Virtual robotic telepresence early childhood mental health consultation to childcare centers in the aftermath of COVID-19: training approaches and perceived acceptability and usefulness.

Introduction: Childcare center closures during COVID-19 impacted education for approximately 40 million children nationwide. Unfortunately, COVID-19 restrictions significantly limited the extent that outside personnel could provide in-person support to educators, resulting in the need for innovative approaches to meet childcare centers' needs. A virtual robotic telepresence approach was applied to early childhood consultation models to promote child resilience while mitigating COVID-19 risks. The goal of this study was to examine how training influenced consultants' and childcare staff uptake of the virtual robotic telepresence consultation approach and their acceptance of this technology. Methods: Ten early childhood consultants received multimedia/simulation training and weekly communities of practice related to virtual telepresence robotic consultation. Telepresence robotic consultation equipment was deployed to 16 childcare centers in a diverse multilingual metropolitan area as a part of a larger randomized controlled trial. Consultants trained childcare staff (14 center directors and 58 teachers) on how to receive virtual telepresence robotic consultation. Demographic information and measures of technology acceptability and uptake were collected from childcare staff and consultants. A mixed methods approach was used including multilevel modeling and focus groups to examine consultation uptake, acceptability, barriers, and facilitators of virtual telepresence robotic consultation implementation. Results: Consultants and childcare staff generally perceived the virtual telepresence consultation approach to be useful and easy to use. Consultant perceptions of the acceptability of technology did not change over time. Childcare staff, center, and consultant factors impacted the uptake of the virtual robotic telepresence consultation approach and childcare staff acceptance of the technology. Focus groups revealed that consultants believed that additional hands-on training with childcare staff would have benefited implementation and expressed a desire for a hybrid approach for consultation. Discussion: Perceptions of telepresence robotic consultation acceptability are discussed, including future recommendations for training.

Initial validation of the Health Environment Rating Scale-Early Childhood Consultation-Classroom (HERS-ECC-C).

The present study validated a newly developed easy-to-use observational instrument, the Health Environment Rating Scale-Early Childhood Consultation-Classroom version (HERS-ECC-C), to measure the quality of the classroom environment within early care and education centers participating in a mental health consultation program in a diverse area of the southeastern United States. Using a confirmatory factor analysis, three factors emerged capturing critical aspects of a high-quality classroom environment and demonstrated good reliability: (1) Supportive Practices, Positive Socioemotional Practices, and Classroom Management (α = .88), (2) Health and Family Communication (α = .79), and (3) Individualizing to Children's Needs (α = .80). Criterion-related validity was established through concurrent associations between the three HERS-ECC-C subscales and the domains of the Classroom Assessment Scoring System (CLASS) and predictive associations with the Childcare Worker Job Stress Inventory. The HERS-ECC-C Supportive Practices and Health and Family Communication subscales were associated with all three CLASS domains, and the Individualizing to Children's Needs subscale was associated with the CLASS Instructional support domain. Higher HERS-ECC-C subscale scores were associated with lower teacher-reported job stress. Findings provide initial evidence to support the use and continued development of the HERS-ECC-C as a tool to evaluate programs and classrooms engaged in mental health consultation professional development interventions.

Automated measures of vocal interactions and engagement in inclusive preschool classrooms.

Classroom engagement plays a crucial role in preschoolers' development, yet the correlates of engagement, especially among children with autism spectrum disorder (ASD) and developmental delays (DD), remains unknown. This study examines levels of engagement with classroom social partners and tasks among children in three groups ASD, DD, and typical development (TD). Here, we asked whether children's vocal interactions (vocalizations to and from peers and teachers) were associated with their classroom engagement with social partners (peers and teachers) and with tasks, and whether the association between classroom engagement and vocal interactions differed between children in the ASD group and their peers in the DD and TD groups. Automated measures of vocalizations and location quantified children's vocal interactions with peers and teachers over the course of the school year. Automated location and vocalization data were used to capture both (1) children's vocal output to specific peers and teachers, and (2) the vocal input they received from those peers and teachers. Participants were 72 3-5-year-olds (Mage = 48.6 months, SD = 7.0, 43% girls) and their teachers. Children in the ASD group displayed lower engagement with peers, teachers, and tasks than children in the TD group; they also showed lower engagement with peers than children in the DD group. Overall, children's own vocalizations were positively associated with engagement with social partners. Thus, although children in the ASD group tend to have lower engagement scores than children in the TD group, active participation in vocal interactions appears to support their classroom engagement with teachers and peers.

Designing a virtual mental health consultation program to support and strengthen childcare centers impacted by COVID-19: A randomized controlled trial protocol.

BACKGROUND: The COVID-19 pandemic has had negative psychosocial impacts on young children; teachers in childcare centers continue to be overwhelmed by how to address the downstream psychological effects children are experiencing. This randomized controlled trial will study the role of a community-based, childcare center-support system in improving resilience and mitigating the long-term impacts of COVID-19 on children's development. METHODS: This study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID 19 Support (JS + CS) virtual toolkit to childcare centers in Miami-Dade County via a Kubi robot. The toolkit comprises four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. Our first aim will utilize a cluster randomized trial to examine the effectiveness of JS + CS on improving the psychosocial functioning of young children, as compared to an obesity prevention intervention control group. Children will be followed at 6, 12, 18, and 24 months. The second aim will examine the mechanisms that contribute to effective uptake by teachers of the JS + CS support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. CONCLUSION: This design will inform the refinement and scaling of JS + CS and generalize impacts to other childcare center interventions in the context of disasters.

Development and initial validation of the Spanish form of the adjustment scales for preschool intervention (ASPI).

The purpose of the study was to develop and validate a Spanish language form of the Adjustment Scales for Preschool Intervention (ASPI) for use by early childhood teachers. A multi-step, mixed method adaptation and translation process of the English form was used to increase the cultural relevance, linguistic comparability, and metric equivalence of the measure in its Spanish language form. Exploratory and confirmatory factor analyses in a diverse sample of preschool children from low-income families (N = 4077) revealed two higher order behavioral dimensions of Overactivity and Underactivity. ASPI dimension scores across Spanish and English language forms were horizontally equated through IRT. Criterion-related validity using multilevel models was established through concurrent associations with social, emotional, behavioral, and academic readiness skills. Policy and practice applications, and future directions for the use of scale scores are discussed.

Parent concerns regarding paediatric obesity in community-based programmes serving children with developmental disabilities.

BACKGROUND: Previous studies show a higher prevalence of obesity among preschool-age children with developmental disabilities (DDs) versus children who are typically developing (TD). Little is known about parent concerns about obesity in young children with DD. The purpose of this study was to examine concerns regarding paediatric obesity among parents who had a preschool-age child with DD compared with parents with a child who is TD. METHODS: A cross-sectional analysis occurred at baseline entry into one of three community-based programmes. Parents of a child with DD (n = 815) or TD (n = 563) were asked obesity-related questions about their child and in general. Multinomial and logistic regression unadjusted and adjusted models were run to generate the odds of obesity concerns based on disability status. RESULTS: The average child age was 38 months. Parent concerns about paediatric obesity differed by disability status. Unadjusted odds of parents 'doing anything to control their child's weight' was 38% lower among parents of a child with DD versus TD (OR: 0.62, 95% CI: 0.48, 0.82). The adjusted odds of perceiving that their child was underweight was 83% higher among parents of a child with DD compared with parents of a child who is TD (aOR: 1.83, 95% CI: 1.27, 2.64). Parents of a child with DD were 179% more likely to believe that childhood obesity is a public health problem (aOR: 2.79, 95% CI: 1.88, 3.96). The models were adjusted for age, sex and race/ethnicity. CONCLUSIONS: Findings indicate that parents of preschool-age children with DD are more likely to acknowledge that obesity is a public health concern. Because some parents of children with DD are concerned about their child's weight, families of preschool-age children with DD may be receptive to the delivery of healthy weight strategies in community-based programs.

Developmental impacts of the COVID-19 pandemic on young children: a conceptual model for research with integrated administrative data systems.

The COVID-19 pandemic made its mark on the entire world, upending economies, shifting work and education, and exposing deeply rooted inequities. A particularly vulnerable, yet less studied population includes our youngest children, ages zero to five, whose proximal and distal contexts have been exponentially affected with unknown impacts on health, education, and social-emotional well-being. Integrated administrative data systems could be important tools for understanding these impacts. This article has three aims to guide research on the impacts of COVID-19 for this critical population using integrated data systems (IDS). First, it presents a conceptual data model informed by developmental-ecological theory and epidemiological frameworks to study young children. This data model presents five developmental resilience pathways (i.e. early learning, safe and nurturing families, health, housing, and financial/employment) that include direct and indirect influencers related to COVID-19 impacts and the contexts and community supports that can affect outcomes. Second, the article outlines administrative datasets with relevant indicators that are commonly collected, could be integrated at the individual level, and include relevant linkages between children and families to facilitate research using the conceptual data model. Third, this paper provides specific considerations for research using the conceptual data model that acknowledge the highly-localised political response to COVID-19 in the US. It concludes with a call to action for the population data science community to use and expand IDS capacities to better understand the intermediate and long-term impacts of this pandemic on young children.

Language Skills, Behaviour Problems, and Classroom Emotional Support among Preschool Children from Low-income Families.

The purpose of this study was to examine the relationship between language skills and behavioural problems and the potential moderating role of the quality of classroom emotional support in this relationship among 242 preschool children from low-income families. The Preschool Language Scale-5 was administered individually to each child. The quality of classroom emotional support was measured using the Emotional Support domain of the Classroom Assessment Scoring System for Pre-Kindergarten. Teachers and parents completed the Child Behaviour Checklist for Ages 1½-5. Results indicated the inverse relationship between language skills and behaviour problems varied by the level of classroom emotional support provided by teachers. Specifically, children with lower language skills exhibited higher levels of behaviour problems in classrooms where teachers provided lower levels of emotional support. Findings from this study have important implications for enhancing teachers' emotional support aimed at children with lower language skills and for future research.

Centering Predictor Variables in Three-Level Contextual Models.

Hierarchical data are becoming increasingly complex, often involving more than two levels. Centering decisions in multilevel models are closely tied to substantive hypotheses and require researchers to be clear and cautious about their choices. This study investigated the implications of group mean centering (i.e., centering within context; CWC) and grand mean centering (CGM) of predictor variables in three-level contextual models. The goals were to (a) determine equivalencies in the means and variances across the centering options and (b) use the algebraic relationships between the centering choices to clarify the interpretation of the estimated parameters. We provide recommendations to assist the researcher in making centering decisions for analysis of three-level contextual models.

Latent profiles of problem behavior within learning, peer, and teacher contexts: identifying subgroups of children at academic risk across the preschool year.

Employing a developmental and ecological model, the study identified initial levels and rates of change in academic skills for subgroups of preschool children exhibiting problem behavior within routine classroom situations. Six distinct latent profile types of emotional and behavioral adjustment were identified for a cohort of low-income children early in the preschool year (N=4417). Profile types provided a descriptive picture of patterns of classroom externalizing, internalizing, and situational adjustment problems common to subgroups of children early in the preschool year. The largest profile type included children who exhibited low problem behavior and were characterized as well-adjusted to the preschool classroom early in the year. The other profile types were characterized by distinct combinations of elevated internalizing, externalizing, and situational problem behavior. Multinomial logistic regression identified younger children and boys at increased risk for classification in problem types, relative to the well-adjusted type. Latent growth models indicated that children classified within the extremely socially and academically disengaged profile type, started and ended the year with the lowest academic skills, relative to all other types. Implications for future research, policy, and practice are discussed.

Methodological considerations in using complex survey data: an applied example with the Head Start Family and Child Experiences Survey.

Complex survey data are collected by means other than simple random samples. This creates two analytical issues: nonindependence and unequal selection probability. Failing to address these issues results in underestimated standard errors and biased parameter estimates. Using data from the nationally representative Head Start Family and Child Experiences Survey (FACES; 1997 and 2000 cohorts), three diverse multilevel models are presented that illustrate differences in results depending on addressing or ignoring the complex sampling issues. Limitations of using complex survey data are reported, along with recommendations for reporting complex sample results.

Complex sample data recommendations and troubleshooting.

Complex survey data, as highlighted in this issue of Evaluation Review, provide a wealth of opportunities for answering methodological and/or applied research questions. However, the analytic issues of nonindependence and unequal selection probability must be addressed when analyzing this type of data. Thus, to ensure that research questions are accurately answered when using complex survey data, researchers must take extra precautions to ensure complex survey data are correctly analyzed. The purpose of this article is to provide software recommendations for analysis of and tips on troubleshooting when analyzing complex sample data.

The role of context in preschool learning: a multilevel examination of the contribution of context-specific problem behaviors and classroom process quality to low-income children's approaches to learning.

Research suggests that promoting adaptive approaches to learning early in childhood may help close the gap between advantaged and disadvantaged children. Recent research has identified specific child-level and classroom-level variables that are significantly associated with preschoolers' approaches to learning. However, further research is needed to understand the interactive effects of these variables and determine whether classroom-level variables buffer the detrimental effects of child-level risk variables. Using a largely urban and minority sample (N=275) of preschool children, the present study examined the additive and interactive effects of children's context-specific problem behaviors and classroom process quality dimensions on children's approaches to learning. Teachers rated children's problem behavior and approaches to learning and independent assessors conducted classroom observations to assess process quality. Problem behaviors in structured learning situations and in peer and teacher interactions were found to negatively predict variance in approaches to learning. Classroom process quality domains did not independently predict variance in approaches to learning. Nonetheless, classroom process quality played an important role in these associations; high emotional support buffered the detrimental effects of problem behavior, whereas high instructional support exacerbated them. The findings of this study have important implications for classroom practices aimed at helping children who exhibit problem behaviors.

Modeling early retinal development with human embryonic and induced pluripotent stem cells.

Human pluripotent stem cells have the potential to provide comprehensive model systems for the earliest stages of human ontogenesis. To serve in this capacity, these cells must undergo a targeted, stepwise differentiation process that follows a normal developmental timeline. Here we demonstrate the ability of both human embryonic stem cells (hESCs) and induced pluripotent stem (iPS) cells to meet these requirements for human retinogenesis. Upon differentiation, hESCs initially yielded a highly enriched population of early eye field cells. Thereafter, a subset of cells acquired features of advancing retinal differentiation in a sequence and time course that mimicked in vivo human retinal development. Application of this culture method to a human iPS cell line also generated retina-specific cell types at comparable times in vitro. Lastly, altering endogenous signaling during differentiation affected lineage-specific gene expression in a manner consistent with established mechanisms of early neural and retinal cell fate determination. These findings should aid in the investigation of the molecular events governing retinal specification from human pluripotent stem cells.

Regulation of prenatal human retinal neurosphere growth and cell fate potential by retinal pigment epithelium and Mash1.

During development of the central nervous system, stem and progenitor cell proliferation and differentiation are controlled by complex inter- and intracellular interactions that orchestrate the precise spatiotemporal production of particular cell types. Within the embryonic retina, progenitor cells are located adjacent to the retinal pigment epithelium (RPE), which differentiates prior to the neurosensory retina and has the capacity to secrete a multitude of growth factors. We found that secreted proteinaceous factors in human prenatal RPE conditioned medium (RPE CM) prolonged and enhanced the growth of human prenatal retinal neurospheres. The growth-promoting activity of RPE CM was mitogen-dependent and associated with an acute increase in transcription factor phosphorylation. Expanded populations of RPE CM-treated retinal neurospheres expressed numerous neurodevelopmental and eye specification genes and markers characteristic of neural and retinal progenitor cells, but gradually lost the potential to generate neurons upon differentiation. Misexpression of Mash1 restored the neurogenic potential of long-term cultures, yielding neurons with phenotypic characteristics of multiple inner retinal cell types. Thus, a novel combination of extrinsic and intrinsic factors was required to promote both progenitor cell proliferation and neuronal multipotency in human retinal neurosphere cultures. These results support a pro-proliferative and antiapoptotic role for RPE in human retinal development, reveal potential limitations of human retinal progenitor culture systems, and suggest a means for overcoming cell fate restriction in vitro.

Long-term vision rescue by human neural progenitors in a rat model of photoreceptor degeneration.

PURPOSE: As a follow-up to previous studies showing that human cortical neural progenitor cells (hNPC(ctx)) can sustain vision for at least 70 days after injection into the subretinal space of Royal College of Surgeons (RCS) rats, the authors examined how functional rescue is preserved over long periods and how this relates to retinal integrity and donor cell survival. METHODS: Pigmented dystrophic RCS rats (n = 15) received unilateral subretinal injections of hNPC(ctx) at postnatal day (P) 21; control rats (n = 10) received medium alone and were untreated. All animals were maintained on oral cyclosporine A. Function was monitored serially by measuring acuity (using an optomotor test) and luminance thresholds (recording from the superior colliculus) at approximately P90, P150, and P280. Eyes were processed for histologic study after functional tests. RESULTS: Acuity and luminance thresholds were significantly better in hNPC(ctx)-treated animals than in controls (P < 0.001) at all time points studied. Acuity was greater than 90%, 82%, and 37% of normal at P90, P150, and P270, whereas luminance thresholds in the area of best rescue remained similar the whole time. Histologic studies revealed substantial photoreceptor rescue, even up to P280, despite progressive deterioration in rod and cone morphology. Donor cells were still present at P280, and no sign of donor cell overgrowth was seen. CONCLUSIONS: Long-term rescue of function and associated morphologic substrates was seen, together with donor cell survival even in the xenograft paradigm. This is encouraging when exploring further the potential for the application of hNPC(ctx) in treating retinal disease.

A novel serum-free method for culturing human prenatal retinal pigment epithelial cells.

PURPOSE: Established techniques for culturing primary human retinal pigment epithelial (RPE) cells have facilitated the laboratory investigation of this multipurpose retinal cell layer. However, most culture methods involve the use of animal serum to establish and maintain RPE monolayers, which can complicate efforts to define and study factors involved in the maturation and function of these cells. Therefore, this study was conducted to develop a simple, serum-free system to propagate and sustain human RPE in vitro. METHODS: RPE was dissected from human prenatal donor eyes and cultured in serum-free defined medium containing the commercially formulated supplement B27 or N2. Cultures were grown initially as adherent tissue sections or suspended spherical aggregates and later expanded and maintained as monolayers. PCR, Western blot analysis, and immunocytochemistry were used to monitor gene and protein expression in established cultures, followed by examination of secretory products in RPE conditioned medium by ELISA and mass spectrometric analysis. RESULTS: In medium supplemented with B27, but not N2, RPE could be expanded up to 40,000-fold over six passages and maintained in culture for more than 1 year. In long-term cultures, typical cellular morphology and pigmentation were observed, along with expression of characteristic RPE markers. RPE monolayers also retained proper apical-basal orientation and secreted multiple factors implicated in the maintenance of photoreceptor health and the pathogenesis of age-related macular degeneration. CONCLUSIONS: Monolayer cultures of human prenatal RPE can be grown and maintained long term in the total absence of serum and still retain the phenotype, gene and protein expression profile, and secretory capacity exhibited by mature RPE cells.

An investigation of classroom situational dimensions of emotional and behavioral adjustment and cognitive and social outcomes for Head Start children.

This study used a developmental-ecological approach to investigate the relationship across the school year between early problems in preschool classroom situations and a comprehensive set of readiness competencies for urban low-income children. Study 1 identified 3 reliable and unique underlying classroom situational dimensions where behavior problems occurred: structured learning, peer interaction, and teacher interaction situations. Boys and younger children evidenced more problematic behavior across all situations. Study 2 investigated the relationship between early problems in the situations and readiness outcomes. Early situational difficulties uniquely and differentially predicted lower peer social and classroom learning outcomes. In combination, both the type of behavior problem (what) and the situational problem (where) explained greater variance in the prediction of readiness outcomes, contributing to a more comprehensive understanding of developmental trajectories.

Protection of visual functions by human neural progenitors in a rat model of retinal disease.

BACKGROUND: A promising clinical application for stem and progenitor cell transplantation is in rescue therapy for degenerative diseases. This strategy seeks to preserve rather than restore host tissue function by taking advantage of unique properties often displayed by these versatile cells. In studies using different neurodegenerative disease models, transplanted human neural progenitor cells (hNPC) protected dying host neurons within both the brain and spinal cord. Based on these reports, we explored the potential of hNPC transplantation to rescue visual function in an animal model of retinal degeneration, the Royal College of Surgeons rat. METHODOLOGY/PRINCIPAL FINDINGS: Animals received unilateral subretinal injections of hNPC or medium alone at an age preceding major photoreceptor loss. Principal outcomes were quantified using electroretinography, visual acuity measurements and luminance threshold recordings from the superior colliculus. At 90-100 days postnatal, a time point when untreated rats exhibit little or no retinal or visual function, hNPC-treated eyes retained substantial retinal electrical activity and visual field with near-normal visual acuity. Functional efficacy was further enhanced when hNPC were genetically engineered to secrete glial cell line-derived neurotrophic factor. Histological examination at 150 days postnatal showed hNPC had formed a nearly continuous pigmented layer between the neural retina and retinal pigment epithelium, as well as distributed within the inner retina. A concomitant preservation of host cone photoreceptors was also observed. CONCLUSIONS/SIGNIFICANCE: Wild type and genetically modified human neural progenitor cells survive for prolonged periods, migrate extensively, secrete growth factors and rescue visual functions following subretinal transplantation in the Royal College of Surgeons rat. These results underscore the potential therapeutic utility of hNPC in the treatment of retinal degenerative diseases and suggest potential mechanisms underlying their effect in vivo.