Who Gets What? Describing the Non-supervisory Training and Supports Received by Home Visiting Staff Members and its Relationship with Turnover.

The early childhood home visiting field lacks a basic understanding of home visiting program staff members' receipt of on-the-job training from experts outside of their programs who are not their immediate colleagues or supervisors. To address this gap, we created a unique dataset by asking program leaders to log the external technical assistance (TA) that staff members received, and we collected a survey from 288 of the same staff members. We performed descriptive analyses to learn how many hours of TA staff members were receiving, what topics the TA most commonly addressed, and what formats (e.g., in-person or virtual/remote, individual, or group) the TA was most commonly provided in. We then associated characteristics of the TA received with staff and program characteristics, as well as with staff members' turnover. Multilevel analyses showed the TA supports that home visiting staff members received differed by role (home visitor or supervisor) and program characteristics, including home visiting model-Nurse Family Partnership (NFP) or Parents as Teachers (PAT)-program size, and maturity. About 23% of the home visiting staff members left their programs over the course of 18 months. PAT staff members were more likely to leave their programs than NFP staff members. We did not find that characteristics of TA received were predictive of staff members' turnover. Implications and the need for further research are discussed.

A structured management approach to implementation of health promotion interventions in Head Start.

Improving the health and health literacy of low-income families is a national public health priority in the United States. The federal Head Start program provides a national infrastructure for implementation of health promotion interventions for young children and their families. The Health Care Institute (HCI) at the Anderson School of Management at the University of California, Los Angeles, developed a structured approach to health promotion training for Head Start grantees using business management principles. This article describes the HCI approach and provides examples of implemented programs and selected outcomes, including knowledge and behavior changes among Head Start staff and families. This prevention-focused training platform has reached 60,000 Head Start families in the United States since its inception in 2001. HCI has demonstrated consistent outcomes in diverse settings and cultures, suggesting both scalability and sustainability.

Effective intervention for expressive grammar in children with specific language impairment.

BACKGROUND: Children with specific language impairment are known to struggle with expressive grammar. While some studies have shown successful intervention under laboratory conditions, there is a paucity of evidence for the effectiveness of grammar treatment in young children in community settings. AIM: To evaluate the effectiveness of a school-based intervention programme for expressive grammar in 5-year-olds with specific language impairment. METHOD & PROCEDURES: Thirty-four 5-year-old children attending a specialized school for children with language impairment participated in the study. Nineteen children received treatment for expressive grammar (experimental group) and 15 children received a control treatment. Treatment consisted of weekly 1-h sessions of small group activities in a classroom setting for 8 weeks. Techniques included direct instruction, focused stimulation, recasting and imitation. OUTCOMES & RESULTS: Results were analysed at the group level and as a case series with each child as their own control in a single-subject design. There was a significant difference in grammatical performance pre- and post-treatment for children who received grammar treatment (Cohen's d = 1.24), but not for a group of children who received a control treatment. Further, no difference in performance was found in the equivalent time period prior to treatment, nor for an untreated target. Treatment success was more pronounced in children without articulation difficulties which interfered with their ability to produce the grammatical targets (Cohen's d = 1.66). Individual analyses indicated the treatment effect was significant for the majority of children. CONCLUSIONS & IMPLICATIONS: Individually targeted intervention delivered in small groups in a classroom setting was effective in improving production of expressive grammatical targets in 5-year-old children with specific language impairment.

Integrating partner professionals. The Early Explorers project: Peers Early Education Partnership and the health visiting service.

BACKGROUND: A range of voluntary sector organizations are involved in the delivery of services to children, particularly within the Early Year's sector and children's centres. Peers Early Education Partnership (PEEP) Early Explorers project is one example of the way in which explicit partnerships are being forged across statutory and voluntary sectors with the aim of improving outcomes for children and families. This paper reports an exploration of stakeholder views and experiences of two Early Explorer clinics located in areas of high deprivation. METHODS: Semi-structured interviews were conducted with a purposive sample of stakeholders (n= 25) from children's centres, PEEP, the health visiting service and service users. Data were fully transcribed and analysed using a thematic approach. RESULTS: The data suggest that the two key groups of stakeholders providing Early Explorer clinics (i.e. health visitors and PEEP practitioners) had quite different objectives in terms of their early goals for the clinic, but that despite these differences good progress was achieved in terms of working together effectively. All stakeholders including service users referred to the presence of PEEP as having improved the quality of the clinic environment, and participating mothers identified a wide range of benefits from the enhanced service. However, somewhat restricted views about the role of practitioners within the clinics were identified by users, and the findings suggest that although the early goals for the clinic had been exceeded, these may have been limited in terms of true 'partnership' working. CONCLUSIONS: Early Explorer clinics appeared to have enhanced the service provided within traditional child health clinics and to have provided practitioners with access to hard-to-reach families and parents with access to services that are consistent with the broader policy aims of improving parent-infant interaction. However, questions remain as to whether the benefit of 'partnership' working was fully realized.

Empowering Head Start to improve access to good oral health for children from low income families.

Surveys over 20 years have documented worsening in the dental health of preschoolers. Healthy People 2010 Midcourse Review reports the country moving away from oral health goals for young children; the slip is 57%. Exacerbating this is the inability of Medicaid to provide for those in need. Most children receive examinations only: few receive comprehensive care. We urge Head Start grantees to adopt a new approach to oral health goals and in this paper offer: (1) a review of the problem and premises preventing a solution; (2) a proposal that Head Start adopt a public health perspective; and (3) specific roles staff and dental personnel can take to mount aggressive strategies to arrest tooth decay at the grantee site.

Cultural competence in occupational therapists working in early intervention therapy programs.

BACKGROUND: Cultural competence promotes equity in health care outcomes and ensures that occupational therapists support clients in culturally relevant daily activities. However, it is unclear to what extent occupational therapists in early intervention therapy (EIT) settings practise cultural competence. PURPOSE: To explore how occupational therapists working in EITsettings work towards cultural competence in practice. METHODS: Qualitative methods in the ethnographic tradition were used to explore five occupational therapists' experiences of working with culturally diverse clients. FINDINGS: Four major themes emerged from the data: (1) learning about culture; (2) applying cultural knowledge; (3) reflecting on culture; (4) family-centred partnerships. The first three themes occurred as a dynamic learning process within the context of family-centred partnerships. The findings corresponded with existing models; however, discussions lacked critical examination of power relationships. Implications. Occupational therapists could develop cultural competence further by engaging in reflexive practice and taking actions to promote equity in healthcare outcomes.

How can parents get involved in preschool? Barriers and engagement in education by ethnic minority parents of children attending Head Start.

An intervention was developed to promote parent involvement with ethnic minority families of children attending Head Start preschool programs. Two hundred eighty-eight predominantly African American families from a small southern city were included in this study. Parent satisfaction with the program was high, yet engagement was less than optimal. Some effects were found for the program, despite low levels of participation. Ethnic minority parents who received the intervention increased the frequency of reading to their child as compared with parents in a comparison group who did not receive the program. The quality of the parent-teacher relationship was significantly correlated with parental participation in the intervention. Program participation and the parent-teacher relationship were correlated with higher levels of children's school readiness abilities. Children in the intervention condition showed stronger end-of-year receptive vocabulary and parent-rated social competence as compared with children who did not receive treatment. This research documents the challenges involved in engaging parents in prevention programs. Strategies for maximizing the benefits of preschool for ethnic minority families and their children are discussed.

[Challenges facing health promotion during early childhood]. / Herausforderungen bei der Gesundheitsförderung im frühen Kindesalter.

The issue of health promotion during the early childhood years is primarily geared towards parents. They should be assisted while developing their health care and educational skills so that they can promote the healthy development of their children. It is also important to strengthen communicators in their work with families. Most children nowadays are physically healthy, but certain health-related risks have increased. Children from families with a low social status are affected the most. Furthermore, early childhood intervention programs have been set up which are aimed at the early and long-term improvement of development opportunities for children and families. These also contribute to ensuring that children enjoy a healthy upbringing and safeguard their rights to protection, support, and participation. Health promotion offers range from education to counseling and extend to outreach work. Among the challenges are the widespread education of parents, promotion of participation, the advancement of key player networking, and improved quality assurance.

Working in partnership with the voluntary sector: early explorer clinics.

The first three years of life have been identified as key to promoting children's later wellbeing, and partnership working across the statutory and voluntary sectors has been proposed as one of the best ways to meet the needs of families. Child health clinics are attended by parents seeking reassurance or help and advice from a health professional regarding child health and development. They have been used in Oxford to develop Early Explorer clinics, in which the statutory health visiting service and voluntary sector Peers Early Education Programme work together with the aim of improving outcomes for children and families. These Early Explorer clinics provide the opportunity to engage parents in supporting their child's development through interaction and non-directed exploratory play. They also offer opportunities to identify vulnerable families, who are provided with additional support. This paper examines a model of partnership working between statutory and voluntary sectors aimed at maximising opportunities to promote the health and wellbeing of infants and their families.

Determining eLearning Preferences to Inform Beverage Policy Training for Early Care and Education Teachers.

OBJECTIVE: To determine the eLearning preferences of early care and education (ECE) teachers for an effective beverage policy training. METHODS: Mixed methods study conducted with ECE directors and teachers in 6 regions throughout Georgia. Researchers used an eLearning survey (n = 646) along with focus groups (n = 6) and interviews (n = 24) to determine eLearning preferences and preferred eLearning format. Descriptive statistics and qualitative content analysis were used for data analysis. RESULTS: Most ECE teachers in Georgia (85%) have never had a beverage policy training. Participants (48%) reported they would definitely use the Internet for training. Qualitative analysis revealed key themes; training should be engaging, concise, hold the trainees accountable, and be interactive. Interactive video is the preferred eLearning format. CONCLUSIONS AND IMPLICATIONS: Interventions that promote national beverage recommended in the ECE setting are critically needed. Study findings may inform other states about the feasibility of using eLearning to provide beverage policy training for ECE providers in other states.

Nothing about us without us: involving families in early support.

Early Support is the England-wide government programme to achieve child-centred and family-focused services for children aged nought to five years with a disability or complex need and their families. Integral to the ethos of Early Support is the understanding that every decision should be influenced and led by children and families. Families are expected to play a strategic role in the development and monitoring of policy and practice, and the service is expected to be proactive in seeking their views. Section 242(1B) of the NHS Act 2006 now places a duty to involve service users in planning the provision of services, changes to services and the operation of services. Yet for many frontline staff, user involvement and partnership working in this way presents real challenges. Using a framework based on principles of interpretive phenomenology, this paper documents efforts to ensure that the stories of families are heard and used to inform the development of proposals for Early Support in Bedfordshire and explores ways to overcoming barriers to meaningful user-involvement.

Reaching kids: partnering with preschools and schools to improve children's health.

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of grantmakers and education experts on May 27, 2009, for an informative discussion about ways in which preschools and schools are working to improve outcomes related to children's health. The Issue Dialogue Reaching Kids: Partnering with Preschools and Schools to Improve Children's Health synthesized the latest research on health-related issues affecting children's educational outcomes. It also provided illustrative examples of foundation-driven initiatives aimed at promoting collaborations between the health and education sectors to improve children's health and development outcomes. This Issue Brief summarizes background materials compiled for the meeting and highlights key themes and findings that emerged from the day's discussion among meeting participants.

Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge.

The purpose of this study was to evaluate the impact of access to communication technology on caregiver quality of life, neurodevelopmental, and medical outcomes (eg, rehospitalization, emergency room visits, or surgeries) in preterm infants, and enrollment in public assistance programs. In this cross-sectional study, we surveyed families of preterm infants in a high-risk infant-follow-up clinic. We estimated associations of access to various modes of communication technology with outcomes, adjusting for sociodemographic and infant characteristics using linear and unconditional logistic regression. Access to email, text messaging, and smartphones was associated with higher quality of life scores on the Multicultural Quality of Life Index, and email and smartphone access was significantly associated with increased enrollment in early intervention. Evaluating smartphone and email access on neonatal intensive care unit discharge is important when considering enrollment in community programs and caregiver quality of life.

[Prevention of risks to children on the basis of early intervention and interdisciplinary cooperation in the example of the model project "a good start to life"]. / Prävention von Kindeswohlgefährdung auf der Basis früher Hilfen und interdisziplinärer Kooperation am Beispiel des Modellprojekts "Guter Start ins Kinderleben"

Infants and toddlers are at high risk of neglect and maltreatment, as they are especially dependent on the care and the safeguard of their parents. Child protection can only succeed if early and preventive support for families at risk and their infants is provided. The project "A good start to life" helps to promote parental sensitive behaviour and care giving competence of parents in precarious life settings and in high risk situations and is aimed to prevent child neglect and abuse at an early age. A relevant prerequisite for child protection is interdisciplinary networking between the involved systems. The main focus of the project is the establishment of collaboration and network structures between the infant and youth welfare system and the health-care system and their services in eight communities in four states in Germany by using so-called round tables as communication platforms. Preliminary results of the round tables are reported in this article together with the results of the evaluation process.

Implementation research for early childhood development programming in humanitarian contexts.

Young children living in conditions of war, disaster, and displacement are at high risk for developmental difficulties that can follow them throughout their lives. While there is robust evidence supporting the need for early childhood development (ECD) in humanitarian settings, implementation of ECD programming remains sparse, largely due to the lack of evidence of how and why these programs can improve outcomes in humanitarian settings. In order to build the evidence base for ECD in humanitarian settings, we review the current state of implementation research for ECD programming (targeting children 0-8) in humanitarian settings, through a literature review and a series of key informant interviews. Drawing from existing frameworks of implementation research and the findings from our analysis, we present a framework for ECD implementation research in humanitarian settings and propose an agenda for future research.

Building capacity in health and education systems to deliver interventions that strengthen early child development.

Building capacity within health and education systems of low- and middle-income countries in order to deliver high-quality early childhood services requires coordinated efforts across sectors, effective governance, sufficient funding, an adequate workforce, reliable data systems, and continuous monitoring, evaluation, and improvement cycles; it also requires partnerships with the private sector, communities, and parents. In addition, building capacity requires leadership, innovation of strategies to fit into existing structures, evidence-based intervention models, and effective partnerships that help make interventions more culturally relevant, help finance them, and help create institutional long-term support and sustainability for them. In this article, we focus on identifying eight critical aspects of enabling systemic support for early childhood services. Every action that strengthens these critical aspects should be seen as necessary, but insufficient, steps toward a national strong governance structure for delivering a locally relevant and comprehensive early child development program that promotes children's developmental potentials.

A Multicomponent Early Intervention Program and Trajectories of Behavior, Cognition, and Health.

OBJECTIVES: To investigate the developmental impact of a prenatal-to-age-5 multicomponent early intervention program targeting families living in low socioeconomic conditions. METHODS: Pregnant women from a disadvantaged Irish community were randomly assigned into a treatment group (home visits, baby massage, and parenting program; n = 115) or control group (n = 118). Children's behavioral problems (externalizing, internalizing), cognitive skills (general, vocabulary), and health service use (number of health clinic visits), were regularly assessed (6 months to 4 years of age). Children's developmental trajectories were modeled by using latent class growth analyses to test whether certain subgroups benefited more than others. RESULTS: High and low developmental trajectories were identified for each outcome. Treated children were more likely to follow the high-level trajectory for cognition (odds ratio = 2.89; 95% confidence interval = 1.55-5.50) and vocabulary skills (odds ratio = 2.02; 95% confidence interval = 1.08-3.82). There were no differences by treatment condition in the risk of belonging to a high externalizing or high health clinic visit trajectory. However, within the high externalizing trajectory, treated children had lower scores than controls (Hedges' g range (2-4 years) = 0.45-0.58; P < .05) and, within the high health clinic visit trajectory, only children in the control group experienced an increasing number of visits. CONCLUSIONS: This program revealed moderate positive impacts on trajectories of cognitive development and number of health clinic visits for all children, whereas positive impacts on externalizing behavior problems were restricted to children with the most severe problems.

Limited access to special education services for school-aged children with developmental delay.

BACKGROUND: Current policy in Oregon limits eligibility of children diagnosed with developmental delay for school-based services. Due to eligibility definitions, children with developmental delay may face additional barriers transitioning from early intervention/early childhood special education into school-based special education services. AIMS: Examine the relationship between enrollment in school-based special education programs given a change in primary disability diagnosis. METHODS: Logistic regression models were fit for children who enrolled in early intervention/early childhood special education services with a primary disability diagnosis of developmental delay and changed primary disability diagnosis before third grade (n=5076). RESULTS: Odds of enrollment in future special education were greater in children with a change in primary disability diagnosis after the age of five in comparison to children that had a change in primary disability diagnosis before the age of five, while adjusting for demographic characteristics (adjusted odds ratio: 2.37, 95% CI 1.92, 2.92). CONCLUSION: Results suggest that children who are diagnosed with a developmental delay and exit early childhood special education due to maximum age of eligibility are more likely to enroll in special education compared to children without a gap in service access. IMPLICATIONS: Gaps in service access during early development are associated with the need for supportive services later on in life.