and activities, teacher and child interactions, materials, equipment, nutrition and health factors can yield critical information for parents and center administrators, teachers and staff. This study provides outcome information in regard to a state-funded Enhancement Grant project in which childcare facilities' personnel were provided with professional development activities to assist them in evaluating their early care and learning programs, and planning and implementing enhancement activities. After three years, a significant improvement resulted in several areas critical to high-quality care for young children.     

Professional perceptions about home safety: cross-national validation of the Home Falls and Accidents Screening Tool (HOME FAST)

The Home Falls and Accidents Screening Tool (HOME FAST) was developed to measure the risk of older people falling within their home environment. If this tool is to be effective, the underlying dimensions perceived by potential raters when using the HOME FAST need to be consistent with the purpose of the tool. The content validation process undertaken to evaluate the HOME FAST and a method to develop a home safety score are described. Experts in home safety assessment were recruited from the British Association of Occupational Therapy, the Chartered Society of Physiotherapists, and the Royal College of Nursing in the United Kingdom. Participants rated each HOME FAST item using a Thurstone technique format. Each item was weighted according to the level of perceived falls risk each expert attributed to the home safety item. Principal components factor analysis identified a two-factor structure interpreted as environment and function underlying the HOME FAST. Results indicated that no item should be deleted from the checklist. Weights were calculated for each item to generate an overall hazard score. Some differences in responses to the degree of risk associated with home safety items were noted between the professional groups. The HOME FAST has captured highly relevant home safety items considered by an expert panel and measures a domain applicable to home safety and falls risk.     

Parents' selections of proprietary day care centers for their school-age children: A study of three southeastern University Communities

A sample of 145 parents whose 5- to 12-year-old children attended one of 25 profit-making day care centers located in three southeastern states completed a questionnaire designed to determine how and why they selected day care for their school-age children. Results revealed that the typical parent visited two or three centers, including the one they ultimately selected, before making a choice. Parents' most common first source of information about day care came from friends; very few first obtained information from child development specialists, licensers, or doctors. Across the three communities, the parents' rank-ordered reasons for selecting day care were strikingly similar. Health and safety, caregiver quality, the child's social development, and the child's educational development were the most important considerations; cost was the least important consideration. In contrast to earlier research with a preschool sample, no demographic or day care selection variables were associated reliably with selecting better quality day care by these parents. Follow-up telephone interviews with 28 parents yielded several possible factors that could have operated to minimize the prediction of quality day care in the present study. Portions of this research were funded by Project ALA 00749, Alabama Agricultural Experiment Station.     

Selecting a Child Care Center: What Really Matters to Parents?

Previous research on parents' decision making concerning child care centers has attempted to evaluate the importance of various characteristics of the centers by having parents evaluate them one at a time. In an effort to better understand how parents evaluate centers when they must consider all the characteristics of the center simultaneously as is done in real life, 235 parents who were in the process of finding child care for their children were surveyed. Utilizing conjoint analysis, parents were presented with profiles of child care centers in which eight center characteristics were varied. Parents evaluated all eight characteristics simultaneously and then indicated how likely they were to select each center. Results indicated that the characteristics of child care centers that most significantly affect parents' decision-making vary based on demographic characteristics of the parents. Single mothers attend most strongly to cost in their decision making, while married mothers attend to the child/staff ratio and married fathers give relatively equal attention to four factors; cost, convenience, child/staff ratio and hours of operation. Further differences in parents' decision-making strategies were found based on parents' education and family income. These findings are discussed in light of the importance of developing child care programs which meets the needs of parents as well as children.     

How and why parents select profit-making day care programs: A study of two southeastern college communities

In this study, 86 parents whose children attended six profit-making day care centers rated as average or above-average in two southeastern college communities were interviewed to determine how and why they selected their children's day care programs. Our results indicated that these parents typically got initial information about day care through second-hand sources (e.g., theYellow Pages, over the phone, through friends and neighbors) and then visited one center—the one they ultimately enrolled their child in. Little information-seeking about day care by first-hand observations of several centers was reported. However, these parents said they selected their center because it (a) provided an educational program and (b) had a competent staff. Next most important on their list of reasons were that the center (c) was close to home, (d) charged relatively low fees, and (e) provided nutritious meals and snacks.     

Providers' evaluations of family day care services

Family day care is an informal and largely unregulated form of child care with providers a key element in creating effective programs. Relatively little is known of how providers perceive the needs of clients [parents and children] and how they evaluate the adequacy of their services in meeting family needs. Thirty-two registered home providers estimated parents' reasons for selecting family day care, and the degree to which their services met parents' and children's needs for care. They also evaluated the importance of program goals and provider qualifications and indicated their experience and training for day care. Knowledge of providers' perceptions of the quality of their services and their ability to meet client needs can help educators create training programs with appropriate content and format.     

Activities of daily living (ADL) and instrumental activities of daily living (IADL) items were stable over time in a longitudinal study on aging

OBJECTIVE: The purpose of this analysis was to examine the stability over time of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items in the Aging in Manitoba (AIM) Longitudinal Study and to evaluate the existence of differential item functioning across settings (home, nursing home). STUDY DESIGN AND SETTING: The study used data from 607 participants of the AIM Longitudinal Study who were more than 85 years of age in 1996 and who had complete data from 1983, 1990, and 1996 for all ADL and IADL items. Rasch analysis was used to examine how the rating scale of the ADL and IADL items was used by participants, and to determine if the ordering of items remained stable across three time periods (1983, 1990, 1996) and the two different settings (home, nursing home). RESULTS: The rating scale worked best when dichotomized into "received no assistance" and "receives assistance." Except for four items (making tea, making meals, doing nursing care, and going outside in any weather), the items were stable across administration periods, and across settings. CONCLUSION: The AIM can be used to evaluate changes in disability over time and may have the potential to identify those at risk for transitions in care.     

Developing a parent guide to quality day care centers

A set of items characterizing high-quality day care programs were rationally derived from the empirical literature and were presented to both day care experts and mothers of preschool children to obtain their evaluations of each item's operational clarity and face validity. The items were then revised and organized in checklist form in preparation for field testing. The items, along with a global nine-point rating scale of quality, comprise the Parent Guide to Quality Day Care Centers.     

Families' experiences of caring for technology-dependent children: a temporal perspective

In the present study, families' experiences of caring for a technology-dependent child were examined from a temporal perspective. This involved exploring the multiple 'technological', 'social' and 'natural' rhythms and routines around which the families' lives were variously structured. A purposive sample of 36 families with technology-dependent children who used one or more medical devices on a daily basis was recruited. Devices included feeding pumps, suction machines, dialysis machines and ventilators. Using mainly qualitative methods, children, parents and siblings were interviewed to establish what the care routines involved and how these impacted on family members. The authors found that the rhythms and routines of care varied across the sample, depending on the type and number of devices used, the individual child's needs, and who provided technical care during the day and/or at night at home and in other settings. While the children's health and quality of life benefited from the technology, the time demands of the care routines and lack of compatibility with other social and institutional timeframes had some negative implications for the children and their families, limiting their participation in school, employment and social life in general. The need to use and oversee the use of some medical technologies at night also meant that many parents suffered regular disruption to their sleep. In conclusion, the authors argue that the care of technology-dependent children at home places considerable time demands on families. Families have little or no access to suitably trained carers who can provide technical care required in the home or away from the home to give parents and the whole family a break from caring where required. More trained carers and short-term care provision, better coordination of services and improvements in the design of devices would all help to reduce the negative effects of the care routines on families.     

Validity Testing the Outcomes and Assessment Information Set (OASIS)

This study evaluated the criterion validity of the Outcome and Assessment Instrument Set (OASIS) items that measure activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive functioning, and depression. A convenience sample of patients (n?=?203) from five home care agencies participated in the study. Patient OASIS items were compared to data collected using gold standard instruments. Correlations range from .44 to .69 for ADLs and .20 to .68 for IADLs. A correlation of .62 was found for cognitive functioning while correlations for depressive symptoms are .36 and .26. OASIS ADLs and cognitive status items are sufficiently valid, but the OASIS depression item is not sufficiently sensitive to the prevalence of these conditions.     

Quality in child day care centres: How to promote it? A study of six day-care centres

How can research be useful for improving the quality of day care? This question is explored on the basis of a pedagogic-organization study in six Dutch day care centres. These day care centres vary considerably with regard to their basic principles, aims and/or target groups (for instance immigrant children, children at risk, working parents). A strong relationship was found between the special goals of day care centres and their quality standards. Most day care centres did not have basic rules for the operationalization of their pedagogical goals in daily practice. Almost all the day care centres were more orientated towards their own pedagogical goals and less towards parental goals and practical needs. To improve the quality of day care we need context-bound theories and evaluation studies in relation to specific aims. Day care centres also need a stronger theoretical framework for working with groups of young children and for cooperation with parents.     

A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) was developed using consensus

BACKGROUND AND OBJECTIVE: To develop a checklist of items measuring the quality of reports of randomized clinical trials (RCTs) assessing nonpharmacological treatments (NPTs). STUDY DESIGN AND SETTING: The Delphi consensus method was used to select and reduce the number of items in the checklist. A total of 154 individuals were invited to participate: epidemiologists and statisticians involved in the field of methodology of RCTs (n = 55), members of the Cochrane Collaboration (n = 41), and clinicians involved in planning NPT clinical trials (n = 58). Participants ranked on a 10-point Likert scale whether an item should be included in the checklist. RESULTS: Fifty-five experts (36%) participated in the survey. They were experienced in systematic reviews (68% were involved in the Cochrane Collaboration) and in planning RCTs (76%). Three rounds of the Delphi method were conducted to achieve consensus. The final checklist contains 10 items and 5 subitems, with items related to the standardization of the intervention, care provider influence, and additional measures to minimize the potential bias from lack of blinding of participants, care providers, and outcome assessors. CONCLUSIONS: This tool can be used to critically appraise the medical literature, design NPT studies, and assess the quality of trial reports included in systematic reviews.     

Perceptions of infant/toddler temperament in three child care settings

The relationships among different types of infant and toddler child care (at home care, family day care home and day care center) and perceived temperament were investigated. Subjects in this study included mothers, fathers and supplementary caregivers (where applicable) of 64 infants and toddlers, aged 5‐22 months from middle to upper middle class homes. Parents and supplementary caregivers (where applicable) completed the Carey Infant Temperament Questionnaire.

ANOVAs were used to assess differences of temperament perceptions between the three child care groups. There were no significant differences between the groups of parents in their perceptions of the nine temperament characteristics or overall temperament. However, caregivers from day care centers perceived the temperament of children in their care as significantly more difficult (p = 0.002) than caregivers of children in family day care homes.     

Effects of item and rater characteristics on checklist recording: what should we look for?

OBJECTIVE: Examinations based on using standardised patients (SPs) commonly use checklist recordings to evaluate students' clinical performance. This paper examines whether and to what extent item and rater characteristics affect the reliability of history checklist recording in an SP-based assessment. METHODS: Checklist items were reviewed for the presence or absence of 5 item characteristics and a 2-point versus 3-point scoring scale. Agreement between checklist recordings obtained from SPs and clinician-examiners (CEs) were compared by item characteristics, scoring scale and CEs' level of involvement in the assessment. RESULTS: Based on 3179 pairs of recordings, the overall percentage of agreement between SPs and CEs was 83% (kappa = 0.64). Agreement was significantly higher for items scored on a 2-point than on a 3-point scale, and when the CE was also the author and the trainer of the station. After controlling for other factors, item characteristics were only marginally associated with level of interrater agreement. CONCLUSIONS: This study suggests that attention should be paid to specific aspects of checklist development and checklist recording training when an SP or CE is used as recorder.     

Improving nutrition and physical activity in child care: what parents recommend

A large percentage of children in the United States spend part of their day in out-of-home child care. As rates of obesity continue to rise, especially among young children, child care has become a focus for nutrition and physical activity intervention. Parental involvement is an important component of these efforts. During summer 2006, parents of children in child care were surveyed to better understand their perceived quality of meals, snacks, and physical activity at the child-care center, and their recommendations for improvement. Parents of children who attended 94 licensed child-care centers in North Carolina were invited to complete a brief survey of perceived quality of meals, snacks, and physical activity at their centers using close-ended questions. Open-ended questions were used to identify suggestions for improvement. Five hundred eight parents from 91 child-care centers completed the questionnaire. The majority of parents reported quality of meals and snacks at the center as either excellent (30% meals, 27% snacks) or good (42% meals, 46% snacks). The main recommendations for improving meals and snacks were to increase fruits and vegetables and provide a variety of healthful foods. The majority of parents categorized the quality of physical activity at the center as excellent (36%) or good (46%), and suggested more structured, outdoor activities for children. Findings from this study provide insight into key areas of concern for parents regarding the nutrition and activity environment of child-care centers. This information may be used to create or modify interventions or policies and to help motivate parents to become advocates for change in child care.     

Sick child care options: what do working mothers prefer?

More than half of all mothers with children under age 6 are in the labor force. Working mothers must take off anywhere from 5.6 days to 28.8 days per employee per year to care for their sick children. In a survey of 134 working mothers with children in day care centers, 70% expressed an interest in sick child care options outside the home, especially a sick room at the child's regular day care center or an infirmary at the parent's workplace. Mothers who chose "out-of home care" were more likely to: be minority (p less than 0.01); be single parents (p = 0.06); earn less than $10,000 annually (p = 0.03); want their children with temperatures of 100-100.9 F to remain in school until the end of the day (p less than 0.01). Communities and day care centers serving especially lower income, minority or single-parent working mothers should consider investigating these out-of-home sick child care options; the savings to employers could be $2 to $12 billion per year, not to speak of the personal savings to the mothers themselves.     

Perspective of parents and caregivers on the influence of full-time day-care attendance on young children

The aim of this study was to explore the experience of parents and caregivers regarding young children in day care. The tiredness of children after day-care attendance was explored. In the autumn of 2009, 41 parents and 35 caregivers of children aged 1.5 years or younger living in the city of Trondheim and nearby communities were assessed using a semi-structured qualitative interview. There was agreement among parents and caregivers that children became very tired after full-time care. In spite of the good quality of the care, with a relatively low child/adult ratio and very experienced caregivers with high educational qualifications, most children became very tired at the end of the stay. Tiredness in children also seemed to accumulate during the week and reached its peak on Fridays. The children adjusted well to care; however, they got very tired when the stay lasted a full day. Children who were picked up somewhat earlier did not exhibit the same level of tiredness.