caring for the caregiver: early head start/family child care partnerships

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213 INFANT MENTAL HEALTH JOURNAL, Vol. 23(1– 2), 213– 230 (2002) 2002 Michigan Association for Infant Mental Health A R T I C L E CARING FOR THE CAREGIVER: EARLY HEAD START/FAMILY CHILD CARE PARTNERSHIPS MARTHA J. BUELL ILKA PFISTER MICHAEL GAMEL-MCCORMICK Center for Disabilities Studies, University of Delaware ABSTRACT: This study explores the results of partnering with an Early Head Start program for four family child care providers. Providers reported on their perceptions of caregiving, the types of support they found useful from the program, and ways the Early Head Start program could better serve the community. Results indicate that providers feel that they benefited from their partnership with the Early Head Start program in both emotional and instrumental ways, that through the partnership they were able to enhance both the quality of their program and increase their sense of support and professionalism. These results are discussed in terms of supporting infant and toddler development by supporting providers. Policy recommendations are also given. RESUMEN: Este estudio explora los resultados de una asociacio ´n entre un programa “Early Head Start” con cuatro agencias que prestan cuidados infantiles a familias. Las agencias reportaron sus percepciones de co ´mo prestar el servicio de cuidado infantil, los tipos de apoyo del programa que les eran u ´tiles, ası ´ como vı ´as para que el programa “Early Head Start” pudiera servirle mejor a la comunidad. Los resultados indicaron que las agencias sentı ´an que se habı ´an beneficiado de la asociacio ´n con el programa “Early Head Start” tanto de manera emocional como instrumental; que por medio de la asociacio ´n ellas fueron capaces tanto de intensificar la calidad de sus programas como de aumentar su sentido de apoyo y profesionalismo. Estos resultados se discuten en te ´rminos de la necesidad de apoyar el desarrollo de los infantes a trave ´s del apoyo a agencias que prestan cuidado infantil. Se dan tambie ´n algunas recomenda- ciones para polı ´ticas de pra ´cticas. RE ´ SUME ´ : Cette e ´tude explore les re ´sultats du partenariat de quatre cre `ches familiales avec un programme de Early Head Start, les programmes Early Head Start e ´tant des programmes de pre ´vention et d’aide gouvernementale a ` la petite enfance de ´favorise ´e aux Etats-Unis d’Ame ´rique. Les cre `ches ont fait e ´tat de leurs perceptions des modes de soin, des sortes de soutien qu’elles trouvaient utiles dans le programme et des manie `res dont le programme Early Head Start d’aide a ` la petite enfance de ´favorise ´e pourrait mieux servir la communaute ´. Les re ´sultats indiquent que les cre `ches pensent que le partenariat avec le programme d’Early Head Start leur a profite ´a ` la fois de manie `re e ´motionnelle et instrumentale. Elles pensent e ´ga- lement qu’avec le partenariat elles ont pu a ` la fois ame ´liorer la qualite ´ de leur programme et augmenter leur sens du soutien et leur sens de professionalisme. Ces re ´sultats sont discute ´s sur le plan du soutien du de ´veloppement du nourrisson et du petit enfant a ` travers le soutien aux cre `ches. Des recommendations sont aussi donne ´es. Direct correspondence to: Martha J. Buell, 316 Alison Hall, Individual and Family Studies, University of Delaware, Newark, DE 19713; phone: 302-831-6032; fax: 302-832-8776.

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INFANT MENTAL HEALTH JOURNAL, Vol. 23(1–2), 213–230 (2002)� 2002 Michigan Association for Infant Mental Health

A R T I C L E

CARING FOR THE CAREGIVER: EARLY HEAD

START/FAMILY CHILD CARE PARTNERSHIPS

MARTHA J. BUELLILKA PFISTER

MICHAEL GAMEL-MCCORMICKCenter for Disabilities Studies, University of Delaware

ABSTRACT: This study explores the results of partnering with an Early Head Start program for four familychild care providers. Providers reported on their perceptions of caregiving, the types of support they founduseful from the program, and ways the Early Head Start program could better serve the community.Results indicate that providers feel that they benefited from their partnership with the Early Head Startprogram in both emotional and instrumental ways, that through the partnership they were able to enhanceboth the quality of their program and increase their sense of support and professionalism. These resultsare discussed in terms of supporting infant and toddler development by supporting providers. Policyrecommendations are also given.

RESUMEN: Este estudio explora los resultados de una asociacio´n entre un programa “Early Head Start”con cuatro agencias que prestan cuidados infantiles a familias. Las agencias reportaron sus percepcionesde como prestar el servicio de cuidado infantil, los tipos de apoyo del programa que les eran u´tiles, ası´como vıas para que el programa “Early Head Start” pudiera servirle mejor a la comunidad. Los resultadosindicaron que las agencias sentı´an que se habı´an beneficiado de la asociacio´n con el programa “EarlyHead Start” tanto de manera emocional como instrumental; que por medio de la asociacio´n ellas fueroncapaces tanto de intensificar la calidad de sus programas como de aumentar su sentido de apoyo yprofesionalismo. Estos resultados se discuten en te´rminos de la necesidad de apoyar el desarrollo de losinfantes a trave´s del apoyo a agencias que prestan cuidado infantil. Se dan tambie´n algunas recomenda-ciones para polı´ticas de pra´cticas.

RESUME: Cette etude explore les re´sultats du partenariat de quatre cre`ches familiales avec un programmede Early Head Start, les programmes Early Head Start e´tant des programmes de pre´vention et d’aidegouvernementale a` la petite enfance de´favorisee aux Etats-Unis d’Ame´rique. Les cre`ches ont fait e´tat deleurs perceptions des modes de soin, des sortes de soutien qu’elles trouvaient utiles dans le programmeet des manie`res dont le programme Early Head Start d’aide a` la petite enfance de´favorisee pourrait mieuxservir la communaute´. Les resultats indiquent que les cre`ches pensent que le partenariat avec le programmed’Early Head Start leur a profite´ a la fois de manie`re emotionnelle et instrumentale. Elles pensent e´ga-lement qu’avec le partenariat elles ont pu a` la fois ameliorer la qualitede leur programme et augmenterleur sens du soutien et leur sens de professionalisme. Ces re´sultats sont discute´s sur le plan du soutiendu developpement du nourrisson et du petit enfant a` travers le soutien aux cre`ches. Des recommendationssont aussi donne´es.

Direct correspondence to: Martha J. Buell, 316 Alison Hall, Individual and Family Studies, University of Delaware,Newark, DE 19713; phone: 302-831-6032; fax: 302-832-8776.

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cap heightbase of textZUSAMMENFASSUNG: Diese Studie erforscht die Ergebnisse der Betreuung von vier Fru¨hforderern im

sogenannten Early Head Start Program (einem Programm der Fru¨hforderung mit Hausbesuchen). DieBetreuer berichten von ihren Wahrnehmungen betreffend Fu¨rsorge, die Art der Unterstu¨tzung, die sievom Programm nu¨tzlich fanden und Verbesserungen, die sie fu¨r die Umgebung nu¨tzlich fanden. Ergeb-nisse zeigen, dass die Betreuer das Gefu¨hl haben durch das Programm sowohl emotional, als auch in-haltlich zu profitieren. Durch die Partnerschaft waren sie in der Lage die Qualita¨t des Programms zusteigern und ihre Kenntnisse u¨ber Unterstu¨tzung und Professionalita¨t zu erhohen. Die Ergebnisse werdenin Bezug auf die Unterstu¨tzung der Sa¨uglingsentwicklung durch die Unterstu¨tzung der Fru¨hforderer dis-kutiert. Es werden auch Richtlinien angeboten.

* * *

The relatively new federal program, Early Head Start (EHS), is designed to enhance thedevelopment of young children between the ages of birth and three who live in poverty. Oneof the requirements of the program is to offer families access to full-day full-year, quality childcare services. The rationale for this requirements is, that in an age when families living inpoverty with young children are limited to two years of government support and are requiredto work (see the 1996 Personal Responsibility and Work Opportunities Act), full-day, full-yearchild care becomes a critical family support service. Furthermore, Early Head Start recognizesthat limiting Early Head Start services to a four-hour, school-year program when the childactually is in care for nine hours a day, year-round can counteract the intervention providedby Early Head Start if that full-day, full-year care is not of high quality. Therefore, Early HeadStart programs nationwide are expected to ensure that no matter the auspice, if the child isenrolled in an Early Head Start program, the Early Head Start program is required to ensurethat all out of home care is of high quality (Federal Register: April 17, 1997 Volume 62,Number 74).

Throughout the United States, the requirement for full-day, full-year, quality care is beingmet by offering full-day, full-year EHS center-based services and by developing partnershipsbetween EHS programs and child care programs. Indeed child care partnerships are explicitlyrequired by the EHS legislation, and the existence of these partnerships is one criterion bywhich EHS programs are evaluated. EHS child care partnership models are organically growingout of existing community child care resources and family and child care provider needs.Among the many different EHS–child care partnership models are those between EHS pro-grams and family child care providers. Given the number of families that rely on family childcare, partnering or coordinating with family child care programs is a challenge being faced byalmost every Head Start and Early Head Start program nationwide.

In the following article we will review the current literature on family child care and family

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can enhance the services provided by family child care programs and increase communitycapacity. The central question of this research is in what ways can family child care providersbenefit from partnerships with EHS programs, and in what ways could EHS increase the ben-efits of partnership for providers. In answering these questions, the providers also provideinsight into larger issues of caregiving and issues specific to infants and toddlers.

In most localities in the United States, family child care consists of one or two individualsproviding care for two to 12 children of different ages. This care is usually provided in thehome of the family child care provider. Typically, the ages of the children cared for span theinfant/toddler/preschool years, with many family child care providers also caring for schoolage children before and after school. In most cases, the child care provider is the only adultwith the children during the day, caring for children from as young as four weeks to as old as12 years.

Family child care is a relatively under studied segment of the early care and educationlandscape (Kontos, Howes, Shinn, & Galinsky, 1995). Despite the lack of research attention,infants and toddlers are more likely to be in family child care than any other form of nonfamilialcare. Because they provide a home-like atmosphere, and typically smaller group sizes thanmany center-based programs, family child care is the first choice for many parents of infantsand toddlers (Galinsky, Howes, Kontos, & Shinn, 1994). Additionally, family child care pro-viders are more likely to accept infants and toddlers into their programs than are center-basedservices (Hofferth & Kisker, 1992).

Family child care providers report that they want to “be like a mother” to the children theycare for (Nelson, 1990). This focus on nurturance is critical to a quality out of home experience(Austin, Lindauer, Rodriguez, Norton, & Nelson, 1997). One feature of family child care thatsupports this nurturing relationship is their ability to providecontinuity of care and primarycaregiving. Continuity of care exists when the same provider is allowed to care for a child overa long period of time. Primary caregiving is characterized by situations where one consistentprovider takes the lead in providing care for a particular child. Continuity of care and primarycaregiving allow for stable attachment relationships to form between the child and the caregiver,thereby supporting infant and toddler mental health and development (Hayes, Palmer, & Zas-low, 1990). Early Head Start promotes continuity of care by requiring children in out of homecare to attend programs with group sizes no larger than eight, and a one-to-four caregiver tochild ratio for ALL children from birth to 36 months. The uniformity of group sizes and ratiosacross the 36 months of EHS also allows programs to ensure that children have primary care-givers over this extended period of time.

The EHS requirement for primary caregiving and continuity of care often makes applyingan EHS model difficult in community-based child care centers where children are often tran-sitioned to new providers at age intervals as small as six months. Because family child careprograms typically have one or two providers that care for children across the age range ofcare, there are no caregiver transitions. This can enhance the emotional attachment availableto the infant or toddler.

Research has shown that nurturance of the provider is related to the mental health of thechildren in care (Hestenes, Kontos, & Bryan, 1993; Howes & Smith, 1995). Furthermore,research on infant and toddler mental health makes it clear that the mental health of the parentis a chief predictor of positive outcomes for the child’s mental health (Cohen et al., 1999;Heinicke, Fineman, Ruth, Recchia, Guthrie, & Rodnig, 1999). To date, there is little publishedresearch addressing how the mental health of nonparental caregivers, such as family child careproviders, is related to the infant and toddler mental health of those in their care.

Because family child care providers usually work alone, they can be very isolated from

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Todd & Deery-Schmitt, 1996). Because family child care providers serve proportionally fewerchildren than do center-based programs, and the services are offered in a private home, thereis often a great deal of variance between states in the amount of oversight family child carereceive. Some states do not require family child care providers to be licensed (Wilkes, Lambert,& VendeWiele, 1998). When licensing does occur it is usually confined to issues of health andsafety, and monitoring the environment for its ability to support optimal cognitive and emo-tional development is not part of the licensing standards (Weinberger, 1998); hence, one cannotequate licensing with quality. Consequently, throughout the United States, there is a greatvariance in the quality of care offered by family child care providers (Kontos et al., 1995). Thevariance in quality is troubling, given the overwhelming evidence that the quality of early careand educational experiences, particularly for infants and toddlers, influences later development(Campbell & Ramey, 1996; Frede, 1995; Lally, Mangione, Honig, & Wittner, 1988; Ramey& Ramey, 1993; Schweinhart & Weikart, 1998).

Factors associated with quality care in both center-based and family child care include arelationship between certain regulatable characteristics of quality and the care that childrenreceive. The Cost, Quality, and Child Outcomes in Child Care (Helburn, 1995) reports thatquality programming is associated with better staff-to-child ratios, staff education, teacherturnover, administrators’ experience, and effectiveness in curriculum planning; with teachers’wages, education, and specialized training the most important factors in discriminating amongpoor, mediocre, and, good-quality child care centers. Teachers with college degrees demon-strated more positive behaviors, such as sensitivity to children, and fewer negative behaviors,such as harshness and detachment. In addition, teachers with at least a bachelor’s degree inearly childhood or child development, or both, provided more appropriate caregiving, includingappropriate curricular activities and room arrangements, were more sensitive and were lessdetached than teachers with vocational training or less. Currently, the National Institute ofChild Health and Development (NICHD) is following a cohort of young children measuringboth development and caregiving environments and caregiving patterns. The NICHD (1998,1999) research also supports the relationship between both higher levels of formal training andexperience and the quality of care providers demonstrate both affectively and in the types ofactivities they provide. It is often a lack of training and/or support to attend training that canmake quality care in family child care difficult.

Despite the many concerns with the quality of family child care, both EHS and traditionalHead Start programs have used family child care settings as placements for children receivingHead Start services (Koppel, 1995; Littman, 1999; Poersch & Blank, 1996). Across the countrythe ways Head Start is incorporated with family child care varies. Family child care may bethe sight for all Head Start programming or family child care can act as a partnering programin providing full-day full-year care. At the time of this writing the Head Start use of familychild care is either called: (1) a locally designed option if discussing a traditional three- to five-year-old program, or (2) a combination option if referring to Early Head Start (according tothe late Helen Taylor, there are no locally designed options in Early Head Start). Althoughthere are no formal regulations regarding Head Start placements in family child care programs,regulations are being developed. However, at the time of this writing, the use of family childcare to delivery Head Start services challenges each program to approach these services basedon knowledge of best practices for caregiving for infants and toddlers. Among the many strat-egies for doing this is to support quality programming in the family child care program.

Many issues contribute to providers offering quality, consistent care including: providerstress and a lack of a support system (Todd & Deery-Schmidt, 1996); a lack of technicalassistance and oversight, arrangement of physical space in order to provide care (Golbeck,

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Crompton, & Townley, 1998); technical assistance (Wilkes et al., 1998), and satisfaction withmaterials (Thornburg et al., 1998). Head Start and Early Head Start programs that work withfamily child care providers can work with programs to assure that these factors are addressed.

BECOMING A NDEHS FAMILY CHILDCARE PARTNER

Northern Delaware Early Head Start (NDEHS) uses as one of its models of child care support,a family child care option. The family child care option for child care support services is partof a spectrum of care options provided by NDEHS, which also includes home-based servicesand center-based services. Family child care providers were part of the original group thatdeveloped the NDEHS program, and awareness of the program in the family child care com-munity has grown through provider networks. Partnership with family child care providersbegins when a provider interested in being part of the program contacts NDEHS. To begin thescreening process for potential partners the program begins with an initial health and safetyinspection. The health and safety check has been derived from the Delaware Department ofHealth and Social Services Office of Child Care Licensing standards. If a provider meets thehealth and safety criteria, an assessment of the environment is conducted using the Family DayCare Environmental Rating Scale (FDCRS: Harms & Clifford, 1989) and our Child CareMonitoring Scale (CCMS), which has been derived from the current Head Start monitoringtool the PRISM.

When the Family Child Care setting has been determined of good quality according to theFDCRS and CCMS, representatives of NDEHS and the family child care provider develop anagreement establishing a partnership between the program and the provider. Families enrolledin NDEHS may then choose to place their children in these family child care settings, or ifNDEHS enrolls an EHS eligible child already in the provider’s care. The fees for these careservices are paid for by the state purchase of child care funds.

The family child care provider partners receive weekly technical assistance visits from theNDEHS Early Care and Education Coordinator, who has been trained in child development,early childhood education, and early intervention services. In keeping with the case loadsestablished for home visitors, the Early Care and Education Coordinator has a maximum caseload of 12 family child care providers. In collaboration with the Early Care and EducationCoordinator, a family child care provider creates her own Quality Improvement Plan. This planincludes items such as the materials and resources the provider needs to enhance her ability tobetter care for and promote the development of the children she cares for. Professional devel-opment plans also identify areas of knowledge and skills that family child care providers needto develop to better care for the children in their charge. To develop these skills and gain theknowledge identified in the professional development plan, the provider, with the assistanceof the NDEHS Early Care and Education Coordinator, identifies possible trainings, classes,and other educational opportunities that will allow her to gain them and enhance her ability tocare for all the children in her charge. A requirement of the NDEHS–family child care provideragreement is that all providers must complete the Child Development Associate (CDA) certif-icate within one year of the start of the partnership. This requirement helps NDEHS meet themission of increasing the quality of family child care for infants and toddlers throughout thecommunity.

In addition to the state fees for child care services paid to the family child care providers,NDEHS provides the caregivers with a stipend to be used to enhance their ability to offer andprovide quality care to the children enrolled in their program. The family child care providers

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the experience for both the Early Head Start and non-Early Head Start children in their careor cover the cost to attend workshops or training (college course work is encouraged). Plansto spend the stipend are based on the Quality Improvement Plan.

IMPACT OF THE NDEHS SERVICES ON FAMILYCHILD CARE PROVIDERS

To determine the impact of the NDEHS support services on the partnering family child careproviders, an in-depth qualitative investigation of the changes in the providers’ programmingsince joining NDEHS was undertaken. Using a case study methodology, four family child careproviders with partnerships with NDEHS were examined for the changes that have occurredin their caregiving since entering the partnerships. It is hypothesized that (1) family child careproviders will identify an increased capacity to offer quality child care for infants and toddlersas a result of partnership with Early Head Start, and (2) family child care providers will identifyan increased feeling of support as a result of partnering with Early Head Start.

METHODS

Participants

Four family child care providers have been working with the NDEHS program since servicesbegan to be offered to children and their families. These four family child care providers eachhave been with the program for at least 24 months. All of these providers are leaders in thefamily child care community, with an explicitly stated sense of professionalism and commit-ment to the families and children they serve, their communities, and the profession of care-giving. Within this group, the average score of the four family child care providers on theFDCRS (Harms & Clifford, 1989) was 5.9 out of 7.0, placing them far above the mean of 3.5found in national evaluations of family child care providers (Kontos et al., 1995).

Each of the family child care providers is distinct in regard to the settings and communitiesin which they work and the families they serve. Each provider is briefly described below.Included in these descriptions is the providers explanation for why they entered the field ofearly care and education. Before examining the effect of Early Head Start it is important tounderstand the motivation of the providers accepted by the program, given that these are thetypes of factors that may present a selection bias and that surely affect the responses of theproviders to the program.

Elaine is a 42-year-old African American with a highly visible level of enthusiasm for herwork with children. She cares for six children between the ages of two to six years. The childrenremain in her family child care setting full-time. She also cares for two school age childrenbefore and after school. Elaine’s family child care operates Monday through Friday from 6:30a.m. to 5:00 p.m. Elaine lives in a quiet, suburban middle-class neighborhood.

Elaine decided to become a family child care provider after she could not find a high-quality child care center for her own children. After searching for quality child care, Elainefelt what she describes as a “spiritual inspiration” to open her own family child care facility toprovide excellent child care not only for her own children but also for other children. Therefore,she quit her job as a legal secretary and started her own family child care site. Elaine reports

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states that she is very happy and satisfied with her chosen profession.Andrea is a 41-year-old African American who lives in and operates her family child care

in an urban, low-income neighborhood with a high crime rate. Her child care services areavailable Monday through Friday from 7:00 a.m. to 4:30 p.m. Andrea cares for six infants andtoddlers, age 1 to 2-1/2 years. Before becoming a family child care provider, Andrea workedin the community services field and at center-based care facilities. She has stated that she hasalways had a desire to work with children and views her abilities “as a blessing from God.”Andrea’s husband and mother, who also has a family child care facility, are very supportiveof her work, and assist her in operating her family child care site. Andrea states that she “lovesher work” and that she cannot think of anything else that she would rather do than to care forchildren.

Brenda is a 53-year-old African American who feels that her ability to care for childrencomes from her religious values. She cares for six children between the ages of seven monthsand five years of age and two additional school age children, before and after school. Brenda’sfamily child care is located in a suburban, lower middle-class housing development with a highproportion of subsidized housing. The operation hours for her family child care services areMonday through Friday from 6:30 a.m. to 5:30 p.m. Brenda reports that after a spiritual search,she discovered that her purpose in life was to care for children and to enhance their develop-ment. Brenda left her job as a food service provider after being in that field for 17 years, andstarted her own family child care site. She began her program as a part-time endeavor, whichquickly became a full-time service. Brenda reports that she does not regret her decision toleave her food services job, and that she is very satisfied with her life as child care provider.

Carol is a 44-year-old European American. She cares for eight children between the agesof eight months and eight years of age. Her family child care facility operates Monday throughFriday, 6:45 a.m. to 5:15 p.m. She lives in a rural area, and operates her family child care sitein a middle-class neighborhood. Ten years ago, she realized that her work as a legal secretarywas not what she wanted to do for the rest of her life. She decided to return to the work shehad done as a teenager, caring for children. At that time, she opened her family child careprogram and reports that she finds great fulfillment in her work.

Data Collection

Information on the professional development activities the providers have participated in sincethey began their partnership was collect through reviewing the providers files and through aone-time semistructured, open-ended interview with each of the participants describing theirexperiences with the NDEHS partnership. The research protocol was reviewed by the institu-tional review board, and before the data collection began, the providers each completed aninformed consent form. The interviews lasted approximately one and a half hour. The basicquestions covered in the interview were: (a) factors that lead the provider to the field of earlycare and education, (b) perceptions of caregiving/caregiving as a profession, (c) instrumentaland emotional support gained from partnership with NDEHS, and (d) unmet needs and sug-gestions for how NDEHS could meet these. The interviews were transcribed, and a system ofopen coding was used to determine themes. Each code identified a central idea (Glesne &Peshkin, 1992). Through a constant comparison of grouping information into codes, themesemerged across the interviews.

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TABLE 1. Training Topics and Hours of Attendance Since Partnering with NorthernDelaware Early Head Start

Training Topic Elaine Andrea Brenda Carol

Child development 2.5 37.5 50.0 19.5Concepts of professionalism 14.0 2.5 45.0 20.0Developmental curriculum planning 25.5 17.5 25.0 29.0Health/safety/nutrition 8.0 19.5 55.0 27.5Management/administration in early childhood 47.0 8.0 4.0 0.0Multitopic training 0.0 0.0 10.0 0.0Understanding children’s behavior 2.5 4.0 2.5 8.0Working with parents and family issues 47.0 1.0 3.5 6.0Conference attendance 13.5 7.5 7.5 14.5Total 160.0 97.5 202.5 124.5

Training time is represented in hours.

RESULTS

Professional Development

Since the formation of their partnership with NDEHS, all four of the family child care providerswere able to earn their CDA certificates. In addition, one of the providers also received nationalaccreditation for her family child care program. As a group, these four women have participatedin over 580 hours of training about child development, early childhood curriculum, andworkingwith families. Depending on their past experience and expressed level of need, different pro-viders chose different professional development topics. For instance, Elaine concentrated onmanagement and administration of early childhood programs and working with parents; Andreafocused on child development, Brenda (who earned the most training hours) focused on childdevelopment, health/safety/nutrition, and concepts of professionalism; Carol earned the mosttraining hours in developmental curriculum planning. See Table 1 for specific informationabouteach of the providers’ training.

Interview Results

The following are results for the semistructured open-ended interviews. Table 2 contains a listof the topics the providers addressed and the themes that emerged.

Caregivers’ perceptions of caregiving.The caregivers provided a general perception of theirdaily caregiving activities and duties. Specifically, the providers were asked to describe whatthe caregiving process is for infants and toddlers and how that process differs from caregivingfor preschoolers and school-age children. The providers were also asked to describe their viewson child care as a profession.

All of the providers pointed to unique challenges in caring for infants and toddlers. Theseincluded differences in developmental level when comparing infants and toddlers with olderchildren and the need for different approaches to caregiving based on these differing needs.For instance, Elaine discussed:

Well, on a daily basis I think infants they require more time. More time, in that moreinvolvement time. With preschoolers, it’s more structured. With infants and toddlers, I find

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cap heightbase of textTABLE 2. Themes Regarding Infant–Toddler Caregiving and Partnerships with Early Head Start

Programs

Topic Theme

Providers’ perceptions ofcaregiving

● Infants and toddlers are very challenging to care for● Developmental differences within the same group are difficult to work with● Assistance is needed in programming and developing curricula for infants and

toddlers

Caregiving as a profes-sion

● Caregiving is a profession that is unparalleled● Caregiving requires specific skills and attitudes that are not universal● Caregiving is not appreciated by the general public and some caregivers’ ex-

tended families● Acquiring training and certifications increased caregivers’ status in the eyes of

parents, their own family, and the public in general● Caregiving is often a spiritual mission or calling for individual caregivers

Benefits of partnershipwith Early Head Start

● Instrumental benefitsassistance with organizing their programsassistance with developing curricula for infants and toddlersfinancial support for the purchase of equipment and materialsfinancial support for training opportunitiesaccess to knowledgeable colleagues/mentors to help with difficult situationsassist caregivers to better work with low-income families

● Emotional benefitsreduced sense of isolationongoing relationship with an adultbeneficial only if the adult is knowledgeable about family child care

● Some benefits were a combination of instrumental and emotional support

Changes in providers ● Identified an increased sense of expertise about caring for infants and toddlers● Identified an increased sense of knowledge about working with families living in

poverty● Reported positive feelings about themselves as professionals● Reported positive feelings about their ability to accomplish difficult tasks

Unmet needs ● EHS should provide services to families living in near-poverty● EHS should expand training and support eligibility to more family child care

providers● EHS should support family child care provider support groups

that it’s basically you go at their pace. And it’s like everything is this one thing, and it’s likeOK this thing has my attention. So basically I find that it’s busy work. I think with themyou need a little bit more nurturing. You know, let them, their needs have to be met. Theydon’t understand “wait.” They cry, they don’t understand “Well I’ll be right there. Infantstheir needs have to be met a little bit quicker.”

The providers were also asked if they saw what they do on a daily basis as a professionand their reasons for their feelings. The group unanimously stated that they felt child care is aprofession. They made two explicit points about caregiving as more than “just a job.” First,they stated that the overall importance of what they do (i.e., caring for children on a dailybasis) is unparalleled. Second, they indicated that while the perception of the general public isthat caring for children is an easy job, what they do on a daily basis requires specific skills and

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cap heightbase of textattitudes to have a positive impact on children’s development and families lives. Carol specif-

ically stated that

. . . what I domakes a difference in their (the children and families) lives, because what Idon’t do makes a difference in their life. If they’re not in some place where they’re beingnurtured, cared for, spoken with, played with, then they’re not growing. They’re not learningany kind of skills at all.

When discussing the professional nature of the work they do, the providers were quick topoint out that many parents and the general public do not see them as professionals. Many ofthe providers stated that they are seen as babysitters and that their status is comparable to thatof a teenager taking care of a child for an evening. Elaine articulated this point of view whenshe stated

So I let the parents see that I’m not just a babysitter. You know, I do shop around for toysand things that’s gonna help their (the children’s) development.

Brenda stated that she uses her CDA as a proof for her professionalism

I’m really excited about my CDA accreditation, and I’m excited about the information andgrowing and feeling professional in the business. Not just quote unquote babysitter, but achildcare (provider), I provide I give I provide service. I offer service to parents to givingquality care to their children.

Another issue that was raised in discussing professionalism was the spiritual aspect ofcaring for children. Several of the providers described caring for children as a personal andspiritual mission in their lives. Elaine reported that she sees her care giving as a calling.

I find this is where I need to be, this is where the Lord wants me to be, and I’m comfortablein being where I am.

Brenda, too, views her profession as a work for God.

I see it (caregiving) as a profession of working for the Lord really. And it happened to bewith God’s children, little people. It’s a profession of nurturing and putting positive seedsin God’s little people.

Andrea referred to the work she does as a holy mission:

It’s nothing but the goodness of God that keeps me going every day, to be able to do whatI do for the sake of the children. So absolutely, I’m on a mission, to provide a clean, safe,healthy environment for children in which they can come, and enjoy themselves and developpositively.

The child care providers clearly articulated that they felt their work was a profession. Theproviders felt that the general public, and at times the parents for whom they provided care,did not see them as professional, but as “babysitters.” The caregivers stated that they used

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cap heightbase of textdifferent mechanisms to communicate to parents, family, friends, and the community that their

work is a profession. These mechanisms included detailing the planning that they do andcommunicating the training and credentials that they earn.

In addition, many of the providers characterized their profession as having a sense of aspiritual mission. Three of the providers clearly stated that their work is to care for and assistin the development of young children.

Benefits of partnership.The family child care providers were asked about the benefits thatthey have seen from being in a partnership relationship with an Early Head Start program.When asked about the positive outcomes of working with NDEHS, they identified both instru-mental and emotional benefits that they received through partnership.

The types of instrumental support the providers identified included: (a) assistance orga-nizing all aspects of their program, (b) curriculum development ideas, particularly for infantsand toddlers, (c) acquiring materials and equipment that allow them to better care for andpromote the development of the children, and (d) financial support for their own educationalopportunities. Emotional benefits included building a relationship with their technical assistantand increasing their sense of self esteem.

All of the providers indicated that one of the ways NDEHS assists them is through as-sistance with organization and structuring of their program. For instance, the providers pointedto assistance in arranging their space. Elaine in particular appreciated this help and stated

My center . . . I feel is set up pretty good, but with my mentor (Early Care and EducationCoordinator), she showed me how it could be arranged even better to point out differentenvironments, separate regions, you know different environments with the dramatic playand separating the quiet spaces.

The providers also discussed their improved ability and capacity to serve children boththrough more targeted curriculum planning and assessment.

. . . helping me with lesson planning as to how important that is on a daily basis to havea lesson plan, even though you’re not following it to the T because you’re dealing withinfants and toddlers. But at least it gives you an idea of what you want to implement, andhow you can incorporate one theme and you can use all of the mediums within that theme.(Elaine)

The information I’ve gotten from the classes has been able to broaden my insight on envi-ronment, routine, doing assessments, evaluations, those type of things I did not do beforebecause I didn’t have the knowledge prior to coming into the program. So, I’ve been ableto really look at the developmental plan for my children, individually, as well as a group.(Andrea)

Carol pointed to her increased ability to use assessment as a valuable planning tool

. . . tocall them (EHS staff) with questions about development, about assessment and aboutthe assessment tools. I didn’t have access to that prior to this.

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cap heightbase of textAn additional benefit of the EHS partnership identified by the providers was the ability

to purchase new materials and equipment that was collaboratively identified by the providerand the Early Care and Educational Coordinator as potentially improving the quality ofprogramming for the children enrolled in the family child care site. Elaine indicated thatperiodically purchasing new materials and equipment allowed her to be seen as a child careprofessional and not as a babysitter. She stated that

If I see something that I know that would help them (the children) and help me to becomea better (caregiver), especially with the parents because they’re looking at “O.K. what haveyou gotten new?” Or “What have you done differently?” And with the program (NDEHS),I’m able to freely see, you know, shop basically without having to worry about where themoney’s coming from. So that looks, I’ll say, as far as professional, it looks better with theparents to see that when they come into the center they can see a new toy. So I let the parentssee that I’m not just a babysitter. You know, I do shop around for toys and things that’sgonna help their (children’s) development.

Two of the providers pointed to increased efficacy in working with families.

Well when they (the parent) have a crisis or a problem concerning school situation or some-times a bus situation I am able to get information from the specialist to get a referral aboutwhere the parent should go. (Brenda)

The family child care providers also identified the availability of funding for training andeducation as an additional benefit of their partnerships with NDEHS. All four of the providersexplicitly mentioned the importance of both funding for training opportunities and the avail-ability of training opportunities through NDEHS. The providers specifically spoke of the sup-port they received for earning their Child Development Associate (CDA) certificates.

EHS has also . . .provided me with information to get me in school. But that has helpedme to become . . . I believe a better quality care provider . . . Now I hold my CDA.(Andrea)

(S)ince I’ve been with Northern Head Start, the program has really advanced me. I’ve earneda CDA. I’m excited and proud of myself. Very proud, [of] something that I didn’t think Icould accomplish. I used to hear all of this accreditation at workshops and I thought thatwasn’t for me. And then, when the program came around and they started to approach us, Isaid, “That sounds too good to be true.” (Brenda)

In addition to the instrumental benefits that the providers identified as a result of theirpartnerships with NDEHS, they also indicated that the emotional support provided by the EHSpartnerships was very valuable to them. They spoke about the value of the mentoring relation-ships they had established with the Early Care and Education Coordinator. Elaine describedher relationship in the following way:

If I’m in doubt, I have a question, or if I don’t understand something, Miss H., she’s alwaysthere to help me. And she always shares light sometimes in dark situations . . . notjustwith the daycare aspects; I find her to be a personal friend where I can confide in her on

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cap heightbase of textpersonal issues also . . . shecomes every Tuesday . . . [and] I look forward to her on

Tuesdays, I really do look forward to her on Tuesdays.

In many cases, the emotional and instrumental support issues were combined. For instance,in discussing the assistance they received in earning a CDA, the providers spoke of both theemotional support and encouragement throughout the process as well as the financial assistancein paying for the validation.

. . . [W]hen I started working with the program [NDEHS], the first person I started workingwith, Helen (the early Care and education Coordinator), and the same way I’m nurturingand encouraging the children, she nurtured and was encouraging me. And a couple of timesI needed [guidance] on a professional point [and] it’s been a blessing to have [someone]to . . . call at any given time. With Northern Head Start, they’ve allowed me to know I’veaccomplished the CDA accreditation that allowed me to know how the program, the stipendhas been such a great blessing. It’s just mind-blowing how I was able to replace just so muchof my equipment. So it’s been, just been really such a financial blessing and the technicalassistance and all the referrals, I just feel like if I run out of information, if I do I can dialthe number.

Provider changes.The family child care providers also discussed changes in themselves thatthey attributed to their partnerships with the Early Head Start program. Three of the providersdiscussed an increased sense of professional expertise and increased knowledge. They reportedthat this resulted in them having more positive feelings about themselves as individuals and asprofessionals.

. . . [T]hat’s one of my accomplishments with them [NDEHS]. Now I have my CDA. Ifelt really good after taking the tests and doing well in the tests. I felt really good aboutmyself accomplishing that, so that’s definitely a positive influence with my development,educationwise with them.” (Elaine)

I’m excited about growing. Not only am I excited about the equipment that the stipends buy,I am really excited about my CDA credential, and I am excited about the information, andfeeling like I am growing and feeling professional in the business. (Brenda)

Its made me more reflective. (Carol)

The information I’ve gotten from the classes has been able to broaden my insight on envi-ronment, routine, doing assessments, evaluations, those type of things. (Andrea)

Unmet needs of providers.The family child care providers were also asked about what ad-ditional support the Early Head Start program could provide that would benefit their ability tocare for very young children and enhance their own professional development. The providersindicated that there was a great need to expand the services offered by NDEHS to more familiesand to more providers. The providers interviewed for this study indicated that they felt trainingopportunities should be made available to all family and center-based child care providers.

. . . [O]pening up a little bit more; I mean I spread [tell people about] Northern Delaware

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cap heightbase of texteverywhere I go . . . [a]nd a lot of providers want the program, they are inter-

ested . . . But theproblem is that they don’t have [a] child [that qualifies for the program].(Elaine)

The providers also indicated that NDEHS could bemore helpful to providers by supportingthe family child care provider networks and support groups that already exist in the community.A number of suggestions included focusing on creating linkages among the family child careproviders.

. . . know that with EHS . . . probably just getting them [other family child care pro-viders] together for some kind of social thing . . . would give the providers a chance tosupport one another, and be supportive of one another. (Carol)

The final piece of guidance the providers offered was the need to expand the services thatNDEHS offers to include more children in the program who live in families whose income isjust above the poverty guidelines. The providers indicated that there were families with teenageparents as the head of the household who needed help but were not receiving services becausetheir family of origin’s income was included in the eligibility intake. The providers also statedthat families who earn slightly above the income eligibility level were in dire need of parentingsupport and information. The providers shared their frustration at not being able to assist thesefamilies by linking them to services.

Because the program has the stipulation . . . theincome bracket, you have to be basicallydirt-right poor, poor, poor, poor, poor, poor, poor, and there are people that are underpriv-ileged that may not meet the (program guidelines) but still fall in that poverty stricken rate.(Elaine)

DISCUSSION

Providing Support to Caregivers

There are a number of significant challenges for family child care providers. One of thesechallenges is that they operate their business in their homes. This can cause a tension betweenthe public, business, caregiving use of home space and the private, family space (Tarwick-Smith & Lambert, 1995). A second challenge is the general isolation that caregivers experience(Kontos et al., 1995). Unless they make an effort to seek out or contact other providers, familychild care providers may not come in contact with colleagues or coworkers for days or evenweeks. A third challenge is that providers often have limited amounts of training or educationin comparison to preschool teachers, public school teachers, or other early care and educationproviders (Kontos et al., 1996). Finally, family child care workers often have limited resourcesand abilities to address difficult situations. Their limited funds and isolation often make itdifficult to find literature or other sources for problem solving (DeBord, 1993). With its abilityto provide technical assistance, support, and resources, Early Head Start programs can be aresource to family child care providers in addressing all of these concerns.

It is apparent from the literature, and from the comments of these four providers, thatprograms that partner with family child care providers can positively effect the quality of care

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cap heightbase of textprovided to young children by supporting the provider (Peters & Pence, 1992). Because of

these challenges, the NDEHS model of support seems to have addressed many of the familychild care providers needs. The NDEHS Early Care and Education Coordinator worked toprovide both instrumental and emotional support to the providers. The instrumental supportaddressed the economic challenges and the logistic challenges the providers faced. The emo-tional support addressed some of the factors of isolation. The results of our interview supportother work done with family child care providers highlighting the usefulness of technicalsupport visits (Deiner & Witehead, 1998; Wilkes et al., 1998).

The supplemental funds used to purchase materials, equipment, and training, while essen-tially instrumental in nature, have also acted to assist the providers in systematically thinkingabout the types of materials they have available for the children in their care andwhat additionalmaterials would foster the children’s development. With the Early Care and Education Coor-dinator, collaboratively analyzing the material available in their centers and deciding what newmaterials to purchase, is at once a professional training activity, a professional relationshipbuilding activity, and a systematic review of the strengths and needs of the children for whichthe providers care. The Early Care and Education Coordinator acts as a catalyst to help thefamily child care provider to think of herself as a professional and to analyze the needs of thechildren in her care.

The relationship between the Early Care and Education Coordinator and the family childcare provider was originally designed as a technical assistance relationship. The Early Careand Educational coordinator was to provide family child care providers with the informationthey needed to increase the quality of care they offer infants and toddlers and to implementthe Head Start Performance Standards. However, in addition to these planned supports theEarly Care and Education Coordinator developed interpersonal relationships with the providersallowing for emotional support to also be offered. In a sense, the educational coordinatorbecame amentor. The term “mentor”was initiated and used by the providers, not by theNDEHSstaff. As a mentor the Early Care and Educational Coordinator provided instrumental andemotional support that allowed the providers to feel that they were better, more effectivecaregivers (Whitebook & Sakai, 1995). It is through these types of supports that EHS and otherprograms can support family child care providers.

Perceptions of caregiving. In discussing caregiving, the issue of professionalism wasraised.This topic brought out two interesting issues—the inconsistency between the providers’perception of their professional status and the perception of the families and communities theyserve, and the providers’ beliefs of the spiritual aspects of their profession. The providers feelthe work they do is professional work, and beyond that it is a calling. They are compelled toprovide care for children. However, they also recognize that society does not always acknowl-edge the work they do as valuable. This combination of being in a profession that is a missionbut which is not often recognized as important or worthwhile in comparison to other careersthat have the traditional trappings of status such as high pay or high profile, can result in asituation where it is critical that providers have access to emotional support and encouragement(Debord, 1993). Programs such as EHS can provide this type of emotional support and pro-fessional confirmation to providers. In addition to supporting providers, through parent edu-cation and training EHS helps parents appreciate their child’s development. It is hoped thatonce parents are made more aware of the profound growth of their infants and toddlers, theywill begin to value the work of the providers.

The providers in our program are clearly committed to the profession of early care andeducation. Their recommendation of offering more service and training to providers is notsurprising. These providers perceive early care and education in their community as a system,

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cap heightbase of textand that by strengthening their system they are strengthened. This is undoubtedly connected

to their strong sense of professionalism. It could be the case that they feel that if the entirefield were to improve they would face less of a challenge in being recognized as professionals.

Limitations and Future Directions

This group of four family child care providers has many diverse characteristics, as do familychild care providers throughout the nation. However, a common characteristic of these four istheir level of dedication to what they perceive as a critical profession profoundly effecting thelives of very young children and their families. The fact that these providers are leaders in theirfield makes the generalizability of these findings narrow. If NDEHS were to partner with moreaverage providers, the ability to make the sorts of changes evidenced by the providers describedhere may well have been compromised. However, given that NDEHS is committed to helpingthe family child care providers meet or exceed the Head Start Performance Standards, and isrequired by federal law to do this, working with less skilled providers is not an option at thistime.

Because EHS programs are required to provide quality services, selecting a random poolof providers and assigning some to a partnership condition and some to a control condition isnot highly feasible. Despite this, using quantitative methods to determine the characteristicsthat support or act as barriers to partnerships is needed. Furthermore, longitudinal research isneeded to examine the effects of partnership over extended periods of time with regard to issuesof provider longevity and professional development.

Another limitation of the current research is the lack of child outcome data. A directionfor future research is to examine, in more fine grained ways, provider characteristics, in par-ticular provider mental health, on the developmental outcomes of the children in their care.Included in the examination of their characteristics, it would be informative to explore whyproviders chose to enter a partnership. Again, this could also provide information on potentialselection biases as well as provide information on motivation.

Finally, a limitation of the current research is our lack of data regarding how the EarlyCare and Education Coordinator perceived the needs of the providers and thoughts about waysto build relationships that offer support and increase quality. Future research should examinethe perceptions of, and strategies used by technical assistants working with family child careproviders to offer guidance to HS, EHS, and other Early Intervention programs choosing achild care partnership model.

Policy Implications

The primary policy implication of this research is that EHS and family child care providerscan form strong partnerships to serve children and families. When compared to the expense ofrunning a center-based program this sort of partnership model is very cost effective. What ismore, these partnerships can help increase the quality of care for the non-Early Head Startchildren served in these facilities. Given the dearth of high-quality infant toddler care for allfamilies, this outcome is critical.

As programs consider partnership models it is important to listen to the needs of potentialpartners. The message from this group of family child care providers seems to be threefold.First, recognize that family child care providers are professionals, and that they offer and fulfilla valued, essential service. Second, provide caregivers with instrumental support necessary tooptimally care for the children in their centers. Finally, perhaps the strongest message from

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cap heightbase of textthis group of providers is to ensure that they have professional, adult relationships with knowl-

edgeable colleagues that will enhance their professionalism and will enhance their ability tocare for children. These messages remind programs working with family child care providersthat they must meet the needs of the providers to meet the needs of the children.

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