DOCUMENT RESUME

ED 352 162 PS 020 953

AUTHOR Provence, Sally, Ed.; And Others TITLE The Zero to Three Child Care Anthology 1984-1992. INSTITUTION National Center for Clinical Infant Programs, Arlington, VA. REPORT NO ISBN-0-943657-25-3 PUB DATE 92 NOTE 140p. AVAILABLE FROM Zero to Three/National Center for Clinical Infant Programs, 2000 14th Street North, Suite 380, Arlington, VA 22201-2500 ($14.95, plus $4 shipping and handling). PUB TYPE Collected Works General (020)

EDRS PRICE MF01/PC06 Plus Postage. DESCRIPTORS Anthologies; *Child Caregivers; Child Development; Child Development Centers; *Day Care; Delinquency; Early Intervention; Educational Practices; *Family Programs; Heterogeneous Grouping; Individual Needs; *Infants; *Interpersonal Relationship; Preschool Education; Student Placement; *Toddlers IDENTIFIERS Zero to Three

ABSTRACT This anthology contains 19 articles selected from the "Zero To Three Bulletin" from 1984 through the spring of 1992 and organized into five sections. The section on relationships in infant/toddler child care includes: "Infants in Day Care: Reflections on Experiences, Expectations, and Relationships," by J. H. Pawl; and "Choosing Child Care for Infants and Toddlers: Look First at the Caregiver," by S. Provence. Articles on applying principles to practice include: "Caring for Infants with Respect: The RIE Approach," by M. Gerber; "Mainstreamed, Mixed-Age Groups of Infants and Toddlers at the Bank Street Family Center," by N. Balaban; "The Center for Infants and Parents at Teachers College, Columbia University: Setting for Study and Support," by A. Axtmann; and "Therapeutic Childcare at Merrywood School," by M. Siegel. The section on child care for infants and toddlers with special needs includes: "'The Sooner the Better Project': Involving Parents and Day Care Staff in the Identification and Treatment of Developmental Delays and Disturbances in Infants and Toddlers," by R. Clark and M. J. Oltmans; "Models of Integration through Early Intervention/Child Care Collaborations," by M. B. Bruder, P. Deiner, and S. Sachs; and "Social Development and Integration: Facilitating the Prosocial Development of Typical and Exceptional Infants and Toddlers in Group Settings," by D. Wittmer and S. Petersen. Articles on supports for child care programs and providers include:(1) "Attending to the Emotional Well-Being of Children, Families, and Caregivers: Contributions of Infant Mental Health Specialists to Child Care," by K. Johnston and others; (2) "Whole Babies, Parents, and Pieces of Funds: Creating Comprehensive Programs for Infants and Toddlers," by P. D. Pizzo;(3) "The Developmentally Designed Group Care Setting: A Supportive Environment for Infants, Toddlers and Caregivers," by L. Torelli;(4) "Shared Reading in Daycare: Successes and Challenges," by G. J. Whitehurst and J. E. Fischel; and (5) "Managing Growth at Child Care Solutions," by R. A. Foote. The section on research in infant/toddler child care includes: "More Pride, Less Delinquency: Findings from the Ten-Year Follow-Up Study of the Syracuse University Family Development Research Program," by J. R. Lally and others; "Model Versus Modal Child Care for Children from Low-Income Families," by D. S. Wittmer; "Infant Day Care: A Cause for Concern?" by J. Belsky; "Responses to 'Infant Day Care: A Cause for Concern?'" (responses by eight authors); and "Infants, Families and Child Care: Toward a Research Agenda," a report from a meeting of infant day care researchers. (SLD)

THE ZERO TO THREE CHILD CARE ANTHOLOGY 19841992

Sally Provence, Jeree Pawl, and Emily Fenichel Editors

ZERO TO THREE/National Center for Clinical Infant Programs Arlington, Virginia 1992 ZERO TO THREE

National Center for Clinical Infant Programs

ZERO TO THREE/National Center for Clinical Infant Programs is the only national nonprofit organization dedicated solely to improving the chances for healthy physical, cognitive and social development of infants, toddlers and their families.

Established in 1977, ZERO TO THREE is committed to:

exercising leadership in developing and communicating a national vision of the importance of the first three years of life and of the importance of early intervention and prevention to healthy growth and development;

developing a broader understanding of how services for infants and toddlers and their families are best provided; and

promoting training in keeping with that understanding.

ZERO TO THREE/National Center for Clinical Infant Programs 2000 14th Street North, Suite 380 Arlington, Virginia 22201-2500 (703) 528-4300 FAX (703) 528-6848 To order publications: 1-800-544-0155 ce, ZERO TO THREEINational Center for Clinical Infant Programs 1992 ISBN 0-943657-25-3 Contents

3Introduction

5 Relationships in infant/toddler child care

7 1. Infants in Day Care: Reflections or Experiences, Expectations and Relationships Jeree Pawl (February, 1990)

14 2. Choosing Child Care for Infants and Toddlers: Look First at the Caregivev Sally Provence (February, 19641

17 Applying principles to practice

19 3. Caring for Infants with Respect: The RIF Approach--Mhgda Gerber (February, 1984)

23 4. Mainstreamed, Mixed-age Groups of infants and Toddlers at the Bank Street Family CenterNancy 3alaban February, 199; )

29 5. The Center for Infants and Parents at Teachers College, Columbia University: A Setting for Study and SupportAnnette Axtrnann ( February, 1984)

35 6. Therapeutic Childcare at Merrywood SchoolMaxine Siegel (September, 1986)

39 Child care for infants and toddlers with special needs

41 7. "The Sooner the Better Project": Involving Parents and Day Care Staff in the Identificaticand Treatment of Developmental Delays and Disturbances in Infants and ToddlersRoseanne Clark and Mary lane 011mans (September, 1986)

46 8. Models of Integration through Early Intervention/Child Care Collaborations Mary Beth Bruder, Penny Deiner, and Sandy Sachs (February, 1990)

52 9. Social Development and Integration: Facilitating the Prosocial Development of Typical and Exceptional Infants and Toddlers in Group SettingsDonna Wittmer and Sandra Petersen (April, 1992)

61 Supports for child care programs and providers

63 10. Attending to the Emotional Well-being of Children, Families and Caregivers: Contributions of Infant Mental Health Specialists to Child Care Kadiia Johnston, Sonya Bemporad, Elisabeth Muir, and Elizabeth Tuters (February, 1990) 74 11. Whole Babies, Parents, and Pieces of Funds: Creating Comprehensive Programs for infants and ToddlersPeggy Daly Pizzo (February, 1990)

81 12. The Developmentaiiy Designed Group Care Setting: A Supportive Environment for Infrats, Toddlers, .ind Caregivers -buts Torelli (December, 1989)

85 13. Shared Reading in Daycare: Successes and ChallengesGrover J. Whitehurst and Janet Fische! ( September, 19911

38 14. Managing Growth at Child Care SolutionsRuth Anne Foote (April, 19911

93 Research on infant/toddler child care

95 15. More Pride, Less Delinquency: Findings from the Ten-Year Follow-up Study of the Syracuse University Family Development Research ProgramJ. Ronald Lally, Peter L Mangione, Alice S. Hjnig, and Donna S. Wittmer (April, 19881

104 16. Model versus Modal Child Care for Children from Low-income FamiliesDonna S. Wittmer (September, 19861

108 17. Infant Day Care: A Cause for Concern ? Jay Belsky (September, 1986)

117 18. Responses to "Infant Day Care: A Cause for Concern?"Deborah Phillips, Kathleen McCartney, Sandra Scan-, and Carollee Howes; Jay Belsky; Stella Chess; Ross Thompson; Prier Barglow (February - December, 1987)

138 19. Infants, Families and Child Care: Toward a Research AgendaResearch Facilitation Committee of the National Center for Clinical Infant Programs, December, 1987

Note: The text of each article in this anthology appears as it was originally published in Zero to Three. Some of the specific programs described here have grown, some have been discontinued, and all, inevitably, have changed. Readers who are interested in current infant/toddler child care research, practice, policy, and training are encouraged to subscribe to Zero toThree and to write or call ZERO TO THREE/National Center for Clinical Infant Programs, 2000 14th Street North, Suite 380, Arlington, Virginia 22201, tel: (703) 528-4300, TDD (703) 528- 0419.

Cover photo: Subjects and Predicates Introduction

The experiences of infants, toddlers, parents, Supports for child care programs and and caregivers in child care have been an providers; and abiding concern of ZERO TO THREE/ Research on infant/toddler child care. National Center for Clinical Infant Programs We place relationships first in this since its founding in 1977. Over the years, collection because we believe, quite simply, dozens of articles about various aspects of that relationships are the major factor in child care for infants and toddlers have determining the quality of child care. In the appeared in our bulletin, Zeroto Three second section, on applying principles to sometimes in issues devoted wholly to the practice, authors do just thatthey tell us topic of childcare, sometimes in issues how their understanding of infants' and focused on other themes. toddlers' development (and the developmen- Our organizational (and editorial) atten- tal needs of parents) shape their child care tion to infantltoddler child care will continue. programs' overall design and guide the most However, we thought it would be useful "ordinary" daily interactions among staff, at this time to collect articles that have children, and families. Child care for infants appeared in Zero to Three from 1984 through and toddlers with special needs isjust the spring of 1992, and make them easily beginning to receive the attention it available to child care professionals, parents, deserves; authors of articles in this section instructors, students, policymakers, and emphasize the rewards of integration for all researchers who share our sense of the participants. The section on supports for importance of early experience and our child care programs and providers recog- recognition that child care represents a nizes the variety of ways that individuals, significant chunk of early experience for communities, and public and private funders many infants, toddlers and their families. can strengthen the infant/toddler child care Somewhat arbitrarily (since a number of systemthrough financial support, contri- articles address more than one theme), we butions to the physical setting, and appro- have grouped articles under five major priate training and consultation. headings: The final section of this collection, on Relationships in infantltoddler child research on infant /toddler child care, requires some special explanation. The first care; two art illustrate two types of child care Applying principles to practice; research: 1) a longitudinal research and de- Child care for infants and toddlers with monstration project that included infant/ special needs; toddler child care as one element of

7 Introduction 3 comprehensive support to families, and 2) who wish we could rely on "the research" an analysis of 1,000 hours of direct obser- to guide some of our most important public vation of two- and three-year-olds in child and private choices. We recommend that care settings. The third article, Infant Day Care: readers pay thoughtful attention to all voices A Cause for Concern?, generated the largest in the infant day care dialogue, and that they number of letters to the editor on a single themselves contribute to it. Meanwhile, the article in the 12-year history of Zero to Three core of the consensus statement from the (collected here as Chapter 13). The ongoing 1987 researchers' summit can remain our dialogue itself prompted the National Center watchword: for Clinical Infant Programs to hold an When parents have choices about selectionand "infant day care summit" in the fall of 1987, utilization of supplementary care for their infants and which resulted in the consensus statement, toddlers and have accessto stable child care Infants, Families and Child Care: Toward a Research arrangements featuring skilled, sensitive and motivated Agenda, reprinted here as Chapter 19. caregivers, there is every reason to believe that both Realizing that experienced researchers can children and families c:41 thrive. Such choices do not and do make different interpretations from existfor many familiesin America today,and data is importantnot only for students inadequate care poses risks to the current well-being learning to think critically but equally for and future development of infants, toddlers and their parents, professionals and policymakers, families, on whose productivity the country depends.

The Editors of Zero to Three Sally Provence, 19801985 Jeree Pawl, 1985 - 1992 Emily Fenichel, 1992

8 4 Introduction Relationships in infant/toddler childcare Infants in Day Care: Reflections on

Experiences, Expectations and Relationships

by Jeree H. Pawl, Ph.D.

Day care, as an important experience for cultural styles. These expectations are not very young children, cannot be separated necessarily either natural or unnatural in from our continued attempts to appreciate some absolute sense. They are there. and understand relationships in general. Day American babies for example, are known to care must be thought about and seen as nap alone and even sleep alone all night. occurring in a context of other relationships Often too, mothers disappear when they Relationships are and as containing relationships. lean over to tuck in the bedding and they're the major issue in out of the line of sight of their infants who When "relationship" is highlighted and day care. articulated as the true issue for children, then may howl or may not howl. Mothers also go to the bathroom (though in my parents and caregivers, the understanding experience less frequently alone than they of what day care is shifts. It is only when would like) and mothers may even go relationships are recognized as the major issue shopping while someone else cares for their that changes in the quality of care can sick child or just because they want to go happen thatwill make the day care of shopping alone or with a friend and children more appropriate. sometimes all day. In this culturethat is Understanding the experience of infants the way itis. On the other hand, surely in day care does not, as it sometimes seems no caveman or cavewoman ever sought a to, primarily involve an understanding of small cave next to theirs in which to place issues of separation. In fact, that focus as their infant at night. Sleeping with infants the major issue of concern may be far more is probably evolutionally "natural" or at least central to the experience of the parent than has a very long history. More of the world it is to the experience of the child. There does it than does not. It behooves one, then, is a separation, of course, both as an event to think very carefully about where we draw in reality and as a psychological process, but lines on what is clearly a continuum and it all happens in a contextto very differ- to pay attention to why we are deciding that ently functioning children, with very X is ok but Y is not. different relationships with their parents and The real task is to try to understand as in very different day care circumstances. In much about infants' and toddlers' capacities addition, children in general have varying and needs as we can and then to apply that experiences with separation from major to our understanding of children's expe- parental caregivers in situations other than rience and particularlyto the individual day care. child's experience, and that includes "day We have expectations regarding the care." tolerances of infants and toddlers for First of all, of course, the phrase "day care" separations that reflect parental needs and itself subsumes a wide range of caregiving

Infants in Day Care: Reflections on Experiences, Expectations and Relationships7 arrangements for children. Licensed center in her sole care and whom the mother herself and licensed family day care are in the described as rough and volatile. minorityrepresenting a far lower percen- It took time for this mother to appreciate tage of out-of-home care than other the meaning of any of this. It took time to arrangements. help this mother experience that her son's More frequent arrangements include a loss of his grandmother and subsequent neighbor who keeps several children, an inappropriate care arrangement were the The assumption unlicensed home where numbers of children major sources of Jose's very difficult that care is all right are cared for, or a private arrangement with behavior. She was able to remember that a friend or relative. It is interesting that in he had, in fact, not been "aggressive and because of consan- many of these latter arrangements concerns impossible from birth." Their difficulty is guinity is about as about separation and about the evils or resolving very nicely in the context of our sensible as as- virtues of day care barely arise. The same program's weekly visits and a better day care person who might deride center care may situation. suming that bio- cheerfully drop her own child off with her In fact, this child had lost not only one logical parenthood mother each morning or have had three au major caregiver but had also effectively lost pairs in her home in 14 months. Clearly, anotherhis mother. Because of her lack automatically the fad of separation is not the issue for this of understanding and her angry response assures sensitive woman; although arrangements which to his expressions of grief, she was not and thoughtful result in her not feeling guilty about her available to him in any familiar reassuring child's care may be her concern. So sepa- way. His grief and despair burdened and child rearing. ration per se is only a part of a far larger angered her, and she rejected and punished and more important issue. him. When the mother was able to under- I have seen more than one child left in stand her son's experience, the problem for the care of a grandmother so incapacitated them both began to resolve, even though that the care was literally dangerous. I have the loss of his grandmother's care remained seen "'others leave their infants with a real loss to Jose. Jose is deeply attached relatives whom they dislike and distrust and to his mother, and with her restoration to by whom they have feltill-treated both him, he isfunctioning quite well. An currently and in the past. The virtues of appropriate day care experience is also salient this for the children were certainly limited, to his good functioning. After the loss of though quite real. They were with someone his grandmother, his need for a day care who had an ongoing meaning in their life, environment which could be truly respon- who may have conveyed her special invest- sive to him was even more vital to his well- ment in some way, and who would continue being. to be an important figure. Though even Sometimes it may feel to parents that they here, situations are very complex. have somehow abandoned their child when Recently, a young woman was referred they have left their child in a day care center to us after calling a Talk Line out of fear or professional family day care home, but that she would injure her 19-month-old that they have not abandoned that child child. He was, she said, horribly aggressive when he is left with a grumpy and almost and had been totally impossible from birth. wholly incapacitated great aunt. The In fact, what we learned was that since his assumption that care is all right because of birth, Jose had been left all day, 5 days a consanguinity is about as sensible week with his parental grandmother while assuming that biological parenthood auto- his mother worked, and that this grand- matically assures sensitive and thoughtful mother had gone back to Nicaragua three childrearing. And thisisilluminating. In months before. Jose's day care situation had either case the care may or may not be shifted to a neighbor who had 6 children adequate. It may be only that the parent I

8 Infants in Day Care: Reflections on Experiences, Expectations and Relationships will feel less guilty in one situation. This nutriments from their environments. The is certainly not unimportant; guiltlessness infant whose primary substitute caregiver will have it own effect on the parent-child is truly available for a responsive, respectful relationship. But what assuages the discom- relationship or the infant who has several fort may he irrational. primary caregivers over the course of a long What isit,in fact, that might make a day, all of whom are appropriately available, parent feel more comfortable? Without a has the opportunity to form some mean- clear awareness of why itmight really ingful relationships. We would, of course, The infant whose matter, the parent may feel comfortable in wish to limit the number of individuals to primary substitute leaving a child when the child has a whom an infant must relate, and relate is relationship with someonea grandmother, the operant word. We want the experiences caregiver is truly a neighbor, or a friend. of the infant or toddler to be predictable and available for a There may be an unarticulated recognition familiar, and the interaction to have within responsive, respect- of the importance of relationships even it those elements which allow the infant to though in much of what any parent would experience her needs as recognized and ful relationship or read or hear, "separation" is often more responded to appropriately. the infant who has discussed as an issue. In fact, in situations Such responsivity cannot be a consistent several primary where a child is cared for by a neighbor, feature of a child's experience in a truly friend or relative, not only the child but the satisfying way .f one person feeds, another caregivers over the parent has relationship with that caregiver. diapers, another rocks and another sings course of a long The parent really knoro:; who that person is songs. That degree of fragmentation creates and therefore has some faith, misplaced or relationships which are undoubtedly too day, all of whom not, in the appropriateness of the child's care. shallow and too abbreviated. However, even are appropriately The same is often true of care provided in if several people do all of these different available, has the the child's home where the "sitter" becomes things during certain serial time periods, a known to the parent as the two casually child is probably capable of establishing a opportunity to exchange daily information of all kinds. sense of mutuality and effectiveness, and form some mean- This continuity for the parent, this that is the major crucial and important factor. ingful reassurance, is often missing, though it need In these circumstances, infants will establish not be, in other kinds of care. In centers their own hierarchies of preferences, both relationships. or other non-relational care, caregivers tend between people ina general way and to be pressed for time, as is the patent, and between people inspecific ways. They sometimes out of discomfort the parent certainly do this in family relationships. In behaves as if there were a sharp division the mood for hi-jinks? That's Uncle Bob's between two worlds and she simply leaves forte. Stomach ache? Mother handles that her child with an uneasy faith that he will well. And Daddy is terrific at wandering be all right-. She does not think, because it around pointing at environmental adven- may seem irrelevant in these circumstances, tureslike wiggly worms, airplanes, and of the "relationship" of her child to the adults dogs digging up the front lawn; besides, he or of her own to them; she only hopes that has that specially silly sound he makes before he is safe, fed and won't cry too much. he snuggles you in the tummy. Relationships between people are not We allow and expect these predilections necessarily conceptualized as the centrally of infants and toddlers in the ordinary course important factor in day care, and the various of events, and they do not worry us at all. continuities which are based on the adult So too, the primary substitute caregiver will relationshipareofteninsufficiently have her strengths, aswill the parent. appreciated. Overall, however, if there are no serious As Sibylle Escalona assured us, infants car, impediments to the parent child relationship be relied upon to put together the available a parent has far more than an edge. There

t 4, Infants in Day Care: Reflections on Experiences, Expectations and Relationships 9 is no question that by and large the parent's zero tolerance for the absence of their investment in the childhis or her claiming mothers, while certain 9-month-olds adjust of the childis transmitted in unmistakable very rapidly. These varying tolerances reflect ways. No one else is so likely to make the the temperament of the child, the quality child feel as good about herself, as special, of primary relationships, the child's expe- Children may be as important or as valued. This unique sense rience with separation and the meaning of soothed and com- of well-being and self-worth guarantees a separation; even then this is all a complex powerful reciprocal response toward the transactional phenomenon with each of forted by others in person who generates that experience And these things affecting the other. their need for us to this person exists in the familiar surround One of the issues around separation is of things and space and people that is where respond to all kinds the issue of whether or not infants you come from and return to. There has "remember" their parentsor what they of thingshunger, never seemed any reason at all to worry experience in regard to them while separ- reassurance, play that responsive parents will not matter most ated. We know from Leon Yarrow's very to a child. and attentionbut early work that infants recognize a change So what are we worried about when small in caregivers within at least weeks. We also will their need just children are in day care? We think about know that infants and toddlers remember to see us be totally their moment-to-moment experience. We do their parents when they are separated from not want a child to feel lost or abandoned assuaged? Probably them. If a five month-old can remember and or to yearn painfully and endlessly for us demonstrate to us that she felt negatively not. and be helpless to fix things. This probably or positively about one of two puppets which means, then, that separation experiences she encountered for 10 minutes one week need to be titrated so as to become tolerable. before, then we are not likely to be forgotten. It is not a good idea to be almost always We don't need to wrestle with the differ- available to a child and then suddenly leave ences between recognitive and evocative him for 8 hours, 5 days a week, whether memory. The recognition of a familiar at 3 months or at two years. Over time, person and ability to call the person to mind and in doses, the child must be given the in her absence are actually on a continuum; opportunity to establish a relationship with both are dependent on the child's experienc- the person with whom he is to be left. ing certain cues associated with the person. And here we get to the issue of individual In any situation, there will be sufficient differences, as well as previous experiences. internal and external cues to evoke memo- Some children find relative strangers quite upsetting, especially when they abruptly ries of us in our absence. The cuing is subtle assume roles other than that of stranger. but very evocative.Itisquestionable, however, whether and when there is enough As we know, certain children will approach after awhile, and others will take a very long organized sense of our constancy and time. Some children can tolerate a quiet, non- eventual reappearance to reassure and quiet intrusive presence whom they are free to the child's occasional yearning for us. engage or not, but they will howl with Children may be soothed and comforted by anguish if someone decides to approach others in their need for us to respond to them. But the parameters of the category all kinds of thingshunger, reassurance, "stranger" are very different for different play and attentionbut will their need just children. Such differences are not in any to see us be totally assuaged? Probably not. simple way connected to a child's age. Some So itmatters even more that the care two-year-olds are as wary as some 9-month- available at the moment does not leave the olds. And some 9-month-olds are as san- child feeling abandoned (This is equally true guine aj an experienced, outgoing three- even when a child is old enough to know year-old. Certain two-year-olds have almost that we will come at 4 o'clock.) 13

10 Infants in Day Care: Reflections on Experiences, Expectations and Relationships It's clear that affective memories as well relationships in the future. To be able to as cognitive memories are encoded. The assess the effects of day care on a particular affective memories are encoded long before child, then, a parent must acknowledge language. It is not clear how, but the evidence really knowthat she or he is leaving the is overwhelming that they are. The internal child with a particular pel-son or set of people; models or relationshipswhat they promise the parent will have to notice what the child's Most vital it seems and how they workare gradually organ- relationship with that caregiver is likely to to me, is that the ized around specific, discriminated people be. I am sure all of us know how unbearable infant or toddler is mothers and fathers and siblings and aunts that is for many parents who have no good and caregivers. Which aspects of the. e choices; if they looked and understood, they cared for in ways relationship experiences will be triggered by would find the reality intolerable. that promote his what later encounters is undoubtedly very Perhaps itis now time to ask if we, as complex. But we are certainly safest in trying a society, indeed wish our children to befeeling effective, to ensure a basic optimistic core to all of capable of deep, abiding intimate relation- respected and Ibelieve our answer would be a these early relationships where we can do ships. understood much so. Most vital, it seems to me, is that the resounding "yes," but we might wonder if infant or toddler is cared for in ways that intimacy is in fact a valued quality in the of the time. promote his feeling effective, respected and majority of personal relationships these days. understood much of the time. The sense of If intimacy is not part of a person's life, does having needs metthe sense that relation- its absence represent "freedom"? Are we as ships hold promisewill hinge not only on a society experiencing a re-evaluation of parental input into the child's experience of human relationships? How do we approach safety and trust; it will develop as well within the transmission of cultural values in the relationships with others. If this occurs both midst of massive cultural change?Itis with parents and with caregivers, then we difficult to think about, for it,too,is a have far less about which we must be transactional, almost circular phenomenon. concerned. Our habitual linear, unidirectional thinking In addition to concerns about the child's fails us when we tiy to decide if our society experience in the mom nt, and mastery of iscreatinga problem with intimacy and separation, many of us have other concerns. separation or whether individual problems WI-at effect will early experiences in day care with intimacy and separation are creating h ve on the quality of relationsl-iips which a 4ocietal tolerance, if not a need, for major the child will be capable of in the future? cultural shifts. Will the child have affective, unverbalized We can expect that parents who are forced memories of abandonment and helplessness, to rely on day care for their infants or whose and have poor trust in relationships? Are internal dynamics more comfortably fit with children monotropicneeding one kind of shared care will have led the way, while nurturance involving a single constant others strain and possibly break under the caregiverand will they be damaged if this demand to place their children in substitute cannot be totally accommodated? We care. We can argue that the demand to place wonder whether, without this, a child will infants in day care will be met increasingly be capable of deep, abiding relationships easily by the children of the children whom characterized by intimacy. we are creating, as they will have no In fact, these long-term issues can best difficulty tolerating separation and attenu- be addressed by understanding and address- ated intimacy. Or we might argue that with ing short term issues. Where care is taken awareness and care we can create children to assure safe, tolerable and rewarding who will balance the demands for separation relationship experiences in the present, we with sufficiently healthy relationships to are doing the best we can to protect adapt without great personal cost both to

t'2e Infants in Day Care: Reflections on Experiences, Expectations and Relationships 11 what society now demands and what it yet mother, my father and other important still treasures. relationships are embedded in my sense of We must recognize that in addition to myself in relation to a world of mutually pressures on parents of infants to remain interacting people whom I basically trust and in the work force, there are other cultural with whom I feel secure. demands for mobility, geographical distance For infants in day care, their world of As parents we can between nuclear and extended family mutually interacting people includes their allow our child in members, and lengthy separations of infants day care providers. These caregivers make and toddlers from their parents. It may be their own important contributions to what day care to miss us, a three-year separation for little George, infants and toddlers come to expect of but she should not between the ages of 2-5; he is with Aunt relationships and how they experience miss herself. Her Franny in Miami because his single mother themselves. Only if that care is responsive, in ;San Francisco can cope with her 7-year- understanding, loving and contingent will a sense of herself, old and her baby but not with him. Life for child's sense of his central importance, and of herself in Jimmy consists of four days each week with competence, effectiveness, and trust and mother and three with dad, now that he's safety be maintained. relation to others two; his parents were separated before his In effect, as parents we can allow our child should not be birth. There are desperate immigrants who in day care to miss us, but she should not damaged. leave their children behind for years and then miss herself. Her sense of herself, and of reclaim them. This family of five has moved herself in relation to others should not be three times in three years in pursuit of work damaged. That is the major loss in being promotions. Clearly these phenomena are separated from a good and adequate parent. both causes and effects. Some people seem Separation itself may be painful in many to adapt with apparent ease to experiences ways, but it pales in comparison with the which others might feel as alienation from child's loss of an effective, competent, well- close human ties.I think we must come to loved self or a socially competent self who grips with the basic questions we are really can relate and be related to. There must be asking and be hard-headed in our responses. relating partners who much of the time In a world filled with massive separations respond to a child as he is and in terms of and losses, the issue of separation in day his needs. There must be a sensitive, caregiving care is of minimalist concern. Yet if we can relationship, not mechanical caretaking. think well about this issue, we may find The childin day care internalizes an paths to addressing larger social concerns. important relationship, one that mixes and We could probably all agree that in our matches, is concordant with or nonconcor- society one must be dependent, independent dant with relationships with mother, father, and interdependent to get the best of what siblings, and others. The degree to which may be gotten. We ought not feel that we these interactions share basic dimensions of can simply take or leave particular people, respect, responsivity and mutuality is the but we must feel that we can function for issue. The 15 minutes shared with Uncle greater or lesser periods of time both with Al cannot compete in the moment, and is them and without themenjoying the a different category of experience from, 8 reality of all of those states. We can only hours, 5 days a week with Martha, even do this if relationships are inside of us in though Uncle Al may be around for the next good and nurturing ways. It is that positive 40 years. Itis true that Uncle Al will be internalization of mutually respectful and a part of one's ongoing life, but the Martha contingent relationships that makes flexibil- or Ann or Bess who cares for an infant or ity possible. I have written this essay alone, toddler over long periods of time and then but I could really master doing so because disappears will be tucked away inside, I am alone in the presence of someone. My shaping the child's expectations and coloring

12 Infants in Day Care: Reflections on Experiences, Expectations and Relationships what he imagines relationships can give him miracles to their parents, while we must and what he can give them. Those expec- know that no baby is perceived as a miracle tations should be as hopeful and as promising allthe time by parents, we must also as we can devise. steadfastly insist that each child in day care In closing, perhaps a quotation from a deserves the highest probability of being short story of Tillie Olsen's will convey what perceived as unique, of being appropriately the essence is of what I am trying to say and respectfully interacted with and of about parents, infants, and day care. having predictable, trusting, mutually determined relationships. By the same token, "She was a beautiful baby. She blew shining bubbles of sound. She loved motion, loved Ugh,. loved color each parent, and each caregiver, deserves and music and textures. She would lie cm the floor respect, understanding, and support for his in her blue overalls patting the surface so hard in or her unique investment in the child. If we ecstasy her hands and feet would blur. She was a can also find ways to help ensure mutually miracle to me, but when she was eight months old respectful, trusting, and ongoing relation- I had to leave her daytimes with the woman downstairs ships between parents and caregivers then we to whom she was no miracle at all....Then she will have the best kind of shared care for was two. Old enough for nursery school they said, the child. and I did not know then what I know nowthe Day care must not be a "parking place fatigue of the long day, and the lacerations of group for children" but a viable, rich place for safely life in the kinds of nurseries that are only parking learning more about the very complicated places for children." but very worthwhile things in the remark- Tillie Olsen describes what will not do. able world of human relationships. While we must know that not all babies are

6 Infants in Day Care: Reflections on Experiences, Expectations and Relationships13 Choosing Child Care for Infants and

Toddlers: Look First at the Caregiver

by Sally Provence, M.D.

Young children need to know and trust the other staff) so that continuity of affectionate adults who take care of them. Parents need care will be assured. to feel confident that their children are well Thinking carefully about skills of the cared for. Central to good child care for person who will actually be caring for an infants and toddlers are human relation- infant or toddlerwhether in the child's ships. Quality of the relationships available, home, in a family daycare home or in a group along with a good physical environment and settingmay be the parent's most effective enough staff to give individualized care to way of choosing child care that will support infants in small groups, should be the development. primary basis for choosing a child care As they observe a family home or group setting. daycare setting or interview a potential The increasing numbers of parents caregiver, parents should recall that because seeking supplementary child care for their children grow and change so rapidly in the infants and toddlers should be aware that first years of life, caregivers must be for several reasons very young children need particularly flexible in their actions and able care planned specifically for them, not a to adjust promptly to changing needs. What scaled-down version of a program designed a caregiver does with a 5-month-old should be quite different from her actions with a for older children. First, the rapid physical growth and developmental changes of 10-month-old, and different still from the blend of firmness, encouragement and infancy require a responsive, flexible caring warmth she will need to help a toddler environment. Second, the "routines" of infant develop. carefeeding, bathing, diapering and com- The following description of a competent fortingare communications of utmost caregiver for infants and toddlers is drawn importance to the baby's cognitive, emo- from evaluation criteria for the Child tional, social and physical development, and Cevelopment Associate Credential for should be performed with sensitivity to infant/toddler caregivers currently being individual rhythms and needs of each infant. field-tested prior to nationwide application. Perhaps most important, the formation of loving The competent caregiver ftinfants and attachments in the earliest years of life toddlers: creates an emotional "root system" for future growth and development. is patient and warm toward infants and Every child needs a solid relationship with toddlers. one or two people in the family, and the enjoys infants and toddlers and derives infant or toddler in daycare needs a main satisfaction from the ability to provide good caregiver (and limited involvement with care.

14 Choosing Child Care for Infants and Toddlers: Look First at the Caregiver is able to form affectionate attachments The following two vignettes, observed at with children. thChildren's House in New Haven, knows how to provide good physical Connecticut, provide glimpses of caregivers care; knows how to evaluate the surround- in a program designed to suppori the devel- ings for safety and comfort and how to opment of infants and toddlers. recognize illness and unusual behavior. Leslie at 4 months: Looking, moving and has sufficient health, energy and grasping resourcefulness to enjoy and guide the From the time they were admitted to abundant energy of infants and toddle d lycare, the young infants at Children's recognizes feelings and responds House were provided with variety in their appropriately; can help the child handle fear, visual em ironment through the use of sadness and anger as well as experience love, mobiles, pictures, and changes of position. joy and satisfaction; and can adjust to rapid Playtime was sometimes in a crib, sometimes changes in feelings, behavior, and physical in someone's arms or in a supportive chair, state. sometimes on a rug or mat on the floor, knows about the development of sometimes out of doors on a blanket. infants and toddlers in general and how By 4 months Leslie was described as an exceptionally strong, vigorous, active baby. needs and characteristics change during the She bounced up and down while siting or first three years. while being supported in a standing position appreciates infants and toddlers as on an adult's lap. She could reach for, grasp, individuals and takes cues about appropriate and wave objects, and move her head and actions from the child's behavior. body to view things that interested her. understands the importance and var- Several playthings were placed near Leslie wherever iety of learning needs and provides approp- she was: in l:er crib, sitting in the infant's seat, or riate activities and materials to stimulate lying on her belly on the floor. She was offered brightly infan titoddler curiosity. colored rattles, soft squeeze toys that made a squeaking sound, hard rubber teething rings, and fluffy, stuffed, engages the child, from the earliest cloth toys. These provided an assortment of shapes, infancy onward, in friendly verbal and non- colors,textures, and densities, which afforded Leslie verbal communication. a variety of stimuli and challenges from which she is aware of the importance of limiting could learn. By changing the toys from time to time, undesirable behavior but is not punitive or her caregiver introduced variety and contrast. given to outbursts of anger toward the child. Terry at 10 months: Investigating and is acquainted with and appreciates the experimenting child's own culture, customs and language. The following episode gives a picture of how respects the parents of the child in care much concentration a 10-month-old can and strives to support the parent-child show. It also reminds us that all "educational relationship. toys" need not be purchasedwhen adults are perceptive and supportive, children can What does good infant /toddler child care learn from almost anythinginthe look like? environment. Whatever may be spelled out in or left out Terry was playing with an aluminum of state licensing standards, described in margarine cup and a flat stick that looked brochures, or observed by parents on pre- like a popsicle stick. He hit the cup with the enrollment visits,itisthe day-to-day stick several times, causing it to flip over. experience of infants and toddlers ina He then used the stick to scoot the upside- daycare setting that counts. down cup along the floor. For ten minutes

Choosing Child Care for Infants and Toddlers: Look First at the Caregiver15 he continued with great concentration, The adults made Terry's play possible by providing alternately flipping and pushing the cup and the margarine cup and stick and by allowing him observing what happened. Later, while in the freedom to pursue his own interest. They supported the kitchen with v:M, who was preparing him by being nearby but did not take an active part food, he discovered the dishwasher and in his play at that time.li would have interfered with Terry's self-initiated investigations if someone had found he could roll the lower rack in and swooped down on him while he was so busily and out. He kept pushing it in and pulling it out, happily engaged with the cup and stick to take him smiling with pleasure as he listened to the away fora bath, or to introduce, or substitute a "proper" changing clatter of the dishes. He then poked toy. later, taking Terry into the kitchen and permitting about in the soap well for several minutes. him the freedom, with supervision,to explore the All of this was done in an engrossed, dishwasher, KM provided a wider variety of experiences exploratory manner. KM spoke to him that would have been available to him in the playroom. occasionally, commenting upon what he was He was learning through following his interest of the doing but allowing him to carry through his moment, supported by an adult. At other times of project in his own way. the day he was involved in adult-initiated activities.

16Choosing Child Care for Infants and Toddlers: Look First at the Caregiver Applying principles to practice Caring for Infants with Respect: The RIB Approach

by Magda Gerber, M.A.

Walking intoa RIE workshop for new ing" to describe RIE's surprisingly simple and mothers and infants, you might encounter commonsensical philosophy, which differs so the following scene: markedly from current trends. We should educate while we care and care Five mothers sit quietly observing their while we educate. Most people think of infants in the adjacent play area. One baby stimulating, exercising and teaching infants has discovered a multi-colored ball,filled as important, glamorous activities. They with just enough air for his palmar grasping think of diapering, feeding and bathing as skill. Another infant sits quietly, looking unpleasant or mundane daily chores. RIE, pensively at her reflection in the dome of however, suggests that caring activities are an upside-down aluminum mixing bowl. the optimal times for interaction, cooperation, Two adults sit attentively among the infants. intimacy and mutual enjoyment, providing One 8-month-old baby approaches another social learning experiences which encourage with outstretched fingers, heading toward fullparticipation of the infant and her an open eye. One of the adults moves closer. educarer. "Refueled" by such caring expe- David reaches for Susan's eyes. Just in riences, infants are re ly to explore their time the educarer touches his hand and environment with only minimal interven- gently strokes both babies, softly saying, tion by adults. A predictable balance of "David, you want to touch Susan's eyes, bt togetherness and separateness is achieved eyes are delicate. We touch faces very which benefits both infants and adults. gently." Resources for Infant Educarers (RIE), The RIE philosophy: Observing the founded in 1978, is a non-profit membership infant explorer organization concerned with improving the Giving the infant time, attention, trust and care and education of infants. RIE offers respectis the foundation of the RIE parent-infant guidance classes, certification philosophy. Our goal is an authentic child training for professionals, public workshops one who feelssecure, autonomous, and and conferences, and consultations to infant competent. Our method, guided by respect group care centers. These services all present for the infant's competence, is observation. the RIE approach, a humanistic-therapeutic RIE trusts the infant to be an initiator, an way of working with infants based on my explorer and a self-learner. Because of this psychoanalytic training and work as a child basic trust, we provide the infant with the therapist. To emphasize how educating and minimal help she needs to overcome an caring for an infant should be inseparable, impasse and allow the child to enjoy mastery I coined the words "educarer" and "educar- of her own actions.

Caring for Infants with Respect: The RIE Approach19 Educarers are sensitive observers how to recover. Children raised this way available when direct help is needed, but not hardly ever have any serious accidents.* intrusive when the infant can solve her own In contrast to the "experts," reinforced by problems. We provide an environment for the media, who urge parents to raise "super- the child that is physically safe, cognitively babies," RIE emphasizes the benefits of challenging and emotionally nurturing. infants' spen.ling peaceful, uninterrupted There the child may freely explore and time following their biological rhythms of falling asleep when sleepy and eating when manipulate, fully involved in learning hungry, rather than having to adjust too projects of her own design. soon to external schedules and unrealistic We allow infants to do what they are ready expectations. We try to reassure parents that and willing to do. We reinforce their self- infants do do what they can doand should initiated activities by paying full attention, not be expected to do what they are rioi while being quietly available, and by ready for. appreciating and enjoying what the infants Parents in the RIE program learn how actually do. Occasional reflections such as infant and family rhythms develop into "You touched the ball, and it rolled away" predictable routines and how "separate time" reassure the child of our full attention. and "together time" can be enjoyed. When infants are allowed uninterrupted play time Saying "It's hard to separate the two cups" between caregiving activities, parents can shows our empathy. A joyful smile when have their own time as well. Children who the infant solves a problem conveys our have learned to rely on being stimulated, pleasure in his success. As we value inner manipulated and entertained by adults may directedness in a child, we prefer gentle lose their capacities to be absorbed in inde- validations to instructions, to criticism, and pendent, exploratory activities. Their par- even to praise. ents easily becomes slaves of the nagging childitired parent syndrome they themselves Contrast with other approaches unwittingly helped to create. This approach contrasts strongly with those As parents and professional students learn used in most infant programs. In programs to observe, they realize that being "busy" I have visited, children are taught, encour- can keep one from intimacy, from really aged and expected to do what they are giving oneself, from paying full attention. They begin to see how many parents work basically not ready to do. Too many infants too hard and try too hardcarrying babies are being propped up when they cannot yet around through sleepless nights, buying maintain a well-balanced sitting position, or expensive toys, learning cribs and teaching are given a toy which they have neither kits; teaching, programming, and following freely chosen nor can freely manipulate. prescribed curricula and forgetting what is Similarly, putting infants into devices such most importantthat all those everyday, as infant seats, walkers, swings, or bouncers routine experiences, like feeding, dressing, restricts them from moving freely. Such bathing and diapering have the greatest devices introduce positions or movements effect on their baby. We remind parents of for which the infant is not yet ready. the cumulative effect diapering alone which occurs some 7,000 times in an infant's RIE believes that a child who has always lifecan have on their child. been allowed to move freely develops not only an agile body, but also good judgment 'At the National Methodological Institute for Residen- about what he can and cannot do. Devel- tial Nurseries, better known as Loczy, in Budapest, oping good body image, spatial relations and Hungary, more than 2,000 infants have been raised with the philosophy described here. In 37 years of a sense of balance not only helps the child raising infants from zero to three, they have had no Darn how to move, but also how to fall and serious accidents. r, 4,4,

20Caring for Infants with Respect: The RIE Approach RIE principles in group care We believe that their own home is the The following sample dialogue illustrates the interaction and natural habitat for the infant. Many infants, learning opportunities in an everyday encounter. however, spend many hours, and sometimes CARER INFANT INFANT LEARNS:, their whole waking day, in group care. While RIE principles are applicable wherever Greets child "You seem to be having infants are raised, their use is particularly a good time with important in the context of group infant your rubber care. giraffe To anticipate To be very special to the people who care Tells and shows for him or her is the right of each infant. what she is going This being special and being important is to do but I want to usually experienced within the child's own pick you up and Pays attention To pay attention family. It gives the child a sense of self and diaper you." a sense of belonging. Group care must work Waits for infant's especially hard to impart this sense, since reaction "You're Both learn even with understanding staff, the child not quite ready so Responds to the becomes one of many. It is therefore all the I'll wait a little. initiations of carer To be responsive to more important that during caregiving (One or two min- (positively or other's expectations activitiesaspecial relationship develops utes later) negatively) between the infant and the carer, who would Asks for coop- Cooperates and ideally be the same person over time. The eration or follows participates The joy of pleasing idiosyncracies, the unique style and tempo child's lead "First and actively of each infant should be acknowledged and we have to remove participating respected. The infant also learns to adapt your overalls. You to the characteristics of his special caregiver. pull out your foot." This kind of relationship helps the child Encourages masteryAchieves mastery The joy of mastery develop a sense of his own identity. "You helped with Becomes playful, Group care can be beneficial when the this (touches foot) teasing, doing the Autonomy environment and schedule are: now pull out the opposite of what other foot." is asked Security challenge set up to serve the child's needs Enters the game Enjoys the process; predictable and consistent and but eventually getslaughs allow the child to explore and interact back to task (busi- with ,--ther infants. ness). "This (smiling) doesn't look like a These conditions can be met most easily in foot, The joy of doing a a small group of 4-6 babies or toddlers. Envi- but more like a hand ronment and scheduling combined with to me." task together special relationships during caring may compensate for the loss of time spent at Enjoys the Process home.

Professional certification training The three phases of RIE training include In RIE professional certification training comparison of infant development theories, classes, educarers develop observational observation of local infant environments, skills, become sensitive to each infant's needs and demonstration of the RIE approach in and personal characteristics, and learn how our parent-infant classes. Our own unique to convey a feeling of specialness to an infant audio-visual library, including films of even though he must share carers. infants raised at the Loczy Institute,

r(.1 1-t.) Caring for Infants with Respect: The RIE Approach21 Hungary, and films, slide shows and with normal, at-risk and handicapped infants videotapes made of our own programs, pro- and their families. vide additional resources for our RIE interns. RIE programs offer professional training, Our students come from diverse disci- parent-infant guidance classes and commun- plines, geographic areas and work settings. ity education. Our work is both therapeutic They are nurses, physical therapists, psycho- and preventive. We believe that infancy is logists, early childhood educators, social a crucial time to develop basic patterns of workers, child care workers, family day care trusting, relating and learning. RIE supports providers and administrators. They work wellness from the very beginning of life.

Li

22Caring for Infants with Respect: The RIE Approach Mainstreamed, Mixed-age Groups of

Infants and Toddlers at the Bank Street

Family Center

by Nancy Balaban, Ed.D.

The setting is the Bank- Street Family Center in New slots ranging from three half-days to five York City. Three children are seated at a small table, full days per week. It is possible for a child each with a dish of paint, paper, and brush. Charlie, and family to continue with the same care- aged 2.11, carefully paints his left hand, one finger giver for two years and to remain in the at a time. He presses the now red hand firmly onto Family Center itself for three years. the paper. "Look!" he exclaims to the caregiver, eyeing Although very little has been written the hand print, "I did it!" Gabe ?..3, makes sweeping about mixed-age grouping of young child- strokes of red on his paper, then swirls the wooden ren, particularly infants and toddlers, handle tip through the painted marks. "You used anthropologist Melvin Konner reminds us both ends of the brush on your paper," the forgiver that grouping children in same-age groups comments. Melanie, 11 months, dips her brush in is a fairly recent phenomenon, designed by the paint and examines the trail it leaves on her adults rather than chosen by children. He paper. She feels the paint with her hand, puts the notes that: brush into her mouth, then makes more marks on the paper. The three children are absorbed in painting for (In) human hunter gatherers, in all apes, in almost nearly 20 minutes. all monkeys that have been studied, the nearly .4biqui- tous play group is a nonpeer, multiagi group of juve- Mixed-age groups of children six months niles. The advantages of the multiage composition of to three years old interact with one another play groups for transmitting nongenetk aspects of in many different ways every day in the Bank behavior in higher animals, for protecting younger Street Family Center, a full-day, main- children, and for facilitating smooth integration of streamed child care facility at Bank Street infants into a wider social wor!.,, are clear. (1975, College of Education. The Center's intent p. 122) is to replicate the natural age span that occurs When children form groups spontane- among children in family groups. Each of ously, they are not rigid about the age of the Center's two infantItoddler groups their playmates. Ellis, Rogoff and Cromer consists of at most 10 children, two of whom (cited in Katz, 1990) observed that children are under a year old, and one or two of in spontaneous groups chose to play with whom have a specific disability. The limit same-age peers six percent of the time, but of two babies younger than one year per chose playmates who differed by at least a group reflects the great amount of attention year in age from themselves 55 percent of young babies need. There are three care- the time. givers in each group. at all times. Families Konner sees the relations of children of can choose to enroll their children for time different ages as constituting a distinct

ki Mainstreamed, Mixed-age Groups of Infants and Toddlers at the Bank Street FamiCenter23 "affectional system" (p. 123). Such a system children who are both older and younger can be readily observed in the Family Center: than themselves. During the 16 to 32 month children bring toys or bottles to another, period, imitation can be seen as a "devel- embrace another, play alongside or with opmentally mature act" (Eckerman, Davis & another, grab playthings, push or hit Didow, 1989, p. 450) that will help toddlers another, or take another's food. Many of become full partners in play with other the children's feelings and experiences with children. each other in the center mirror those that However, toddler interactions in the exist between siblings or among children's mixed-age group are not limited to imitation. friends in the wider community. Indeed one A recent study of children 18 months and of the advantages of a mixed-age child care 24 months (Brownell, 1990) found that setting is the opportunity it affords children pairing a younger and an older child led to who have older or younger siblings to more interaction and more turn taking than express some of their rivalrous feelings in occurred with pairs of children the same age. a non-judgmental environment. In addition, One- and two-year-olds were seen actively adjusting their behavior to others, not merely the mixed-age setting gives single children imitating. The older children in the mixed the experience of a child-populated milieu. dyads made more complex and frequent In the following anecdote, a toddler social overtures to their younger partners expresses her feelings about a sibling figure than to their same-age peers. The 18-month- within the benign setting of the Family olds were more interactive with two-year- Center. olds than with their exact contemporaries. Sam, 8 months, is on joyce'5 lap, engaged in a "drop In a study of larger groups of children, the clothespin into the can" game. When Joyce arms Goldman (1981) found that a mix of ages the clothespins, Sam retrieves, then chews on them. facilitated the social participation of both Twenty-three-month-old Zoe watches from across the older and younger preschool children. room. Suddenly, Zoe swoops in close to Sam, hugs We might speculate that children in a him roughly around the neck, grabs the clothespin mixed-age setting begin to learn what to from his mouth, and runs off into the other room. expect from older and younger playmates Sam screams. Joyce comforts him. In a few minutes, and how to behave toward them. Children Zoe returns. She hands the clothespin to Sam. "First in primary school mixed-age classes look to you took it away, and now you're giving it back," older children in the group for leadership Joyce observes to Zoe. and help, and are drawn to give "sympathy" Sam was startled, but not hurt. He learned to younger children (French, 1984). In the that although an older child can be a threat, Family Center, we see three-year-olds he can count on the adult to protect him. organizing the play in which two-year-olds And Zoe, who responded to an impulse, had take part. We see two-year-olds often time to feel some twinge of guilt as she raced comforting and gently patting one-year olds around, clutching Sam's clothespin. On and infants. Perhaps these behaviors are the returning the object, Zoe learned that a precursors of altruism. prosocial act is worthwhileit has its own Relationships in the mixed-age group may rewards. also represent the beginnings of true friend- ship (Hartup, 1975). We frequently see Opportunities for social develop- infants as young as seven or eight months ment among children expressing preferences among children in The mixed-age group provides many oppor- the group. They become excited when a tunities for children to develop social, caring special friend arrives for the day, may offer a tangible "gift" to another child, or become and nurturing capacities. Particularly before they begin to talk fluently, toddlers learn agitated when less favorite child makes an overture. a great deal by imitating the behavior of

24Mainstreamed, Mixed-age Groups of Infants and Toddlers at the Bank Street Family Center Opportunities for social develop- sticks and starts to sing a familiar song while tapping ment through continuity of care her sticks together. All the children are very absorbed in the songs, even though only the older ones sing and A child enrolled in a mixed-age group at the play consistently. The three-year-olds, "play" their Family Center isvirtually assured of sticks and sing most of the words. Twenty-three- remaining with the same caregivers and month-old Helen sits, watching the three-year-olds; some of the same children for at least two after the third song, she begins to tap her sticks years. Because stability of caregivers and of together once or twice. As the singing ends, Rosie, 20 the child care setting are associated with the months, sings "Ba, ha, bar strikes her sticks, and development of social competence (Howes smiles broadly. & Stewart, 1987), this arrangement offers The mixed-age group fosters skill in pre- a distinct advantage to children and families. tenu ,play. While Piaget postulated that child- Howes (1988) found that toddlers who ren begin "role enactment" at age three, spent a year or more together in a group Dunn and Dale (1964) found that two-year- were more socially competent and had less olds who play with mother and older siblings difficulty with each other than children who begin "to understand, cooperate in, and had been in the group less than a year. contribute to joint pretend play considerably Further, children who moved with their earlier than supposed" (p. 134). While not friends to a new group had less difficulty yet able to "plan" the play, two-year-olds can adjusting to the new group than children perform the roles assigned them. who moved without friends. Indeed, Vygotsky's concept of the "zone Based on these empirical findings as well of proximal development" (1978) may as our conceptual understanding of the provide a more relevant model for under- importance of early relationships, the Family standing mixed-age groups than Piaget's Center makes every attempt to provide observations. Vygotsky defines the zone of continuity of care. Sam, who entered as a proximal development as six-month-old, will be cared for by the same the distance between the actual developmental level, person next fall when he is 18 months old. as determined by independent problem solving, and It is even possible that he will be with the the level of potential development, as determined same caregiver the following year, when he through problem solving under adult guidance or in is 30 months old. Changes occur in the child collaboration with more capable peers.... membership of the group only when the what is in the zone of proximal development today older children go to the preschool group and will he the actual developmental level tomorrowthat younger children enter. Children are not is, what a child can do with assistance today she will moved when they reach a certain age or be able to do by herself tomorrow. (pp. 86-87, attain a specific skill, like walking. emphasis added) Playing with both older and younger Opportunities for learning skills children provides intellectual and social In the family, children who are six months challenges that guide the less mature, to three years old reach, mouth, grasp, younger child to internalize new under- r-ed themselves, crawl, walk, talk, standings and skills. Seasoned child care and make-believe. In the Family Center, providers (Hignett and Rossiter, n.d.) know children learn many different skills from one the value of two-year-olds watching three- another. In the following anecdote, children and four year olds using the toilet. The father learn how to enjoy singing together and of a 10-month-old, watching his baby observe the skill involved in playing a musical interact with older children in the Family "instrument." Center, exclaims, "He's so sophisticated!" It Nine children, aged 18 to 38 months, are sitting is important to remember, of course, that comfortably in a circle with three caregivers. Bess, the just as in a real family, children in a mixed- aregiva, Juts given each child a pair of percussion age child care group need individualized

4, Mainstreamed, Mixed-age Groups of Infants and Toddlers at the Bank Street Family Center 25 attention. In order to meet the needs of the meatballs. A child sitting nearby joins the game. She wide age range in Family Center groups and and Nat decide to have a meatball party and invite to minimize the press of the group during the bear. Tom 2.6, and Rosie, 20 month, are the long day, the caregivers frequently divide absorbed in watching. As the play den,,,, the OT the children into smaller groups. In the continues to position Nat's legs. morning, for example, two children and a The children who are mainstreamed caregiver may go out to buy fruit for snack engage in all the activities offered at the at the local market; three others may take Family Center. Wearing his leg braces, Nat a walk around the building; and the crawls to the activities he chooses and plays remaining four or five may stay in the room freely with other children. Totally integrated to paint, play with water, sand or dough, into the group, he is a verbal, delightful or read stories. The infants, meanwhile, may three-year-old and a devoted block builder. be sleeping in the nap room. Family Center staff have had to learn to empathize with differently abled children Mainstreaming at the Family Center without feeling sorry for them. This process Within its mixed-age setting, the Family has involved a growing awareness that care- Center is committed to providing a main- givers cannot permit the children with streamed environment for differently a!-,led disabilities to insist that other children con- very young children. Twenty percent of the form to their limitations. For example, al- children in the Center have cerebral palsy, though some children enjoy crawling along spina bifida, Down syndrome, or develop- with Nat, at some point their game will come mental delays due to premature birth. A to an end. The others will run off or climb special educator coordinates special services, up to the loft. The child with cerebral palsy engages in the classroom with each child and is left behind, unable to participate. The staff teacher, and works closely with their must be supportive and straightforward in families. She coordinates the Individualized helping him come to terms with his situation. Family Service Plan (IFSP) and the Individ- This is a challenge for the staff. "We give ualized Educational Plan (IEP) for preschool Nat options." explains Karen Chaglasian, the children. An occupational therapist, physical special educator. "If he agreed, we would pick therapist, and speech therapists provide him up and run with him, holding him down services on site, most frequently in the child's at the level of the other children. Or we classroom, so that the child's schedule is not might ask if he wants to ride a scooter to disrupted by being removed from the group. go fast with the others. We don't point out By watching therapists in the classroom, what he can't do-he already knows that." caregivers learn new ways of participating "All the children have options," Chaglasian in the child's development. continues. She describes an instance in which There is nothing mysterious or hidden a group of children including Gayle, who about any child's disability. Children's was in a wheelchair, were painting each questions are answered clearly and directly. other's legs with water. The children were "Nat wears braces to help strengthen his unable to reach Gayle's legs, so they painted legs. He's not able to walk on his legs." Other the wheels. "All the children had a choice children are often included in the work of of how to adapt and continue the play." therapist and child with a disability, as the following anecdote shows. The caregiver's experience in a mixed-age setting: Staff reflections The OT is seated on the floor. Nat, aged 3.3, is in front of her, facing out. As she works on positioning Family Center staff enjoy the challenge of his legs, she plays a make-believe game with him that planning materials and activities that are involves a group of animal figures. In the game, the appropriate for the wide age span in their pig is hungry. Nat says he can have spaghetti and groups. They rely on open-ended materials

4, 26Mainstreamed, Mixed-age Groups of Infants and Toddlers at the Bank Street Family Center with a wide appeal. Amy Flynn, a head children over a long period of time. She has teacher, believes that using water, paint, seen them go through varying developmen- sand and dough "helps you understand the tal phases and knows them. very well. many ways a material can be used, above Parent reflections and beyond your own adult conception." Staff must be able to shift focus. They When prospective parents visit the Family must consider the approach to use when the Center, Laura Guarino describes the com- whole mixed-age group is together. They mitment to mainstreaming and mixed-age must be able to work in small groups, groups. Before parents see the classrooms, sometimes with children the same age and she prepares them and guides their obser- sometimes with mixed ages. Above all, they vations toward the children's interactions. are challenged to think about individual Occasionally, a parent of a two-and-a-half- childrenapart from the group and devel- or three-year-old child in the mixed group opmental issues. Consistent and well- will ask if the child is bored. Observing the conceived staff development is important to child in action and talking with the teacher help caregivers take advantage of the usually allays the parent's fears. Sometimes setting's great potential for learning. Laura a parent will worry that the two-year-old Guarino, the Family Center's director, notes who was just weaned will "fall apart" seeing the need for constant communication, one-year-olds with their bottles. Ms. throughout the day, between herself and Guarino reminds the parent that "develop- staff members. ment isn't linear. If children backtrack a little, "I would never go back to caring for just they'll still move forward." Parents who do babies, as I did in my former job," says chose the Family Center are enthusiastically Barbara Abel, a head teacher at the Family supportive of the program. They especially Center. "You can't give the individual like the chance to build a continuing attention to three or four babies that you relationship with the same teachers over two can to two babies." Still, the need to assure years. babies' safety is a real challenge. Infants must In sum... be protected from all sorts of physical danger (including the temptation to taste crayons, The mixed-age, mainstreamed Family paint and glue) as well as jealous or curious Center is a place where children, staff and toddlers. parents grow and learn together. Itis a Abel enjoys the wide age range at the setting that respects and embraces individual Family Center. She loves to see the two's differences as the zest of life. beginning to emulate the three's. Even a References range of three months to 15-18 months seems too narrow to Abel Brownell, CA. 1990. Social skills in toddlers: Competencies and constraints illustrated by because the developmental issues around autonomy are same-age and mixed-age interaction.Child Devel- so pressing for all of them-there are no older children opment,61, pp. 838-848. in the group with some developed controls to provide a Dunn, J and Dale, N. 1984. I a daddy: Two year balance. You're dealing with all the same develop- olds collaborate in joint pretend with sibling and with mother. In I Bretherton (ed.)Symbolic play: mental issues at once, and because the young toddler's The development of social understanding.New York: conflict is between being a baby and being big, the Academic Press. babies often become their target's. Eckerman, CO, Davis, CC and Didow, SM. She finds little biting and hitting in the 1989. Toddlers' emerging ways of achieving social coordination with a peer.Child Development, mixed-age group. When older children help 60, pp. 440-453. the younger ones, they are doing whatwas French, DC. 1984. Children's knowledge of the done to them. The caregiver provides a social functions of younger, older and same-age consistent example, since she is with the peers.Child Development,55, pp. 1429-1433.

Mainstreamed, Mixed-age Groups of Infants and Toddlers at the Bank Street Family Center27 Goldman, JA. Social participation of preschool Katz, LG, Evangelou, D & Hartman, JA.1990. children in same- versus mixed-age groups. Child The case for mixed-age grouping in early education. Development, 52, pp. 664-650. Washington, D.C.: NAEYC. Hartup, WW. 1975. The origins of friendship. In Konner, M. 1975. Relations among infants and M Lewis and L Rosenblum (eds.) Friendship and juveniles in comparative perspective. In M Lewis peer relations. New York: John Wiley & Sons. and L Rosenblum (eds.) Friendship and peer relations. New York: John Wiley. Hignett, W and Rossiter, D. n.d. Day care: What form it should take. Pittsburgh, PA: Louise Child Shapiro, E and Biber,B. 1972.The education of Care Center. young children: A developmental-interaction approach. Teachers College Record, 74,55-79. Howes, C. 1988. Peer interaction of young children. Monographs of the Society for Research in Vygotsky,LS. 1978.Mind in society: The develop- Child Development. Serial No. 217, 53:1. ment of higher psychological processes. M Cole, V John- Steiner, S Scribner, and E Souberman (eds.) Howes, C and Stewart, P. 1987. Child's play Cambridge, MA: Harvard University Press. with adults, toys and peers: An examination of family and child-care influences. Developmental Psy- chology,4, 23:3, pp. 423-430.

28 Mainstreamed, Mixed-age Groups of Infants and Toddlers at the Bank Street Family Center The Center for Infants and Parents at

Teachers College, Columbia University: A Setting for Study and Support

by Annette Axtmann, Ed.D.

John was seven weeks old when he and his of relationships between infants and parents. mother appeared at the Center for Infants This criterion is based on our understanding of the parent-child relationship as the crucial and Parents at Teachers College. We could context for human growth and development barely see the top of his head poking up in the earliest years. It guides decisions made out of an infant sling wrapped against his on an ongoing basis within our developmen- mother's breast and behind a huge cart tal approach, which recognizes that students, covered with video equipment which she parents, infants and faculty learn from one wheeled before her into our office. John's another and grow together. mother appeared tired, yet eager to resume Enrollment is on a first come, first served her graduate studies in educational technol- basis for parents who are students, staff or ogy and, at the same time, have John near faculty at the University and whose baby her as much as possible. is between6weeks and24months of age. This poignant image of John, his mother Three staff care for8babies at a time in and the video equipment stays with us as the Center, with each staff member respon- representative of a population of parents sible for observational and caregiving work with2or3families. One staff member is with very young children attempting to assigned as the child's primary caregiver and manage home, school and career simultane- attends the first developmental visit with the ously. They are increasingly visible at parents, the baby, and the director. Columbia University. Their requests for on- site infant care presented us with an Programs for infants and parents opportunity to serve them and, at the same Several unique features of the Program for time, develop an interdisciplinary setting in Infants and Parents allow us to be responsive which university students are able to engage to individual and changing needs of our in practice and observational studies which families: prepare them for research, educational and developmental visits which are part of clinical work with very young children and the enrollment, ongoing participation and their parents. exit processes we are developing with our To ensure a comfortable balance between families; our service to families and our responsibil- a flexible schedule of child care; and ities for professional preparation, research interage grouping of children6weeks and outreach activities, we place highest to 24 months of age. priority on the supp )rt and strengthening

r

The Center for Infants and I'arents at Teachers College, Columbia University 29 Developmental visits and the degree of harmony in the way they The developmental visits and our flexible adapt to one another. It is therefore helpful schedule of child care work together to help in interpreting their behavior later on. We the parents clarify their feelings and needs have also found that imitating the parents' in relation to their careers, to provide the caregiving techniques can ease the child's staff and the parents with concrete infor- first days in group care. mation concerning the child's developmental A flexible schedule of child care process and, most importantly, to encourage the parents to work with us on a reciprocal Regular child care hours range from one day 6 4days a week for basis. In addition, the visits yield vivid images a week forhours to 5 2 3hours teach of the way parents and children interact with hours todays a week for 7hours one another. Since observations of the visits day. The Center is open for child care are collected in writing and on video tape a day,4days a week during the academic by staff and other students working with year. The7hours shift slightly from the director, visit records, with informed semester to semester depending on a needs consent of parents, become part of a data survey of currently enrolled families run at bank for research purposes. the end of one semester in preparation for Guided by pediatrician Martha Leonard the next. of the Yale Child Study Center, we use Our flexible schedule of child care begins developmental materials and tasks as well with an adjustment period during which we as questions about a child's history in what provide the parents with child care hours we call a "developmental observation." The as close as possible to those they request, director is responsible for the observation with the understanding that these hours with the help of the parents, the child and may or may not be the best for their child the child's primary caregiver. Similar visits or for them. While experiencing their first for purposes of updating information about separation from their child on as near to development are scheduled as requested or their own terms as possible, parents have needed throughout a family's participation an opportunity to refine choices about the in the Center. time they will spend pursuing their careers, A second visit of each family to the Center caring for their child themselves, and being is providing invaluable in our work. It is together as a couple, as well as about the designed to give the child's primary caregiver kind of supplemental child care they find and other staff members an opportunity to most comfortable. observe the interactions between parents It is the child's openly expressed reactions and child which occur naturally on a day- to the new experience which most strongly by-day basis. One or both parents, the child influence the deliberations and final decision and the child's primary caregiver participate of parents and staff regarding the regular in this visit. The caregiver explains that she schedule of child care hours. In the case of wants to learn from the parents how to care one family, the adjustment period lasted one for the child before the child enters group day, since neither child or parent seemed care and may suggest the parent show the discomfited by the separation from one child areas and materials in the comfortable, another on the first or subsequent days. The well-furnished infant parent room. The adjustment of another family took6weeks, caregiver role is that of participant-observer with several changes in both days and hours and does not involve intervention unless the from the ones originally requested by the situation becomes uncomfortable. We have parents. found that this visit also provides informa- The baby is introduced into group care tion about the ways in which parent and by her or his primary caregiver, who works child interact, their modes of communication individually with the child while other care-

30The Center for Infants and Parents at Teachers College, Columbia University givers first come to know the child from attempting to work, study and rear their a distance. Gradually, as irdicated above, the infants. care of each child is shared by 2 or 3 care- Information gathered through individual givers. This systematic sharing is necessary studies, research projects and the day-by- because our caregivers observe and work no day observational work of the staff is shared more than 10 hours per week with the babies with the parents as it is developed and in and their parents. The balance of their time completed form. Parents who enroll in our during the week is spent attending classes program for infants and parents do so with which occur at different times at the the understanding that they and their baby University.Itisquite possible that the will participate, within clearly specified limits, enthusiasm of our caregivers for their in our study and outreach activities. worki.e., lack of the usual "burn out" Recently, we invited some of the parents experiencedis due to our flexible, limited to join the staff in presenting the Center's caregiving schedules as well as the relation- work to conferees at the College. ships we help them draw between the work Work in our Center for Infants and and their studies. Parents has suggested several questions with Interage grouping important implications for practice and further study. We have observed in many Our interage grouping of infants 6 weeks of our parents a remarkable capacity to grow to 24 months of age makes it possible for and learn with their babies in i.,dividual us to admit families at a time in the child's ways, day by day, as we work with them. life when many parents seem to feel a strong Is this capacity related, in part, to the fact need to resume work outside the home yet that they come to us for help with the care lack societal support to do so. Interage of their baby at a stressful time in their lives, grouping allows us to maintain a small when they are struggling to manage work, operation, in keeping with accepted stand- study and home? If so, others designing ards for quality group care of infants, and, programs to support families might wish to at the same time, to serve a family for up incorporate aspects of our program, such as to 18 months. It also provides a family-like the opportunity for parents to choose and setting where very young and older babies can interact with one another. Our syste- experience the times for child care that seem to them the best for their individual needs matic observations indicate that interactions between children ranging in age from 7 and to respond as fully as possible on an weeks to 24 months are often mutually on-going basis to the expressed needs of the particular population. We feel these aspects facilitative in nature. One study focusing on interactions among parents, children and encourage our parents to make thoughtful caregivers in our group care facility describes and realistic decisions basic to the develop- "an ethos of familial conviviality." ment of family relations. Another area for investigation is the po- Additional studies and questions tential for human growth, particularly the Additional studies- conducted by the staff and growth of empathy and social competence, non-staff students working with the director in infants 6 weeks to 24 months of age, who have included topics such as separation issues are grouped together on a day-by-day basis. in day care settings, Infants and tempera- Systematic study of individuals who have ment and a study of the relations between this experience when they are young can two siblings who attended the Center at the yield implications for developmental theory same times. Data are also being gathered and practice, particularly as programs for for a survey study related to the well-being infant toddler group care expand to meet and productivity of older parents who are parental demand.

r t)t) The Center for Infants and Parents at Teachers College, Columbia University31 These and other questions which occur quickly, smiling with delight.Evidently, to students, parents and faculty as we work peek-a-boo was a game they played together. together with infants permeate and bring David's mother brought him to the infant- daily excitement to the active yet academic parent room for their second developmental atmosphere of the Center for Infants and visit. During this visit, David, his mother Parents. We cannot help but be optimistic and his primary caregiver were sitting on about the potential for service of clinicians, the floor several feet away from a large educators and researchers trained in this at- colored mobile. David gazed toward the mosphere, where study is a part of practice mobile and lifted up his arms in a gesture and the quest for further knowledge which seemed to say "take me up." His becomes a key ingredient of teaching and mother did not respond to this gesture but caregiving. kept on talking to David's caregiver. David The Center for Infants And Parents: put his arms down, crawled past his mother Two Family Portraits until he was directly under the mobile, and whined. As he did so his mother got up from David the floor, went toward the shelf across the David, dark-haired with delicate features and room, took the "rockaring" toy from the blue eyes, was 7 months, 22 days old when shelf, brought it back and placed the toy on he, his mother and father came to the Center the floor beside David, commenting, "He has for the first of two visits which would pre- one at home and can work it." David grabbed cede his enrollment in the Center for regular a ring from the center of the 'rockaring" child care. David's parents, recently arrived while at the same time he continued to gaze in the U.S. from the Middle East, seemed upward at the mobile. Mother turned back extremely eager, almost desperate, to enroll to her conversation with the caregiver. Later, David in the Center's program so that they the two women got up and walked across might have more time to work on their the room, leaving David behind on the floor. doctoral studies at Columbia University. His mother gave no indication of including David smiled at his primary caregiver from him in this change of position. The caregiver, his stroller and appeared comfortable in his who must have felt uncomfortable at leaving parents' arms. In discussing his feeding David behind this way, invited David to schedule his parents said: "He is not well "come over here." David watched them and organized." They told us he did not use a cried out sharply. Then, he crawled ener- bottle and so when his mother went to the getically across the room atter the two library and his father cared for him from women. noon until around 5 in the afternoon, he All together, the two developmental visits drank juice from a cup and was fed soft food yielded: a mother, father and baby newly with a spoon. He nursed off and on during away from their homeland who spoke little the balance of the day and night. When English; an unusual feeding schedule; and asked, the parents could not describe differ- some lack of responsiveness to cues from ences between his cries according to the the child, in that the parents did not seem situation or his specific need at the time. to differentiate his cries nor read his gestures This, and David's feeding pattern, seemed in ways that made sense to us. At the same unusual to us. On the other hand, David time, we found a child who smiled happily responded to most of the tasks included in in his parents' arms, displayed a good deal the developmental observation at or above of energy lccatirg and obtaining desired his age level. For instance, toward the end people and objects, and whose mother was of the visit a cloth was placed on David's seeking child care advic- as well as relief from head by one of his parents. He pulled it off the daily care of her child.

32The Center for Infants and Parents at Teachers College, Columbia University The parents requested 7 hours of child him at home she waited until they arrived care, 2 days a week. As with other families, at the Center. Upon arrival, she fed him we agreed to try these hours during their fruit sauce and nursedrn. When she left adjustment period. On the first and subse- the infant-parent room he did not cry. In- quent days, David refused to eat food or stead, he began to whimper and cry when drink the juice offered to him by his father. the 4 hours were just about up and it was As soon as his father left the infant parent time for her to come to the Center, nurse room, he cried in a way that seemed to us him there and take him home with her. We to lack communicative quality expected of were struck at this time by the seemingly babies 7 months of age. We could not console intimate relationship between where and him and he appeared unable to console when David nursed and his ability to manage himself, i.e., he did not resort to his thumb, on his own without his mother for a more had no "blanket" or other transitional object, or less regular interval of time. and would not relax into sleep when pushed David began to enjoy his time in the about in his stroller. His parents responded Center more and more. Toward the end of to this state of affairs by shifting their work his 6th week with us he was observed in hours so that David's mother, rather than a high chair feeding himself raisins as he his father, brought him to the Center. She watched his primary caregiver manipulate stayed with him for several seven hour a "pop" umbrella. She asked David; "where periods, nursing him from time to time and did the man go?...where...there he watching his primary caregiver with him. is ... peek-a-boo." Later, the same caregiver She asked questions, e.g., "How do parents stepped over the gate out of the infant- know when a baby's ears hurt?...older pa rent room while David stood, hanging babies probably tell them." The caregiver onto the gate, watching her go into another responded: "Babies have other ways, such room. A few seconds later, he dropped down as tugging at their ears." During this period and crawled back into the infant-parent we observed David's mother lean way over room toward four other babies and another on her side so that her face was level with caregiver grouped together on the floor his as he manipulated 2 colored rings. In around a large bin filled with sand. This and contrast to her lack of response to his similar incidents indicated that the staff of gestures of interest in the mobile during the Center, David's parents and David had their second developmental visit, she seemed found a regular schedule of child care hours to be trying to take his perspective of the suitable for this family. rings. One is never quite sure why a baby is Despite this intensive work by mother and finally able to cope with what appears to caregiver, David cried, invariably, when his be a difficult situation. Certainly, David's mother slipped out of the infant-parent general health, tenacity and curiosity about room for a short time. Therefore, we asked people and things around him as well as his our clinical consultant to observe mother and parents' desire to achieve a satisfactory child together and meet with David's resolution of their child care needs, eager- parents. Among other things, the consultant ness to learn from the staff and clinical suggested we change David's hours to 4 days consultant, and willingness to adjust their a week, 4 hours at a time, instead of 2 days own as well as David's schedule were very a week, 7 hours at a time. Although we important in the progress made by his followed her advice, we experienced no real family. change in David's behavior. We did experience a change, however, John after David's mother initiated a slightly new John was seven weeks old when his parents feeding pattern for him. Instead of nursing brought him to the Center for their first

The Center for Infants and Parents at Teachers College, Columbia University33 developmental visit. His mother appeared no indications of distress when his parents very tired. She kept saying, "I have to leave left him in the infant-parent room without soon ... have a class." His father, a lawyer, them. seemed less ambivalent about the situation. During subsequent weeks John's mother John's mother took him out of his "Snuggli," gained physical strength. She would leave removed a pacifier from his mouth and her baby with us and go to the library or placed him on his back on a quilt spread class close by. Later, she would run up after out on the floor. He stretched out his legs class to nurse or play with John and talk and gazed upward. During the developmen- to the caregivers. Toward the end of the tal observation he smiled radiantly at his semester the family had arranged a weekly primary caregiver. He did not hold the rattle schedule whereby the parents shared the in his hand as one might expect from a child caregiving of John on a regular basis, and his age, but did grasp the director's hand also spent time together as a family and as when she hooked it in his and looked into a couple. John's mother had a part-time job his eyes. John's responses were clues to us in the mornings and was pursuing a doctoral that his seeming delight in people could help degree at Teachers College through two us engage him in the developmentally useful evening courses. One evening at about 6:45 gentle physical exercises (such as "pull to sit" she came striding down the hall toward the and "bicycle") which occur naturally at the Center. She was glowing with anticipation, changing table. As the parents, director and saying, "I really missed him!" And later, as primary caregiver became more involved she pulled on his snowsuit, she said, "I really watching John respond to the developmental like him!" It seems John's mother had sorted tasks during the visit, his mother seemed out some of her needs and was managing to relax a bit. Toward the end of the visit, with 3 degree of zest. she nursed him. She said no more about As for John, he responded to the physical going to class, but stayed the entire time exercise and special toys staff designed and required for the visit. made for him as if enjoying his interaction We began John's trial period immediately with us. Later, this enjoyment grew to en- after the first visit with a tentative schedule compass the other babies, with aplomb and of 3 days a week, 7 hours a day as requested enthusiasm. John is now 20 months old and by the parents. In contrast to David, we has manifested no more than an occasional settled on these as the regular schedule of and fleeting sign of discomfort at separation child care hours for John, after a four-day from his parents. As his mother said, "The trial period. We did so because John gave Center is a second home to him."

34 The Center for Infants and Parents at Teachers College, Columbia University Therapeutic Childcare

at Merrywood School

by Maxine Siegel

Infants and toddlers who are disabled or at children with mild impairments to be risk of developmental delay are also highly enrolled in community daycare, the devel- vulnerable to abuse and neglect. How can opmentally delayed children enrolled in our we best meet the needs of these children specialized program are moderately to and their families? severely involved. Three child care staff Although early childhood educators and members serve these eight children, two childcare workers have often been over- staff at any given time. looked as resources for this population, in Only three of the eight children, who can fact an appropriately staffed and individu- be either non-handicapped or developmen- alized therapeutic day care program can offer tally delayed, are Child Protective Services unique opportunities to protect and support referrals for therapeutic day care. Since the such children and families. families of abused or neglected children tend Merrywood school in Bellevue, Washing- to be dysfunctional, loading the full day pro- gram with such children overly stresses staff. ton has served developmentally disabled in- With an amalgam of children's abilities and fants and toddlers and their families for more levels of family functioning represented in than a generation, under the auspices of the the program, however, staff can give the state's Division of Developmental Disabil- attention they feel necessary to the poten- ities and Crippled Children',: Services. We tially abusing /neglecting parents and main- felt that our expertise would make it rela- tain other levels of interaction with better tively easy to serve abused and/or neglected functioning families of handicapped or non- children of the same age, and in 1984 we handicapped children in the group. Staff are responded to a state of Washington Division also more able to respond to the demanding of Children's Services request for proposals. daily care needs of therapeutic day care child- The result is Therapeutic Childcare, a pro- ren: these may include attention to diaper gram designed for abused or neglected rashes, bathing, monitoring illness, feeding children who are referred by Child Protec- and coping with behavior problems. Most tive Services order to keep the family importantly, however, all parents and child- intact, protect and nurture the child, and ren in the school serve as incidental models counsel and closely supervise parents. for one another across the boundaries of Only ten children are enrolled in Merry- disabilities, family characteristics, and ages. wood's child care program. A maximum of The three therapeutic child care students eight are scheduled to attend on any given are each enrolled five days a week in day day. Of these eight, four are non- care. They attend from six to ten hours per handicapped and four are developmentally day. Because the full spectrum of special disabled. Because itis desirable for young education and counseling components is

Therapeutic QHilicare at Merrywood School35 available, therapeutic day care participants meet with families at least weekly to discuss may be involved in whatever menu of behavior management, child development services seems most appropriate and for and other issues. They are also the principal whatever frequency, intensity and duration liaisons with Child Protective Services, seems indicated. Children use the day care Public Health physicians, and other classrooms at Merrywood as home base for resources. naps, meals and "down time." They then go from there to whatever classroom or Case vignettes therapy services are in their plan. This model The program for the A's, whose develop- provides both consistency of staffing and mentally delayed year-old son Philip exhi- flexibility to choose among program com- bited failure to thrive and severe eating prob- ponents. The Merrywood School program lems, involved attending hour-long therapy also makes an effort to match parents' needs sessions twice weekly with their child, with particular staff talents. meeting with the social worker weekly, We encourage parents to bring their playing with their son daily on the Merry- children to school because they can then wood grounds, and several days of volunteer spend some time in the program, speak with work each week in her son's special school staff informally, and again meet other classroom for Mrs. A. Philip was enrolled parents in the school. Because non-day care in day care while living with foster parents, children come to Merrywood fur specific and the parents' daily visitation was super- classes or therapy only, many families relax vised at Merrywood. Because feeding was in the parent lounge, observe class from a such an enormous problem, the A's initially one-way mirror, and chat with one another. came in at meal time to work with staff When therapeutic child care parents join in feeding Philip. We soon noticed, however, them, they benefit from the casual modeling that this was too stressful a period for both of appropriate parenting techniques: separ- child and family. We backed off, let staff feed ating from children at the beginning of the the child and encouraged Mom and Dad just school day, greeting them after class, be- to come and play daily--a far less anxiety havioral modification, even supervision in producing and more reinforcing activity. the parking lot and use of car seats. They Gradually the parents increased their invol- are able to see what toys, skills, and activities vement and learned new skills and Philip are appropriate for their children and get returned home. Today he is still enrolled at a great deal of positive feedback from staff. Merrywood, but in the developmental When parents do not transport their disability program, rather than in therapeu- children, staff do so in private cars equipped tic day care. We continue to monitor his with car seats. They send notebooks back health and development and to provide phy- and forth daily with progress reports, art sical and speech therapies as well as special work, and generous praise for both parent education. After an initially hostile response and child; parents say they are eager for the to the program, his parents worked hard feedback. and were extremely cooperative. The Merrywood also assigns each therapeutic medical arid social service community and day care family to a case manager. To avoid an excellent foster family also did their parts overstressing any one professional, this role to achieve this success. isdivided among staff and is not the George is the developmentally delayed responsibility of the hands-on child care year-old son of mildly retarded parents. His worker. A social worker serves as the key program consists primarily of daily special contact with one family; a second is served education classes and consultant therapy by his classroom teacher and a third by the services. His family's program emphasizes program coordinator. These professionals meetings with a classroom teacher weekly

S.

36Therapeutic Childcare at Merrywood School at home or at the school. Parents also attend Services or Merrywood suggestions. School monthly all school parent education discus- staff are carefully feeling their way to insure sion sessions. Mr. and Mrs. B have been maximum care and protection for the child extremely cooperative and have made while interfering as little as possible with excellent progress. A teacher has worked the family's very fragile bondinglattachment with them in the home on such basics as process. We are endeavoring to gain Mrs. how to arrange toys, how to play with their C's trust, but at this stage The cancels or son, what is normal behavior for a two-year- is not home for home visits by staff and old, what are reasonable expectations, and spends as little time at school as possible. effective behavior management techniques. We are keeping in mind Crittenden's Together they have gone through their toy observation (1983) of a paradoxical effect of box and chosen what is appropriate for his mandatory daycare. Rather than offering age. A great coup occurred recently after respite to overly stressed families, the little George had broken a prized piece of separation involved in day care can interfere china; his mother noted that her instinct was with an already tenuous attachment process to hit him, but instead she "timed herself made problematic by earlier separation out" and walked away. Both parents have experiences such as foster care. To avoid asked staff for retorts to friends who urge exacerbating family rejection, agencies must them to spank their son, They are now able treat the family unit, not merely the child, to reply that "for George that won't work, and work to gain the trust of families and so we do it this way." The family, who used involve them in their child's program. to refer to their child as "rat" or "monster," has begun to enjoy finding new positive pet names for George. Bibliography John was physically abused and entered Barber-Madden, R. "Training Day Care Pro- the therapeutic day care program after hos- gram Personnel in Handling Child Abuse Cases: pitalization for hematoma and resulting Intervention and Prevention Outcomes." Child hemiplegia. Fortunately he has no lingering Abuse and Neglect 7 (1983): 25-33. disabilities as a result of his trauma, but he Crittenden, P. "The Effect of Mandatory Protec- demonstrates a number of neurological "soft tive Daycare on Mutual Attachment in Mal- treating Mother-Infant Dyads." Child Abuse and signs" and without intervention would likely Neglect 7 (1983): 297-300. become one of the many at-risk infants and Field, Tiffany. "High Risk Infants 'Have Less toddlers who later develop school problems. Fun' During Early Interactions." Topics in Early He has been assessed by physical and speech Childhood Special Education 3 (April 1983): 395-402. therapists and spends two hours daily in the Cabinet, Laille. "Child Abuse Treatment Failures special education preschool classroom (with Reveal the Need for Redefinition of the Prob- lem." Child Abuse and Neglect 4 (1983): 395-402. consultant therapy services) where he now Lero, D. "Early Childhood Educators: Their functions as one of two non-handicapped Contact with Abused and Neglected Children." models. His father, primarily responsible for Child Welfare 59 (March 1980): 169-178. the abuse, has left the family. However his Roberts, M. "Reciprocal Nature of Parent-Infant mother is extremely neglectful and the Interaction: Implications for Child Maltreat- situation requires constant supervision. Mrs. ments." Child Welfare 58 (June 1979): 383-92. C. brings John to the program but has done Yates, A. "Predicting the Abusive Parents' Response to Intervention." Child Abuse and Neglect little else to comply with Child Protective 7 (1983): 37-44.

BEST COPY AVACUEI

Therapeutic Childcare at Merrywood School37 Childcarefor infants and toddlers with special needs "The Sooner the Better Project":

Involving Parents and Day Care Staff in

the Identification and Treatment of

Developmental Delays and Disturbances in

Infants and Toddlers

by Roseanne Clark, Ph.D. and Mary Jane Oltmans, M.A.

What happens when an infant or toddler a week as they eat, sleep, play, get tired, in day care has undiagnosed, unmet devel- get dirty, get upset and are comforted. opmental needs? First, the caregiver may Trained and experienced caregivers are not experience difficultya child may require only in an excellent position to observe and extra assistance, may withdraw or act out identify children whose behavior and aggressively, may arouse feelings of frus- development are of concern, but they also tration or ineffectiveness. Second, the have an opportunity in their daily interac- parents, who may be experiencing similar tions with parents to observe disturbances feelings of inadequacy in their relationship in early parent-child relationships. with this child, may react to the "public" The Sooner the Better project (TSTB) is an innovative initiative that was developed exposure of the child's problems in the day in response to the frustrations and expressed care setting by ignoring the problem or with needs of day care personnel who recognized increasingly negative feelings toward the that developmental day care, while pro- child. Third, the child, perhaps coping already moting the well-being of most children and with negative experiences and frustration families, was insufficient to meet the special related to the developmental issues involved, needs of very young children experiencing may experience anxious, negative responses developmental delays and disturbances, and from adults both at home and in the day the needs of their families. Day care staff care setting. could recognize problems but lacked the At the same time, an infant-toddler day training to diagnose them and, more impor- care setting has tremendous potential to tantly, to develop treatment plans. At the serve as the source of screening, evaluation, same time, they knew that the lack of referral, follow-through, and emotional publicly funded programs for disabled and support for very young children with special at risk infants and toddlers often meant that needs and their families. Day care s'eaffrb- children, families, and caregivers would be serve children 8-10 hours a day, five days forced to "wait it out" until the child became 4

"The Sooner the Better Project": Involving Parents and Day Care Staff 11 three. TSTB is designed to tap the enormous ferrals for evaluation by caregivers for the power of caregivers, parents, and infant children in their charge. They told us of their mental health professionals working to- concerns that a referral of, for example, a getherwithin the day care settingon child with delayed language would reflect behalf of the child. poorly on their own "teaching." Referral of TSTB is based in Baby Toddler Nursery, a child exhibiting depressed, somber affect, a child care program for children from four on the other hand, might be seen as intrusive months to three years of age, sponsored by into the parents' "personal life." TSTB staff the Infant Welfare Society of Evanston, recognized the need to develop a relationship Illinois. Three-quarters of the 61 children of mutual trust with caregivers, working enrolled are from low-income families. The with them individually or in teams in their center is not university based, but funded own classrooms. This allowed us to under- through a combination of public (Title XX) stand better the caregivers' experience of the and private sources. Ratios of caregivers to child and to communicate respect for their children range from 1:4 for infants to 1:7 professional competence through collabor- for two-year-olds. ative efforts to obser e, evaluate and plan Ihe professional caregivers at the center for the child's special needs. come from a variety of backgrounds, with It has been continuous work around the well over half living inthe community needs of individual children that has con- served. Most have received their training at tributed most to furthering development of local colleges;all have completed some caregivers' clinical observation skills, changes courses, and a few have earned an A.A. in attitude about infants' and toddlers' need degree. Staff of TSTBall working part- for affectively involved and responsive care, time on the projectinclude the director and and well-deserved professional pride in assistant director of the day care center, a having observations respected and ideas incorporated into treatment plans for special psychologist, a clinical psychology graduate student, and asocial worker from the needs children. We also saw caregivers Community Coordinated Child Care (4C) generalizing new attitudes and patterns of behavior to their interaction with other agency. children. Expanding professional competen- "Freeing up" caregivers cies of infant-toddler caregivers TSTB emphasized that caregivers needed to Initial TST3 efforts included an assessment be allowed time to work individually with of caregivers' knowledge of what delays and special needs children. This process allowed disturbances look likein children under them to experience such a child in a new three, what infants need to experience in waynot just as demanding, but as needing their relationships with adults in order to special approaches. Caregivers experienced develop optimally, and what problems in themselves in a new way as wellnot only parent-child relations look like in the earliest as making snacks, changing diapers, and years. Staff designed two in-service pro- picking up cots, but as being affectionate, grams that focused on: 1) the psychosocial responsive and interested in what an needs of young children in group care and individual child can do, what he is trying 2) caregiving approaches for supporting to say. The program allowed time for development of communications and lan- responsive care. Caregivers were "freed up" guage skills. Some caregivers also attended also to spend time with parents, enlisting aclass onhe exceptional child offered them to the fullest extent possible in through the local community college. planning and providing care for their child. Interestingly, we found that communica- tion of information itself resulted in few re- 42 42"The Sooner the Better Project": Involving Parents and Day Care Staff Clinical services research arched away from comforting or cuddling. In addition to TSTB's clinical services, a Perhaps most devastating, the results of a research component was begun this year in brainstem auditory evoked potential showed order to evaluate the efficacy of providing no response in the left ear and diminished screening and making preventive interven- ability to hear in the right ear. tion services available for all families with While Brian made gains both physically children under three in group care. Using and emotionally over the next few months, data from a parental stress questionnaire, it became clear to day care center staff that we will be looking at the relationship complete spontaneous recovery was between parental stress and developmental unlikely. The report from the developmental delays and disturbances in this population. assessment conducted at 11 months by the Preliminary data indicate good sensitivity center's consulting clinical developmental and specificity for the TSTB risk assessment. psychologist described Brian as lying on his Indications are that day care intake proce- back in the infant room when she came to dures that include developmental screening get him for testing, his color grey or dusky, or assessment, along with inquiry about the his affect dampened and somber. He level of stress and social support experienced appeared sick and listless. Brian was alert, by families, will assist day care staff in recog- however, and watched intensely the activity nizing the special needs of infants and of the others in the room. Asked by the parents in their programs and the role that psychologist for their observations and the day care program may provide in experience of Brian over the prior few addressing those needs. weeks, center caregivers described him as lying on his back unless held, often crying Two years with Brian or wearing a distressed expression, and being A description of TSTB's work with Brian extremely difficult to comfort. When they and his parents suggests the benefits looked at him, he would quickly avert his provided by this project for the child, for gaze. They felt that he was fragile and needy, the family, and, no less importantly, for but they also felt that they didn't know what professional caregivers. to do to help him. Brian was a healthy, active, curious and Results of the Bayley Assessment indi- well-functioning infant until he contracted cated an MDI of 71 and a PDI of 58. Some hemophilus influenza which developed into of Brian's failures were on items requiring bacterial meningitis. He was eight months vocalization or auditory skills, and others old at the time. A bright-eyed child with required a higher energy level than Brian dark, wavy hair, he had just been enrolled was capable of at the time. His psychomotor in Baby Toddler Nursery when he became functioning was greatly impaired, and illand was hospitalized for ten days. though he did demonstrate age-appropriate Returning to the nursery after two weeks fine motor skills, the quality of his move- at home, he was completely changed. Once ments were of concern, with stiffening and robust and energetic, Brian was listless and arching noted. While Brian was quiet, wary sickly. Able to crawl and pull himself up to and withdrawn when the assessment began, stand at eight months, at nine months he he appeared to be able to make use of the could not sit unsupported and had little psychologist's holding him, and focusing his control of his head and neck muscles. His interest with quiet enthusiasm and positive organizational and self-regulating abilities affect did not overstimulate him. He was had regressed, and his affect had become able to become more involved with the test somber and depressed. Formerly friendly materials. A very bright child, Brian was able and affectionate, vocalizing and socially to complete age level items that did not tax responsive, he now averted his gaze and his physical energy level or require auditory

"The Sooner the Better Project": Involving Parents and Day Care Staff43 comprehension. He brightened when he To understand Brian's parents' perspec- built a tower of two cubes, and he became tive better, itis important to know that involved in reciprocal, responsive play with during the period of his illness and initial the psychologist. recovery they were also struggling to regain By his first birthday, however, Brian still their equilibrium. They had just completed had a somber demeanor, had difficulty with an interstate move and dual career changes head and neck control, and was able to sit when Brian became ill. Particularly for his unsupported for only brief periods. Most mother, the loss of Brian as a healthy, serious, he did not appear to respond to responsive, competent infant was very sounds or to spoken language. difficult, and the experience of Brian as Not surprisingly, it was difficult for Brian's ignoring and uncoope -ative left her feeling parents to accept his disabilities. In contrast, frustrated and ineffective. it was difficult for daycare staff to under- In the two years since Brian's illness, his stand and accept his parents' reluctance. parents have come to accept his disabilities While parents of a special needs child have to a significant degree. Their interaction with very deep needs which are both emotional their son is far more positive and affectively and practical, caregivers' needs are largely attuned than formerly. He seeks comfort practical, having to do mostly with providing and approval from them, and they have come care and promoting development. In Brian's to be proud of his achievements, even in case, this difference was accentuated because learning sign language. the parents were coping with the loss of Another dimension of this experience for their healthy infant, while caregivers were Brian's caregivers was the opportunity for emotionally involved only with the child he professional growth. Because of their work had become. with Brian, they were receiving consultation Since the initial evaluation, the extent and from, and working with, other professionals. nature of Brian's hearing disability remain They were helped to understand Brian's unclear. Audiograms and other tests have needs, which in turn helped them to avoid indicated borderline normal hearing (suffi- feelings of rejection and frustration. They cient for speech development), but Brian were given practical suggestions for struc- continues to be unresponsive to spoken turing his environment and for helping to language. His parents maintain that he can promote his optimal development. Relieved hear and are determined that he use oral of regular caregiving responsibilities for language exclusively. While they have short periods in order to work alone with cooperated in learning sign language, they Brian, they helped him learn that adults can primarily use spoken language intheir be expected to be responsive. In many ways, interactions with him. Brian's speech their experience was one of personal and therapist, on the other hand, wants him to professional growth. learn sign language simultaneously with oral The role of the day care center as a whole language, on the theory that sign language through these two years has been five-fold: will provide him with more communicative 1) providing a developmental clinical assess- ability more quickly, as well as giving him ment of Brian's strengths as well as areas the construct of "language," which may help of compromised functioning; 2) assessing him to learn speech. Brian in fact has learned Brian's parents' resources, coping abilities, sign language quickly and uses it well, now relationship with Brian, and personal needs; teaching his caregivers new words. He can 3) carrying out therapeutic plans developed also initiate communication and express his for Brian, especially around communication growing autonomy: recently, in response to skills;4) coordination of evaluation and his caregiver's sign to sit, Brian vehemently services of a number of agencies and private made the sign for "walk." providers; and 5) serving as a source of

44"The Sooner the Better Project": Involving Parents and Day Care Staff interested, available, and empathic support professionals who have an obvious involve- for parents. This last function has included ment with the child. Because contact is so exchanging anecdotes about Brian and his frequent, it is at times casual. Because it is accomplishments, listening to his parents' so readily available, it does not add another frustrations and triumphs, reflecting on and "appointment" to an already heavy schedule. interpreting feedback from other profession- The day care center supports both Brian and als, problem solving, developmental gui- his parents in ways that more traditional dance, and encouragement. The day care services for infants and families facing center has proven to be an ideal source of developmental problems may find difficult support, particularly because of the oppor- to achieve. tunity for daily contact between parents and

4 ro-

"The Sooner the Better Project": involving Parents and Day Care Staff45 Models of Integration Through Early Intervention/Child Care Collaborations

by Mary Beth Bruder, Ph.D., Penny Deiner, Ph.D., Sandy Sachs, M.Ed, LCSW

Families of young children with disabilities, Connecticut likeallfamilies, have many roles and The state of Connecticut has been allocating functions to fulfill. One of the most im- funds to train day care providers to serve portant functions is the need to work for young children with special needs for the a living. Infants and toddlers with disabilities, past three years. The Department of Human like people of any age with disabilities, Resources and the Department of Mental deserve opportunities to participate in the Retardation have been contracting to the typical experiences of their culture. Deliv- Division of Child and Family Studies, De- ering early intervention services within partment of Pediatrics at the University of community child care programs offers an Connecticut for this training. The Division opportunity to support the development of has also received a federal in-service training young children with disabilities and their project (HCEEP), The Day Care Training families through the kinds of comprehensive Project, to develop a model curriculum on community-based, family-centered services the integration of children with special needs envisioned by P.L. 99-457. Yet the challenges into day care centers. Additionally the ur such a model to both the early interven- Division has two demonstration projects tion system and the child care system are (HCEEP), jointly referred to as the Early many. Childhood Special Education Community Connecticut, Delaware and Massachu- Integration Program, funded to assist setts are three states that have accepted this existing early intervention agencies (Depart- challenge. Each state is currently developing ment of Mental Retardation for children model early intervention programs within birth to three; Department of Education for community child care settings. Each is using children three to five) to expand their service a combination of federal and state funds to delivery options into community day care provide a variety of services to enrolled child- settings and nursery schools. ren, families, and child care staff. This article, based on a symposium presented at the Delaware National Center for Clinical Infant Pro- The state of Delaware has also be ?.n using grams' December, 1989 National Training both state and federal funds to train day Institute, will describe activities within each care providers. Delaware First was a three of the three states and discuss issues of year statewide demonstration project service delivery, training, policy development (HCEEP) designed to provide quality early and evaluation which have emerged in all intervention for handicapped and at-risk in- of the states' efforts. fants and toddlers in mainstreamed family 4 G

46Models of Integration Through Early Intervention/Child Care Collaborations day care homes. Project designers recognized service delivery issue in all three states. The the potential of family day care, where six projects currently underway that deliver children or fewer are cared for in the early intervention within the child care provider's own home, to offer the individ- setting are focused on young children who ualized care needed by children with are already identified as eligible for these disabilities. A second goal of the project was services. In addition, however, the Del Care to facilitate both formal and informal support Project (Delaware) and the Day Care systems for families by providing respite and Training Project (Connecticut) train child a break from caregiving responsibilities for care providers to identify children in their some families, while providing high quality programs who may be eligible for additional child care for employed parents of young services. children with disabilities. The third goal was The issue of who pays for early inter- to increase the number of family day care vention services delivered within the providers throughout the state trained to community child care setting has been a care for special needs infants and toddlers. central one in each state. Complicating this A second effort, Project Del Care, has used issueisthe existence of very different state P.L. 99-457 funds to expand this model traditions in paying for early intervention to center-based child care programs. and for child care. Early intervention services Massachusetts for infants and toddlers with disabilities where they have existed under state auspices The state of Massachusetts is using P.L. 99- and with Medicaid reimbursement--have 457 Part H funds from the Department of typically been provided at little or no cost Public Health to support the Day Care/Early to families, regardless of family income. Intervention (El) Collaboration Pilot,to Child care, however, has generally been re- develop day carelearly intervention collab- garded in this country as the financial res- oration projects at four sites. Activities at ponsibility of the parents, although tax each site include selection of children to be credits and some direct subsidies have eased enrolled, joint child and family assessment, the burden for some categories of families. the joint development of Individual Family In Massachusetts, a fifteen-month De- Service Plans (parents, day care and EI staff), partment of Public Health grant to each of establishment of a working partnership, the four participating day care/early inter- defining the role of consultation for each vention programs covers: 1) the costs of day program, working out role definitions to care for 8-10 children per site; 2) the costs highlight the strengths of each service type of transportation to the day care site; 3) costs and working closely with the 8 to 10 families of liaison activities by a designated member participating at each of the four sites. Each of the four partner sites proposes to target of the transdisciplinary team of each children for these combined services who collaborating early intervention program; are at high risk for developmental delays due and 4) salary of a developmental educator to environmental risk factors. or social worker for the day care program. Although the model projects differ some- The cost of specialized Early Intervention what among the states, a number of issues services is provided through the combination recur as early intervention services are of state, federal and third party funding integrated within child care settings. These sources used by all 43 DPH Early Interven- issues cluster around service delivery, tion Programs. training, evaluation, and policy development. The Connecticut funding pattern reflects the conflict between early intervention and Service delivery child care financing. If an early intervention The identification of children who are eligible team determines that an infant or toddler for early intervention services represents a should receive early intervention services

C;" Models of Integration Through Early Intervention/Child Care Collaborations47 within a community early childhood setting, affected adversely. Both Delaware and the Department of Mental Retardation will Connecticut use Thelma Harm's Family Day generally pay for part-time participation in Care Rating Sc 'e or Early Childhood the child care program (for children birth Environmental Rating Scale to screen all to three). If parents wish to use the site for potential child care sites. The Connecticut full-time child care, they must pay the addi- Early Childhood Special Education Com- tional costs. (The local Education Agency munity Integration Program uses an inter- follows these same procedures for children nally developed site selection tool. age 3 through 5.) In addition to child care Unfortunately, the high demand for fees, the early intervention agency pays for quality infant and toddler child care far ex- whatever specialized services are outlined in ceeds the supply across the country. the IFSP. These typically include direct Providers have a wide range of formalized services to the child or consultation to child training, observational skills, and ability to care staff by a special education teacher and nurture and care for very young children. other professionals. In some cases, the costs In center-based care, particularly, one needs of instructional aides and adaptive equip- to be alert to whether the quality and ment have been covered. Transportation can amount of individual attention provided is be provided by an early intervention enough to meet the special needs of infants program bus or reimbursement to the and toddlers with developmental delays or family. disabilities. Quality of care may vary greatly The Delaware system is still evolving. The within a child care setting. Del Care project Del First project paid the full child care costs staff report the greatest diversity among for 21 infants and toddlers with special needs one-year-old and toddler classrooms. Mas- who were placed in family day care homes. sachusetts currently provides a large system The Del Care project, a center-based of subsidized day care for working parents initiative, offered to pay centers' standard and parents participating in educational and child care rates for children with special training programs. One infant care model needs but found child care centers unwilling being used is the "primary care" model where to participate on this basis. Recognizing the one caregiver is assigned to 3 or 4 infants additional costs to child care programs for or toddlers to promote consistency of care the extra planning and record keeping and bonding between caregiver and child. involved in participating in a demonstration When staff in the Connecticut and project, Del Care now uses a sliding scale, Delaware projects have felt that they are with rates based on the additional effort working, for lack of alternatives, with child required to serve specific children. All care providers who are not offering high programs are given at least $50 a month quality care, they look for opportunities to for planning, record keeping, working with offer consultation and support. Good rap- the project staff and implementing the child's port (perhaps facilitated by monetary IFSP. A provider caring for a child with an incentives) between early intervention and overall developmental delay receives an child care staff is essential. The fact that in additional $100 a month; a program serving the Del Care Project, project staff select the an extremely involved child who requires classroom for each child with special needs tube feeding and extensive stimulation provides an opportunity to discuss with the might receive an additional $150. child care program director the variability The overall quality of caregiving within of quality between classrooms and ways to participating day care programs is another bring about improvements. service issue within all states. When program In all three states, staff turnover within qualityis poor, the development of any both early intervention and day care pro- young child, regardless of special needs, is grams is high, affecting the quality of chil-

48 Models of Integration Through Early Intervention/Child Care Collaborations dren's experience. Family day care homes needs of individual providers into the have the most stable staff; however, the training. The activities of the Connecticut numbers of these placements (in Connec- Day Care Training Project range from on- ticut there are over 5,000) and the limited site workshops, to small group institutes of number of children within each (6) create 5-7sessions, to individual technical assist- a very large system to work with. It should ance. Not only is training free to child care be noted that the national turnover for day providers, but additional incentives include care providers is at 41% due to a number meals for participants, money for substitutes of reasons, primarily pay ($5.35 an hour andlor reimbursement for time spent in on- nationally). site training sessions, and continuing education credits. Training Early intervention staff have also been the Training isa primary service of early recipients of training through the Early interventionlchild care collaborative projects Childhood Special Education Community in all three states. Massachusetts provided Integration Program in Connecticut. The funds for four staff of the statewide child content of this training has revolved around care resource and referral network to receive early intervention service delivery with a intensive training regarding infants and focus on meeting each child's unique needs toddlers with special needs. These trainers through team development and coordination are now teaching a course entitled "Infants with the child care program. The particular and Toddlers at Risk" at four sites across focus for the early intervention staff the state. Several of the trainers have chosen involved in this project has been on their to co-teach the course with an early inter- accommodation to their changing roles as vention educator and to include presenta- consultants to child care programs, and the tions by early intervention parents. The development of new skills to fulfill this role. Massachusetts Office for Children sponsors These skills have included communication, this course and an "InfantlToddler Devel- collaboration, and consultation skills, as well opment" course for college credit, offers as the management and facilitation of service workshops through the12child care re- delivery teams. As with day care staff, the source and referral agencies, and this spring training of early interventionists has is sponsoring a conference to bring together incorporated the use of ongoing needs day care and early intervention staff assessments and the development of flexible, statewide. The Department of Public Health effective training activities which use adult funds four outreach and training programs learning principles. that provide training around child health and All three states provide training to families development issues. The Early Intervention of young children with disabilities. Families Programs themselves provide child-specific have been by far the most responsive and services and training to child care providers enthusiastic audience. Of some surprise was around children enrolled in child care the extensiveness of family training needs. settings. Early Intervention staff are pro- Most have requested training on basic inter- vided statewide training through the efforts vention issues, including their rights and of the Continuing Education Consortium for responsibilities under P.L.99-457andP.L. Early Intervention Programs and the 94-142,types and goals of intervention Massachusetts Early Intervention Consor- services, funding and reimbursement issues tium (of parents and providers). and developmentally appropriate goals and Both Connecticut and Delaware offer activities. specific training courses to day care provid- A major training issue which has emerged ers. Based on the principles of adult learning, from all three projects is the need for more these courses incorporate the concerns and on-site day care consultation, both on

Models of Integration Through Early Intervention/Child Care Collaborations49 general and child-specific issues. In Massa- than before. In both instances,it was chusetts and Connecticut providers of state- documented that the training made provid- subsidized day care systems are requesting ers newly aware of what they didn't know. on-going, on-site training concerning the Both projects are now redesigning their many children they serve who are experien- scales to insure a rating on the specific cing developmental delays due to environ- content of training. mental factors. In addition to the day care training outcomes, Connecticut has an evaluation Evaluation plan which includes child impact (develop- All three states have evaluation plans to mental change and behavioral change across monitor their individual projects. Massachu- a range of instruments), family impact setts is using a process evaluation for the (attitude, use of community resources and 15-month pilot projects. The main goals of support systems, and satisfaction with the evaluation are to document: 1) the training and project outcomes), and program development and process of program impact (early intervention program profiles, partners working in collaboration; 2) the early childhood environments and training integration of children into "normalized" outcomes). Evaluation outcomes are avail- settings; and 3) the impact of early inter- able on request from all three projects. vention services in child care settings on children and families. The evaluation will Policy development include a parent questionnaire and a staff This area will have the greatest long-term questionnaire. The providers will examine impact on the overall efficacy and usefulness variables of family functioning, styles of of the early intervention/child care model. parent-child interaction and social/emotional According to the Carolina Institute on Policy and behavioral adaptations of children, as Development, policy refers to the rules and well as assessing and marking children's standards that are established in order to developmental progress. allocate public resources to meet a particular Delaware has focused on child change as social need. Each of the early intervention/ one indicator of effectiveness. There are child care initiatives is working with state problems in this strategy, however. These agencies and advisory boards to establish, have included the briefness of the interven- refine and evaluate policies which facilitate tion for some children, the difficulty in this service delivery model. locating appropriate assessments for chil- In Connecticut, policies have been initiated dren with multiple disabilities, the time lag within two state agencies responsible for between initial assessment and placement direct early intervention services. The within day care, and a general sensitivity to Department of Mental Retardation has the problems of over-testing children. revised its early intervention program Delaware is also measuring the satisfaction philosophy to include a statement that with child care among parents of both "transdisciplinary quality early intervention children with disabilities and non-disabled services for infants,toddlers, and their children, and the environmental changes families will be tailored to each family's needs which occur within participating day care and delivered in the home or in places that settings. teach or care for typical young children." The The training of day care providers in Department of Education has focused on the Delaware and Connecticut has been eval- delivery of preschool special education uated extensively. An issue which has sur- services within a range of least restrictive faced has been the use of self-rating scales settings, including nursery schools and day by the trainees. In both states, trainees rated care programs. Local programs have fol- themselves as knowing less after training lowed suit with changes of philosophy,

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50Models of Integration Through Early Intervention /Child Care Collaborations expansion of program sites in the commun- Children licensing standards, the revision of ity and the development of new practices. state teacher certification, the use of JEPTA The advisory board to the Early Childhood and state Employment and Training dollars Special Education Community integration to train child care staff, efforts of the Child Program has been instrumental in develop- Care Resource and Referral agencies to assist ing local policies which include interagency parents and to recruit providers to serve agreements, bus training protocols, practices children with special needs, and the devel- for "aides" on leave, and time for "teaming" opment of a coordinated system of child find and consultation with community early and developmental screening. childhood progi-ams. An additional policy being investigated Conclusion within Delaware concerns equalization of The states of Connecticut, Delaware and caseloads among early intervention staff. For Massachusetts are attempting to expand example, a developmentally delayed child early intervention service delivery options from a well-functioning family in a high for infants, toddlers, and their families. quality family day care home is one child The integration of child care and early in the case load. Another child, also intervention services is appealing for a num- diagnosed as developmentally delayed, may ber of reasons. First, families with children come from a home with a single mother with special needs want to be part of who is herself mentally retarded. The child community-based support systems designed also may have two older siblings in special for all children and families. Second, the child education, no telephone, and be enrolled in who is receiving early intervention services a child care center of questionable quality. will have the opportunity to learn, practice Serving these children well does not require and generalize skills in a normative envir- equal amounts of time and energy. Child, onment designed to support all aspects of family and setting variables are being taken his development. Third, early intervention- into account in an attempt to address and ists and child care providers will have an equalize case loads. opportunity to learn from each other and In Massachusetts, funding of the collab- collaborate on practices that will benefit all oration pilot is an expression of a policy goal of the childi en enrolled in their programs. to expand access and support to child care Before model programs become replicated for children with specialized needs. The widely, many issues of service delivery, approach to interagency policy development training, evaluation and policy development involves the encouragement of coordination remain to be resolved. In Connecticut, of services at the local level, while simul- Delaware and Massachusetts, parents, child taneously sewing a common thread of care providers, early interventionists, collaboration and integration through the trainers, administrators and policymakers many early childhood state policy, advocacy are working together to realize the potential and advisory groups. Complementary state of integrated child care and early interven- efforts include the current revision of the tion services for children and families. Special Needs Section of the Office for

Models of Integration Through Early InterventionlChild Care Collaborations51 Social Development and Integration:

Facilitating the prosocial development of typical

and exceptional infants and toddlers

in group settings

by Donna Wittmer, Ph.D. and Sandra Petersen, M.A.

Traditionally, children who spent their first McEvoy, 1988). Children who come to group three years of life at home with families care from difficult early relationships may learned about relationships within their need very special care to even begin to feel family circle. Now, increasing numbers of comfortable around strange adults and other American toddlers are being cared for in children and later to enjoy and learn from groups, away from their parents for large other children. parts of the day. These include toddlers with This article describes attributes which disabilities for whom early intervention comprise the foundation of social compe- takes place in community-based settings tence in the toddler: 1) a sense of competence such as child care centers or socially inte- and self-confidence, 2) learning to trust and grated play groups (Bruder, Deiner & Sachs, like others, and 3) the prosocial skills that 1990; Gilkerson, HilliardIII, Schrag & come from learning "the other side of the Shonkoff; 1987; Han line & Hanson, 1989; relationship." The role of the caregiver in Klein & Sheehan, 1987; Newby, 1990; the development of social competence in Turnbull & Turnbull, 1990). toddlers with special needs in socially Consequently, caregivers and early inter- integrated settings is illustrated, and recom- ventionists have an increasingly significant mended strategies for promoting these role in supporting the development of social attributes of prosocial interactions for all competence in toddlers, both typical and toddlers follow each section. exceptional. Toddlers who come to a group A sense of competence, mastery, and skillswill need setting with early social self-confidence ongoing support from caring adults to reinforce and strengthen those skills. We Jamal was thin and frail when he began know that preschoolers with special needs attending the child care center. A few weeks earlier his first birthday had been show improved peer-related social compe- celebrated in the hospital, where he was tence when in socially integrated settings being treated for "failure to thrive." In (Guralnick, 1990),especiallywhen teachers Jamal's home, the adults were preoccupied promote positive social interactions between with the effects of terrible losses and per- typical and exceptional peers (Odom & sonal violence. During his first year no one

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52Social Development and Integration in Group Settings had time or energy for Jamal. By his second This sense of the infant that "I am important. year, he didn't expect any attention. I can do things. I can communicate. I can At the child care center Jamal indiscrimi- make things happen. I can get my needs met" nately produced a flat smile and held out is at the root of all motivation to interact his arms for anyone who approached. with others. When an infant feels confident Sometimes he would wander around carry- that he or she can get a response, then the ing a toy in each hand, but giving the impression that he had forgotten they were infant is much more likely to attempt to there. interact with toys, peers, and adults. The caregivers recognized that they Shareen picks up a toy and throws it at would need to help Jamal become aware of another toddler in her child care center. himself and his own needs before he would The teacher reprimands her. Shareen beg- be able to enjoy the other toddlers. ins to follow the teacher. Although they were busy. caregivers found At lunch time, Shareen sits, not eating special times to feed him alone in addition her food. The caregivers discuss how she to the group's snack and meal times. At never eats her lunch and yet she always naptime he was rocked to sleep in loving wants the dessert that follows. One care- arms. Often, he sat quietly in the caregiv- giver reaches over the table and takes Sha- ers' laps, comforted by the closeness. reen's plate and throws it into a large trash For several months there was little can. Shareen angrily gets up, comes around change in him. Then, slowly, from the the table, picks up her plate out of the haven provided by his caregivers, he began trash can, and throws it on the floor. to express some of his feelings. He looked Another caregiver picks it up and says, "I happy to arrive at the center. don't like that, that makes a mess on the As Jamal expressed more feelings, he floor." The caregiver sits on a chair and began to act in his own behalf. He chose with gestures invites Shareen to come sit toys that he wanted and would give his on her lap. Shareen approaches and begins caregivers a fleeting, proud smile while to hit the caregiver on the legs. The care- playing. He was interested in new activities. giver says firmly but gently, "That hurts, I Sometimes he stood near other children, don't like you to hit, do you need a hug?" watching them, and smiling at their Shareen melts into the caregiver's lap for a activity. hug. Having adults patiently learn about This toddler, observed in a community- Jamal's feelings and his desires helped him based child care center, has a difficult att- begin to know himself and see himself as achment history (Wittmer, 1991). She did being able to make good things happen not initiate interactions with peers. Rather with other people. she remained close to her special caregiver. In a young child's first relationships with When peers approached her, she rejected adults the infant learns, "I am worthy of them. While quite ambivalent in her rela- getting a response. I am someone impor- tionships with adults, it seemed as if she tant." An infant's feelings of self-worth and had to gain competence and self-confidence self-confidence grow each day when he is with adults before she could enter the with a person who cares enough to try to world of peers. Luckily for this little girl, understand what it is the baby is commun- one of the caregivers understood and met icating and meet the baby's early needs for the deep need that she seemed to have to comforting and nurture. As infants make be close, get hugs, and consistent caring things happen, as they behave and get a attention from the special adult with whom she was developing a relationship. prompt response, as they learn about cause and effect relationships in their first Observed in a play group setting, typical relationship with a special adult, and as their toddlers with a good relationship history deep emotional needs are met, they gain a were seen as "attractive interactive partners" sense of competence and self-confidence. (Jacobson & Wille, 1986). These children

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Social Development and Integration in Group Settings53 received the greatest number of positive during the first years of life, do they then responses from their peers as compared to have a sense of competence with peers? Are toddlers with insecure attachment histories they sought after as interesting partners? who were either uninteresting (with avoi- We do not yet know the answers to these dant attachments) or disruptive, combative questions. and resIstant (with ambivalent attachments). The parents of infants with special needs They had greater confidence and effective- have been found to compensate and work ness in dealing with objects and people. They harder at reading often subtle cues, so that were more interesting, and other children they can comfort the infant and interact in sought them out as playmates. positive ways (Minde, Perrotta & Hellman, When infants do not feel that they can 1988; Wasserman, 1985). This pattern works master the environment of people and with the infant and his special caregiver. objects, they may give up and avoid people, However, as the toddler with disabilities objects, or bothor interact with them in moves into the world of peers, she may have inappropriate ways. Children who have difficulty communicating her needs. More- suffered early abuse, for example, are not over, the young child's peers, both typical well prepared for later relationships. Main and exceptional, have fewer skills for and George (1985) observed that abused compensating for the toddler with special infants were much less likely than others needs than did his special adult. The child to approach their caregivers in response to will need a sensitive, attuned adult to friendly overtures; when they did so they interpret her desires to interact with other were more likely to approach to the side, children. to the rear, or by turning about and The caregiver also needs to teach other backstepping. In response to friendly children how to compensate for skills that overtures the abused infants more fre- are lacking or emerging, and how to build quently avoided peers and caregivers or on the strengths of the toddler with special combined movements of approach with needs, so that peers can enjoy each others' movements of avoidance. company. In a study of an integrated child These children require a reparative care setting, only seven percent of the total relationship with an adult. "It is only when positive/neutral interactions observed relationshipsare recognized as the major issue (Wittmer, 1991) involved the toddler with that changes in the quality of care can special needs as a recipient of initiations from happen that will make the day care of other toddlers. And approximately half of children more appropriate." (Pawl, 1990) It the incidents of peers comforting, helping, is essential that a child care provider or early or giving to toddlers with special needs in interventionist attempt to fulfill the child's integrated settings occurred after the early, unmet needs for security by being a teacher requested the typically developing sensitive, responsive partner. The child may child to do so (Wittmer, 1991). (Interestingly, not easily accept the adult's overtures. The there was also only one occasion when a adult must be persistent and unconditionally toddler with special needs was observed to available, realizing the importance of helping be the recipient of any type of negative build the toddler's self-confidence in relation- approach from other toddlers.) ships with adult's first and peers later. Henry, a child with cerebral palsy, 15 car- How applicable are these observations to ried by his caregiver to the midst of ci.ild- young children with disabilities? Are ren playing with miniature balls in a wad- toddlers with disabilities developing a sense ing pool. Propped in his teacher's lap, of competence and self-confidence in Henry watches Alex dive in and out of the relationships? If they have had a positive hundreds of colorful balls in the pool. Sev- relationship with their primary caregivers eral girls push some of the balls on Henry

1.)k 54Social Development and Integration in Group Settings and he smiles. After Henry watches for another five minutes, the teacher asks Alli- Strategies for helping children learn self- son to throw some balls to Henry. She throws a ball in Henry's direction and the confidence in relationships and developing teacher then assists Henry in throwing the children's self esteem: ball back to his playmate. They take several turns, as Henry smiles. 1. Respond quickly and sensitively to toddlers' expressed Henry gave positive feedback to his peers needs so they will feel secure and important and gain self- who were playing with him. Other young confidence in learning how to communicate their needs. children with special needs may not. In a 2. Make sure that each child builds a strong, positive relation- population of typical toddler peers, the ability ship with at least one adult in the room. Infants and to initiate appropriate prosocial overtures toddlers need a secure base to which they can return for appeared to exceed their ability to respond comfort, an adult from whom they can learn that they ai e in a manner to sustain the social interaction special. (Bronson, 1975). Wittmer (1991) found that 3. Give particularly attractive toys to the child with disabilities several toddlers with special needs avoided, or the child who is having difficulty with peer interactions, ignored, or cried when other toddlers tried sometimes letting that child use a new or seldom offered to interact with them. All toddlers, including toy. This will help make the child a more attractive play toddlers with disabilities, need special help partner and develop the child's sense of competence. in knowing how to respond to another toddler's initiations. 4. Raise the status of the child with disabilities by your oven loving, welcoming attitude. Say, "I love sitting next to Learning to trust and like Ting-Ting. She gives me big smiles." others: Wanting to be social 5. Use books in the classroom that show children and adults Trevor was the first child with a disability with disabilities in a positive light. Read stories about child- to attend the child care center. Trevor had ren with special needs. This will help toddlers with disabili- Down syndrome. At the age of 18 months ties develop a sense of self-worth and typical toddlers he crawled, and he didn't use any language. understand disabilities and see the strengths of exceptional Because of their own ideas about his dis- toddlers. ability, Trevor's care providers perceived 6. Use posters in your room which show children with dis- him as being fragile and in need of protec- tion from everyone and everything in the abilities participating in daily activities with other children. environment. They kept him away from 7. Interpret thr sometimes subtle cues of children to other the other toddlers, strapped him into an children. "He said, 'Hi.' Say 'hi' back," or "She's really look- infant seat at mealtimes, held him on their ing at that doll. I think she wants that doll." Another way laps during play times, and had him nap- to interpret is to "talk for" the child with disabilities, saying ping in an anteroom, so that the other "Sarah wants to help with those blocks. She says, 'I want children "didn't bother him". to play, too!" Trevor was very lonely in child care. He was about to teach the child care providers 8. Find some way for the child with disabilities to communi- about the impact being around other child- cate. If he/she cannot speak, you might try sign language, ren can have on a child. The toddlers in the pictures, or communication boards. classroom did interesting things nonstop. 9. Enhance the competencies of children with disabilities by: They ran from one side of the room to the providing room for strollers, wheelchairs, or walkers other, challenging each other with a look to between all activity areas; providing toys and activities join in or keep up. They copied each other's table banging and screaming, making them within reach from a stroller or wheelchair; providing adap- louder with each imitation. They carried tive furniture that allows the -hild to participate in an toys everywhere. activity such as art; adapting toys with switches for a As Trevor watched the other children severely physically involved child; adapting toys and mate- playing, moving, and singing he became rials for easier use, for example, making crayons or

I . )) Social Development and Integration in Group Setting!:55 markers wider for easier grasping by wrapping masking month-olds, compared to ten to twelve- tape around them; and varying lights, sounds, and textures month-olds, showed significantly higher in order to provide important information for children frequencies of both interactions with peers with sensory impairments. and contacts with toys. Watching and distant 10. Make a point of seating a child with disabilities close to the social contact were more common than most socially competent of his peers, particularly a compe- physical contact. Children from 10 to 24 tent but somewhat younger child. months do not appear to treat each other like physical objects. Their social responses r Ng toward each other are not like those made toward adults (Eckerman, Whatley & Kutz, increasingly frustrated by the care provid- 1975). ers' failures to move him along with the Imitating another's actionsis a core group. Sometimes he would join in the behavioral accomplishment during the imitative play from a distance. He began to toddler period. Watching and imitating are pounce on any opportunity when he was seemingly very important ways that toddlers not physically constrained to crawl, and learn from each other. Their ability and in- then walk, to where the other children were. His movements became raster and terest in imitating increase as toddlers be- more purposeful. Trevor's moment-by- come older (Eckerman, Davis, & Didow, moment goal seemed to be to get close to 1989). the other children and do what they were What do we know about imitation among doing. This interest in watching and imitat- toddlers with disabilities in integrated ing proved to be a powerful motivating settings? Wittmer (1991) found that in four- force for him to try activities he'd refused teen hours of observation of seven toddlers, before. Being familiar with sign language the toddlers with a variety of special needs made him proficient at finger plays during made 117 initiations to other children. Only music time. Trevor's previous interest in six percent of these resulted from a teacher's letting balls roll away from him and crawl- direction to interact with another child. ing after them gave way to shyly hanging Twenty-three percent of all positivelneutral around ball play at the center, and insist- ently initiating reciprocal ball play at home behaviors included watching another child, with his parents. while 23 percent of the behaviors included For Trevor, being able to watch other imitating another toddler. Approximately 70 children provided an opportunity to expe- percent of the total interactions of the ob- rience the many ways in which he and they served toddlers with special needs with other were the same. Being around other child- children were with typical peers, 24 percent ren motivated him to try the wide range of were with a mixed group of typical and ex- activities that could allow him to be part of ceptional peers, and only six percent were the group. with other special needs toddlers alone. It In infants' first relationships with adults, would seem these children enjoyed being they learn to enjoy being with other people. with typical peers. Seventy-nine percent of Babies with positive first experiences learn all interactions (as initiators and recipients that adults (and people in general) can be of interactions from other children) were caring, loving, and responsive. Thus infants positive; these included joining in play, com- learn to like people. They believe that people forting, helping, giving, saying "Look at me," (adults and children) are fun and inter 'sting conversing, or showing or offering a toy. to be with and that they can benefit from Two children with severe motor impair- being near them. ments, however, did not initiate to other Toddlers show an interest in other children. Another toddler with language de- children, as well as adults, and want to be lays also did not initiate interactions on his around them. Twenty-two to twenty-four- own.

t.- 0 C)

5t Social Development and Integration in Group Settings Kevin wandered around the play room, James, another toddler, scooted in next running first to the chalk board and then to Amber facing the xylophone. James over to the swing. A teacher, rocking a picked up one mallet and began to strike boat full of children, called to him. "Kevin, the keys carefully and with great pleasure. do you want a ride?" Kevin glanced at the "Warta play?" he asked Amber, who was boat and ran to the other side of the room. sitting very still, except for snuffly brea- The teacher called again as she rocked the thing. Amber slowly looked a James, who boat, "I need some help. Will you help me took her gaze as an affirmative response. rock the boat?" Kevin again ran to the James picked up the second mallet, used his other side of the room and from a safe chubby fingers to pry open her stiff fists, corner watched the teacher rock the boat fitted the mallet against her palm and for several minutes. The teacher gestured helped her close her fingers around the for him to come over. Kevin looked long- stick. "Now you can play, Amber", he said, ingly at the teacher and boat and walked as he began to help her make her own slowly to the boat and began to help push. music. The teacher sang, "Row, row, row your As they interact in their first relationships, boat." young children "learn the other side of the These children needed a caregiver to take relationship" and then model the sensitive a very active role in helping them "get caring or the not-so-loving responses that started." Caregivers may need to guess the they have received. They then use those meaning of the child'ssignals, help to same interactive strategies with both adults manipulate the child's hands to sign or play, and peers. and actively engage the child in some form The child who is responded to by adults of social contact. in affectionate, kind, empathetic ways is learning how to be a communicative partner Learning the other side of the who knows how to take turns, listen, relationship: How to be prosocial empathize and help. Park & Waters (1989) This morning nothing in the toddler found that when two children who had room interested Amber. She stared ahead experienced affirmative first relationships blankly while fingering a cracker at the with their mothers played together, the play snack table. She didn't seem to notice when was more harmonious, less controlling, more the other children cleared their things and responsive, and happier than when children moved on to play around the room. who had not experienced positivefirst Amber has a syndrome that made her head grow large and heavy for her body to relationships played together. Howes & carry. Her nose is small and her tongue so Farver's (1987) work shows that toddlers in large in her mouth that sometimes simply child care, ranging from 16 to 33 months maintaining her breathing and sitting of age, responded prosocially to peers who upright require all of her concentration and showed distress. Ninety-three percent of energy. peer responses to children's cries were Amber's care provider lifted her from the prosocial in nature. snack table to a quiet spot on the carpet. Children who have been abused also show "Here's your favorite, Amber," the care- that they have learned "the other side of giver said directly into Amber's ear as she the relationship". In their 1985 study of 10 showed her a shape sorting box. Amber did abused and 10 matched toddlers, ranging in not respond. "Would you like a record?" the age from one to three years and all from caregiver tried again, "Or maybe this families experiencing stress, Main and and the caregiver set a small xyl- ophone in front of Amber. The caregiver George found that toddlers who have been moved across the room to talk to another abused will not show concern for a toddler child, maintaining her quiet supportive atti- in distress. Rather, the abused toddlers were tude as she moved from child to child. found to physically attack, show fear, or

t) Social Development and Integration in Group Settings57 and attempted to comfort the crying toddler. Strategies for building on and encouraging This ambivalent approach, alternating be- tween comforting and angry, hurting children's desire to watch, imitate and be attacks, probably reflects how the abused near others toddlers were treated by the important adults in their lives. The nonabused toddlers 1. Place infants beside each other on the floor, in supported from stressed families did show concern and seats, or facing each other in high chairs. Infants like to sadness, and often attempted to comfort a watch each other. toddler in distress. 2. Provide duplicates of toys to encourage parallel play. In a more specific illustration of what it 3. Offer toys and activities that promote social interaction means to learn the other side of the rather than isolated play. Some favorites among toddlers are relationship, typically developing infants a large bin full of ping-pong balls, water, or sand; coloring or learn about the ways their parents compen- painting on a huge sheet of paper that everyone shares; or sate for them in infancy as communication musical instruments. partners. We know that children as young 4. Find a way to include children with special needs meaning- as three will simplify their language with fully in all activities. They need to participate fully with younger children, dolls, and animals. Tod- appropriate goals. dlers may in turn compensate for the 5. Care providers should make an effort to have typically limitations of a child with disabilities as a developing peers near the child with disabilities during the communication partner (with a little encour- day. Sometimes we tend to group all the children who need agement from adults). When typical toddlers special help together and they have less opportunity to learn in an integrated setting began an interaction from more competent children. If a child with disabilities is with a toddler with special needs, 88 percent not independently mobile, he should be moved with the rest of the children when they move. If the children move from of those behaviors could be considered pro- the snack table to free play, a care provider should help the social (comforting with a pat on the head, child with disabilities to move with the others, so that he is saying "sorry", turning on the water in the not always the last to get to a new activity or the last to get sink, playing ball, giving a turn). These a turn. behaviors did not happen frequently, but 6. Build on toddlers' inherent desires to imitate others by fo- approximately 50 percent of the behaviors cusing the attention of the child with disabilities on the observed were initiated by the typical toddler behavior of other children. If other toddlers are patting a herself (Wittmer, 1991). table, say "pat-pat-pat" as you show the child how to pat Haniya a toddler with cerebral palsy, hislher hand on the table. Encourage all of the children to crawled with great difficulty, making her play imitative games with sounds and movements. way across the sand to the door of the 7. Toddlers like to play beside each other. A child with special building. Carl, riding by with great speed needs may need help joining the other children in settings on his tricycle, came to an abrupt halt, got such as a sand box or a wading pool. off his bicycle and leaned down by Haniya. He patted her head gently, and then 8.It may be necessary to use supports and prompts to help some children stay involved in activities with other children. hopped on his bike and rode off. The strategies used to support the child should be a3 non- Although this action on the part of Carl intrusive as possible. If a spoken facilitation such as, "Look may seem condescending to some, it dem- what you did. You moved it way over here" does the job, it onstrated that Carl seemed to want to is much better than your standing behind the child guiding comfort Haniya, and did so in the best way his hands in yours. he knew how. Patting Haniya on the head had no benefit for himself and thus seems 4MINE11110111111 truly a prosocial act. Caregivers, however, also play a very show anger to the distressed toddler. Three important role in helping young toddlers of the abused toddlers alternately attacked learn how to be helpful, caring, and kind.

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58Social Development and Integrition in Group Settings The caregiver positioned Haniya on the countertop, so that Haniya could hold her Strategies for helping children become more hands under the faucet. Jonathan appeared out of nowhere to wash his hands before prosocial snack. The caregiver said to Jonathan, "Please turn on the faucet for Haniya." Jon- 1. Respond quickly and sensitively to babies' needs so they athan did. Haniya glanced at him and gave will feel secure and learn how to treat others gently and a faint smile. She stuck her hands under kindly. the faucet of running water, seeming to 2. Model treating all children in the ways you want them to enjoy the cool feeling on her hands. Jona- treat others. Your example of kindness and appreciation than stuck his hands under the water also will influence the tone of the interaction among the and then quickly ran off again. Haniya toddlers in your room. peered at the place where Jonathan had 3. Help toddlers learn cause and effect in so .ial relationships. gone. Teach them how their behaviors affect others. Say "You Are toddlers with special needs learning smiledthat made her happy" or "You hit himthat hurt the other side of the relationship and be- him" (said with feeling). having in prosocial ways? Four of the seven 4. Offer toy, that promote cooperation, such as a heavy toddlers observed did not comfort others wagon with a handle large enough for two children to pull (Wittmer, 1991). However they did help (2% together. of positive initiations), they gave objects 5. Coach peers through approaching the child with disabili- (7%), showed objects (3%), showed affection ties. "Here, Juan, you can ask Michael if he wants this puz- (1%), smiled at a peer (13%), and touched zle or that one. Good. Carry them to Michael. Hold them gently (3%). They also did a great deal of where he can look at them. Ask him 'Which one, watching and imitating and "Imitation is the Michael?'," etc. sincerest form of flattery." Only 12 percent 6. Point out every child's prosocial behaviors with admiration of the prosocial actions of the toddlers with to the other children. special needs were teacher-directed. The few 7. Encourage problem solving and understanding by using hurtful behaviors of these children involved dolls with special needs. Say, "This doll can't see. How can slapping, yellingat, and scolding other we help her eat?" children. There is evidence that children are capable 8. During free play times, subtly arrange small groups of two to three children to increase cooperative play. of initiating positive acts and behaving more prosocially as they mature. Holmberg (1980) 9. Encourage children to help each other. Say, "His nose is found that the frequency of both initial running. Get a tissue please," or "Turn on the faucet for positive acts and "elaborated interchange Kayla, please." patterns" increased with age across12- 10. Acknowledge the differences between children, but stress month to 42-month-old children. Eckerman, the likenesses among them. "Taylor uses his hands to talk, Whatley and Kutz (1975), found that instead of his mouth. But he wants another cookie just like toddlers' positive interactions outnumbered you!" or "Jane's hands have trouble holding the chalk, but negative ones, and positive interactions she likes all the pretty colors on her picture, too." increased at a faster rate than negatives ones. 11.It may be necessary to teach a child with severe disabilities Toddlers demonstrate the first steps of how to perform such basic social skills as smiling. This may social competence through their prosocial be done by rewarding the skill (i.e., smiling) when it behaviors in group settings. Caregivers as appears spontaneously or by direct instruction. well as parents help young toddlers develop the foundations of social competence by helping them (1) gain a sense of competency and self-confidence, (2) learn to like and enjoy others, and (3)learn how to be r prosocial through experiencing the positive BEST "t'''17 aspects of "the other side of the relationship."

Social Development and Integration in Group Settings59 Bibliography young handicapped children in day care. Topics in eariy childhood special education, 7 (1), 13-27. Bronson,WC. 1975.Developments in behavior with age mates during the second year of life. In Main, M & George, C. 1985. Responses of M Lewis and L Rosenblum, (Eds.) Friendship and abused and disadvantaged toddlers to distress in Peer Relations. New York: John Wiley and Sons. agemates: A study in the day care setting. Developmental Psychology, 21(3), 407-412. Bruder, M, Deiner, P, & Sachs, S.1990.Models of integration through early intervention/child Minde, K, Perrotta, M, & Hellman,J. 1988. care collaborations. Zero to Three, X(3), 14-17. Impact of delayed development in premature infants on mother-infant interaction: A prospec- Eckerman, C, Davis, C & Didow, S.1989. tive investigation. The Journal of Pediatrics, 112 Toddlers' emerging ways of achieving social 142. coordinations with a peer. Child Development, 60, Newby, P. 1990. Individualized child care for 440-453. infants and toddlers. ACEI Infancy Division Newslet- Eckerman, C, Whatley, J, & Kutz, S. 1975. ter, 3(1), 1-3. Growth of social play with peers during the second year of life. Developmental Psychology, 11,42- Odom, S & McEvoy, M. 1988. Integration of 49. young children with handicaps and normally developing children. In S Odom & M Karnes George, C & Main, M. 1979. Social interactions (Eds.), Early intervention for infants and young children of young abused children: Approach, avoidance, with handicaps: An empirical base, (pp.241-267), Bal- and aggression. Child Development, 50, 306-318. timore:Paul H. Brookes. Gilkerson, L, Hilliard III, A, Schrag, E, & Shon- Park, K & Waters, E. 1989. Security of attach- koff, J. 1987. Report accompanying the educa- ment and preschool friendships. Child Development, tion of the handicapped act amendments of 60,1076-1081. 1986and Commenting onP.L. 99-457. Washington, D.C.: National Center for Clinical Pawl,J. 1990.Infants in day care: Reflections on Infant Programs. experiences, expectations and relationships. Zero to Three, X (3), 1-6. Guralnick, MJ. 1990. Major accomplishments and future directions in early childhood main- Turnbull, HR & Turnbull, A.1990.The unful- streaming. Topics in Early Childhood Special Education, filled promise of integration: Does Part H ensure different rights and results than part B 10(2),1-17. of the Education of the Handicapped Act? Topics Han line, M & Hanson, M.1989.Integration in Early Childhood Special Education, 10 (2), 18-32. considerations for infants and toddlers with multiple disabilities. DASH, 14(3), 178-183. Vandell, D & Mueller, E. 1980. Peer play and friendships during the first two years. In Foot, Honig, A & Wittmer, D.1992.Prosocial devel- H, Chapman, A & Smith, G (Eds.). Friendship and opment: Caring, helping, and cooperating: A Social Relations in Children. New York: Wiley. resource guide for parents and professionals. New York: Garland Press. Wasserman, G, Allen, R, & Solomon, C. 1985. At risk toddlers and their mothers: The special Howes, C & Farver, J.1987.Toddlers' responses case of physical handicap. Child Development, 56, to the distress of their peers. Journal of Applied 73-83. Developmental Psychology, 8.441-452. Wittmer, D. 1991. Toddlers with special needs Jacobson, J &Wille, D. 1986. The influence of as initiators and recipients of prosocial behav- attachment pattern on developmental changes iors. University of Colorado, Denver. Junior in peer interaction from the toddler to the pre- Faculty Award Report. school period. Child Development, 57,338-347. Klein, NK & Sheehan, R.1987.Staff develop- ment: A key issue in meeting the needs of

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60Social Development and Integration in Group Settings Supports for childcare programs and providers 10 Attending to the emotional well-being of children, families, and caregivers: Contributions of infant mental health

specialists to child care

Editor's note:

The essence of good child care for infants years been sensitive to issues of emotional and toddlers lies in the quality of the re- development and well-being in the day care lationships between and among caregivers, context. As understanding of infant mental parents and children. It is in the context of health issues has increased, specialists have these relationships that both the common, provided assistance to parents and caregivers basic needs and the unique, individual needs around the needs of troubled or difficult and wishes of very young children are met individual children. More recently, mental or not. It is in the context of these rela- health specialists have explored ways to tionships that infants and toddlers continue make day care settings in general more to develop their expectations about how the supportive of the emotional well-being of world is and how the adults in that world infants, families and caregivers. behave. Attachment, intimacy, empathy, The three essays that follow have been separation, autonomy and sense of self and adapted from seminar presentations at the self-worth are major issues in the first three December, 1989 National Training Institute years of lifenot only for infants, but for of the National Center for Clinical Infant parents and for child care providers as well. Programs. They describe three distinct but Good child care for infants and toddlers related models for incorporating infant builds on adults' awareness and understand- mental health insights and strategies into ing of these issues and their ability, through the practice of day care for very young their relationships with each other and with children. These models include mental health the children in their care, to encourage their consultation to day care programs; program healthy resolution. design and evaluation; and advanced training Providers, planners, and observers of child for day care professionals themselves. care for infants and toddlers have for many

Attending to the emotional well-being of children, families, and caregivers63 Mental health consultation to daycare

providers: The San Francisco Daycare

Consultants Program

Kadija Johnston, M.S.W.

Mental health con- Daycare Consultants is a recently established available her specific expertise, knowledge and understanding of young children. Just sultation, whether component of the Infant-Parent Program (UCSF) providing case-centered and pro- as a child's interest in learning about the it focuses on a par- grammatic consultation to caregivers serving world depends on how the information is ticularly difficult children birth to 5 years of age. While case- presented, so the caregiver's interest in exploring new developmental and psycho- child or on an centered consultation isnecessary and helpful, the effort is intended to have a logical theories depends on the consultant's equally distressing positive effect on all the children in any day ability to create a predictable and protective care program with which we are working. atmosphere, and to recognize, empathize but more general with and respond to a caregiver's particular The essence of good care lies in the quality program issue, is concerns. As the caregiver begins to feel that of relationships between caregivers, parents her experience isunderstood, she will centered upon and and children. Our appreciation of the power develop trust in the consultant and, even- of relationships comes from our experiences conducted through tually, in the consultant's knowledge about as caregivers in both regular and therapeutic relationships. children and adult-child interaction. day care settings, as consultants to a variety Consultation aims ultimately at improving of agencies, and as infant parent psychother- the overall quality of care provided to chil- apists. It is this appreciation that led to our dren by increasing caregivers' awareness and program's conceptualization of what mental understanding of the child's experience. But health consultation should be. this aim is realized only as the caregiver Mental health consultation, whether it comes to appreciate and value the genuine focuses on a particularly difficult child or on importance of her impact on the children an equally distressing but more general in her care. Thisis no simple process, program issue,is centered upon and especially when the caregiver's relationship conducted through relationshipsthose be- is not with one child but with a group of tween consultant and consultee, and be- young children, each with unique needs and tween adults (parents and caregivers) and wishes as well as common developmental children. It is the similarities between these needs. relationships and the parallel processes Caregivers often seek mental health involved in them that inform our under- consultation for the first time when they standing of how consultation proceeds. are especially worried, alarmed or frustrated Only by forming a positive relationship by the behavior of a particular child. Even with a provider can a consultant truly make though the eventual goal of consultation is

k' 64Mental health consultation to day can providers to improve the overall quality of care for is needed. Her relationship with thehild's all of the children in a particular program, parents also allows the consultant to put the initial step in the process must be to together a picture of the child's background respond to a caregiver's immediate needs. and relationships, in order to help the The consultant strives to learn about the caregivers better understand the child's expectations that both the caregiver and current behavior. As the child's behavior child carry into their relationship with one becomes more comprehensible, caregivers another; to help the caregiver interpret the are better able to respond empathically and needs which are being expressed by the with appropriate action. child's behavior; and to understand and Two vignettes illustrate our work. In the empathize with the feelings that the child first, providers who initially request consul- engenders in the caregiver. tation around one troubled child discover Children who are experien .ing difficulties, that the usefulness of understanding a child's and consequently are difficult to care for, feelings and needs is not limited to a partic- arouse feelings of anxiety, anger and self- ular case. In the second, program consul- blame. As the caregiver begins to feel that tation is requested initially and directly. the consultant understands and empathizes Cara and her caregivers: with these feelings and is not condemning or judgmental, a trusting and mutually Case-centered consultation The initial step in respectful relationship can develop. Within The director of an infant/toddler day care the process must be this relationship, the consultant's more center and her staff requested case consul- didactic developmental and mental health tation because of their worries about Cara, to respond to a information can become useful in shifting a frequently withdrawn and unresponsive caregiver's imme- the caregiver's perspective about a particular toddler. Her worrisome behavior had begun diate needs. child's difficulties or about broader program several months earlier when, at one year issues. of age, Cara had been moved from the infant Itis important to note that when a to the toddler room. particular child is the focus of consultation, One of the first things that the consultant we involve the child's parents from the discovered was that despite the fact that beginning. Information about the child is Cara's mother visited her child regularly shared with the consultant only with the during lunch time, day care staff had parent's knowledge and consent. Observa- discussed Cara's situation with parents only tion of the child at the day care setting infrequently. Now, at the very time that with the parent's permission and at the Cara's caregivers and parents needed to help caregiver's convenienceis followed by each other the most, they remained unfa- ongoing consultation to the caregivers and miliar to, and increasingly suspicious of, each continued contact with the family. he other. specific ways in which a consultant may Talks with Mrs. Brown, Cara's mother, prove useful to a particular family are confirmed the consultant's hunch that the determined by the family's needs and wishes. child's parents shared the caregivers' Initially the consultant may simply help the concerns. Not only were they upset about parents acknowledge and understand that Cara, but they were further distressed at their child is having some difficulties, but not being able to share their worries with the consultant deals with whatever concerns day care staff. arisefrom exploring the effects of the With the parents' consent and with child's past on his present needs, to helping mother present for part of the time, the parents with issues of childrearing, to consultant visited the toddler room to ensuring that parents are engaged with observe Cara. She noted the quality of all appropriate agencies when longer term help the interactions in the roomboth those

Mental health consultation to day care providers65 involving Cara and her mother and those only at those moments when they, the involving other mothers and toddlers. All caregivers, chose to relate to them. When the day care staff were kind and warm. They they came to see that they were an important worked diligently at feeding, diapering, and part of children's experience all of the time offering a variety of play options. However, in day care, they could begin to appreciate these activities of the caregivers seemed, that the children might often feel alone and paradoxically, to obstruct interaction among abandoned. adults and children rather than to encourage Now discussion could begin about what Once the care- it. While Cara was the most withdrawn the caregivers' relationships with children givers were aware toddler in the group, none of the ten children could be. Their new sense of significance seemed able to secure specific engagement did not mean that caregivers had to, or were of themselves in a with their caregivers in response to their able to, become singlemindedly invested in relationship, they interesting discoveries or through their interacting with an infant every minute. verbal expressions. They showed little Rather, once they were aware of themselves could focus on the curiosity and spoke or vocalized infre- in a relationship, they could focus on the infants rather than quently. The impression was that as the ii(Cants rather than on the particular on particular children failed to be responded to, they came activities of feeding, diapering or presenting to expect no response, and had begun not objects. activities. to seek any. The caregivers also came to think differ- Similarly, communication between par- ently about their importance to parents as ents and caregivers seemed almost non- they recognized the need for all the adults existent. When they did speak to one in a child's life to share an understanding another, conversation was strained and of the child's ongoing experience. Rather stilted. The presence of parents in the room than simply presenting parents with charts seemed to confuse further what the child- of bowel movements and feeding times, the ren's relationships with their caregivers caregivers began sharing anecdotes that pro- should or might be. No one appeared to vided parents with a way of participating understand who was responsible for the in their child's experience even though they children; no one addressed the confusion were separated from one another. As parents, caregivers and children were clearly parents were able to reciprocate, the care- experiencing. Parents' arrivals and depar- giving adultsparents and child care staff tures were particularly awkward and silent. knew both the child and each other better. The consultant began meeting with the Rather than feeling either competitive with director and the toddler room staff. one another or totally and separately Although the consultant's initial questions responsible, they could begin to recognize pertained to Cara, staff began over time to their shared responsibility for the child. think about their experiences with other children and families in their program. They Changes and choices: Program realized that because of her temperament consultation and previous experience in other relation- The following glimpses of the initial sessions ships, Cara was expressing distress in more of a program consultation illustrate the discernible ways than the other toddlers. But many levels of intervention and numerous as discussions with the consultant continued, relationships involved in this type of the caregivers began to recognize the impact consultation. of a general lack of relatedness throughout The new program director of a very large, the program on other toddlers, on parents, subsidized day care center called for consul- and on themselves. It was particularly tation. He was concerned about the level important for caregivers to reexamine their of distress, apathy and resignation that perception that they existed for the children seemed pervasive among the staff in one u

66Mental health consultation to day care providers of the center's classrooms. But new on the The opportunity to choose change, rather job and pressed by multiple demands, he than succumb to it, ultimately allowed this could not offer ideas about why the staff to remember what it was they had once classroom staff and children were suffering. enjoyed about their jobs. They were able An observation and a discussion with to envision ways in which they could Paula, the head teacher, suggested to the improve their program. Not surprisingly, the consultant that the preponderance of process of implementing change was more particularly difficult children in this class- significant than the programmatic change room contributed to some degree to eve- itself. For example, when staff members Not surprisingly, ryone's sense of helplessness. But so did were able to anticipate and control the the process of recent changes and cutbacks in personnel. changes in routine involved in introducing implementing Change itselfthe way its occurred and it's a morning free play period to the program, effect on both caregivers and children- they became able to think about thechange was more became the focus of several meetings. importance of preparing children in advance significant than the In her first meeting with the consultant, for the new format. Passing along the Paula expressed a wish to make more control that they had been allowed to take, programmatic changes in her own staff and curriculum. staff could give children choices about where change itself. She felt no hope, however, that the and with whom they wished to play. classroom aides would support any of her But the new free play period meant that ideas. In exploring with Paula why the aides children now needed new kinds of assistance might lack the enthusiasm and interest from the staff, who once again questioned which would be needed to make successful their abilities and their relationships with changes in the classroom, the consultant children and each other. An aide, apparently realized that the notion of change that was uncomfortable inthe unstructured play inspired by interest and enthusiasm was period, reverted to ritualized preparation of foreign not only to her aides but to Paula snacks or monitoring of the bathroom, tasks herself. she had previously been relegated to Meetings with the classroom staff, all of perform. The head teacher was able to whom had worked in the center for more convey her irritation to the consultant, but than ten years, revealed that change in the not directly to the aide. The consultant now center had come to be associated inextricably worked to understand the meaning of the with lossloss of staff, loss of pay, loss of aide's behavior; to acknowledge the head vacation time, and, most significantly, loss teacher's distress while helping her gain of control. Change, intheir experience, empathy for her staff member; and to help simply meant being acted upon. The the head teacher understand some of the consultant reflected on the impact of these ways in which her own past experiences experiences. She also recognized that even made it Jifficult to express concerns to staff. meeting with her, given the fact that they Within the network of trusting relationships had not requested the consultation them- that had been established, difficult feelings selves, might seem to the staff like another could be expressed and new ways of relating unwanted change, a burden added to an to children supported. already overwhelming job.

t.; 6

Mental health consultation to day care providers67 Promoting and safeguarding early

relationships in chllcare:The Child Care Dallas Family Day Home system

Sonya Bemporad, M.A., CSWIACP

Our programmatic response to infant daily in a variety of settings and programs. mental health issues in day care should be An infant mental health perspective is a seen in the context of policy as well as central influence upon Child Care Dallas practice. For some babies and their mothers, program design, especially in those settings "good enough" day care supports de \ elop- which the Agency manages directly. We are ment; for others it will not. What if day determined to safeguard to the greatest extent possible the infant's development of We are determined care itself is the or a pathogenic factor in an infant's development? Are we attempting a sense of self within meaningful, positive to safeguard the to cure a disease we have created? How do relationships. To this end, we have looked infant's develop- we differentiate among babies' needs? How for ways to assure: 1) continuity of care- do we "protect" the ones for whom "good giving, both during the child care day and ment of a sense of over time; 2) protection of the primacy of enough" day care does not suffice? the parental relationship through parental self within mean- The fact that we develop the best possible control over and access to the child care ingful, positive program design for infants in day care, or setting; a sense of intimacy in the child care relationships. shore up relationships and development with experience; and placement of siblings consultation, should not take our energy and together. A family day home system has attention from the needs of all babies to have seemed to be the best way to assure that a primary, intimate, ongoing relationship the same person relates to the infant and with an emotionally invested caregiver for family each day, that the young child is cared whom this baby has special meaning and for in a small group, and that the entire importance. experience retains an intimate, domestic Parental leave provides an opportunity for quality for everyone involved. the primary parent and baby to attach before Program and social work staff at Child other caregivers enter the relationship. It is Care Dallas have developed several strate- this kind of policy, combined with sound gies to make this vision work as an ongoing child care programs and practices that we system to assure that child care settings need to foster the healthy developmen:- of foster the healthy development of infants infants and families. and families. Child Care Dallas is an eighty-nine-year- The ongoing relationship between the old United Way and federally funded day agency and the family day home mother care agency that cares for some one begins with a social study of each family thousand infants, toddlers, and preschoolers day home. The strengths and weak .lesses

68Promoting and safeguarding early relationships in child care of the home are evaluated with a view to The agency works with parents to take understanding what kinds of infants at what a careful look at the beginning of the child developmental stages this particular home care arrangement, with visits planned to the could nurture well. The worker explores the family day home before care begins. Dis- day care mother's motivation for this kind cussion is encouraged about the distress both of work, her feelings about young children, infant and parents feel as separation occurs. her own in-home relationships, her thoughts When, as sometimes happens, infants and about dealing with isolation and loneliness, toddlers do not show developmentally and her attitudes about childrearing. She is appropriate distress in the unfamiliar setting, invited to describe her own experiences of we are concerned. We work with the family loss and separation, and think about the day home mother to gain a better under- kinds of behaviors in infants and toddlers standing of the quality of the infant's that she finds appealing or unappealing. The relationships and to think about ways of prospective family day home mother is strengthening the child's important relation- encouraged to express and reflect on her ships, both with the parents and with the feelings about working parents who place family day home mother. their infants in child care and, given that A detailed annual program audit provides Child Care Dallas serves Protective Services a way to look at the experiences of infants, clients, about parents who mig'it neglect or parents and caregivers over time. We meet abuse their young children. Itis our ex- with each family day home mother to review the physical environment, safety, health perience that providers' feelings of compe- practices, play opportunities, awareness of titiveness or differences in values between children's development, opportunities for provider and parent can be addressed and communication of feelings, how parents are A detailed annual resolvedbut only if opportunities are involved in encouraging the child's develop- offered for them to be recognized and ex- program audit pro- ment, and relationships with parents. We pressed. The social worker isespecially then use the results of that review as a guide vides a way to look sensitive to the caregiver's ability to under- for the ongoing work with the child devel- at the experiences stand that her own history has something opment specialist, social worker, and day of infants, parents to do with the quality of the care she will home mother. be able to give infants and families. Assessment of infants and toddlers in care and caregivers over The placement process with the family is several times a year allows the agency to time. similarly attentive to emotional issues. A know where children are developmentally, child and family historyis taken which and to plan genuinely individualized pro- includes experiences of pregnancy and child- grams for each child. Our assessments have birth; current developmental information; been based on observations of the child previous separations of parents and child; across various developmental domains. We previous child care experience; and informa- are exploring the use of Gilbert Foley's tion about how the infant communicates Attachment/Separation/Individuation Index distress and can be comforted. Parents are to focus our assessments on the child's asked to describe what they particularly achievement of self and object constancy, value in their child. They are invited to dis- those developmental achievements most at cuss their expectations about their relation- risk in substitute care. When our assessment ship with the day home mother. With some observations have been made and summar- 50 homes in the Child Care Dallas system, ized, we meet with parents to share our families do have choices about placement. impressions and to get their perspective on They are encouraged to visit several homes the child's development. to see which seems most consonant with If worries about an infant or toddler's their own needs and feelings. development are expressed by the parent,

. . (.) Promoting and safeguarding early relationships in child care60 the day home mother, the child development provide consultation to other day home specialist who visits the day homes monthly, mothers, or conduct training workshops. or the social worker who is in contact with The turnover rate among family day home the parents, a staffing is scheduled to share mothers has decreased from 40 percent information and think through strategies. annually three years ago to less than 20 Just as we value the overall primacy of the percent this year. Similarly, by making parental relationship, so we try to protect professional staff in the central agency the primacy of the day home provider/parent accountable for their own specialized work relationship. Rather than adding another child development or social workrather professional to the equation, we try to help than generally responsible for management the day home mother work directly with of the family day home system, we have the parents to share and resolve concerns increased satisfaction and reduced turnover about a child's development. Of course, among these employees as well. when specialized help outside our system is We continue to be concerned about the needed, we will work to arrange this. central aspects of emotional development Our system is an evolving one. We have that may be at risk when infants and toddlers seen important positive changes and are are in child care. Including the Attachment/ continually looking for new ways to under- Separation/Individuation Index as part of our stand and protect the emotional well-being periodic assessment of children will give us of infants and toddlers in child care. a more sophisticated understanding ofhow Reducing turnover among family day they are faring in these areas. While our home mothers as well as professional staff outcome research to date has looked at how has been a prime goal, a prerequisite for well children who have been in our day care creating a child care system where contin- programs function in school, we look uing relationships can be relied upon. As we forward to developing outcome measures work with day home providers, we have that will rell('ct children's level of success encouraged more autonomous functioning at the central tasks of the first three years among them, supported professional accred- of lifeat the quality and nature of their itation, and offered increased pay to provid- human relationships. ers who increase their professionalskills,

fib

70Promoting and safeguarding early relationships in child care An infant mental health training model for

daycareprofessionals: The C.M. Hincks Institute National Day Care Training Project

Elisabeth Muir, M.N.Z.A.C.P. and Elizabeth Tuters, M.S.W., C.S.W.IM.C.A.P.P.C.

Recent infant observational and attachment thought established in the course of our own research emphasizes the importance of the efforts, as infants, to cope with failures in earliest infant-caregiver relationships for the attachment relationships. Reflected in the development of optimal human functioning. society at large, such avoidance may take The quality of a child's various attachment the shape of training for early childhood relationships seems to have more to do with professionals that specifically excludes that child's development than whether or attention to emotional development, or of not the young child's was cared for solely social policies that dismiss the relationship by parents or in a day care setting as well needs of infants and young children. (Morris, 1989, personal communication). Precisely because day care facilitiesin Therefore, anyone involved with the early Canada are relatively closed to the influence caretaking of children needs to understand of children's mental health professionals, we the importance of a hierarchy of attachment at the C.M. Hincks Institute for Training, relationships to the child's emotional Research nd Resource in Toronto decided development, as well as the effects of an to trai ay care staff themselves as mental equivalent hierarchy of separation experien- healtconsultants and involved the day care ces. It is also important to understand the system in planning the training program. mutual impact of relationships that cross In a federally funded pilot project, the generations and involve many parts of the Clinical Infant Program of the C.M. Hincks young child's worldthe family, day care Institute is training three day care fellows providers, day care institutions, and societal per year, selected from senior day care pro- and political systems (Bretherton, 1985; viders who are interested in expanding their Emde, 1988; Fraiberg, 1980; Main and role and the quality of day care in the com- Goldwyn, 1984; Stern, 1985). munity. Fellows gain expertise in mental To achieve such understanding, however, health consultation to day care while sharing involvesfor most of uslearning to see, a common core curriculum with other know and feel what we have previously mental health professionals in training at the avoided seeing, knowing and feeling about Institute. infants' experiences in relationships (Bow lby, As we planned the training model, we 1979; Tuters, 1Q88; Tuters et al., 1989). Our knew that the day care fellows would come avoidance may stem from defenses of to us well-trained in behavioral, physical,

An infant mental health training rniadel for day can profi---,:-.ionals cognitive and social development. We Our training program for three fellows wanted our curriculum to include knowledge (a masters level teacher of early childhood of psychoanalytic concepts, with an emphasis education at a community college; a masters on individual development over time; know- level day care supervisor; and a doctoral level ledge of attachment issues; knowledge of consultant to infant day care programs) has family relational systems; and knowledge of been underway since September, 1989. Vi- consultation and system sensitivity. We gnettes from the observation seminars knew that our greatest challenge would be exemplify the trainees' learning experiences, designing training that would be acceptable and so far serve to validate our expectation to, and congruent with, the requirements of the powerful impact on the self of learning of day care while, at the same time, helping through observation. the day care fellows come to see, know and feel what they had previously been avoiding A vignette from the Infant seeing, knowing and feeling. Observation Seminar The fulcrum of the The fulcrum of the learning experience As she described interactions between the learning experience of our day care fellows is observationof mother and the older toddler sibling of the infants, of small children, and of assessment target infant, the trainee herself expressed of our day care fel- and treatment. Structured observation, an concern that although she was meant to be lows is observa- accepted part of the training programs for observing the infant in the family, she was tionof infants, of child psychotherapists in many countries, in- bringing to the seminar observations only cluding Canada, is an emotional learning of the interactions between the mother and small children, and experience. Trainees experience the impact the toddler. She said, however, that it was of assessment and on themselves of observing the developing not possible to observe a feeding or sleeping infant, through understanding the feelings baby. Seminar members acknowledged the treatment. aroused in themselves. For day care provider difficulties of observing without impinging trainees this means becoming able to see on the mother's or infant's space, but what in the past they have been unable to described their own observations of feeding recognize: that is, e pain and distress of or sleeping infants. A question was raised an infant or small child and his parents concerning how much the mother being separated from each other; the effect of this observed was able to become preoccupied experience on the developing child, on the with her infant while she felt so compelled parents, and on the day care providers; and to attend to her older child's needs. It was how they all cope. as if, at those times, the infant did not exist. Infant Observation involves the student The observer became painfully aware that in weekly in-home observations of the she, like the mother, but for her own developing infant in the family, from birth personal reasons, had not been able to "see" over a period of one to two years. Obser- the infant. The seminar group had helped vations last from 45 minutes to an hour, her discover something about herself and with the observer behaving as naturally as her experience of infants which she had possible but interacting minimally with the hitherto avoided knowing. infant and family. Note-taking is discour- In this same seminar session, another aged; narrative descriptions of the observa- trainee became aware that she too was tion are written from memory and discussed avoiding self-knowledge. In her own obser- in weekly seminar groups. The observations vation, she visited a mother who, depressed that have been described, and feelings that and discontent with her third baby, indicated have been stirred up, are shared with other in conversation that she felt she could not group members and worked through in meet the needs of her infant because her discussions. The Small Child and Clinical own needs were not being met. The observer observation seminars follow a similar described finding herself not observing the format. baby, but rather engaging in conversation

72 An infant mental health training model for day care professionals with the mother about knitting. She realized believed that observation and understanding that she had been pulled into this mother's a small child's emotional experience were world, colluding with the avoidance of her important) could not be understood by this infant's needs. teacher. This would seem to parallel the child's situation. A vignette from the consultation We believe that training based on obser- application seminar vation helps trainees fully understand the The day care fellow reported that the day impact on themselves of the experience of care teacher of the small child being observed day care and all of its vicissitudes. Our by the trainee asked her how long and for training helps them understand the expe- what purpose the trainee would be observ- riences of infants, children, families and day ing the child, indicating that she felt it was care providers. They come to understand a waste of time. The teacher also inquired how much the source of a child's distress about the in-home observat'is this trainee lies within the family system, how much had made of this child. The trainee carefully in the day care system, how the interre- explained the purpose and duration of the lationship of day care and family systems observation and clarified boundaries with impinge upon a child's emotional experience, respect to confidentiality. The following and how intergenerational repetitions can week, the same teacher repeated the same become intersystemic re-enactments. To questions. She added that she too was plan- struggle with what needs to be done in the ning to further herself; she did not intend earliest years of lifeis to Make possible to remain a day care teacher forever. different outcomes for infants and small The trainee could recognize issues of children, for families, and for day care confidentiality and competition and had be- providers. gun to understand the existence of many levels of communication and the power of References personal issues to influence behavior. As she thought about the impact of the teacher's Bowbly, J. 1979. Knowing What You Are Not Supposed to Know and Feeling What You Are communication on her, she was left feeling Not Supposed to Feel. Canadian Journal of Psychia- lazy and advantaged, in comparison with the try, V 24, pages 403-408. relatively deprived, hardworking day care Bretherton, I. 1985. Attachment Theory: Retro- provider. Her clarification about limits on spect and prospect, In, Bretherton and Waters the sharing of observational information (Eds.) Growing Points in Attachment Theory and Research, Monographs of the Society for increased her sense of being perceived as Research in Child Development. V 50 (1-2, a person who"had it all" but was withholding Serial No. 209), 3-35. what she had (desired information) from the Main, M and Goldwyn, R. 1984. Predicting needy teacher. rejection of her infant from mother's represen- Whenever the trainee offered some tation of her own experience: Implications for the abuse-abusing intergenerational cycle. Child thoughts about the children's behavior, this Abuse and Neglect, V 8, 203-217. day care teacher was quick to minimize her Morris, A. 1989. Personal communications. contributions. When asked by the trainee Stern, D. 1985. The Interpersonal World of the Infant. for her own thoughts about any behavior New York: Basic Books. or interaction, the teacher would make a Tuters, E. 1988. The relevance of infant obser- b -ief, dismissing comment, indicating to the vation to clinical training and practice: An inter- t:.ainee the teacher's reluctance or resistance pretation, Infant Mental Health Journal, V 9 No. 1, to attempting any understanding beyond a Spring. superficial level of the meaning of a child's Tuters, E, Muir, E, Huntley, M and Rustin, M. behavior. The day care fellow was left feeling 1989. Workshop presentation on infant observa- tion, 4th Congress World Association of Infant that she could not communicate clearly I'sychiatry and Allied Disciplines, Lugano, that her own behavior (as someone who Switer7land.

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An infant mental health training model for day care professionals73 Whole Babies, Parents and Pieces of Funds:

Creating Comprehensive Programs for

Infants and Toddlers

by Peggy Daly Pizzo

Every day, providers of early childhood mentally ,,,oropriate care that is carefully services to infants and toddlers deal with tailored Lc) the needs of each baby, in- the needs of the whole baby with pieces of cluding those with developmental delay. In funds. Very few whole funding streams are the parlance of early intervention services, organized so that providers of early child- this may be a least restrictive environment hood services can use one funding stream or a more facilitating environment for in- to serve the whole baby in a family-centered fant, with special needs. Thus this child care way. program may be eligible for some reimburse- But there are many pieces of federal ment as an early intervention service under funding available to support states, local gov- Public Law 99-457. ernments and community-based programs But in each case, the early childhood ser- striving to provide high quality, comprehen- vices provider must first analyze whether sive early childhood services for infants and the services they are currently providing or toddlers. At last count, the General Account- wish to provide are "a good fit" both with ing Office (GAO) enumerated 46 federal the needs of child and family and with the programs which provide funds for child care services reimbursable under a particular or related servicesand the GAO list did funding stream. And then the provider must not include Medicaid, a funding source which use the technical language of that funding we explore in this article! (General Account- stream, not the language of the early child- ing Office, 1989). hood services field, to describe the activities. By doing so, however, practitioners, ad- "Piecing together" the funds ministrators and advocates of comprehen- To "piece" together the needed funds, early sive services to disadvantaged children may childhood services must learn and use the be able to open up multiple new layers of technical jargon associated with each par- funds needed to help pay for the caregivers, ticular funding stream. An early childhood specialists, health, nutrition, social and edu- program which helps low-income families cational services and equipment that "whole obtain health, educational and social services baby" programs need. is, in Medicaid parlance, providing case man- agement services and may be eligible for Purpose of this article Medicaid reimbursement for doing so. This This article will inform leaders in the early same program may also provide develop- childhood field about the value of the whole

7(1;

74Whole Babies, Parents and Pieces of Funds baby approach to child care.Itwill also service-system centered approach which describe the diverse "pieces" of funds which sees the services as the center around which can be blended together by child care pro- the child and family must revolve. It is also grams (or in some cases, by child care distinct from the child-centered approach resource and referral agencies) to facilitate which may take a profound interest in op- the care and education of "whole babies" timizing the development of the child but instead of fragments of the needs of those very little interest in the developmental babies. challenges and changes, feelings, convictions and level of satisfaction with the services The "whole baby" approach to child that the parent experiences. (ACCH, 1987; care Edge and Pizzo, eds., 1988; Woll and Pizzo, The whole baby approach to child care is eds., 1988.) one that sees the infant as a human being A family-centered approach sees the whose physical, cognitive, emotional and parents of children as usually the most important persons in a child's life. Services social needs cannot be dealt with as separate are then structured not just to care for the domains of development. Multiple and inter- in the day-to-day absence of the related strands of development combine in child parent(s). Family-centered early childhood the infant and toddler in ways that "blur services strive to motivate and empower the the lines" between these developmental parents to improve the skills they need to domains more deeply than is ever experi- be effective and confident nurturers and enced again in the lifespan. educators of their own children (if improve- Early childhood educators and specialists ment of those skills is needed). In addition, in infant and child development face the family-centered services strive to motivate challenge of how to respond to this unique and empower parents to be effective advo- characteristic of infancy with early childhood cates for their children', educational, health, services that are comprehensive. This means nutritional and social needs (if improvement services that do not segregate intellectual of advocacy skills is needed). stimulation from immunization or promo- tion of prosocial bohavior from protection Five sources of federal funds and against accidental injury.It means, for the whole baby family-centered example, services which concentrate on approach to child care skilled and sensitive nurturing of a some- With the exception of funds for comprehen- what unresponsive baby while also concen- sive services like the Head Start program trating on correcting the anemia which is and the Comprehensive Child Development making the baby listless. Centers (a demonstration program), almost The family-centered approach to all other federal funds focus on one or at most two objectives related to the child's child care well-being. Almost none make funds avail- Struggling to meet the needs of the whole able to foster parent development as well baby is one of two central challenges in early as child development. childhood services for infants and toddlers. However, there are at least five sources The other challenge is the delivery of the of federal funds which can be brought into service in a family-centered rather than a early childhood and child care programs provider-centered or even only a child- seeking to become more comprehensive (or centered way. into resource and referral agencies which The family-centered approach essentially support the development of comprehensive sees the family as the constant in the child's early childhood programs in their commun- life, around which the service systems must ities). These funding sources are described revolve. Itis distinct from the provider o in summary form below.

Whole Babies, Parents and Piety:, of Funds 75 I. Federal funds for child care under availablein each state for resource and the Family Support Act of 1988 referral services designed to assist the parent in locating child care. Reimbursements can- Open-ended federal funds are available for not exceed the market rate in each locality. child care for every child eligible for Aid to FSA funds can be used to provide a wrap- Families with Dependent Children (AFDC), around service to early intervention, family whose family meets the conditions set forth resource and support or Head Start services in the Family Support Act (FSA) of 1988. which are currently part-day. In a wrap- This new law modifies Title IV-A of the around, these funds are used to lengthen Social Security Act. the day or otherwise lengthen the time that Eligibility for FSA funds the services are available so that the AFDC These child care funds are available as part parents can fulfill the requirements of the of a broader program, whose purpose is to Family Support Act. provide incentive and support to AFDC II. Federal funds for child care under families who participate in employment or Social Services Block Grant (SSBG) training. The part of the FSA which most or Title XX directly affects infants and toddlers is the requirement that parents between the ages Funding for child care is also authorized of 16 and 20 who have not yet finished high under Title XX of the Social Security Act. school participate in full-time educational Title XX is the social services funding stream. activities,regardless of the age of their Each year a cap on funds for Title XX is children. appropriated. Within that federal limit, then, The new law also requires parents of states may draw down federal funds to help children aged three and up to participate in them provide social services for any family employment and training as a condition for who is currently eligible under both federal participation in Aid to Families with Depen- and state policy. Usually these are families dent Children. States may impose the with very low incomes. One of the social identical requirement on AFDC families services which the state may elect to fund with children aged 1 to 3, but are not re- is child care. (Each state decides how much money it will spend on e.t:h of the social quired by federal law to do so.Finally, parents of children of any age may access services which are eligible for federal this federal source of support for child care matching funds.) if they volunteer to participate in employ- Child care providers typically participate in Title XX by negotiating a purchase of ment or training. These Title IV-A or Family Support Act service contract with the state administering agency, by which the state purchases child (FSA) funds can be given to either eligible care "slots" from the provider for a defined child care providers or to eligible parents, number of children eligible for Title XX. Pur- who then are expected to pay the providers. chase of service funds are usually provided Unlike Title XX (see below), there is no cap as a reimbursement to the child care provider on Title IV-A funds appropriated every year. for a defined amount of time that the child Thus, the federal government can provide, or children have spent in the child care on an open-ended basis, federal matching program. Typically, no funds are provided funds for every eligible child who participates for resource development, that is to create in child care that meets the requirements new child care programs. of state and federal law. However, like Title XX, these funds will typically be per-child reimbursements for day to day child care services.r.limited amount of hinds will probably also he made

16`-,;l 7tWhole Babic,:, l'aronts and l'ictoc of Funck III. Federal funds related to child of the working poorthe population of care and comprehensive preventive children served by child care programs for health care (including family support economically disadvantaged childrenare services) under Medicaid increasingly eligible for Medicaid and, at state option, for case management services. Child care services are typically required by As of April 1, 1990, states must include state law to prohibit admittance to the pro- in Medicaid all pregnant women, infants and gram to any child who has not met age- children up to age six whose families cur- appropriate immunizations. (There are rently earn less than 133% of the federal exceptions in family day care.) In addition, poverty line. All of these families are eligible there are often state requirements that chil- for the full range of preventive health care, dren have physical examinations or health for medical treatment and for case manage- assessments in order to safely participate in ment services, if the state has chosen to child care. These are usually considered adopt case management services as one of necessary safeguards to a child's health when its options. (Note that this new mandate may being cared for in groups. make the children of many Head Start and However, for low income families in child care providers eligible for Medicaid as particular, both child care providers and well.) parents are often deeply frustrated by the difficulties parents experience in obtaining Medicaid and case management services these basic health services either prior to Early childhood service programs or child entry into child care or throughout the care resource and referral agencies which course of the child's participation in child either have developed or have the potential care. to develop good working relationships with In some states, child care programs, family the parents of low income infants and resource and support programs, Head Start toddlers are well-situated to provide case programs and child care resource and re- management. Good case management ferral services which serve Medicaid-eligible req iires a long-term commitment to the families can now apply for and receive family and to assisting the family to secure Medicaid funds to assist families in gaining the services that the children and other access to needed medical, social, education members of the family need. It also requires and other services. a commitment to helping the parent find In Medicaid terminology, the service of a "medical home" for the childa good assisting families in this way is called case ongoing source of medical care which can management services. This is an optional both prevent and treat health problems. Medicaid service and must be specifically Finally, good case management depends on included by the state in its Medicaid plan persistence in exchanging and coordinating before case management services can be information among parent, medical home, funded. child care provider and, at times, other health and social service providers. New eligibility for Medicaid To become eligible to be reimbursed for Medicaid is authorized under Title XIX of case management services, providers of child the Social Security Act. It provides open- care, family resource and support, early ended federal matching funds for those intervention, Head Start or child care eligible services provided to eligible individ- resource and referral services need to take uals. Historically, the children eligible for the following steps: Medicaid were typically (although not identify whether at least some of the (ways) of such low incomes that they par- population served by their program is or will ticipated in the state's Aid to Families with be eligible for Medicaid and whether they Dependent Children program. Now children need case management services;

I

Whole Rabies, Parents ,Ind hetes of Funds 77 decide what the elements of the case logist) and apply to become an EPSDT management services to be provided the provider. families will include; As with case management services, good ascertain whether the state has yet screening and assessment requires the adopted this option in its State Plan; exchange of information and coordination with a "medical home" for each child. Col- discern who is designated by the State laboration with parents is also essential both Plan as eligible to be reimbursed as a case to obtain input relevant to the assessment manager; and fo encourage and support parents in apply for a Medicaid provider number obtaining follow-up remediation of problems and discuss methods of reimbursement with detected by the assessment. the state Medicaid agency. IV. Federal funds for child care Medicaid and transportation programs providing nutritious meals Child care programs or resource and referral and snacks under the Child Care agencies which assist Medicaid-eligible Food Program families in gaining access to needed medical Infants and toddlers undergo such rapid services by providing transportation to physical and mental development that their doctor visits, dental appointments and other need for food with appropriate caloric and medical providers can be reimbursed for this nutritional content isacute. In addition, service under Medicaid. mealtimes for infants and toddlers are Many child care providers and perhaps essential moments in the development of a even resource and referral providers use baby's emotional health and capacity for vans to transport children and caregivers for social interaction. Therefore staff need to such child-care related activities as field trips. have unhurried feeding times with babies During the significant periods of non-use, and toddlers. providers can use vans to transport children The costs of purchasing, preparing and and parents to health services. This is a serving nutritious food to infants and tod- natural adjunct of case management services dlers can be offset by funds from the Child and Medicaid can pay for all or part of the Care Food Program. Authorized under the operating costs (including insurance) of the National School Lunch and Child Nutrition vehicles. Act, this program is administered at the federal level by the U.S. Department of Agri- Medicaid and developmental culture. At the state level, however, itis assessment and health education administered by the Department of Educa- Finally, under the Early and Periodic tion, the Department of Human Resources Screening, Diagnosis and Treatment (or Social Services) or the Department of (EPSDT) provisions of Medicaid, qualified Health. child care programs may also provide All children in nonprofit child care centers developmental assessments and health and sponsored family day care homes are education for Medicaid-eligible children and eligible for some type of reimbursement. be reimbursed by Medicaid for doing so. However, in centers, children in the higher State law may limit the licensure of end of the income ranges qualify for only individuals qualified to either perform devel- a slight reimbursement, while children in the opmental assessments or provide health lower income ranges qualify for a more education to individuals with certain types substantial reimbursement. For-profit cen- of degrees. However, child care programs ters are eligible for participation in CCFP can enter into contractual relationships with if their total child population is comprised qualified individuals (e.g., licensed psycho- of at least 25 °h low-income children,

78Whole Babies, Parents and Pieces of Funds currently defined as children participating in Part H of P.L. 99-457, the Education of Title XX. (Recent legislation authorized a the Handicapped Act Amendments of 1986, small pilot project to broaden this definition.) encourages states to identify and provide The steps which providers of early early intervention services to infants and childhood services must take to apply for toddlers who are developmentally delayed reimbursement differ for centers and for or have a physical or mental condition likely home-based programs. Qualifying centers to result in developmental delay. (States may can apply directly to the administering state also serve infants and toddlers who are "at agency for reimbursement. Family day care risk of having substantial developmental homes must work through a nonprofit spon- delays if services are not provided.") Part H soring agency, often a center or a resource monies are for the planning of services or and referral agency. Since the red tape of the expansion of services. States are applying for reimbursement can be cumber- encouraged to coordinate multiple funding some to some center providers, some centers streams; for example, they may use Medicaid are choosing to apply in ways similar to to help finance the costs of identifying family day care homes, i.e.,through an Medicaid-eligible children through compre- agency that takes responsibility for the hensive health and developmental assess- paperwork. ments. Central to the philosophy and implemen- V. Federal funds for child care tation of Part Fl of P.L. 99-457 is the devel- services which provide early opment of an Individualized Family Service intervention services Plan, based on a multidisciplinary assessment of the child and, with the concurrence of Family day care homes, child care centers the family, a statement of the family's and Head Start programs for infants and strengths and needs related to enhancing the toddlers are increasingly asked to enroll development of the child. To the extent infants and toddlers with a variety of special appropriate, early intervention services must health care needs, developmental delays or be provided in the types of settings in which atypical patterns of development. This infants and toddlers without handicaps increasing demand is in part due to state participate. efforts to locate children eligible for early Early childhood programs that wish to intervention services. The demand also become case managers for the infant and reflects parents' need for infant and toddler toddlers eligible for P.L. 99-457 services may services which will help them participate in be able to contract with the state to do so. the labor force. Rising medical and other Similarly, those programs that are qualified expenses associated with the upbringing of to provide part of the required multidisci- children with special needs propel even more plinary developmental assessment may be of their parents into the work forceand able to contract with the state to do so. into the search for child care. It is not clear yet how many states will Early intervention services for children contract with early childhood programs to under three have been defined in federal law provide early intervention services in child as services "designed to meet a handicapped care settings. States may be reluctant to use infant's or toddler's developmental needs in the limited funds appropriated for Part H any one or more of the following areas: of P.L. 99-457 to fund the entire costs of physical development, cognitive develop- an all-day, all-year early childhood program. ment, language and speech development, But they may find it more cost-effective to psychosocial development or self-help skills." fund part of the costs of an existing com- (Education of the Handicapped Act Amend- munity child care program, and to supply ments of 1986.) the program with appropriate specialized

Whole Babies, Parents a nuCa Pieces of Funds70 services and equipment, than to finance need is the exchange of information, start-up costs for new early intervention throughout the entire early childhooder- services. Child care providers interested in vices delivery system, of creative and providing early intervention services should workable ways to piece together funding contact the lead agency for Part H of P.L. streams. Parents can't be in two different 99-457 in their state and discuss this with service sites at once. Families don't do well agency representatives. They should also try when parents constantly feel torn in two. to identify state and local parent advocacy Furthermore, babies can be damaged by organizations concerned with special needs narrowly focused services which ignore, for and make their interest in serving infants example, their health needs in order to be and toddlers with special needs known to exclusively devoted to their cognitive or these organizations. Child care resource and emotional needs (or vice versa). And once referral agencies can help early childhood "broken," babies don't get "pieced back program providers connect with the lead together" easily. It's better to piece the funds, agency and with parent advocates for provide the support to parents and procure children with special needsas they can also the support we need to help nurture the help parents of infants and toddlers with babies. That's the challenge that faces us now special needs become aware of their options and will continue to face us throughout the under P.L. 99-457. coming decade. Outlook for the future The amount of federal financial support for References early childhood services is likely to expand Association for the Care of Children's Health substantially over the next few years. (ACCH). Family-Centered Care for Children With Spe- Congress will enact child care legislation. cial Health Care Needs. (Washington, D.C., ACCH, Congress will also expand the funds for 1987.) Head Start. Eligibility for Medicaid and funds Edge, Elsie and Pizzo, Peggy, eds. Four Critical for the Child Care Food Program and for Junctures: Support for Parents of Children With Special Needs. (Washington, D.C., National Center for P.L. 99-457 may also expand. But the Clinical Infant Programs, 1988.) necessity of piecing together funds in order General Accounting Office. Child Care: Government to serve the whole baby and to empower Funding Sources, Coordination and Service Availability. parents will not fade away. (Washington, D.C., U.S. General Accounting One of the most compelling needs of the Office, 1989.) 1990s in the field of early childhood services Woll, Jose and Pizzo, Peggy, eds. The Open Door: Parent Participation in State Policymaking About Children for infants and toddlers is the investment With Special Health Needs. (Washington, D.C., of more funds in all the categories of support National Center for Clinical Infant Programs, mentioned above. But an equally compelling 1988.)

t

80Whole Babies, Parents and Pieces of Funds 12

The Developmentally Designed Group Care

Setting: A Supportive Environment for

Infants, Toddlers and Caregivers

Louis Tore' li, M.S.

The physical environment in a group care where the teacher takes out baskets of setting affects children, caregivers, and their Dup los, brings them to the middle of the interaction. A well-designed environment is, room, and sits on the floor surrounded by ten toddlersall shoulder to shoulder. After of course, safe for infants and toddlers, but only a minute or so, one child grabs another's it also supports their emotional well being, Duplos. While the teacher encourages this stimulates their senses and challenges their pair to "be gentle," the same battleis motor skills. A well designed group care beginning between two other children. Then environment promotes children's individual a toddler who has been racing around the and social development. It is comfortable and classroom suddenly runs to the middle of aesthetically attractive to both children and the room and kicks the tower of another their caregivers. child who has been deeply involved in play. A developmental environment is designed In contrast, a developmentally designed specifically to promote learning that is both environment offers infants and toddlers age appropriate and child-directed. The set- choices of activities and opportunities to ting, layout and equipment all give infants break away from the larger group. A multi- many opportunities to challenge themselves level design, for example, varies the floor through seeing, touching, feeling and mo- height with appropriately scaled platforms, ving. In surroundings that are safe to explore lofts, "nests" and canopies. These mini freely, infants learn to map their environ- learning environments set up a landscape ment cognitively, to manipulate it, and to for safe exploration in which infants can handle a toy, look at a book, stack blocks, master it. In group care classrooms without a crawl up steps, or simply watch the adults and other children from a cozy semi-enclosed developmental design, one generally "private space." observes young children spending a signif- For toddlers, a developmental design icant amount of time in either aimless would also include an area for manipulative wandering or teacher-directed activities. play with Duplos, shape sorters, pop beads, Because making friends is a social skill that and the like. Such an area would be enclosed depends on experience as well as age, a group by shelves, low walls, or carpeted platforms. care environment that is teacher-directed Because this would be one of several activity can deprive infants and toddlers of oppor- areas available, toddlers could choose them- tunities to enjoy positive interaction with selves when they wanted to engage in this their peers. Consider a toddler classroom kind of experience and for how long.

The Developmentally Designed Group Care Setting 81 Mini learning areas encourage privacy and support this need. When the setting lacks small-group interaction rather than wand- appropriate equipment, the ten-month-old ering and herding. In smaller groups, young still moves, but she uses the high chair to children can be intensely involved with each pull up to standing and then is redirected other. In an environment that encourages because thisisnot safe. The eighteen- focused play in small groups, relationships month-old attempts to use the toy and book among children are less aggressive and more shelf as a climbing apparatus, but he too supportive. is redirected. The two year-old who con- After her classroom was redesigned tinually gets up on the table to jump off according to developmental concepts, a is redirected as well. The message to these toddler teacher summarized the differences children is: "Self-initiated exploration is not for children and for herself: acceptable." But an environment designed to meet "You can feel the difference when you walk in the room. It's so much more comfortable! Instead of moving infant and toddler needs supports and around aimlessly, the kids are much more focused on encourages active exploration. The children activities. Now they can be active in the classroom get the message that it is fine to explore without getting into each other's space.Instead of and take risks here. Their motor exploration climbing on furniture, they have a place to climb. leads to motor competence, which then Having all this storage makes me a much more contributes to emotional well-being. organized teacher.Ina way I really feel spoiled. But then I think, the kids deserve this, and I deserve this. The role of equipment It makes me feel so happy." Appropriate equipment isessential to Let us consider some specific elements of meet the motor needs of infants and toddlers a well-designed group care environment for in group care. Equipment also affects peer infants and toddlers. relationships significantly. For example, equipment that may be ideal for individual Layout development may be a burden in a group Create mini-learning environments by care environment. And since the field of placing multi-level activity areas around the group infant careisinits own infancy, periphery of the classroom. This leaves the choices of commercially available equipment middle of the room open for traffic lanes are still liTited. Consider the infant ladder-slide found in and "stage set" activities such as music and movement experiences. The open central many child care centers. Older infants and toddlers love to use it, but only one child section itself can be varied by using portable equipment such as carpeted risers and at a time can play on it. In order for children to use this slide safely, the caregiver must bolsters. police it, having children wait their turns Motor challenge and redirecting those who have difficulty doing so. Because motor activity is critical to the If the equipment were designed to allow overall development of infants and toddlers, more than one child to use it simultaneously, the physical environment must provide safe the situation would no longer be stressful and appropriate motor challenges. A devel- for either children or caregiver. Toddlers opmentally designed environment supports could be more actively involved in motor ease of movement, which then encourages exploration, and they would also have an active exploration. opportunity for positive peer interaction. Contrast an environment that encourages Instead of controlling and redirecting, the climbing, crawling, running and jumping caregiver could be observing, learning more with one that does not. The need to move about the infants in her care. still exists, but the environment does not

82The Developmentally Designed Group Care Setting Flexibility for mixed age groups children's use, locate storage space on the walls, at a height of 48 inches or more. Mixed age groups present a particular Infant/toddler caregivers inevitably spend challenge. The environment must support much of their time changing diapers. Well- the motor interests of older infants and designed storage in diaper changing areas toddlers while providing safe, relaxed care can leave the caregiver available to engage for young infants. in responsive interaction with the child Shelving, low walls, large pillows, mats, during diaper changing. platforms and portable risers can all be used to separate different activities and thus Mental health respond flexibly to the diverse needs and A developmentally appropriate space is interests of a mixed age group. When the designed to be emotionally supportive for whole group is in the room, the caregiver both children and adults. The setting can enclose a corner with a few portable encourages relaxation. It invites one to spend risers. Younger infants will be safe in this time. protected space with a caregiver, while the Track lighting, carpeting, pillows, textured older infants and toddlers move freely wall hangings, plants and animals can all around the classroom. When half the group contribute to a comfortable environment. is outdoors or several infants are napping, Photographs of children and family the caregiver can redesign the space to allow members; wide, full - length plexiglass mir- for more open play and movement. rors; and hammocks for rocking infants all offer emotional support. (Hammocks work Using storage for flexibility better than rocking chairs because they allow Every activity area in the classroomfor the caregiver to rock more than one infant eating, manipulative, art, books, blocks, at a time if necessary. Rocking chairs can etc.should have its own storage space. To seriously hurt an infant who crawls behind reserve as much space as possible for one in motion; they also take up floor space,

The Developmentally Designed Group Care Setting 83 while hammocks can be taken off their hooks components of care are equally critical. While and stored when not in use.) considerable attention has been paid to adult/ Windowsespecially those that open and child ratios, caregiver training and parent look out to trees, grass, and passersby involvement, group size has still not been contribute to a relaxed setting. Because older recognized uniformly as a key variable in infants and toddlers love to watch others, quality care. A decade ago the National Day child-level windows that look into another Care Study (Ruopp, 1979) found that too classroom can function as an additional many children and adults grouped in one learning center. space affected relationships adversely. When more than seven infants or eleven two-year- Privacy olds were cared for in a groupeven with Being alone provides time essential for one adult for three infants and one adult reflection and growth. Although most adults for four two-year-oldsobservers saw more recognize the need for privacy, we often crying, hostility, and apathy and less expect infants and toddlers to function well cooperation, reflection and elaborate play in group care situations for upwards of ten than in smaller groups. In large groups, the hours a day, five days a week. Private spaces infant experiences sensory overload and has in the group care environment support the a harder time forming a close relationship development of the young child'sself- with a specific caregiver; forming a group concept and personal identity. They assist identity is difficult. all ages in understanding the "I" in relation to the "thou." Conclusion A private space could be a tunnel, a A developmentally designed environment carpeted built-in cabinet with the doors offers infants and toddlers opportunities to removed, a cozy loft space, or a f-,w risers explore, make choices, and master their enclosing a small corner of the room. Instead world. It offers caregivers a chance to be of experiencing the stress of being in a large observers, facilitators and supporters of all group all day, the infant can withdraw to aspects of development in the early years. a private space to rest, observe, and recharge A well-designed child care environment not emotionally. With access to a private space, only reassures families but invites them. two toddlers who are just beginning to When an environment is designed to be develop a relationship can go off together. functional, attractive and developmentally Opportunities for privacy not only support supportive, everyone feels well cared for. the infants' developing sense of self; they also reduce aggression among children. The people in the environment References Ruopp, R, Travers, J, Glantz, F, and Coelen, C. While a developmentally designed envir- 1Q79. Children at the Center: Final Report of onment adds significantly" to the quality of the National Day Care Study. Cambridge, MA. grout care for infants and toddlers, other Abt Associates.

84 the Developmentally Oesigned Croup Care Setting Shared Reading in Daycare:

Successes and Challenges

by Grover J. Whitehurst & Janet E. Fische].

In her wonderful book, Beginning to Read ment condition, children were read to in (MIT Press, 1990, pg. 85), Marilyn Adams small groups by their teachers, but parents estimates that a typical middle class child were not involved. Finally, in a control con- enters first grade with 1,000 to 1,700 hours dition, children engaged in small group toy of one-on-one picture book reading, while play under the guidance of their teacher. The We have learned the corresponding child from a low-income intervention lasted six weeks. Children were pretested and post-tested on a variety of family averages 25 such hours. "Is there any how much more chance," she asks, "that (the] first grade assessments of language development. The good news is that the intervention we need to learn to teacher can make up for that difference in works inthis setting. Children inthe 360 hours of one-on-twenty instruction?" turn daycare cen- school+home condition were significantly The obvious answer is no. ters into wellheads ahead of children in the control condition Title XX programs, work-fare initiatives, on standardized tests of both receptive and of literacy for and various job training programs have expressive language; the differences were resulted in large numbers of children from young children. about 213 of a standard deviation, which cor- low-income families receiving publicly sub- responds to about five months of language sidized daycare..At the Stony Brook Reading age in this age range. Children in the school- and Language Project, we have been ex- only condition fell in between children in ploring daycare as an environment that the control and school+home conditions. We might compensate for some of the impov- also looked at more specific measures of erishment in experience with books that is vocabulary growth and found that children the lot of many children from low-income in the school+home group had learned large families. numbers of new words that were specific We have just completed a study with 70 to the books they had shared with their three-year-olds from low-income families in parents and teachers. We are excited by these five daycare centers in Suffolk County, NY. results because the effects are reasonably Children in each classroom in each center large for such a brief intervention, and be- were assigned randomly to one of three cause we had not been sure that parents conditions. Two treatment conditions in- of low-income children and daycare teachers volved an intervention celledDialogue Reading would be successful dialogic readers. that we developed and have sh. vn to he At the same time, we have learned how effective in other settings. In our study, much m or- we need to learn to turn daycare children in a school+home condition were centers into wellhead.; of literacy for young read to at home by their parents and at children. Of the five daycare centers with school in small groups by their teachers using which we worked, one did n. t implement dialogic techniques. In a school -only treat- the reacliny, package succecsfully in the first

Shared Reading in Daycare: Sue'cesses and Challenge:,85 place (reading only about once per week of our daycare centers never have parent rather than once per day as encouraged), meetings, and they are not routine in any. and another dropped the program as soon We have shown that parent involvement is as we had post-tested the children. Only two a critical component of success, but someone of the five centers have continued the has to care enough to engage parents in the reading program with enthusiasm, even process. We are leaning though each center was informed of the What are the solutions to these problems? Over the long term, one might hope for towards volunteers positive results. A principal issue is organ- izational. Dialogic reading is interactional a gradual increase in the standards and to provide one-on- reading. It requires the child to talk and the practices of daycare centers so that they one or small group teacher to listen and respond actively. These become more educationally relevant and so requirements mean that dialogic reading that the development of linguistic and shared book read- cannot work if a teacher tries to share a cognitive skills in children and the involve- ing for children in book with the whole class simultaneously. ment of parents as partners in educational daycare. This large group reading was without goals are seen as critical components of their exception the form of literacy experience mission. However, that may be a very long that was employed in the daycare centers term goal. As witness, the daycare centers prior to our program. In contrast, we insisted that cooperated in our program are much on no more than a one-to-four ratio for better than the national average. For shared reading. On paper, each center had instance all are nonprofit centers whose enough staff to accomplish this arrange- directors hold college degrees and have a ment, with the typical classroom/group strong sense of mission. Many of the consisting of about 14 children, a teacher, teachers are also college graduates and the and a teacher's aide. It meant that one adult facilities are appropriate and well maintained. would need to care for the majority of the Staff turnover is relatively low. Problems children while the other adult engaged in in instituting a shared reading program in shared reading with a smaller group. Three these settings would be dwarfed by those such sessions of about 10 minutes each that would likely be encountered in run-of- during the day would have allowed each child the-mill proprietary centers with low wage, in each classroom a daily dose of small group high turnover staff in states with minimal shared reading, and would have required regulation of daycare. only about 30 minutes of reorganized time We are leaning towards using volunteers out of the daycare day. However, daycare to provide one-on-one or small group shared centers are not by tradition organized so that book reading for children in daycare. The children are divided among adults in a way success of groups such as Literacy Volun- that approximates the staff to child ratio. teers of America in working with problems Rather, one adult often takes charge of a of adult illiteracy suggests that there is a large group, while the other adult prepares large pool of people who will volunteer their materials for later use, handles problem time to advance the cause of literacy. It would children, or takes a well deserved break. Or take only five adults, each willing to volun- both adults provide traffic control functions teer 30 minutes a week, to staff a small group and handle problems asall children are shared reading program for a typical daycare engaged in play activities. Reading to classroom. Some of these adults could children in small groups requires a different probably be found among the family mem- organization, and it is seen by teachers as bers of children in daycare. Retirees are an- more effortful than their typical practice. other potentially large group of volunteers. Another organizational issue has to do with We do not underestimate the problems training and encouraging parents to share involved in instituting wide spread volunteer books with their children at home. Several programs for shared book reading in daycare 0iJ

86Shared Reading in Daycare: Successei. and Challenges centers, or in incorporating some other give them ... good things to eat; we try mechanism for shared reading into preschool to teach them to be clean and polite, good programs. The task isformidable. In natured, thoughtful, and fair ... We must justifying the effort, I turn again to Marilyn do as much with reading. In our society, Adams, who says, "We hug [children], we their lives depend on it" (1990, p. 91).

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Shared Reading in Daycare: Successes and Challenges 87 14 Managing Growth at Child Care Solutions

by Ruth Anne Foote

Child Care Resource and Referral (CCR&R) Support Center. For the first five years of Services see themselves as a vital part of its existence, Solutions was the only CCR&R the country's child care system. Their rapid offering referral to the general public in growth during the last decade has resulted Georgia. Solutions began with a $5,000 in large part from the urgent demand for grant from the Metropolitan Atlanta infant child care. When Child Care Solutions Community Foundation, a $3,000 grant began to provide resource and referral from the Gannett Foundation, and three services for 11 metropolitan Atlanta counties part-time staff members working a total of in1983, 42.5percent of the parents who 33 hours per week. Fortunately, Solutions' called that year were seeking care for parent agency, Save the Children, was children under12months. In ensuing years, willing to absorb significant administrative the percentage has remained fairly constant, costs, and its own staff members were ranging only from36 to 42percent. The willing to double up on responsibilities in parents who have called upon Child Care order to meet a pressing community need. Solutions are often first-time users of child The referral service listed 630 family day care. Their families have never turned to care providers in seven counties in its data sources outside the family for infant care, base and offered referral to 2600 parents and their employers' personnel policies have in its first year. assumed that children were cared for by a By 1990, Child Care Solutions employed non-working spouse. They have found little 16 full time equivalent staff members and in their experience or their support struc- listed 1094 family day care providers, 643 tures to help them locate and select care- centers, 257 school-age programs, and96 givers for their babies. half-day preschool, in eleven counties in its Child Care Resource and Referral Services data base. It offers referral to8,000parents can provide much needed support, not only each year. (All referrals are to providers to parents, but to all constituents of a child registered with the nepartment of Human care system, including providers, employers Resources, but referrals are not recom- and communities. In order to cope success- mendations.) fully with increasing demand, however, a Our range of services has widened as well. CCR&R must manage its own growth care- In addition to counseling parents, Solutions fully. This article describes several major offers: principles for managing growth that have a provider warm line, which offers helped us at Child Care Solutions through technical assistance and information on the exhilarating process of coping with cur- registration and training to family day care rent demands, and gathering resources to providers; meet new demands. two family child care resource rooms The growth of Solutions in suburban counties; Child Care Solutions began in1983,a pro- a consultant who assists churches and jectof Save the Children's Child Care not- for profit organizations in starting child

88Managing Growth at Child Care Solutions L) care centers and programs for school-age children; What is Child Care Resource and Referral? a trainer who works with both centers and family day care providers; and Child Care Resource and Referral Services are a vital part of the country's child care system. They serve all the system's an emergency child care specialist who constituents. assists families in crisis in resolving child care problems. CCR&R offers referral, consumer education, problem solving, and information on child care to parents, usually Solutions manages contracts offering "en- through telephone consultations. hanced referral" (vacancies are confirmed before parents are called back) and other CCR&R offers training, technical assistance and consulta- tion to child care providers, much of it directed toward helping employee assistance to 100 companies. Sister family day care providers and other child care programs get programs at Save the Children/Child Care started and meet licensing or other standards. Support Center offer payment for child care through vouchers, special assistance, and CCR&Rs work with employers to help them understand their employees' work and family conflicts and offer programs advocacy for quality child care in three low- to relieve work/family stresses. income communities; provide advocacy and technical assistance on school-age child care CCR&Rs work with communities to help them plan for issues; and offer special assistance and children's needs for care while parents work. The focus is on the collection of data on child care demand and supply, and support to refugee families and family child advocacy to help communities develop affordable, accessible, care providers. Staff of Child Care Solutions quality child care. have assisted in the organization and development of three new CCR&Rs in other parts of Georgia and are helping to develop Other CCR&Rs around the country were two more services during 1991. We have (and still are) generous with advice about joined with these five groups to organize what worked and what didn't. Solutions staff a Child Care Resource and Referral network took the advice seriously and developed a for Georgia. service that reflected the best thinking of How does a project manage growth like those experts. As a result, while we have that? Our seven years of experience have done a great deal to fine-tune those early taught us some principles that seem worth policies and procedures and to expand our sharing. scope, little has had to be undone and done I. If you expect rapid growth in a over at the referral service itself. project, start with careful planning This is a difficult principle to put into place and get a good foundation before you retroactively. When an agency finds itself under great stress from high demand for begin to grow. service and only then recognizes that it lacks Save the Children/Child Care Support basic structures to deal with such demand, center staff spent several months in research itis ha:d to stop and redesign structures. and consultation with experts around the Especially if its manager is service oriented country before opening the eferral service. and impatient with planning processes, an We collected an extensive library of CCR&R organization can become less and less effec- materials from other agencies. We stated tive. Sometimes an outside consultant can basic goals for the project, thought through assist if work on basic structures must be procedures, and put policies in writing before undertaken in an ongoing operation. How- collecting the database and beginning ever, the people who are carrying out the referrals. We developed plans for collecting day-to-day business of an agency are the and analyzing data. people who know what needs to be done.

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Managing Growth at Child Care Solutions89 They need to be the decision makers in this did not go down, but staff stress was greatly kind of process; the consultant is the reduced. facilitator. 3. Growth in staff size is itself a Agreed-upon goals, well-thought-out pro- cedures, and clearly stated, fully understood crisis. It needs to be planned for and policies become more and more critical as managed well. demands for service increase. For example, One of Solutions' first service problems we formulated a complaint policy, with concerned how to maintain an equal op- procedures to follow in dealing with both portunity referral service when requests parents and providers, before we opened our from parents and providers conflicted with first referral line. our policy. To deal with this issue,all members of the staff sat down together and 2. Manage demand to the extent hammered out a policy statement and pro- that you can. cedures. The whole staff knew the policy Child Care Solutions began small, with a and followed the procedures. Helping new plan to expand. During the first year of staff (who were not at that meeting and operation, Solutions referred to family day do not even work directly with anyone who care providers only, adding other forms of was there) to understand and implement the care in subsequent years. Promotion of the same policy is a task that requires more time service to useialso began small; we notified and skill than developing the procedure in other social service agencies of the service the first place. and placed classified ads in neighborhood As staff grows, good trainers of new staff newspapers. Later we sought greater expo- and good supporting materials for the sure through-fivertisingin the Yellow training are critical to maintaining a project's Pages, television and newspaper public original quality and level of commitment. service announcements, and press releases. Project managers are often reluctant to let These efforts never were a primary activity, go of the task of orienting and training new since demand for referrals rapidly challenged employees, even though other demands on our ability to respond, and has remained managers' time mean that orientation and high. training are slighted. Eighteen months after the project began, A gradual process of turning over respon- staff found themselves overwhelmed by sibilityfor training to another staff parent demand. Parents experienced long member--eventually to more than one other delays in getting referrals, and counselors personoften works. The manager may were spending valuable telephone time begin the orientation of new employees explaining to parents why they couldn't herself and then turn over parts of the work any faster. This was an experience we training, to experienced staff members. At were going to repeat in some form on other the same time, she may designate a staff occasions. member to pull together training materials A timely visit from Ethel McConagy and and procedures. Eventually, one of those Fran Rogers of Work!Family Directions staff members will have demonstrated the helped us to manage the crisis. They sug- interest and ability to take full responsibility gested that we turn our telephones off for training new employees. If she or he earlier in the day; we would thus limit call - is given plenty of time to work on the project, to the number we could serve. We did this, careful attention, and increasing responsi- using the momentsif relief to take a look bility, she or he will develop in the job. at our referral procedures and redesign them Eventually even the most reluctant of to be faster and more effective. We disco- managers will feel comfortable delegating vered that the numbers of parents we served responsibility for training of new staff.

90Managing Growth at Child Care Solutions Project managers can follow the same record keeping systems, work schedules, and pattern in releasing and delegating other other program structures. management functions which they at first Computers: When demands increase more feel uniquely qualified to undertake. rapidly than resources, most of us hope that computers will help us cope. But our 4. Think carefully about how you CCR&R counselors had serious concerns introduce change in a growing about the possibility that computers might program. reduce the personal quality of their work. The old card files and office set-ups that In order to make best use of what computers worked for a few part-time staffers become offer and keep the most personal quality of dysfunctional as a program grows. Manag- child care consultation and referral, adap- ers begin to fantasize about computers and tation is required of both counselors and expanded space. New systems, however, computer systems. Solutions used compu- may not solve existing problems as quickly ters gradually, beginning with storing data as staff members would hope, and they in one small personal computer and moving frequently create new problems along the to a networked system with counselors way. doing intake and referral searches on line. Rearranging !Tare: Urgent demands on sp.-ice To make the transition work, we needed are common to grovng, underfunded the help of computer experts who were programs. Most of us who thrive on devel- willingto take the counselors seriously, oping new programs assume that the ability counselors who were willing to change, and to function in crowded work spaces is a sign lots of time. Glitches and failures were a of competence and strength of character. part of our transition. Counselors had to There comes a point, however, when con- "check" computer systems by their old gested work space impairs program function. manual systemssome more times than Rearranging or expansion must begin. Child othersbefore they really trusted the Care Solutions survived several rearrange- computer. We spent more time than we had ments of space, with varying approaches and expected, and confronted and solved more results. problems than we had imagined, before new Once, a few staff members remained be- computer systems became as effective as we hind in the evening and rearranged the office had hoped. We retain a manual referral space without consulting other staffers. system to use for back-up when the They achieved in efficient use of space, a computer system is down. quickly completed project, and a less than 5. Flexible staffing patterns, and positive response from their unconsulted flexible staff, help agencies cope with colleagues. On the other hand, we realized the rearrangement of space begun with a growth. brainstorming session and working toward From the beginning, Child Care Solutions consensus would require more time and has relied on counselors who work on the patience with group process than most of referral phones part-time. Some counselors us were willing to invest. Staff reacted well are part-time workers; others are full-time to a process that involved key staff members employees who have other tasks in the developing alternative plans, inviting reac- agency and spend some time each week on tion and advice from users of the space, the referral phones. The arrangement adapting the plan in light of the advice, and reduces burnout, since telephone referral is describing the rearrangement beforeit a demanding and repetitive task. It had en- occurred. abled us to employ some excellent staff who Similar consultations with staff improve wished to work part-time, including mothers the quality and acceptability of changes in of young children, graduate students, and

r ) Managing Growth at Child Care Solutions 91 retired professionals. Part-time telephone 6. An established agency can help counseling also has allowed employees to significantly to develop and stabilize carry out a variety of tasks and prove them- a rapidly growing new program. selves adept at new skills before new Much of Child Care Solutions' success and positions opened in the growing project, rapid growth can be credited to the fact that giving us a good opportunity to train and we are a part of a larger agency, Save the promote from within. Maintaining and Children/Child Care Support Center, which supervising a part-time staff increases has used its resources to develop and stabilize demands on the supervisor, however; he or our program. Being part of a larger agency, she becomes the primary communicator whose purpose is to improve the lives of with an in-and-out staff. poor children by improving child care, has The combination of program growth, the helped to develop and articulate the goals use of part-time staff, and promoting from of Child Care Solutions. Child care resource within results in a staff which is often in and referral agencies' constituencies and transition. Flexibility is necessary in staff funders are so diverse that direction and members who work in a rapidly growing focus can be difficult to maintain. While we program. For people who need alot of at Child Care Solutions continue to be control over their jobs, rapid growth may challenged by growing demand and are eager be more frustrating than invigorating. New to expand our role, our place within Save programs and programs that expect rapid the Children clarifies our purposeto help expansion need to look for workers who are make quality child care available for Atlanta's flexible,creative,andfacechange working families, and especially for the confidently. poorest of those families. Fulfilling that task and finding the resources to do so will continue to be a demanding venture.

"2Managing Growth at Child Cart. Solutions ResearchoninfantItoddler childcare More Pride, Less Delinquency:

Findings from the Ten-Year Follow-Up Study

of the Syracuse University Family Development Research Program

by J. Ronald Lally, Peter L. Mangione, Alice S. Honig and Donna S. Wittmer

The findings were dramatic, and captured (Berrueta-Clement, Schweinhart, Barnett, the attention of The Washington Post, The London Epstein and Weikart, 1984). Significant Times, and The Los Angeles Times: Ten years findings in other areas emerged from our after their participation in the Syracuse Uni- follow-up study as well: versity Family Development Research Girls in the program group, but not Program, children had a 6% rate of juvenile boys, were performing significantly better delinquency compared to a 22% rate for in school than their counterparts in the children in a control group. Not only was control group. Interestingly, these positive the control-group delinquency rate almost findings only began to appear during early four times greater, but the offenses were adolescence; information on the elementary much more severe. Of the four program- school years indicated no differences group children with probation records, three between the program and control group. By were charged with simple unruliness and the the 7th and 8th grades, three-fourths of the fourth with one-time juvenile delinquency. program-group girls had C averages or In contrast, of the 12 control-group children better; none was failing and none had more with criminal records, five were chronic than 20 school absences during the previous offenders; control children committed acts year. In contrast, more than half the control of burglary, robbery, physical assault, and group girls had averages below C; 16% were sexual assault. In addition, the cost to the failing; and 31% had more than 20 absences. court and probation department for handling Teachers rated girls from the program group the cases was estimated at $12,000 for the as having more positive attitudes toward program group and $107,000 for the control themselves and other people. group. Compared to control-group parents, Our findingsassociating high quality parents who had been in the program early education and family support with reported feeling proud about the positive reduced delinquent behavior in adoles- social attitudes and behaviors of their cencecorrespond to those of the longitud- children and the degree of unity in their inal study of the Perry Preschool Project family. They were also more likely to advise

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More Pride, Less Delinquency95 young pe to learn something about The Family Development Research themselves and accomplish all they could, Program: Target audience and con- while control parents were more inclined to ceptual framework counsel young people to concentrate just on Like other intervention programs begun in "getting by." the 1960s and '70s, the Family Development Compared to control-group children, Research Program (FDRP) attempted to those inthe program group felt more break the well-documented link between positively about themselves in early adoles- low-education, low-income households and cence and were more likely to expect children's later educational difficulties. education to be a continuing part of their Unlike other programs which focused on lives. Fifty-three percent of the program preschoolers or on infants, or on parents, the group but only 28% of the controls antic- FDRP provided a full complement of edu- ipated that they would be in school at age cation, nutritional, health and safety, and 17 or 18. human services resources to families begin- Our intervention Statistically significant findings such as ning prenatally until children reached these are precious to practitioners, program elementary school age (Honig, 1977; Honig was designed to developers, rearchers, policymakers, and and Lally, 1982; Lally and Honig, 1977a). In influence the per- advocates concerned with the well-being and 1969, 1970, and 1971 FDRP recruited 108 manent envi- development of children and families. They families with incomes of less than $5000 per bolster our clinical knowledge of the positive year (in 1970 dollars) into the program in ronment of the effects of high quality early childhood ex- the last trimester of pregnancy. Mothers had child, the family perience. Findings concerning the differen- less than a high school education, and a his- tory of either no paid work .r semi skilled and the home. ces between program and control children that seem to emerge only over the long term, work. Their mean age was 18 years; more in important domains such as school per- than 85% were single parent heads of house- formance and delinquency, are particularly holds. Despite energetic attempts to main- important to bring to the attention of tainracial balance in the program, the decisionmakers. In addition to being able to majority of families served were black. "chalk one up" on the side of the scorecard Our intervention was designed to influ- that says, "early intervention works," it is ence the permanent environment of the also important to describe in some detail child, the family and the home. We saw what kind of early intervention seems to be parents as the primary teachers and sustain- effective, and for whom. Planners and ing caregivers in a young child's life, and implementers of demonstration programs hoped to support parent strategies which must make clear whom they served, what would enhance the development of the child they hoped to accomplish, how they pro- long after intervention ceased. Conse- ceeded, and the conceptual underpinnings of quently, we viewed parent contact as the their interventions if others are to be able primary intervention and child care as to understand and replicate their work. This supplementary; this strategy differed from article first gives a feeling for the philosophy that of child-oriented programs of the time, and way of working of the Family Devel- which saw enriched child care as the core opment Research Program, and second de- of the program and parent contact as lineates the follow-up effort, procedural "outreach." In actual operation of the pro- issues in this kind of research, and the gram, however, both parent contact and meaning of its major findings. child care became crucially important and integrated aspects of the comprehensive, long-term intervention. We assumed that a guarantee of high quality child care for 50 weeks a year for the first five years of their

/ 96More Pride, Less Delinquency children's lives would greatly assist families ment of creativity, and designof an in meeting the life challenges theyfaced, as environment that supports exploration in a well as positively influence the perceptions, spatial rather than exclusively time-bounded emotions, and intellect of the children organization of programmatic offerings. served. Child care staff at the Syracuse University Five theoretical rationales shaped the goals Children's Center functioned under a more and objectives of the intervention program. specific set of agreed-upon assumptions. Piagetian equilibration theory, which They believed that the program children stresses judicious provision of toys, mate- were capable of: rials, and human interactions in sensitive 1) learning something about anything in relationship to the developing abilities and which they showed interest; understandings of the child, helped to shape 2) learning to understand that their ac- the infant curriculum both in the home and tions and choices had an impact onothers; center. Piaget's attention to thecrucial im- portance of active child participation inthe 3) learning that cooperation and concern construction of knowledge was also em- for the rights of others would ultimately phasized. allow them to express their own creativity, excitement, curiosity, and individuality more Language developmental theories sug- gested that adult modeling and expansion fully; of child language, contingent responsiveness 4) learning that wonder and exploration to early infant coos and babbles, interactive were encouraged byadults; and turn-taking talk, and frequent book reading 5) imitating the actions of staff toward would increase child language repertoire children and other adults. (Bernstein, 1964). Additionally, these children were treated Erikson's theory of each child develop- as special creations, eachwith particular skills mental stage as, optimally, the positive and specialties that would be appreciated by outcome of a series of nuclearconflicts or and useful to the larger society. Thesespecial struggles between opposing emotional powers were to beprotected and allowed adjustments and attunements, focused to rise to ascendance by theadults who spent program concern on thedevelopment of the daytime hours with them. In summary, basic trust, sturdy autonomy, and learning the context that was fostered set a daily tone initiatives in the children served(Erikson, of freedom of choice and awareness of re- 1950). sponsibility; an expectation of success in each Saul Alinsky's (1971) theory of com- child; confidence in the fairness and consis- munity organization shaped the way in tency of the environment; anemphasis on which FDRP personnel perceived their role creativity, excitement, and explcration in in the community served and the tonewith learning; expectation of internal rather than which parent contacts were maintained. external motivation; and a safe, cheerful Minsky had theorized that "To give people place to spend each day. help while denying them a significant part in the action contributes nothing tothe Program components development of the individual. In the deepest Parent involvement: The major thrust of FDRP sense it is not giving buttakingtaking their was to maximize familyfunctioning by sup- identity" (p. 123). porting a rich quality of family interaction From John Dewey and the British and increasing family cohesiveness. A cadre Infant School movement, the FDRP project of paraprofessional home visitors called drew the concepts of the importanceof Child Development Trainers (CDTs) was freedom of Choi' e for children, encourage- recruited and trained intensively to encour-

More Pride, Less Delinquency97 age strong, nurturing mother-child relation- had a well-trained staff anda strong local ships that involved giving affectionate bodily and national reputation. Lally added the contact, respecting children's needs, andre- FDRP home visitation component andan sponding positively to young children's open-education model for children from 18 efforts to learn. to 60 months of age. Alice Honig remained During weekly home visits, CDTs taught program director of the Center, where she families Piagetian sensorimotorgames supervised staff training and assessment of during daily routines. They also helped the multiple components of the FDRP. mothers to learn ways to modifygames and The Children's Center, lodged ina huge activities in order to match the unique church basement, included three main interests and characteristics of the individual groupings that were designed toaccommo- child. CDTs offered positivesupport and date developmental stages of the children encouragement to mothers as they inter- served. acted with their children and also responded Infants 6 to 15 months of agewere cared All caregiverswere positively and actively to the parent's need for in an "Infant-Fold" five daysa week for encouraged to use to fulfill her aspirations for herself. Many a half day each day. Each caregiver was mothers came to rely on the CDTas an assigned to four infants. Caregivers worked creativity in advisor and confidante on personal relations, in pairs, with group size limited to eight embedding learn- finances, career changes, and education. The infants. The caregiver assigned toan infant ing activities in CDT served as a liaison between the family was expected to form the principal relation- and community support services, including ship with the child. Activitieswere tailored daily care routines the child care component of FDRP; in to the individual level of skill of each child. and informal addition, she helped families to learn to find All caregivers were encouraged touse and use neighborhood resourceson their encounters. creativity in finding ways to embed Piagetian own, for example, giving families specific sensorimotor games, fine and gross motor practice in learning how to make and activities, sensory stimulation and activities, maintain contact with school personnelas and language and book experiences in daily children reached school age. activities, daily care routines and informal The Parent Organization: As FDRPprogres- encounters, as well as in more formal sed, parents developed both formal and learning experiences. informal associations. Onegroup of families, Babies from 15 to 18 monthswere in a specifically concerned about the education special transition group with full-daycare of their children after FDRP, asked for five days a week. Self-feedingwas encour- training in classroom observation and for aged, and larger play spaces with sliding information about parents' rights in relation cabinets encouraged toddler autonomy and to the schools. They observed Syracuse freer choice of materials. Comforting and kindergarten and first grade classrooms and emotional support from the caregivers made their findings available toprogram remained freely available to these older parents so that they could be advocates for babies. their children. Informally, parents joined Children from 18 to 60 monthswere together for cooperative food purchasing; together daily in a family style environment two single mothers in the program moved designed by Margaret Lay (Lay and Dopyera, in together to share resources. 1977) and similar to the British Infant School The Children's Center: A pioneer childcare in philosophy and structure. Children had and educational facility for infants, toddlers, freedom of choice and access to four major and preschoolers, the Children's Centerwas areas: large muscle, small muscle, sense per- founded in 1964 by Bettye Caldwell. When ceptions, and creative expression/snack. J. Ronald Lally became project director of Additionally, the children had a large variety FDRP in 1969, the Children's Center already of wheeled toys and equipment in the big

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1.25 1.4 I.6

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MANUFACTURED TO AIIM STANDARDS 0\> BY APPLIED IMAGE.INC. gymnasium that was used in inclement ments). Parents were interviewed in depth weather when the children could not go after three and five years in the program outdoors to their enclosed play area. Chil- to assess the effectiveness of the CDT's dren ate lunch in groups with a teacher at efforts. Weekly and Monthly Home Visit each table; parents were free to join the lunch Reports permitted data gathering on the groups and visit whenever they chose. course of parental responsiveness to the The family style program had several CDT's work. rules. No physical aggression was permitted. When program children were 36 months Materials had to stay in their appropriate of age, a longitudinal control group was es- areas and to be cared for, not destroyed. tablished for the duration of the FDRP. The Thirty-second "time outs" were used for control children were carefully matched in flagrant transgressions. The opportunity to pairs with program children with respect to interact with children of different ages was sex, ethnicity, birth ordinality, age, family used by teachers to promote prosocial be- income, family marital status, maternal age, havior and sensitive awareness among and maternal education status (no high- Enhancing staff children of the differences between younger school diploma) at time of the infant's birth. skills was as inte- and older capabilities. Stanford-Binet IQ scores, and many other Staff training: Enhancing staff skills was as tests and observational measures of program gral a part of FDRP integral a part of FDRP as helping the chil- and matched control children, were com-as helping the dren to flourish. All staff, including care- pared at 36, 48, and 60 months. Scores for children to givers, home visitors, researchers, testers, the program and controls were also collected secretarial staff, the cook, bus drivers, and at 72 months. flourish. driver aides, participated in intensive two- week training sessions every fall. These Short-term impact on child sessions were important for personal revival functioning and renewal of motivation as well as for Cognitive functioning: At 36 months of age, refining child observation skills and deep- program children scored significantly higher ening understanding of Piaget and Erikson. on the Binet test than their control counter- During the year, staff held weekly case con- parts (Lally and Honig, 1977b). As the chil- ferences to discuss in depth the progress, dren grew older, however, these differences problems and strengths of a particular child. disappeared. When they were 60 months of Every staff member who could contribute age (at the end of the program), program to a child's experiences at the Center was and control children looked similar to each invited to participate in these conferences, other across a variety of measures of cog- and frequently several staff members nitive development and intellectual ability. collaborated in devising ways to help a par- Social-emotional functioning: At 36 months of ticular child. age, program children exhibited social- emotional functioning superior to that of Assessing the Family Development control children as measured by the Social Research Program Emotional Observer Rating of Children The carefully spelled out goals of the FDRP (Emmerich, 1971). This superior functioning program and the even more specifically de- continued in kindergarten. In the first grade, fined roles and activities required of staff program children continued to behave pos- members made the tasks of assessment clear, itively toward other children, but their be- if complex. A variety of psychometric tests havior toward teachers had _hanged. and ecological observation measures in class- Program children displayed both signifi- rooms were administered to assess how the cantly more positive and negative behavior children were faring (see Lally and Honig, toward adults than control children did. 1977a and 19776 for full details of all assess- Program children sought out teachers

(1'1 I 1 More Pride, Less Delinquency99 through many more negative bids than controls remained in the sample through 60 when in preschool or kindergarten and were months of age as well. Nine years later, when observed to smile and laugh less frequently. the longitudinal study commenced, we were In a complete report of this investigation, able t,obtain informed consent from 65 it was hypothesized by the researchers that program families, representing 79% of the the expectations of the children for person- families who finished the program, and 54 alized attention from the teacher were control families, or 73% of the control violated, and their behavior changed accord- families who were still in the sample at 60 ingly (Honig, Lally & Mathieson, 1982). A months of age. number of parents reported that their chil- We found about 80% of the program and dren were frustrated with their school ex- control families by publishing announce- periences, with one parent reporting that her ments in local newspapers, by distributing child complained that he wasn't learning information about the study in local schools, anything. and through word of mouth among study families and friends. Finding the last 20% Methodology of the ten-year follow- of the follow-up sample was much more up study difficult. We hired a recruiter who had vast experience doing community work in low- We sought to In our comprehensive follow-up study, we sought to gather information on the func- income neighborhoods. He located families gather information tioning of the study children in school, in through informal conversation on the street and, ultimately, through developing a net- on the functioning their family, and in the community. We also work of contacts in the neighborhoods wanted to investigate how the family func- of the study child- where study families lived. It is noteworthy tioned as a unit and how it related to the ren in school, in that this group of "hard-to-find" families, community. Data were gathered from school who were eventually found and who records, court records and probation depart- their family, and in consented to participate, consisted of by and the community. ment records. We asked teachers to complete large the least organized and least stable a questionnaire that involved rating the families in the entire sample. academic and social functioning of each study Contact with the families was made by child in their class. Interviews of 2 to 21/2 the research team first to obtain signed hours in length were conducted with the permission forms and then later to schedule study children and one of their parents or and conduct parent and child interviews. guardians, almost all with the study child's Maintaining contact with the families turned mother. Parents completed a demographic out to be difficult in a substantial number data form, filled out questionnaires, and res- of cases. A subgroup of families within the ponded to open-ended questions on their sample moved frequently, often without perceptions of their child's school and social leaving a forwarding address. Some lost tele- functioning, the quality of their family life, phone service, some would fail to be home their aspirations, and the like. The study at an appointed time for an interview, or, children completed a questionnaire and res- in a few cases, because of severe problems ponded to various interview questions about in the family such as domestic violence, some their functioning in school, their social avoided having continued contact with the attitudes and behavior, their family life, and research team. As it turned out, parent inter- their aspirations. The interviewers were ad- views were conducted with 51 of the 65 vanced students in one of the helping follow-up program families and 42 of the professions who were kept blind to family 54 follow-up control families. For the child status in the study (program or control). interview it was possible to perform 49 out Of the 108 children who started the pro- of 65 possible program sample interviews gram, 82 completed the full five-year and 39 out of 54 possible control sample intervention. Seventy-four of the matched interviews.

100More Pride, Less Delinquency What the above data indicate is that it far, the strongest program effects have been was impossible to maintain contact and in the domain of social deviance and conduct interviews with about 25% of both functioning in the community. The findings the follow-up program and control families reported in this study correspond to other from whom we were able to obtain parental research that has shown high quality early consent. This is only part of the story, childhood programs lower the incidence and however. Among those families we were severity of juvenile delinquency in children ultimately able to interview, it was much from low-income communities (Berrueta- easier to maintain contact with and arrange Clement et al., 1984). The Syracuse children interviews with the program families than are still young. To the extent that early with the control families. The last 10 delinquent behavior predicts later criminal- interviews (about 25%) conducted with ity, we would expect the gap between the control families required an enormous program and control group to increase. It amount of patience and persistence. Inter- is conceivable that the costs of criminal viewers would arrive at a home at an involvement in the control group, as com- appointed time only to find no one there. pared to that in the 7rogram, will continue Because about half of these families had no to mount. telephone, someone from the research team In addition to the findings on juvenileThe strongest pro- would have to keep appearing until the delinquency, family interview data indicated gram effects have family was at home. Unlike the families with that program families tended to value pro- whom it was easy to maintain contact and social attitudes and behavior, education, andbeen in the domain conduct interviews, the "hard to study" family unity. Likewise, program childrenof social deviance families were very impoverished and disor- tended to express more positive feelings and functioning in ganized. The larger proportion of the "hard about themselves, take a more active ap- to study" families in the control follow-up proach to personal problems, and seethe community. sample, 25% of the control group inter- schooling as a vital part of their life. Thus, viewed versus 10% of the program group the program appeared not only to prevent interviewed, was one indication that a severely deviant behavior, but also to be substantial sub-group of families within the associated with more positive attitudes and control group was functioning poorly. values in the children and parents. The In analysis of the possible effects of message that came across in the interview attrition on the make-up of the follow-up from the program families was a proactive program and control samples, we undertook approach to life or a belief that one can act two statistical comparisons. When we to better one's circumstances, that one can compared the follow-up program sample take steps to reach one's full potential. This with the original program sample at the close stood in contrast to the control families, who of the intervention across five key variables tended to emphasize that one should simply (e.g., Stanford-Binet scores, mother's edu- seek to survive or get by. cation) we found no significant differences. In the domain of school functioning, the Likewise, the follow-up control sample did program girls but not boys benefitted from not differ significantly from the original the Syracuse intervention. Multiple sources control sample across the five variables. of data support this conclusion, including school grade average data, school attendance Discussion of follow-up findings data, and teacher ratings. As highlighted in the opening paragraphs It is important to recall that the transition of this report, the Syracuse Family Devel- to elementary school was difficult for both opment Research Program clear!), had a program boys and girls. No sex differences positive impact on the children and families were found in the analysis of sociallemo- who participated in the intervention. Thus tional functioning of program children in

More Pride, Less Delinquency101 first grade. In both the program and control tudinal follow-up samples and how such samples, girls were retained less often than attrition affects the interpretation of com- boys during the elementary school years. parisons between program and control However, only program girls showed follow-up samples. improvements in school functioning as they Finally, it is important to discuss, in general entered junior high school. terms, just what worked, what did not, and Why did we find improvements in school what we would recommend for future longi- only for the program girls? It may be that tudinal interventions with similar popula- for a number of reasons the school years tions. Although itis almost impossible to are more difficult for the black male child separate out the specific effects of parent (Stevens, 1982). Perhaps the impact of the participation from the child's participation in It seems clear that intervention was not strong enough for the the Children's Center, it seems clear that program to counteract an elementary school our original notion our original notion to involve families intim- experience that routinely involved restric- ately as intervention agents paid off. The to involve families tions, conflict and failure. This suggests that, advice that program parents gave their intimately as inter- to be optimally effective, intervention pro- children about how to function in life and grams need to continue in some form the things program parents report they take vention agents paid throughout childhood, at the very least to pride in with regard to their parenting as off. support the positive effects of early inter- compared with control parents seem key to vention in a child's life. the prosocial, motivational, and educational One finding uncovered while doing this differences between program and control follow-up study must be addressed. We children. One hypothesis that could be encountered what we believe to be a per- generated for the long-range differences plexing issue in doing longitudinal research between the samples is the lasting impact with low-income, "multi-risk" families. Both on the parents and the parent-child relation- the "hard to find" and "hard to study" families ship after intervention ceased. were families whose long-range outcomes One discouraging finding was that the tended to be negative. This may have led intervention had practically no impact on to a positive bias in the follow-up data for family income and career advancement of both the Syracuse program and control the parents. It became painfully clear as follow-up samples, though this positive bias follow-up data were being collected that was much more pronounced in the control many families, both program and control, sample. As it was, in investigating the inci- still lived in poverty and in neighborhoods dence and severity of juvenile delinquency, we found many more control children in that they considered dangerous and harmful serious trouble. Of the last 10 control to the development of their children. A num- families interviewed, each interview having ber of children interviewed discussed the required a tremendous effort to complete, discrepant goals of school and neighborhood 6 of the families had a study child involved and the difficulty they had integrating the in juvenile delinquency. Thus, in order to two. We had hypothesized at the start of obtain results that are as accurate as possible, the intervention that the environment in an investment must be made to find and which the child was raised would have a study those very families who are most continuing effect on the child well after difficult to find and study. Moreover, intervention ceased and that is why parent appropriate measures of difficulty in retriev- participation was so strongly emphasized. ing and investigating a follow-up sample What was not emphasized strongly enough need to be developed. With such measures, was the power of the neighborhood and the it will be possible to gauge more precisely need for special supports during the tran- the degree and type of attrition in longi- sition from program to school.

102More Pride, Less Delinquency U The Family De-s.?lopment Research Pro- personal-social behaviors in preschool settings. (Report gram was successful in many ways, as our prepared for Project Head St art, Office of Child Development.) Princeton, NJ: Educational Test- data suggest, with both the program boys ing Service. and girls served. We feel that three mod- Erikson, E. 1950. Childhood and society. New York: ifications of the program would make similar WW Norton. undertakings even more effective.First, Gray, SW. 1983. Enduring effects of early inter- developmental transitions, such as the tran- vention: Perspectives and perplexities. Peabody sition from preschool to school, should be Journal of Education, 60(3), 70-84. carefully planned for. Abrupt endings to Gray, SW, Ramsey, BK & Klaus, RA. 1982. From 3 to 20: The Early Training Project. Baltimore: Uni- intervention should be avoided. Second, vershy Park Press. service institutions and agencies that are Guttman, L. 1980. Recent structural laws of already a part of the community, including human behavior. The Bulletin of the Institute of Com- informal neighborhood organizations, munications Research, Keio University, 14, 1-12. should be intimately involved in the creation Hans, S. 1987. Syracuse University longitudinal follow- and continuation of an intervention. Third, up study: Current teachers' ratings of subjects' behaviors, attitudes and achievement. Paper presented at the programs should be designed so that they Society for Research in Child Development's can change and adapt services based on biennial meeting, Baltimore. continued readings of the changing family Honig, AS, Lally, JR, and Mathieson 1982. needs. Lally, JR & Honig, AS. 1977a. The Family The Family Development Research Program Lon- Development Research Program: A program for gitudinal Follow-up Study was made possible by prenatal infant and early childhood enrichment. grants from the W.T. Grant and Harris Founda- In MC Day & RD Parker (Eds.) The preschool in action: Exploring early childhood programs (pp. 147-94). tions, The intervention program was supported by the Boston: Allyn & Bacon. Office of Child Development, Department of Health, Lally, JR & Honig, AS. 1977b. The Family Develop- Education and Welfare, OCD-CB-100. ment Research Program: A program for prenatal, infant & early childhood enrichment. Final Report. Syracuse, NY: Syracuse University. Lay, MZ & Dopyera, JE. 1977). Becoming a teacher Bibliography of young children. Lexington, MA: D.C. Heath and Alinsky, SD. 1971. Rules for radicals. New York: Company. Random House. Lazar, I & Darlington, R. 1982. Lasting effects Bernstein, B. 1964. Social class, speech systems of early education: A report from the Consor- and psycho-therapy. In F Riesman, J Cohen & A tium for Longitudinal Studies. Monographs of the Pearl (Eds.), Mental health of the poor. New York: Society for Research in Child Development, 45, (203, Free Press of Glencoe. Serial No. 195). Berrueta-Clement, JR, Schweinhart, LI, Barnett, Seitz, V, Rosenbaum, LK, & Apfel, NH. 1985. WS, Epstein, AE & Weikart, DP. 1984. Changed Effects of family support intervention: A ten- lives: The effects of the Perry Preschool Program on youths year follow-up. Child Development, 56, 376-391. through age 19. Ypsilanti, MI: HighiScope Press. Stevens, JH. 1982. Research in review: From 3 to Emmerich, W. 1971. Disadvantaged children and their 20: The Early Training Project. Young Children, 37 (6), first school experiences. Structure and development of 57-64.

More Pride, Less Delinquency103 X16

Model Versus Modal Child Care for

Children from Low-Income Families

Donna S. Wittmer, Ph.D.

Karie (age 1 year, 11 months), a child dently knocks the paint cup on the floor. abused at home, sits on the potty chair in He crumples up his paper again. "Eric, the bathroom of the child-care center. The don't" the teacher yells angrily. "Let me get assistant sits on a chair blocking the door- you some orange paint" she says to him in way. "Yoa just sit there until you go," says a distressed voice. She leaves. Eric puts the the assistant to the little girl. Karie sits painted string (covered with blue paint) m looking very sad. his mouth. A different teacher says, "Eric, This scene, observed in a child-care center, please do not put paint in your mouth." was one of many distressing events recorded Eric takes the string out of his mouth. during approximately 1000 hours of obser- Then he puts it back in again. "Eric, nasty," vation of 100 two- and three-year-old says the teacher. He removes the string again. He tries to pull the string off the children in centers serving primarily children pencil with his hand. He doesn't succeed, from poverty families (Wittmer, 1985).I so he uses his mouth to get the string off. could contrast each disturbing interaction or He chews on the string. He has paint all event with a positive one, but the disturbing over his mouth. The teacher never gets events tell a tale that must not be ignored him more paint, and finally he's removed a tale of child care where one sees very well- from the paint table. intentioned but highly stressed, often un- Children from low-income families are at trained, and poorly paid caregivers; high-risk risk for language and other learning prob- children with pressing needs; hopelessly high lems, as well as social-emotional disturbances child-staff ratios; group size that is too large; (Golden & Birns, 1976; Greenspan, 1981; and too few support services offered to Lally & Honig, 1977). These high-risk chil- children and their parents. dren almost uniformly attend modal child Eric (age 2 years, 2 months) sits at the care as opposed to model child care. Modal paint table with paper, a paint cup, and a child care is a term that was used by Belsky pencil with a string attached to it. The (1979) when describing the New York City caregivers want the children to hold on to child care programs studied by Golden et the pencil, dip the string in the paint cup, al. (1978). Itis the mode, the customary, and paint on the paper. Eric crumples up the primary means of child care. Modal child his paper. The teacher says, "Oh, dear, care occurs in unlicensed or in state-licensed Eric" in a disgusted voice. The caregiver family day care homes and in licensed day says to another teacher in a voice loud enough for Eric to hear, "Eric needs to be care centers. Modal child care is what is avail- demoted to the walker's room (the room able to the majority of low-income families for the 12- to 18-month-old babies), as she in the United States. Low-income children's straightens up Eric's paint paper. Eric tries fees are subsidized in licensed family day care to put the string in the paint cup. Hetcp-2

104Model Versus Modal Child Care for Children from Low-Income Families homes and in licensed centers.1 Because each (7) Support services such as health state determines the licensing standards for services (including medical and dental that state, standards and quality vary greatly. services), social worker, and counselors for Model child care is seen typically in uni- various problems and sophisticated mental versity or university-connected centers. health referrals. These centers provide child-sensitive, In contrast, the modal child care provided cevelopmentally enriching care, which can for at-risk children sadly lacks these help to prevent or ameliorate the learning qualitieswhich are necessary if child care and relationship problems of children in is to have a positive impact on development. poverty. Based on the needs of these chil- Ridiculously high caregiver-child ratios in dren, model child care can consist of: licensed child care are often enough to make (1) Highly trained and well-qualified staff, high quality impossible. including staff with training in special edu- In Arizona, for example, state regulations cation, infant and toddler development, and allow a ratio of 8 infants to one caregiver. the special skills required for work with Most states allow a caregiver to work with abused and/or neglected children; at least 10 toddlers. Anyone who has tried (2) A program that is responsive to the to care for that number of infants knows how difficult, if not impossible, it is to wipe individual child's needs and includes both a noses and change diapers in a nurturant way high level of positive adult-child interaction and communication and the availability of while providing a developmentally enriching program for the children. a range of interesting play materials which are developmentally appropriate; Jerel (age two years,4months) stands (3) Small group sizes and low child- up on a chair. The caregiver tells him to get down. He loudly asserts himself by teacher ratios; saying, "No!!" The caregiver approaches (4) Many opportunities for pre-and in- him and he takes off running across the service training of staff; classroom. She catches him and yells at him. He hits at her. She sits on him and (5) A method for assessing a child's need yells, "You don't need to think you're bet- for special services; ter than anyone else. You're going to learn (6) Parent education, including home to listen." He starts crying. She lets him visits, parent meetings, and parent involve- up. ment in the classroom; Most caregivers in modal child care are not required to have had training in a child Licensed child care for children from low-income related field. Yet they are often working with families is funded by Title XX. The Title XX Social developmentally delayed children and highly Services Block Grant provides federal assistance to stressed families. More children are being states for support for child care services for poverty court-ordered into day care because of abuse families. In 1977 $2.7 billion was given states on a 75%/ 25% matched basis to provide social services to families and neglect in their homes. In one licensed living in or near poverty. Of these funds, $800,000 child care center in a large city in New York, or .03% was used for licensed center and family care. 50%of the children have been identified as In addition, $200,000 was provided un a nonmatched basis, primarily for the purpose of upgrading day care abused or neglected. Yet this center receives based on federal regulation standards. In 1982, under no special funds for training caregivers or the Reagan administration, there was a 25% reduction providing the badly needed social support in social service funds. States are no longer required to match federal funds and are no longer required to services. allocate a specific portion of the funds for welfare Jayne (18 months) goes from teacher to recipients. These policies result in less money available teacher crying, hands held up (wanting to for licensed child care just when there has been an increase in women working and an increase in poverty be picked up). The caregivers ignore her or (McMurray, G. & Kozanjian, D., 1082). tell her `No." She cries in despair and

Model Versus Modal Child Care forChildrkdranLow-Income Families 105 finally goes to a young high school boy When I first began observing in child care who is temporarily assisting in the class- centers, I was angry at caregivers for the room. He looks to the head teacher and inappropriate behaviorI saw occurring. asks permission to pick Jayne up and com- Then I realized that their behavior reflects fort her. The head teacher says, "No, if we the general failure of society to value child pick her up, she'll always want to be care as a "prime opportunity for primary pre- picked up." Jayne continues crying. Finally vention" (Caldwell, 1970). If licensed child she drops to the floor and begins pounding care were seen as an early opportunity for her head on the floor. A teacher picks her giving children a "Head Start," regulatory up and sits her on a chair at a table. Jayne cries, screams, and kicks so hard the chair standards could be written and funds falls backwards, and Jayne hits her head on allocated by federal, state, and local govern- the floor. An assistant picks her up, puts ments as well as by a multitude of other her on her tummy on the assistant's lap, agencies, to provide a humane and devel- and pats her back. Jayne sobs herself to opmentally enriching program for these sleep. young children who attend licensed child There are many competent and caring care.Still,asignificant problem would teachers and directors who work in child remain. The majority of children from low- care and those I have interviewed feel dis- income families whose parents are employed tressed. They express great frustration attend unlicensed home care. Norlander (1986) regarding the number of children in their argues that the system casts a blind eye on care, the neediness of the children, the lack unlicensed providers, thus presenting of opportunity to work with parents, the serious obstacles to those who are ceeking dearth of evaluation and referral resources to make quality family day care available. for the children, the fact that more abused No one really knows what is happening to and handicapped children are being placed poverty children in these child care settings. in their care, the lack of special services, and Edward Zigler (1982), in the foreword to of course, their own low pay and low status. his book Day Care-Scientific and Social Policy Issues, siates,"By far the thorniest issue in day care, Bobby (age 2 years, 3 months) walks to however, is the fundamental issue of quality the block area. He starts taking blocks off the shelf. He then drops them (seemingly versus cost. As Ruopp and Travers (1982) on purpose) on Glenn who is sitting on the have pointed out, 'After a decade of research, floor. Glenn cries. Bobby gets more blocks quality day care can to some degree be both and approaches Glenn from behind while defined and delivered ... The question is: attempting to hit him. Glenn moves away. Who will pay the piper and how much will Bobby then drops a block on Tina's back he be paid?" and runs away. Tina cries. Bobby climbs Yet the piper must be paid somehow, or up on a play ironing board and hits the many children will continue to be lost in wall with a block. He spies Glenn, hurries this world of low-quality child care that pro- down, and yells, "Hey, you" angrily to pel.F them down a path toward low achieve- Glenn. Glenn walks away. Eric hits a card- ment and unrewarding human relationships. board box with a block. Melvin, another Low-income families have no choice be- boy, approaches Bobby and Bobby hits at tween modal and model child care. Although him. many are part of the I bor force, struggling "Go to jail. You're bad. You just stay in jail until I tell you to get up," yelled the to provide for their children, their income assistant teacher as she led Wayne (age 2) is so low that they still must use subsidized, out of the gym and made him sit against modal ca re (and fear the consequences of the wall as punishment for some misdeed losing them eligibility). Society has an op- he had done in gym. He sits angrily glar- portunity and a responsibility to provide ing at the assistant. more than modal child care offers. The cost- 104

106Model Versus Modal Child Care for Children from Low-Income Families effectiveness of comprehensive early inter- Golden, M, Rosenbluth, L, Grossi, M, Policare, vention programs has been proven (Barnett, H, Freeman, H and Brownlee, E. 1978. The New York City Infant Day Care Study. Medical and 1985). The human costs of not providing Health Research Association of New York, New high quality care are evident all around us. York. Neither society nor the children can afford Greenspan, S. 1981. Psychopathology and adaptation such costs. All our children need and deserve in infancy and early childhood. New York: Interna- tional Universities Press, Inc. the best care we can provide. Lally, R & Honig, A. 1977. Final ReportThe Fam- ily Development Research Program. Sponsored by the Office of Child Development Health, Education, References & Welfare. Available from Dr. Alice Honig, 200 Slocum Hall, Syracuse University, Syracuse, Barnett, WS. 1985. The Perry Preschool Program and New York 13210. Ifs Long-Term Effects: A Benefit-Cost Analysis. The McMurray, G & Kozanjian, D. 1982. Day care High/Scope Educational Research Foundation, and the working poor. Community Service Society 600 North River Street, Ypsilanti, MI 48198- of New York. 2898. Norlander, K. 1986. Casting a blind eye. Regulation of Belsky, J & Steinberg, L. 1978. The effects of family day care in New York State. Child Care Inc., day care: A critical review. Child Development, 49, New York, N.Y. 929-949. Wittmer, D & Honig, A. 1985. At risk toddlers: Caldwell, B, & Smith, LE. 1970. Day care for Their influence on teacher behavior in day care. Paper the very young--prime opportunity for primary presented at the National Center for Clinical prevention. American Journal of Pu lbic Health, 60 (4), Infant Programs Fourth Biennial National 690-697. Training Institute, Washington, D.C. Golden, M & Birns, B. 1976. Social class and Zig ler, E & Gordon, E. 10412. Day &re Scientiln infant intelligence. In M Lewis (Ed.) Origins of and Social Policy 15510'5. Boston: Auburn House Intelligence: Infancy and Early Childhood, New York: Publishing Company. Plenum Press.

Model Versus Modal Child Care for Children from Low-Income Families107 Infant Day Care: A Cause for Concern?

by jay Belsky

Work on this paper was supported by a grant from and toddlers were cared for by a relative the National Institute of Child Health and Human (77% in own home, 18% in relative's) and Development (R011-I D15496) and by an NIMH 24% were cared for infamily day care Research Scientists Development Award (Kamerman, 1986). (K02MH00486). The diversity of arrangements that con- Every essay on day care invariably begins stitutes the reality of infant care in America with an opening comment regarding the today poses serious challenges to scientists social changes we have all witnessed during who seek to discern the "effects" of day care the past two decades. These changesand on young children (to say nothing of its their consequences vis-a-vis child careare effects on their families). After all, families not news to readers of Zero to Three. One that use day care and those that do not may point worth noting, though, involves the differ from each other in a myriad of ways, rapid growth of employment not simply for as families that use one type of care may women in general, or for those with young differ from families using another type. The very concept children inparticular, but specifically for Thus, the very concept of "effects of day of "effects of day those with infants under one year of age care" appears misplaced, as between-group (Klein, 1985). Not only is this the fastest comparisons are plagued with a host of con- care" appears growing sector of the employed-mother founds that cannot be teased apart by most misplaced. labor market, but the most recent statistics statistical or design controls. How are we reveal that virtually one of every two women to know whether so-called "day-care effects" with a child under one year of age is now are effects of day care or of being in families employed (Kamerman, 1986). that have others share in the rearing of their When it comes to considering the care infants? We must recognize that compar- which the infants of these mothers receive, isons between day-care-reared and home- itis imperative that we understand what reared infants represent comparisons of we are talking aboutand we are not, for early development in contrasting ecologies the most part, talking about day-care centers. rather than "effects" of day care in the pure, The overwhelming majority of infant care causal, or experimental sense of the word. is provided in private homesin 1982, a full Having cautioned the reader regarding the 27%; not even 10% of infants whose mothers nature of conclusions that can be drawn are working are to be found in centers (Klein, from research regarding any "effects" of day 1985). Moreover, tremendous diversity care, I feel compelled to make a final intro- characterizes infant care in private homes. ductory comment before proceeding to con- The most recent statistics describing the care sider the developmental correlates of non- of children under three years of age reveal maternal care initiated in the first year of that (as of June, 1985) 45% of these infants life. This has to do with the political and

108Infant Day Care: A Cause for Concern? 166 personal contexts in which research on day care of their mother and who did not start care is conducted, reported, and discussed. preschool (on a three-half day-a-week Day care is a very emotionally charged topic, schedule) until they were 21/2 and 3 years especially when we are talking about babies. of age. Because I am not sure that this family The moment a poor scientist stumbles on reality of mine does not influence my reading evidence suggesting a potentially negative of the scientific evidence, I share it here. effect of day care and reports it, a host of Concern with the development of ideologues are raising questions, criticizing methodology, mounting ad hominem infants in day care: A 15-year attacks, or simply disregarding the data perspective entirely in their pronouncements. As I went In the early 1970s, prevailing cultural atti- to testify before Congress in the fall of 1984, tudes led to the belief that exclusive maternal people warned me not to raise concerns rearing, particularly during the early years, about infant day care because of their was essential for healthy psychological devel- political implications. I decided, however, to opment. The principal organizing question behave as a scientist and present the evidence of day care research thus became, "Does as I regarded it. My own personal sense is rearing outside of the confines of the family that few individuals are truly open-minded in a group program adversely affect intel- about infant day care. Politicians, like many lectual, social and, especially, emotional others, are either for day care or against development?" This specific interest in the it; they sift through the research looking for developmental consequences of day care, and ammunition for their arguments while particularly a concern for negative effects, finding fault with, and thus dismissing, any derived from policymakers' and scientists' evidence that reads the other way. feeling of obligation to protect the public Scientists, of course, are susceptible to from harm. If day care proved detrimental similar biases, however much we try not to child development, they would not want to be. This fact was brought home to me io be in the.::)s.itiun of advocating policies Few individuals are recently in a most vivid way as part of a to promote, or even support, the group truly open-minded correspondence with a colleague whose rearing of young children beyond the con- work on and opinions about day care I admire fines of the family. If such early rearing about infant day and respect immensely. In sharing with me experience was found to disrupt the nor- care. her plans to carry out a meta-analysis of mative course of early childhood, the best research bearing on the influence of day care interests of the public would be served if on infant-mother attachment, this mother mothers or fathers did not work unless it of a young infant in sitter care wrote to was absolutely essential. me that "I think historical and cross-cultural When I reviewed the literature on the data can be used tosupport the positionthat effects of day care in 1977 (Belsky & shared caregiving, which is what day care Steinberg, 1978) and again in 1980 (Belsky, is, is not detrimental to child development" Steinberg, & Walker, 1982), 1 found little (emphasis added). if any evidence of detrimental effects of non- Since holding a point of view, either con- maternal child care on infant development. sciously or unconsciously, and for whatever This was especially the case for model, reasons, prior to the analysis of the evidence university-based, research-oriented pro- may involve a considerable risk of bias en- grams. Only one conclusion could be tering into the reading of such evidence, I reached: infant day careneed notdisrupt the feel it is important to make several facts clear child's emotional development. about my circumstances: I am the father of In terms of most day care research, emo- two darling and demanding young sons who tional development has been conceptualized spent their entire infancies in the primary in terms of the quality of the affective tie 1 G

Infant Day Care: A Cause 'or Concern?109 linking child to mother. This focus upon the showing a toy) and/or who approach mother attachment relationship was based upon a to seek comfort if distressed are character- great deal of theory suggesting that the ized as having secure attachments. Those emotional security which this bond pro- who fail to greet mother (by averting gaze) moted in the child would affect his/her or who start to approach mother but then future well-being, particularly his/her turn away are considered to be anxious- feelings about self, others, and capacity to avoidant in their attachment; and those who form relationships. In order to study the seek contact yet cannot be comforted by effect of day care on the security of the mother and who cry in an angry, petulant infant-mother attachment relationship, manner or hit away toys offered by mother researchers employed the Strange Situation, are considered anxious-resistant intheir a laboratory procedure in which the baby attachment relationship. Infants who are is subjected to a series of brief separations In numerous studies these patterns of and reunions with mother and stranger and secure and insecure attachment relationships characterized as his /her behavior is observed. have been found to be predictive of individual having secure at- Early studies of infant day care which differences in later development, such that tachments look, as employed this procedure or some variant of those infants who are characterized as it revealed not only that day care infants having secure attachments look, as a group, a group, more com- were as likely to get distressed home- more competent than their agemates whose petent than their reared children when confronting c. stranger attachments to mother are characterized as insecure (Bretherton, 1985; Lamb etal., agemates whose or being separated from mother, but also that they clearly preferred their mothers as 1985). All of this is not meant to imply that attachments to objects of attachment. Caregivers, then, the child's future development is solely or mother are charac- were not replacing mothers as the source unalterably determined by the nature of the of infants' primary emotional bonds, and this infant-mother attachment bond, but merely terized as insecure. was, and still is, regarded as a good thing to indicate why a focus upon reunion seems especially since the evidence also indicates so important to understanding the develop- that day-care infants can and do form mental correlates of infant day care. healthy affectional ties to individuals who respond to their needs in their uay care Another look at the evidence environment. In the time since my initial reviews of the It is of special significance that in all the day care literature, a number of additional initial work done on infant day care, and investigations have been reported which not on which the preceding conclusions were only have raised concerns in my mind about based, attention was paid to whether or not the developmental correlates of nonmaternal the infant became distressed upon separation care initiated in the first year of life, but and whether or not she/he approached and have also led me to re-examine earlier re- interacted with a strange adult. In the years search. It is not my intention to provide an which followed the first wave of studies of exhaustive summary of my current reading infant day care, it became abundantly clear of the evidence (see Belsky, 1986), but rather that the most revealing and developmentally to outline my thinking. meaningful aspect of the infant's behavior In my 1980 review, only a single inves- in the Strange Situation was his /her orient- tigation raised any real concern in my mind ation to mother upon reunion following regarding infant care. Vaughn and his col- separation, something which simply had not leagues (1980), studying a sample of low- been considered in the early studies. indeed, income caucasian women and their firstborn attachment researchers now distinguish be- in the Minneapolis-St. Paul area, found that tween three types. Infants who positively infants who were reared in what appeared greet their mothers (with a smile or by to be low quality, if not frequently changing,

110Infant Day Care: A Cause for Concern? child care arrangements were especially like- Consider first the fact that, at the same ly to show a particular pattern of attachment time that Vaughn and his colleagues (1980) to mother if they had been enrolled in care were following their Minneapolis sample at in the first year of life. Specifically, th,2y were two years of age and Farber and Egeland disproportionately likely to display a pattern (1982) were discerning no significant dif- of avoidance in which they refused to look ferences between day-care and home-reared at or approach mother when reunited with infants, another study provided further her after brief separations in the Strange evidence of a pattern of avoidance associated with early substitute child care. This study Situation paradigm. of middle-class infants in Michigan revealed In addition to the Minnesota study which that those babies who began day care (in firstraised some concerns in my mind, a variety of arrangements) in the first year several other findings in the literature in of life displayed greater avoidance of their I have consistently 1980 could also have been regarded as potential mothers in the Strange Situation separation evidence of negative effects. For example, cautioned against procedure (Schwartz, 1983) at 12 months Ricciuti (1974) found that at one year of age of age than did home-reared infants. This over-interpreting day-care-reared infants cried more in re- heightened avoidance was also chronicled by such group sponse to separation than did a home-reared Wille and Jacobson's (1984) investigation of differences. group. In another study of a very small 45 18 month-olds from the Detroit area; sample, Rubenstein, Howes, and Boyle when studied with their mothers in the (1981) observed that children who were in Strange Situation, those children displaying day care during the first year of life had insecure-avoidant attachment patterns were more temper tantrums than those cared for found to have experienced more than three at home by mothers on a full-time basis. times as much extra-familial child care as In my writings I have consistently, and I their securely attached (to mothers) coun- believe wisely, cautioned against over- terparts (15.9 hours/week versus 4.5 hours). interpreting such group differences, partic- And, in still another study, this one of af- ularly because they emerged in a context fluent families in the Chicago area, Barg low in whichvirtually all other measures (1985) found higher rates of avoidance as revealed no differences. We should look for well as decreased rates of proximity-seeking trends and patterns, I counseled, and not and contact maintenance for those infants be swept away by a single variable, especially experiencing good quality, stable "other- when other studies fail to discern a similar than-mother" care in the home than for a day care-home care difference that could be comparison group whose mothers did not interpreted as an effect of day care. work outside the home during the baby's When it came time for me to review the first year. literature again in 1982, I found that a few These newly emerging data,itis of more studies revealed what could conceiv- interest to note, turn out to be quite ably be viewed as evidence of negative effects consistent with trends in the more general of day care on the development of infants day care literature concerning preschoolers. (see Belsky, 1984). In fact, each time I have As Clarke-Stewart ...nd Fein (1983) observed their comprehensive review of the gone back to my files of day care reports, in evidence appearing in the most recent edition first to prepare my Congressional testimony in 1984 and then to prepare a talk to the of the authorative Handbook of Child Psychology, American Academy of Pediatrics in 1985, I children in day care are more likely than children at have found that disturbing evidence keeps home to position themselves further away from mother, and to ignore or avoid mother after a brief accumulating. I am not talking about a flood separation. The difference is not observed in every of evidence, but at the very least a slow, child or every study, but the consistent direction of the steady trickle. differences is observed. (p. 948)

1 Infant Day Care: A Cause for Concern? 111 BEST COPY AVALME There is, then, an emerging pattern here in "there is no way to determine at this point which we see supplementary child care, if the apparent avoidance of mother especially that initiated in the first year, whether observed in day care children in some studies in home or in centers, sometimes associated is a disturbed or adaptive pattern" (p. 949; with the tendency of the infant to avoid or emphasis in original). But this very uncer- maintain a distance from the mother fol- tainty leads me to wonder about the meaning lowing a series of brief separations. Some, of other data regarding the subsequent social as i have already indicated, contend that such development of those children who expe- behavior reflects an underlying doubt or rienced nonmaternal care in the first year. mistrust about the availability of the mother to meet the baby's needs and, thus, an The long term development of day- insecure attachment. Moreover, since it is care-reared infants known that heightened avoidance of the The very first investigation of the social mother is related to a set of developmental development of preschoolers with infant day outcomes, such as noncompliance and low care histories involved the developmental frustration tolerance, which most develop- follow-up at three and four years of age of mentalists would regard as less than de- children who began nonmaternal, group care sirable, some are inclined to conclude that toward the end of their first year at the the quality of the mother-child bond and Syracuse University Infant Care Center thereby, the child's future development may (Schwarz et al., 1974). When compared to be jeopardized by nonmaternal care in the a group of children reared exclusively at first year of life. home until entering a preschool day care Other scientists read the very same evidence program, those with infant care histories in a very different way. Even though they ob- were found, four months after entering the serve the same pattern of avoidance among preschool, to be more physically and verbally infants in day care, they interpret this not aggressive with adults and peers, less as a deficit or disturbance but rather as cooperative with grown-ups and less toler- positively adaptive and possibly even ant of frustration. When the children from precocious behavior. Since day care infants the Minnesota studies, which first linked "There is no wa, to experience many separations, they reason, infant care with insecure-avoidant attach- determine at this it is sensible for them not to orient toward ment, were studied at two years of age, mother. In addition, because the tendency somewhat similar results emerged. Al- point if the appar- for children as they get older is to remain though Farber and Egeland (1982, p. 120) ent avoidance of more distant from their parents, the were led to conclude on the basis of their avoidance of mother among day-care-reared analysis of the problem-solving behavior of mother observed in 12-18-month-olds is seen as evidence of early the Minnesota toddlers that "at two years day care children in maturity: of age the effects of out-of-home care were no longer striking" and "that the cumulative some studies is a In children receiving care exclusively from mother, adverse effects of out-of-home care were disturbed or adap- avoidance may he a pathological response reflecting an interactive history with a rejecting mother, while for minimal," careful scrutiny of the data leads tive pattern." children in day care greater distance from, or ignoring a more cautious reader to a different of mother at reunion may be an adaptive response conclusion. reflecting a habitual reaction to repeated daily separa- Not only was it the case that toddlers tions and reunions. In these latter children, greater whose mothers began working prior to their physical distance from mother and apparent avoidance infant's first birthday displayed significantly may,infact,signal aprecociousindependence. less enthusiasm in confronting a challenge (Clark-Stewart & Fein, 1986, p. 949.) task than did children who had no day care Which interpretation is correct? I concur experience, but it was also the case that these with Clarke-Stewart and Fein (1983) that day-care-reared infants tended to be less

112Infant Day Care: A Cause for Concern? compliant in following their mothers' in- island found that "children who began group structions, less persistent in dealing with a care in infancy were rated as more malad- difficult problem, and more negative in their justed (when studied between three and five affect. A more thorough analysis of these years of age) than those who were cared same data by Vaughn, Deane, and Waters for by sitters or in family day care homes (1985) further revealed that although 18- for the early years and who began group month attachment security was a significant care at later ages" (McCartney et al., 1982, advantage to the children who were home- p. 148). These conclusions, it is important reared as infants when studied at 24 months, to note, were based upon analyses which the securely attached infants who had controlled for a variety of important back- entered day care in their first year looked ground variables, including child's age at time more like toddlers with insecure attachment of assessment and mother's IQ, age, and histories (from home-and day-care groups) ethnicity. In a retrospective investigation of than like home-reared children with secure 8- to 10-year-olck who varied in their pre- infant-mother relationships. That is, early school experiences, Barton and Schwarz entry to day care in the first year appeared (1981) also found that day care entry prior to mitigate the developmentally beneficial to 12 months was associated with higher effects of a secure attachment that is so often levels of misbehavior and greater social with- noted in studies of home-reared middle- and drawal, even after controlling for the lower-class children. educational level of both parents. What is most notable about these findings Finally, and perhaps most noteworthy, are from the Syracuse and Minneapolis studies, results emanating from a longitudinal inves- and even from other investigations (see be- tigation of kindergarten and first-graders low), is that the very child development out- reared since they were three months old in comes associated with early entry into an extremely high-quality day care center supplementary child care are the same as, at the University of North Carolina. or at least similar to, those that have been Comparison of these children with others implicated in the attachment literature as the reared for varying amounts of time in non- (undesirable) child development outcomes maternal child care arrangements initiated correlated with early insecure attachment to sometime after the first year of life revealed Studies in the liter- mother. Indeed, the tendency of the early that children who received center-based care ature which do not in the first year of life, in contrast to those day care infants in the Minneapolis and focus specifically Syracuse studies to be less compliant at two receiving care any time thereafter, were years of age leads me to wonder whether rated: on attachment also I was too ready in early reviews to explain as more likely to use the aggressive acts hit, kick, raise concerns away Rubenstein, Howes, and Boyle's (1981) and push than children in the control group. Second, about infant day similar findings regarding the significantly they were more likely to threaten, swear and argue. more frequent temper tantrums and Third, they demonstrated those propensities in several care. school settingsthe playground, the hallway, the decreased compliance of 3 112-year-olds who lunchroom, and the classroom. Fourth, teachers were had been in supplementary care in their first more likely to rate these children as having aggressive- years. ness as a serious deficit in social behavior. Fifth, Other studies in the literature which do teachers viewed these children as less likely to use such not focus specifically on attachment also strategies as walking away or discussion to avoid or raise concerns about infant day care. These extract themselves from situations that could lead to studies report results that are not inconsist- aggression (Haskins, 1985, p. 700). ent with the notion that infant care may promote anxious-avoidant attachments. For Conclusion example, a study conducted in Bermuda What are we to make of the evidence just involving virtually all two-year-olds on the summarized? The first point which must be

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Infant Day Care: A Cause for Concern? 113 made before drawing any conclusions is that enough that there is sufficient evidence to not every study of infant day care reveals lead a judicious scientist to doubt this line a heightened risk of insecure-avoidant of reasoning; by the same token, however, attachment or of aggression, noncompliance, there is more than enough evidence to lead the and disobedience. Nevertheless, itis clear same judicious individual to seriously I conclude that that if one does not feel compelled to draw entertain it and refrain from explaining away entry into care in only irrefutable conclusions, a relatively per- and thus dismissing findings that may be suasive circumstantial case can be made that ideologically disconcerting. Anyone who has the first year of life early infant care may be associated with kept abreast of the evolution of my own is a "risk factor" for increased avoidance of mother, possibly to the thinking can attest to the fact that I have pint of greater insecurity in the attachment not been a consistent, ideologically driven the development of relationship, and that such care may also be critic of nonmaternal care, whether expe- insecure-avoidant associated with diminished compliance and rienced in the first year of life or thereafter. attachments in cooperation with adults, increased aggres- Having struggled to maintain an open mind siveness, and possibly even greater social with respect to the data base, so that the infancy and height- maladjustment in the preschool and early evidence could speak for itself, I know how ened aggressive- school-age years. difficult a task this is. I am well aware, too, ness, noncom- What is most noteworthy about these that my gender and the more or less very possibilities is that they are strikingly con- traditional nature of my family structure pliance, and sistent with basic theoretical contentions of could bias my reading of the evidence. withdrawal in the attachment theory. Itis certainly not in- Itis certainly true that the very same preschool and early consistent with attachment theory that evidence that I have presented for purposes repeated separations in the first year of life, of raising concern (not alarm) and encour- school years. as routinely associated with day care usage, aging others to reconsidr.r the developmental might affect the emerging attachment correlates of infant day care could be relationship, and even disturb it from the organized in a different manner. This not standpoint of security (or at least avoidance). only should be, but has been done, and very Further, the theory clearly assumes that well indeed (Clarke-Stewart & Fein, 1983; avoidance reflects some doubt on the part Hoffman, 1983; Rubenstein, 1985). It is also of the infant with respect to the availability the case that virtually any one of the studies and responsiveness of the mother and may cited above could be dismissed for a variety well serve as a coping strategy to mask anger. of scientific reasons. But in the ecology of Finally, the theory clearly assumes that an day care, perfect field research seems almost avoidant attachment places the child at risk impossible; moreover, it would seem that the (probabilistically) for subsequent social more prefect it is, the less generalizable it difficulties, with diminished compliance and might be. cooperation, increased aggressiveness, and This complexity inherent to infant day even maladjustment being, to some extent, care research underscores a most important expectable outcomes (or at least subsequent point that also cannot be sufficiently em- correlates). phasized. When we find infants in care we The point of this essay, and my reason are not only likely to find them in a variety for writing it,is not to argue that infant of arrangements usually resulting from their day care invariably or necessarily results in mothers working outside of the home, but an anxious-avoidant attachment and, there- also for a variety of reasons and with a by, increased risk for patterns of social devel variety of feelings and family practices opment that most would regard as unde- associated with these care arrangements. sirable, but rather to raise this seemingly Thus, infant day care refers to complex real possibility by organizing the available ecological niches. This means, then, that any data in such terms. I cannot state strongly effects associated with care are also asso-

114Infant Day Care: A Cause for Concern? .1_12 ciated with a host of other factors. Thus, In R Ainslie (Ed.), The child and the day care setting it would be misguided to attribute any effects (pp. 1-34). New York: Praegner. associated with nonmaternal care to the care Belsky, J. 1986. The effects of infant day care reconsi- dered. Paper presented to National Academy of per se, or even to the mother's employment. Sciences Ad Hoc Committee on Policy Issues in Not to be lost in this discussion, however, Child Care for Infants and Toddlers, Washing- is the fact that the correlates of day care ton, D.C. which have been chronicled (i.e., avoidance, Belsky, J, & Steinberg, LD. 1978. The effects of aggression, noncompliance, withdrawal) day care: A critical review. Child Development, 49, 929-949. have been found across a host of ecological Belsky, J, & Steinberg, LD & Walker, A. 1982. niches and caregiving milieus. Thus, these The ecology of day care. In M Lamb 7(E1c1-1.), "effects" or correlates of early supplementary Childrearing in nontraditional families (pp. care have been found in samples of impov- Hillsdale, NJ: Erlbaum. erished (Haskins, 1985; Vaughn et al., 1980), Bretherton, I. 1985. Attachment theory: Retro- spect and prospect. In I Bretherton & E Waters middle-class (Rubenstein, Howes, & Boyle, (Eds.), Growing points in attachment theory and research. 1981), and upper-class families (Barg low, Monographs of the Society for Research in Child Develop- 1985), and with children cared for in unstable ment, No. 209, Vol. 50, Nos. 1-2, pp. 3-36. family day care (Vaughn et al., 1980), high Clarke-Stewart, KA, & Fein, G. 1983. Early childhood programs. In MM Maith & JJ Campos quality centers (Haskins, 1985; Schwarz, (Eds.), Ph.D. Mussen (Series Ed.), Handbook of child Strickland, & Krolick, 1974), poor quality psychology: Vol. 2. Infancy and developmental psychobiol- (McCartney et al., 1982), and even in-home, ogy. New York: Wiley. babysitter care (Barg low, 1985). Such Farber, EA, & Egeland, B. 1982. Developmental consequences of out-of-home care for infants in variation in the samples studied, yet a low income population. In E Zigler & E Gor- similarity in the developmental outcomes don (Eds.), Day care: Scientific and social policy issues associated with nonmaternal care in the first (pp. 102-125). Boston: Auburn. year, lead me to conclude that entry into Haskins, R. 1985. Public school aggression care in the first year of life is a "risk factor" among children with varying day-care expe- rience. Child Development, 56, 689-703. for the development of insecure-avoidant Hoffman, L. 1983. Maternal employment and attachments in infancy and heightened ag- the young child. In M Perlmutter (Ed.), Minnesota gressiveness, noncompliance, and withdraw- symposium on child psychiatry (pp. 101-127). Hills- al in the preschool and early school years. dale, NJ: Erlbaum. Under a variety of imaginable conditions, Kamerman, S. 1986, February. Infant care usage in particularly pertaining to the quality and the United States. Report presented to National Academy of Sciences Ad Hoc Committee on stability of the care arrangement, the tem- Policy Issues in Child Care for Infants and peramental vulnerability of the child, and Toddlers, Washington, D.C. economic-social stresses to which the family Klein, R. 1985. Caregiving arrangements by is subjected,it seems likely that risk employed women with children under one year of age. Developmental Psychology, 21, 403-406. associated with early care would increase. McCartney, K, Scarr, S, Phillips, D, Grajek, S, & Schwarz, JC. 1982. Environmental differences among day care centers and their effects on children's development. In E Zigler & E Gordon References (Eds.), Day care: Scientific and social policy issues (pp. Barg low, P. 1985. Other-than-mother, in-home care, 126-151). Boston: Auburn. and the quality of mother-child relationship. Paper pre- Ricciuti, HN. 1974. Fear and the development of sented at the biennial meetings of the Society social attachments in the first year of life. In M for Research in Child Development, Toronto. Lewis & LA Rosenblum (Eds.), The origins of fear Barton, M, & Schwarz, J. 1981, August. Day cure (pp. 73-106). New York: Wiley. in the middle class: Effects in elementary school. Paper Rubenstein, J. 1985. The effects of maternal presented at the American Psychological Associ- employment on young children. Applied Develop- ation's Annual Convention, Los Angeles. mental Psychology, 2, 99-128. Belsky, J. 1984. Two waves of day care research: Rubenstein, J, Howes, C, & Boyle, P. 1981. A Developmental effects and conditions of quality. two year follow-up of infants in community- 1 I

Infant Day Care: A Cause for Concern?115 based day care. Journal of Child Psychology and Psychi- Vaughn, B, Gove, FL, & Egeland, B. 1980. The atry, 22, 209-218. relationship between out-of-home care and the quality of infant-mother attachment in an eco- Schwartz, P. 1983. Length of day-care attend- ance and attachment behavior in eighteen- nomically disadvantaged population. Child Devel- opment, 51, 971-975. month-old infants. Child Development, 54, 1073- 1078. Willie, D, & Jacobson, J. 1984, April. The influence Schwartz, JC, Strickland, RG & Krolick, G. of maternal employmott, attachment pattern, ertrafamilial 1974. Infant day care: Behavioral effects at pre- child care, and previous experience with peers on early peer interaction. Paper presented at the meetings of the school age. Developmental Psychology, 10, 502-506. International Conference on Infant Studies, Vaughn, B, Deane, K, & Waters, E. 1985. The New York. impact of o t-of-home care on child-mother att- achmer 'ality: Another look at some endur- ing questions. In I Bretherton & E Waters (Eds.), Growing points in attachment theory and research. Monographs for the Society for Research in Child Development, No. 209, Vol. 50.

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116Infant Day Care: A Cause for Concern? 18' Responses to "Infant Day Care: A Cause

for Concern?" Selective Review of Infant Day Care Research: A Cause for Concern!

by Deborah Phillips, Kathleen McCartney, Sandra Scarr, Carol lee Howes

In the September, 1986 issue of Zero to Three, search examining the influence of child care Jay Belsky states that "entry into care in the on infant-mother attachment. This meta- first year of life is a 'risk factor' for the analysis was conducted by two of the current development of insecure-avoidant attach- authors (McCartney & Phillips, in press). ments in infancy and heightened aggressive- The complete findings will soon appear in ness, noncompliance, and withdrawal in the an edited volume of research on motherhood preschool and early school years" (p. 7). This (Birns & Hay, in press). is a startling conclusion with far-reaching Belsky implies that the meta-analysis was implications for both political and personal biased by the family status and ideology of decisions about reliance on infant day care. the authors. A meta-analysis is a statistical And despite the caveats and qualifiers method for analyzing the combined results sprinkled throughout the article, it is this of multiple studies that, by definition, holds grave pronouncement that will become the less potential for bias than a personal liter- heritage and most quoted of Belsky's ature review. Several precautions were also remarks. taken in this instance: a search of Child Devel- This is unfortunate. Belsky's admonition opment Abstracts and Bibliography was conducted, that infant careapparently any nonmater- excluding only those studies that did not use nal infant careexposes infants to risk the Strange Situation to assess attachment constitutes one individual's interpretation of or that did not report data for proximity research on infant care that is at best, to mother and avoidance of mother. Four- selective, and at worst, misinterprets the teen studies were identified. A research available data. Under any condition, a assistant who was unaware of the purpose selective review is cause for concern. But of the analysis coded each of the articles. when the stakes are as high as they are in Finally, given the frequent criticism of meta- the area of infant day careanxious parents analysis on the grounds that less valid studies and precariously funded programsthe are given equal weight with carefully review requires careful scrutiny, and, we controlled studies, the moderating influence believe, substantial revising. of methodological strengths and weakness With respect to the issue of insecure of each study was explicitly examined. attachment, Belsky refers to, but does not What did we discover? Two results are report, the results of a meta-analysis of re- important. First, the effect-size estimates for

-1. 1

Responses to "Infant Day Care: A Cause for Concern?"117 the four measures of attachment (explore, ever, question his subsequent conclusion cry, proximity, avoidance) showed negligible that "the very child development outcomes day care-home differences. This suggests associated with early entry into supplemen- that children attending day care are no tary child care are the same as or at least different than children reared at home on similar to those that have been implicated mother attachment as assessed through the in the attachment literature as the (unde- Strange Situation. Second, the examination sirable) child development outcomes corre- of methodological moderators revealed that lated with early insecure attachment to ratings of avoidance were affected by whe- mother" (p. 5). Nowhere isit ascertained, ther judges were "blind" to the children's for example, to what degree the results of substitute care experience. Judges who were the Minneapolis project are due to the not blind were more likely to find differences multiple family stresses associated with po- between day care and home-reared children, verty or the unstable care arrangements of such that day care children were rated as the children in conjunction with, or instead more avoidant. This documents an unfor- of, the age at which the children entered We question the tunate experimenter expectancy effect. child care. And regardless of causality, we Belsky draws heavily upon one longitud- question the validity of premising a gener- validity of premis- inal studythe Minneapolis sample studied alized argument about infant care largely on ing a generalized by Farber and Egeland (1982) and by Vaughn a sample of very low-income, single mothers argument about and his colleagues (Vaughn, Deane, & with unplanned pregnancies and inconsist- Waters, 1985; Vaughn, Gove, & Egeland, ent child care. infant care largely 1980)in his analysis of this attachment One of us (Howes & Stewart, 1986) has on a sample of very literature. It is critical for your readership recently completed a study that compares to know that this research was designed to directly the influence of age of entry into low-income, single study early maladaptation in parent-infant child care and the stability of child care in mothers with interactions. As described by Farber and 55 toddler-age children who were enrolled unplanned preg- Egeland, "The sample was drawn from a local in family day care when they were between maternal and child care clinic which serves 2 and 23 months old. Only 36% of this nancies and incon- families of lower socioeconomic back- middle-class sample stayed in the same sistent child care. grounds. The majority of the mothers were family day care home from the time they single and receiving some form of public entered day care until they were observed assistance at the time their babies were born. in the study. Children who changed child Most of the pregnancies were not planned" care arrangements more often were less (pp. 107-8). Infant day care, in this study, competent in their play with peers. Boys who was most frequently provided by an adult entered child care as younger babies and had female, often a relative or friend of the few child care changes were most likely to infant's mother. At least 80% of the infants engage in high level play with objects. This experienced a change in the substitute care- suggests that the stability of the child care giver during the period they were receiving arrangement is more important than the age out-of home care. The authors conclude, "In the child begins child care. sum, out-of-home care arrangements were It should also be noted that the results quite varied and changes in these arrange- of the Schwartz study (1983), as discussed ments were a routine" (Faber & Egeland, by Belsky, are overgeneralized. Belsky states p. 111). that this study shows that "babies who began We do not have any quarrel with Belsky's day care in the first year of life displayed reporting of these data. They have been greater avoidance of their mothers ... (p. reported in reputable journals and edited 4). In fact, only those babies who began full- volumes. Given the meta-analyses results time care as infants showed greater avoidance and other available evidence, we do, how- of their mothers. Those in part-time care

1 18 Responses to "Infant Day Care: A Cause forConcelnt were no different in attachment from infants The most significant finding of this not in child care. research is that child outcomes are affected The only other available review of the by the quality of their child care programs. research on attachment and infant care Age of entry into care showed only one (Gamble & Zigler, 1986) is more circumspect significant effect out of a total of 20 outcome in its conclusions, and we believe far more measures, while quality showed consistent in line with the evidence. Gamble and Zigler effects. Child care is not a uniform inter- state as a "tentative" conclusion, "In families vention and sh, Ad not be discussed as facingsignificantlifestresses,substitute care sucha point that has been emphasized by during the first year increases the likelihood many reviewers of child care research of insecure parent-child attachments" (p. 35, (Clarke-Stewart & Fein,1983; Etaugh, 1980; emphasis added). And in an accompanying Rutter, 1981; Scarr, 1984; Zigler & Gordon, article (Young & Zigler, 1986), policy re- 1982), including Belsky (Belsky, Steinberg, commendations that include efforts to im- & Walker, 1982). Just as home environments prove the quality of infant care and make are not all the same, day care environments parental leaves more widely available are are not all the same, and some are betterChild care is not a for children than others. outlined. uniform interven- Belsky sidesteps this major finding, and The second argument put forth by Belsky states, instead, that the Bermuda study de- tion and should not concerns the effects of infant day care on monstrates that maladjustment is a conse- children's social development, specifically be discussed as quence of early entry into child care. The maladjustment and aggression. Belsky such. "maladjustment" measure used in this study concludes on the basis of the Bermuda child actually consists of three scales, each of care study (McCartney, Scarr, Phillips, which was rated by a parent and a caregiver. Grajek, & Schwarz, 1982), data from the Only one of the six ratings showed a sig- Abecedarian Project (Haskins, 1985), and nificant effect for age of entrycaregiver data reported by Rubenstein, Howes, and ratings of children's anxiety. Moreover, Boyle (1981) that early infant care, "may also quality of care was just as important a be associated with diminished compliance predictor of the caregiver anxiety ratings as and cooperation with adults, increased age of entry. PerLps most important, we aggressiveness, and possible even greater must ask if any of the children in the study social maladjustment in the preschool and were, in fact, overly anxious. The answer early school-age years" (p. 6). In our inion, is no. The actual range of caregiver anxiety a far more cautious and restricted conclusion ratings was 1.00 to 2.67 on a scale on which is, in fact, warranted. the highest possible score is 10.00. Thus, the Specifically, the Bermuda study (also highest score actually obtained for a child reported in McCartn2y, 1984; McCartney, in this study was 2.67a score of 6.73 is Scarr, Phillips, & Grajek, 1985; and Phillips, considered "anxious" by the authors of the McCartney, & Scarr, in press) did not scale (Behar & Stringfield, 1974). So to examine "poor quality" centers, as Belsky portray any of the children in this study as claims (p. 7), but centers that ranged widely over-anxious, let alone maladjusted,is in quality from excellent to poor. The central inappropriate. purpose of this research was to examine Belsky also bases his conclusions about the whether variation in the quality of center- social development of children who enter based care affects children's cognitive, child care as infants on a study conducted language, and social development. Family by Haskins (1985). Belsky characterizes these background and age of entry into child care data as showing greater aggressiveness for were controlled statistically prior to examin- "children who received center-based care in ing the effects of day care quality. the first year of life, in contrast to those

Responses to "Infant Day Care: A Cause for Concern?"119 receiving care at any time thereafter " Belsky does not, however, report a follow- (p. 6). In fact, Haskins states that "my results up study of these children (Rubenstein & will not support these conclusions" (personal Howes, 1983) which revised several of the communication, October 1986). conclusions reached in the initial study. Studies converge to What Haskins' data do show is that "chil- Thus, the authors later conclude that "For suggest that early dren with extensive expefience ina late emotional development, individual cognitively-oriented day-care program were differences in the actual experiences and entry into day care rated by their public school teachers as more behaviors of the toddlers in day care are may be less impor- aggressive" (p. 700). In direct comparisons more important than is attendance in day tant than the kind with children who had extensive experience care per se. We found that later behavior in licensed child care centers that did not problems, test anxiety, and aspects of the and quality of care place a great emphasis on a cognitive curri- mother-child affective relationship were children receive culum, significant differences emerged, such predicted by individual differences in the toddlers' experiences and behaviors in day while in day care. that only the children in the cognitively oriented programs showed higher aggres- care and they were not predicted by whether siveness upon school entry. Thus, we must the toddler had been in day care or at home" again circumscribe Belsky's conclusions (pp. 41-42). they apply only to children who attended Similarly, Howes & Olenick (1986) report a single intervention program with a that toddlers in high quality child care particular type of curriculum. In fact, the centers demonstrated accelerated self- children with extensive experience in regulation while toddlers in low quality licensed child care centers showed lower centers lagged behind both children who amounts of hitting, kicking, and pushing were in high quality centers and at home than children with less day care experience. with their mothers. Therefore, when critical The results of the Haskins study relate studies are not eliminated from the review, directly to questions about the type of day they converge to suggest that early entry care curriculum to which young children are into day care may be less important than exposed. They have little to say about age the kind and quality of care children receive of entry into child care and, to the extent while in day care that conclusions can be drawn about amount An additional problem must be noted with of day care experience, it appears that this respect to Belsky's review of research on the factor alone does not predict aggressiveness social effects of infant day care. On page in kindergarten and first grade. These are 5, he refers to the Farber and Egeland (1982) quite differentalmost oppositeconclu- study and concludes, "Not only was it the sions from those that Belsky draws from case that toddlers whose mothers began this research. working prior to their infant's first birthday A third published study that Belsky cites displayed significantly less enthusiasmin to draw conclusions about the social confronting a challenging task than did development of children who enter child care children who had no day care experience, as infants was conducted by Rubenstein, but it was also the case that these day-care- Howes, and Boyle (1981). In this study, reared infants tended to be less compliant in preschool-age children who had been in child following their mothers' instructions, less care as infants were found to be less persistent in dealing with a difficult problem, compliant when asked by their mothers to and more negative in their affect." complete a boring task than children who In fact, only one of these results showed had been at home. Furthermore, mothers significant effects for the mother's work status of child care children reported more temper enthusiasmand then only fur boys. The other tantrums than mothers of children reared results failed to reach significance, e.g., p=.09 exclusively at home. for compliance, p=.13 for persistence, p=.10 120Responses to "Infant Day Care: A Cause for Concern?"it for negative affect. Nonsignificant group evidence is inconclusive." At a minimum, differences are also included among signif- when we venture to draw conclusions from icant effects in Belsky's reporting of a relatively small and contradictory collection Schwarz, Strickland, & Krolick (1974) of research evidence, we must qualify our (Schwarz, personal communication, Octo- conclusions to explain to whom they apply, Sometimes "good ber, 1986). Itis highly unconventional to under what circumstances, and with whatscience" means say- report nonsignificant effects as reliable remaining questions. group differences. The evidence on infant day care is noting "I don't know- Finally, it is instructive to examine other all in. In fact, carefully controlled studies of the evidence is infant day care are rare. Yet, we do know evidence which should also be weighed in inconclusive, a comprehensive review of the effects of that quality makes a difference and that infant day care. Benn (1985), in a study of treating infant child care as a homogeneous 41 upper-class children from intact families environment fails to reflect the real diversity using family day care homes with fewer than of infant care. We also know that the existing 3 children or a sitter for child care, found data confound family stress, the child's age that male infants who started child care of entry into care, the length of time in care, during the latter half of the first year of and the stability and quality of care, thus life were more likely to be insecurely leading us to be very cautious about attached to their mothers than were male attributing the consequences of care to any infants who began child care earlier. Howes single one of these variables. Many other & Rubenstein (1985) report that children equally important issues have received scant who entered center or family day care earlier empirical attention, such as the role of child (children entered between 2 and 15 months care as a support system for working families of age) had higher frequencies of touching and the role of fathers in children's (and and laughing with their caregiver than mothers') adjustment to child care. children who entered care later. Schwarz and Of course, any consistent findings of detri- his colleagues (Schwarz, Kro lick, & Strick- mental effects would be cause for concern, land, 1973) studied peer interactions among as noted by Belsky. And any clues in the children who entered center based care research literature about how to define high earlier (5-22 months, average=9.5 months) quality infant care should be studied versus later (24-47 months, average=36 carefully. This latter issueisparticularly months). The results showed that the early compelling. Because, while we continue to entry group exhibited more positive affect debate the merits of infant care, the realities upon-tering the peer group, showed less of economic and demographic life in America tension upon entering the group and five tell us that infant day care is here to stay. weeks later, and also had higher (more positive) social interaction scores than the late group on day one and five weeks later. References Scientists who study controversial and Behar, L, & Stringfield, SA. 1974. A behavior it emotion-laden issues sometimes find rating scale for the preschool child. Developmental difficult to suspend judgment in the face of Psychology, 10, 601-610. complex and contradictory research evi- Belsky, J. 1986. Infant day care: A cause for con- dence. Infant day care is among the most cern? Zero to Three, Vol. VI, No. 5, pp. 1-9. controversial and emotion-laden issues that Belsky, J, Steinberg, LS, & Walker, A. 1982. The developmentalists study. It is precisely under ecology of day care. In M Lamb (Ed.), Childrearing in nontraditional families. Hillsdale, NJ: Erlbaum. these circumstances, however, thatitis incumbent on the scientific community to Benn, R. 1985. Factors associated with security of attach- ment in dual career families. Paper presented at the use the utmost caution. Sometimes "good biennial meeting of the Society for Research in science" means saying "I don't knowthe Child Development, Toronto, Canada.

Responses to "Infant Day Care:jatlfor Concern?"121 Birns, B, & Hay, D (Eds.), in press. Different faces of children's development. In E Zigler and E Gor- motherhood. New York: Plenum Press. don (Edo.), Day care: Scientific and social policy issues. Clarke-Stewart, KA, & Fein, G. 1983. Early Boston: Auburn House. childhood programs. In MM Haith & JJ Campos Phillips, C, McCartney K, & Scarr, S. In press. (Edo.), PH Mussen (Series Ed.) Handbook of child Child care quality and children's social develop- psychology: Vol. 2 Infancy and developmental psychobiol- ment. Developmental Psychology ogy. New York: Wiley. Rubenstein, J, & Howes, C. 1983. Adaptation to Etaugh, C. 1980. Effects of nonmaternal care on infant day care in S Kilmer (Ed.) Advances in early children: Research evidence and popular views. education and day care. Greenwich, CT: JAI Press. American Psychologist, 35, 309-319. Rubenstein, J, Howes, C, & Boyle, P. 1981. A Farber, EA, & Egeland, B. 1982. Developmental two year follow-up of infants in community- consequences of out-of-home care for infants in based day care. Journal of Child Psychology and Psychi- a low income population. In E Zig ler & E Gor- atry, 22, 209-218. don (Eds.), Day Care: Scientific and Social Policy Issues. Rutter, M. 1981. Social-emotional consequences Boston: Auburn. of day care for preschool children. American Jour- Gamble, T, & Zig ler, E. 1986. Effects of infant nal of Orthopsychiatry, 51, 4-28. day care: Another look at the evidence. American Scarr, S. 1984. Mother care, other care. New York: Journal of Orthopsychintry, 56, 26-42. Basic Books. Haskins, R. 1985. Public school aggression Schwartz, P. 1983. Length of day-care attend- among children with varying day-care expe- ance and attachment behavior in eighteen- rience. Child Development, 56, 689-703. month-old infants. Child Development, 54, 1073- Howes, C, & Stewart, P. 1986. Child's play with 1078. adults, peers and toys. Unpublished manuscript, Uni- Schwarz, JC. Krolick, G, & Strickland, RG. versity of California at Los Angeles. 1973. Effects of early day care experience on Howes, C, & Olenick, M. 1986. Family and child adjustment to a new environment. American Jour- care influences on toddler compliance. Child nal of Orthopsychiatry, 43, 340-348. Development, 57, 206-216. Schwarz, JC, Strickland, RG, & Krolick, G. Howes, C, & Rubenstein, J. 1985. Determinants 1974. Infant day care: Behavioral effects at pre- of toddlers' experience in day care: Age of entry school age. Developmental Psychology, 10, 502-506. and quality of setting. Child Care Quarterly, 14, Vaughn, B, Deane, K, & Waters, E. 1985. The 140-151. impact of out-of-home care on child-mother att- McCartney, K. 1984. The effect of quality of achment quality: Another look at some endur- day care environment upon children's language ing questions. In I Bretherton & E Waters (Edo.), development. Developmental Psychology, 20, 244- Growing points in attachment theory and research. 260. Monographs for the Society for Research in McCartney, K, & Phillips, D. In press. Mother- Child Development. hood and child care. In B Birns, & D Hay (Edo.), Vaughn, B, Gove, FL, & Egeland, B. 1980. The Different faces of motherhood. New York: Plenum relationship between out-of-home care and the Press. quality of infant-mother attachment in an eco- McCartney, K, Scarr, S, Phillips, D, & Grajek, S. nomically disadvantaged population. Child Devel- 1985. Day care as intervention: Comparisons of opment, 51, 971-975. varying quality programs. Journal of Applied Devel- Young, KT, & Zigler, E. 1986. Infant and opmental Psychology, 6, 247-260. toddler day care: Regulations and policy implica- McCartney, K, Scarr, S, Phillips, D, Grajek, S, & tions. American Journal of Orthopsychiatty, 56, 43-55. Schwarz, JC. 1982. Environmental differences Zigler, E, & Gordon, E (Eds.). 1982. Day Care: among day care centers and their effects on Scientific and Social Policy Issues. Boston: Auburn.

122Responses to "Infant Day Care: A Cause for Concern?" 1111 Risks Remain

by Jay Belsky

Several years ago I wrote a chapter entitled any disagreement whatsoever. Why then "Two Waves of Day Care Research: Devel- have I broken a promise to myself and risked opmental Effects and Conditions of Quality" the wrath of colleagues and other child care (Belsky, 1984) in which I updated past re- professionals? The reason is simple. As I views of research on day care and child stated in my article entitled "Infant Day development (Belsky & Steinberg, 1978; Care: A Cause for Concern?," evidence kept Evidence kept Belsky, Steinberg, & Walker, 1982). En it I crossing my desk which was directly at odds crossing my desk with conclusions I had reached in my original concluded that under certain specifiable con- which was directly ditions (e.g., modest group size, well trained analysis of day care research (Belsky & staff, supervised family day care providers) Steinberg, 1978), yet consistent with at odds with con- children's day-to-day experiences in day care findings that first captured my attention ansinns I had are developmentally facilitative (e.g., more while writing my second and third reviews positive interactions with caregivers and age- (Belsky, 1984; Belsky, Steinberg, & Walker, reached in my orig- mates, less aimless wandering) and, as a 1982). As I focused more and more upon inal analysis of day these studies my attention was drawn not result, children's development is enhanced. care research. Future investigations, I pointed out, needed only to a possible relation between insecurity to move beyond "between-group" analyses of attachment and are initiated in the first year, which compared children with and without but also to evidence on such infant care day care experience and employ "within- whichI had read before but had never group" designs that permitted analysis of the defined in terms of such a restricted devel- conditions under which day care experience opmental period. Children who initiated care enhanced or undermined children's develop- in the first year, the evidence suggested to ment. I was so pleased with this paper and me, seemed at risk not only for insecurity the way in which it sidestepped the entire but for heightened aggression, noncom- day care debate that I promised myself I pliance and possibly social withdrawal in the would refrain from further reviews of preschool and early school years. studies comparing children with and without My first response to discerning such experience in child care programs. Since day trends in the literature was to search for care was here to stay, I reasoned, the most possible moderators of these associations useful knowledge would come from research between care initiated in the first year and that examined variation in children's expe- children's social and emotior:al functioning. rience in day care and sought to identify Could it be that the risks mentioned in my the conditions of quality. original essay were evident principally when This point of view which I embraced but care was of low quality, when it was provided a few years ago and, on the basis of my in one locale versus some others, or when initial Zero to Three article (Belsky, 1986) now children came from certain kinds of families, seem to have abandoned, is a basic message were males and females, or began care early of my critics' analysis of my essay on infant or late in the first year? Try as I did to discern day care. It is not one with which I have order in the studies which focused upon

1 -1 Risks Remain123 I. 4, children whose child care experiences were of preschoolers who had and had not initiated in their first year, I found that there experienced center care in their first year. was insufficient grounds for concluding that The point of this discussion is not to argue any parameter which Iconsidered was that quality of care does not matter. That principally responsible for the risks which it does is best demonstrated, Ibelieve, in I thought (and still think) I had found to the Bermuda studies (McCartney, Scarr, be associated with day care initiated in the Phillips, Grajek, & Schwarz, 1Q82,), since it child's first year of life. was infants in poor quality centers who In fact, much as I would have welcomed seemed adversely "affected" by their care ex- the opportunity to conclude that it was the perience (and it was for this reason that 1 quality of care in the first year which dis- cited these studies as implicating poor quality It was evidence tinguished studies finding and not finding centers). Rather, my point is to argue, in direct response to the criticism that I have from supposedly problematic developmental "outcomes" to be associated with care initiated in the first year, failed to consider variation in quality of day non-risk samples I discovered there was just too much evi- care, that when information pertaining to which convinced dence, given the dearth of studies actually quality of care is considered across research focusing upon quality of care in the first reports that the data are by no means as me that I had little year, that was inconsistent with this con- consistent as one might like and certainly choice but to write clusion. Consider first in this regard the fact not consistent enough for me to feel con- the essay. that the soon-to-be-published study by fidentin saying thatifthere are risks Barg low et al. (in press) linking insecurity associated with care in the first year of life and day care initiated in the first year was itis as a result of quality and not age of of infants from economically.svc;1-off entry. families using good quality care. Consider Phillips et al. are disturbed by my sugges- next the fact that in the Haskins' (1988) tion that they, like me, might by affected study of aggression in the early school years, by ideological and personal biases when it it was only the children with 60 or more comes to evaluating research on the devel- months of care experience when they opmental correlates of day care. But itis entered kindergarten (i.e., had been in car, hard not to feel justifiedin noting this since their first year) who displayed height- possibility when they contend thatI have ened levels of aggression and that all these premised "a generalized argument largely on children had experienced center-based care a sample of very low-income, single mothers, of the highest quality. Consider, too, the fact with unplanned pregnancies and inconsis- that the Howes and Olenick (198b) study tent care." If the only data I had to go on which Phillips et al. cite as evidence that were those from the Vaughn et al. (1980) quality matters most (and it might) deals study to which they refer, then it would with children 18 months of age and older have been totally irresponsible for me to and says nothing about when these children make the arguments I did in my essay. But started day care and what the quality of their the fact of the matter is that it was evidence care was in their first year. This latter point from suppoedly non-risk samples which also pertains to my critics' citation (and convinced me that I. had little choice but to quotation) of the Rubenstein and Howes write the essay. It is time that my critics (1983) report, sinceitwo.s experiences opened their eyes to the fact that there are measured in the second year of life tnidich pre- data in the literature that pertain not to just dicted three-and-a-half year functioning; extremely high-risk samples and refrain also noteworthy is the fact that this report from casting all opinion which dissents from presented the same evidence which I cited their mainstream line of argument as being in my original essay indicating that behav- based upon a single and supposedly discre- ioral differences existed in the functioning dited study or upon the diatribes of extremist

124Risks Remain ideologues whose rhetoric far exceeds the the space allocated), was not so much evidence. "selective," as my critics contend, as it was It will not do either to imply that I have focused. As a result,Ifind little real misrepresented the evidence which I cite as inconsistency between the findings Phillips my critics note that not all the group dif- etal.summarize from McCartney and ferencesI mentioned in the Farber and Phillips'(in press) meta-analysis which Egeland (1982) study reached traditional focused upon care through the preschool levels of statistical significance. But I am years and those emanating from my much bothered by the implication that I intended more circumscribed inquiry. My general to mislead; in fact, I constructed my sentence sense is that direct comparison of the two in a most deliberate manner to contrast the efforts to summarize research on day care significant difference on the enthusiasm is not truly possible given such striking Group differences variable with differences on other variables difference in focus. that are marginal which were purposefully cast as trends not In view of the attention my critics draw achieving conventional levels of significance. to the contrasting conclusions which their and qualify as And while it is also true that I erred in citing review and mine generated,I must call trends should not attention not only to the empirical "noise" four differences as significant in the Schwarz be dismissed out of et al. (1974) study, Phillips et al. commit a that may be introduced when research on comparable error by implying that more care initiated in the first year and thathand. than one difference which I cited was non- focused on care begun thereafter are not significant (i.e., .05) when, in fact, three of distinguished, but also to the need for more the four group differences which I cited did sensitivity to the methodological require- meet the conventional .05 significance level. ments of research on attachment. In In all this discussionby Phillips et al. and particular, special attention must be paid to by myselfwe should not lose sight of the the inclusion of subjects as young as five fact that criteria of significance, statistical or months of age in experiments with the otherwise, reflect social conventions and are Strange Situation in some day care studies not engraved in stone on some tablet handed (Doyle, 1975; Doyle & Somers, 1978) and down from some all-powerful force. Group to the employment of methods in other differences that are marginal and qualify as studies which required that important trends in the common parlance of our reunion behavior (avoidance, resistance) be science, I believe, should not be dismissed noted during c. single live viewing of the out of hand, particularly in the case of Strange Situation (Brookhart & Hock, 1976; research on infant day care in which we should Hock, 1980). The fact of the matter is that want to know if there might be evidence no investigator today would use any data of disconcerting consequences. collection method other than videotaping, In reading Phillips et al.'s critique of my which permits repeat viewing, nor endeavor essay, I am repeatedly struck by their un- to study the attachment behavior of infants willingness to restrict themselves to tl,e under 10 months of age in the Strange cncus of my papernamely, care initiated Situation. Thus, by including studies with in the first year of life. As noted above, I such problematic designs and methods in restricted my own analysis to this develop- meta analyses, the statistically oriented mental epoch, making no claims regarding care summarizer of research runs the risk of initiated at any other times (despite implications accepting the null hypothesis simply because to the contrary), precisely because it was here of the potential insensitivity of the studies and only here that concerns had developed under consideration. in my mind. My summary of the literature, Whatever conclusions are reached, then, which was never purported to be com- though, I think it is important to reconsider prehensive (and could not have been given the total context in which information on

Risks Remain125 infant day care is considered. All too often Regardless of whether my critics accept I sense that there are some who judge it this line of reasoning, I must alert them to irresponsible,if not dangerous, to raise the fact that many parents of young babies concerns and draw attention to evidence that are trying to decide wheth. vv.() incomes is disconcerting. Child care advocates like are absolutely necessary and whether it Phillips et al. assert that families and child might be wiser to defer the return of the care programs need to be protected and come second parent (typically the mother) to the close to implying that any break in the ranks labor force until after the infant's first year No policy position regarding the consensus conclusion that day of life (particularly given the options currently available). In reading my critics' has a monopoly on care is fine and dandy is a moral transgres- sion. There are several problems with this response to my essay I am forced to wonder the risk or utility line of reasoning in my opinion. The fi -st why it is that discussion of research by child associated with is that it assumes that any presentation of care professionals is almost always cast in terms of families in which parents have no scientific evidence. evidence indicating that infant care as currently experienced in the United States is associated with choice but to work. Although these may be problematical developmental outcomes the kinds of families with which they deal provides fuel for critics of nonmaternal care most often, as well as the ones with whom policy makers should be most concerned, it and the employment of women with young needs to be recognized that there exists a children. In view of the fact that, in all likeli- good number of families that could manage hood, such employment of mothers is here to forego two incomes, particularly ifit to stay, I would contend that such evidence turned out that a developmental period as provides ammunition for those who want narrow as the first year were identified as more support for child care programs or one associated with whatever risks might more choices for parents rearing young be associated with day care.Isuspect, children. Indeed, the child care system in this moreover, that such families would very country is sufficiently limited, particularly in much like to have such information were comparison to virtually all other western it to become available. Consideration of such nations, that it may only be by marshalling families reminds us that no policy position evidence regarding risk that apolitically has a monopoly on the risk or utility asso- significant case can be made that action must ciated with scientific evidence. Due consid- be taken. So long as child care advocates eration must be given, in terms of analyses focus upon the policy risks and personal guilt of the developmental correlates of infant day that might be associated with analyses such care, to those families in which mothers as mine, opportunities to argue for support choose to stay home (or are still deciding), of child care may well be missed rather than not just to those in which mothers must taken advantage of. Indeed, in light of the work. absence of progress which has been made The essay I wrote reflected my desire to in this country in the policy arena since the bring to the attention of child care profes- failed implementation of the Federal Inter- sionals the fact that, in contrast to just five agency Day Care Requirements, child care or ten years ago, there exists now a sizeable advocates may well want to consider alter- body of evidence linking care initiated in the native politicalstrategies. Rather than first year of life with patterns of child avoiding or explaining away disconcerting functioning that ought to be a cause for evidence (and there is now a good deal of concern. This is not to say that benefits do it), it might be wiser to embrace it and argue not arise from nonmaternal care or that such that current policies and the practices they disconcerting correlates of early care are introduce threaten the well-being of children found in every study, characterize every and families in the United States. child, are inevitable or even are caused by

126Risks Remain experience in infant day care arrangements Doyle, A, & Somers, K.1978.The effects of group and family day care on infant attachment as routinely experienced in the United States behaviors. Canadian Journal of Behavioral Science, 10, today. In view of the fact that it remains 38-45. unclear, given the current state of the Farber, E, & Egeland, B. 1982. Developmental evidence, under which conditions these consequences of out-of-home care for infants in correlates of care are most likely and most a low income population. In E Zigler & E Gor- don (Eds.), Day care: Scientific and social policy issues. unlikely, it seems appropriate to characterize Boston: Auburn. infant day care as a risk factor. This phrase HaskinsR. 1985.Public school aggression does not imply that risk is inevitable, only among children with varying day care expe- heightened. Future research, we must hope, rience. Child Development,56, 689-703. will illuminate these very conditions. Future Hock, E.1980.Working and nonworking moth- policy, we must further hope, will enable ers and their infants: A comparativestudy of maternal caregiving behavior and infant social families to maximize their choices, with behavior. Merrill-Palmer Quarterly.26, 79-101. affordable and quality infant care being oni' Howes, C, &Olenick, M.1986.Family and child of them. care influences on toddler compliance. Child Development,57, 206-216. McCartney, K, & Phillips, D. In press. Mother- hood and child care. In B Birns & D Hay (Edo.), References Different faces of motherhood. New York: Plenum. Barg low, P, Vaughn, B, & Molitor, N. In press. McCartney, K, Scarr, S, Phillips, D, Grajek, S, & Effects of maternal absence due to employment Schwarz, J.1982.Environmental differences on the quality of infant-mother attachment in a among day care centers and their effects on low-risk sample. Child Development. children's development. In E Zigler & E Gordon (Edo.), Day care: Scientific and policy issues. Boston: Belsky, J.1984.Two waves of day care research: Developmental effects and conditions of quality. Auburn. In R Ainslie (Ed.), The child and the day care setting. Phillips, D, McCartney, K, Scarr, S, & Howes, New York: Praeger. C.1984.Selective review of infant day care Belsky, J. 1986. Infant day care: A cause for con- research: A cause for concern! Zero to Three, this cern? Zero to Three, Vol. VI, No.5, 1-7. issue. Howes, C.1983. Adaptation to Belsky, J, & Steinberg, L.1978.The effects of Rubenstein, J, & day care: A critical review. Child Development,49, infant day care. In S Kilmer (Ed.), Advances in early education and day care. Greenwich, CT: JAI Press. 929-949. Belsky, J, Steinberg, L, & Walker, A.1982.The Schwarz, J, Strickland, R, & Krolick, G.1974. ecology of day care. In M Lamb (Ed.), Infant day care: Behavioral effects at preschool Nontraditional families. Hillsdale, NJ: Erlbaum. age. Developmental Psychology,10, 502-506. 1980.The Brookhart, J, & Hock, E.1976.The effects of Vaughn, B, Cove, F, & Egeland, B. experimental context and experiential back- relationship between out-of-home care and the ground on infants' behavior toward their moth- quality of infant-mother attachment in an eco- ers and a stranger. Child Development,47, 333-340. nomically disadvantaged population. Child Devel- opment,51, 971-975. Doyle, A. 1975.Infant development in day care. Developmental Psychology,16, 31-37.

RisksRemain127 "Infant Day Care: A Cause for Concern"

Stella Chess, M.D.

I wish to express my reaction to Dr. Jay we are finally brought up to date in the Belsky's article, "Infant Day Care: A Cause 1980's by the long term studies by Quinten, for Concern." It is a curious article, in that Rutter & Liddle showing that "Institution it disclaims personal bias as a scientist, views reared women showed a worse psychosocial with alarm those scientists who have outcome in adult life compared with controls, Our aim should be personal bias that day care is not detrimental but there was great hetereogeneity, with to supply good sub- to child development, explains the great some women functioning very well." Surely variability in quality and type of day care this outcome cries for an examination of the stitute care to al!. utilized by working parents, gives a nod to factors involved in the positive outcomes so working women of the hetereogeneity of family environments that, when institutional upbringing is needed, it can strive toward increasing the all economic levels. of children in day care, yet concludes that entry into day care in the first year of life proportion of those who have good out- is a risk factor for underdesirable develop- comes. A cry of alarm over the poor out- mental outcomes. I also wonder why Belsky comes ending in elimination of all institu- places so much emphasis on the personal tional care is of no help unless it were true that all institutional care is in fact disastrous. bias among the proponents of day care, and Surely we should not duplicate, with day fails to give equal weight to the biases of care, this first overall condemi ation, based opponents of day care. primarily on the results of poorly functioning I have read the excellent paper by Phillips, units. McCartney, Scarr & Howes taking issue A second point that strikes one in reading with Belsky's article in terms of the selec- Belsky's article is his statement, highlighted tivity of the day care research findings that on page 5 by repetition in large type, that he reports. I am grateful for their scholarship "the child development outcomes associated and careful statistical critique. My remarks with early entry into supplementary child will be clinical in nature. care are similar to those undesirable devel- Dr. Belsky's paper brings echoes of an opmental outcomes correlated with early earlier judgment spearheaded by the reports insecure attachments to mother." As a of Bowlby and Goldfarb that institutional clinician I am made quite uneasy by over- rearing of children was always to be con- simplified one-to-one judgments. Through- demned. However, later careful studies by out the article, the Ainsworth Strange B. Tizard and Rees and J.Tizard and Situation is assumed to be the valid mode colleagues in the 1970's provided evidence of determining the child's actual attachment that the issue was really a good versus a to the mother. Substantial clinical doubts bad institution rather than a blanket attack have been voiced about the ability of a short, on all institutions for children. We could now simple laboratory procedure to judge a identify the factc 's that would make in- complicated child-mother relationship. To stitutional care a positive experience. And quote Rutter (1981), who cautioned about

128"Infant Day Care: A Cause for Concern" I C. drawing co' Jusions from "... curious pro- a "risk factor" can only cause unnecessary cedures involving mother, caretakers and guilt among working mothers and provide strangers not only going in and out of rooms ammunition for the many elements in our every minute for reasons quite obscure to society who are hostile to the idea of the child but also not initiating interactions spending public funds sufficient to provide in the way they might usually do." (p. 160). good day care facilities for all young children. Also in the Strange Situation rating, the infants who ignore the mother when she returns are called "avoidant," indeed a pe- References jorative term, and classified as insecure. But Quinten, D, Rutter, M, & Liddle, C.1984.Insti- isit not possible that in a child who is tutional Rearing, Parenting Difficulties, and confident that his or her mother will return Marital Support. Psychological Medicine16:151-169. after a brief absence, the mother's return Rutter, M.1981.Maternal Deprivation Reassessed. Second edition. Middlesex, England. Penguin does not call for any special recognition of Books. this event? Tizard, B, & Rees, 1.1974.A Comparison of Surely, in view of the fact that one of Adoption, Restoration to the Natural Mother, every two women with a child under one and Continued Institutionalization on the Cog- year of age is employed and hence needs nitive Development of Four-Year-Old Children. Child Development45:92-99. child care arrangements, our aim should be Tizard, J.1974.The Upbringing of Other Peo- to supply good substitute care to all these ple's Children: Implications of Research and For working women of all economic levels. An Research. Journal of Child Psychology and Psychiatry. unsupported dictum that such day care is 15: 161-173.

"InfantDay Care: A Cause for Concern"129 Attachment Theory and Day Care Research

by Ross A. Thompson

At the risk of helping to turn volumes 7 psychological foundation leading tolater and 8 of Zero to Three into the Journal of Day difficulties in the preschool and school-age Care Debate,I am writing to contribute years. The latter viev, is consistent with our another viewpoint to the fruitful exchanges long-standing beliefs about infancy asa emerging from Jay Belsky's review of day formative period, but implies much less care research (Zero to Three, September 1986). plasticity to early development than may It concerns the use of attachment theory actually be true (see Thompson, in pressIal). as a prism through which Belsky interprets If Belsky is correct, it certainly heightens the findings from this research literature. concern of parents and practitioners as well Attachment theory figures prominently in as researchers about how early day care Belsky's review in several ways. First,it experience may shape not only current but galvanizes his concern about the possibly also subsequent socioemotional develop- detrimental effects of day care because, as ment. Whether the secur- he notes, attachment theory underscores the Although Belsky is correct that attach- ity of attachment importance of the infant's confidence in the ment theorists argue that there is continuity caregiver's accessibility which might be in how successfully a child negotiates devel- predicts later socio- threatened by early, repeated daily separa- opmentally appropriate taskswith a secure emotional func- tions. Second, attachment theory inclines attachment in infancy providing the basis for more optimal later socioemotional tioning depends on Belsky to interpret a baby's distance- maintenance or avoidance of the mother as functioning (see Ainsworth, Blehar, Waters, the degree of con- reflecting an insecure attachment relation- & Wall, 1978; Sroufe, 1979)such a view sistency in the ship (rather than, say, precocious independ- is not entirely supported by the relevant ence or simply a different social style). Third, research evidence. Instead, in a comprehen- child's caregiving attachment theory leads Belsky to associate sive review of the attachment literature, my conditions over this infantile behavior with the antisocial colleagues andIrecently concluded that time. behavior sometimes observed in preschool- whether the security of attachment predicts ers with day care experience, arguing that later socioemotional functioning depends on early attachment insecurity places a child "at- the degree of consistency in the child's risk" for subsequent social difficulties of this caregiving conditions over time (see Lamb, kind. Thompson, Gardner, & Charnov, 1985). Each of these theoretical assumptions is When attachment ispredictive of later controversial, but it is the third assumption behavior, it is usually when there is sub- which merits especially critical attention by stantial consistency in caregiving influences students of early development. It is one thing over this period (indeed, some samples have to argue that early, extended day care ex- been specifically selected for consistency in perience may not foster optimal socioemo- care). In contrast, when conditions of care tional functioning in infancy (a point to change markedly (e.g., a new primary care- which I shall later return); it is another to giver, or the same caregiver under markedly suggest that such experiences provide a different social conditions, or additions or

130Attachment Theory and Day Care Research I 4., changes in substitute caregivers), attach- are strong links between later behavior and ment relationships themselves tend to the quality of care the child experiences change and do not predict the child's later (Belsky, in press). This picture is sensible if behavior very well. we assume that children's behavior as pre- We thus concluded that a secure or in- schoolers is affected not only by early day secure attachment by itself does not neces- rare experience, but also by subsequent sarily foreshadow later socioemotional experiences of care which may maintain or functioning, but rather early attachment change these early influences. status combined with consistent caregiving In short, a secure or insecure attachment influences which help to maintain and in infancy, by itself, does not lead inevitably support early influences on the child may to certain psychosocial outcomes in children; predict later development. This makes sense, it is the ongoing quality and consistency of of course, when we appreciate that a young care which isimportant. If caregiving child's personality is shaped by long-term conditions change in the early years (which caregiving influences, with contemporary is more likely in day care than home-reared influences having at least as important an children) it may be more difficult to predict effect on the child as past influences. Over later outcomes based on early caregiving time, for example, experiences of sensitive, influences alone. We need to look, in responsive parental care which contributed addition, at the quality and consistency of initially to a secure attachment may lead also later care. to a child's positive, prosocial behavior as a This is not meant to imply that if early preschooler, but not unless those patterns day care experience contributes to insecure of care are maintained. In a sense, then, a attachments, we should not be concerned. secure or insecure attachment in infancy Rather, we should not assume that the Day care children provides a picture of current conditions of care, child's later socioemotional functioning is regularly expe- but cannot predict the child's later behavior necessarily impaired as a result. But does early unless those caregiving influences are day care experience contribute to attachment rience changes in maintained over time to shape the child's insecurity? My own review of the evidence their conditions of cited by Belsky leaves me with considerable later development also. care. This is an important conclusion when doubt that it does (see Thompson, in press discussing the effects of early day care [6]). One reasonisthat the evidence experience on attachment relationships and suggesting that early day care experience later socioemotional behavior, because day contributes to avoidant attachments is very care children regularly experience changes weak. For example, in Belsky's own study in their conditions of care (e.g., transitions (Belsky & Revine, in press) and in Barg low's to new caregivers or to new care arrange- research (Barg low, Vaughn, & Molitor, ments). Even if early day care experience 1987), between 26 percent and 31 percent contributed to the development of insecure of their day care subgroups were rated attachments (a conclusion of considerable insecure-avoidant in the Strange Situation, debate, as Belsky acknowledges), the later which is somewhat higher than average. consequences of this would be hard to pre- However, their home-reared or low-day- dictinlight of the diverse subsequent care comparison groups also had a higher- caregiving influences these children are likely than-usual proportion of securely attached to experience. And, in fact, this is consistent infants (65 percent to 79 percent, depending with the empirical picture: Preschoolers with on the subsample), leading to group differ- day care experience show a range of positive ences which were partly a result of char- as well as negative social behaviors, they acteristics of the comparison groups used. exhibit negative behaviors which often When I instead compared the patterns of diminish and disappear over tune, and there attachment described by Ainsworth and her

1-"4,0+ Attachment Theory and Day Care Research131 colleagues (1978), I could find no significant to attachment insecurity issufficiently differences in the security of attachment compelling to describe early day care as a between them. In short, while infants with "risk factor" for problems in early socioemo- substantial day care experience inthese tional development (see Thompson, in studies did show a somewhat elevated press[b)). Taken together, I think the only proportion of avoidance attachments (al- scientifically justifiable conclusion which though the majority were securely attached), social scientists can offer when asked by the difference was not substantial enough policymakers about the effects of early day to mark their overall pattern of attachments care experience is: "We still don't know." as significantly different from the norm. While such a conclusion is inconsistent with Furthermore, we must exercise consider- the researcher's desire to be authoritative able caution in interpreting avoidant behav- and knowledgeable when asked for policy ior in the Strange Situation as reflecting an recommendations, it not only fairly repres- insecure attachment relationship when day ents the current state of our knowledge in care samples are concerned. Itis wise to this area, but also acknowledges the other remember that the Strange Situation has considerations which must legitimately play been validated primarily for American a role in this policy debate. middle-class samples, the large majority of One such issue which has remained sur- which were likely to have been home-reared prisingly unaddressed by researchers con- at the time these studies were conducted. cerns the quality of care which is normatively Variations in cultu- The cross-cultural studies of attachment available to young families seeking out-of- using the Strange Situation procedure (see home care for their infants and young chil- ral child-rearing Lamb et al., 1985, for a review) have con- dren. It is very expensive to provide good practices seem to vinced most researchers that a child's per- quality infant care, and the quality of day affect Strange sonal history must be considered very care- care which is accessible to such families is fully when interpreting his or her Strange further undermined by the financial limita- Situation behavior. Situation behavior, because variations in tions they experience in the cost of care they cultural child-rearing practices (such as those can afford, as well as the generally high relating to the frequency of contact with turnover of child-care workers, wide-spread strangers, regularity of separations from social perceptions that caring for young mother, and other factors) seem to affect children is essentially "unskilled" labor, and Strange Situation behavior in ways which the general unwillingness of state and federal may be independent of the security of the governments to regulate the quality of early infant mother attachment relationship. Since care or subsidize its expense (see Young & day care infants differ from home-reared Zig ler, 1986). Although we have some in- babies in precisely those ways which these formation concerning the links between the cross-cultural studies have found to be quality of early care and its effects on young important (i.e., experience with strangers, children (see, for example, Ruopp, Travers, separations from mother), it is reasonable Glantz, & Coe len, 1979), we have yet to to question whether the Strange Situation apply these findings to a systematic analysis behavior of day care infants means the same of the quality of care which istypically thing as it does with home-reared infants. availableand affordable--to most of the Until we are certain that it does, the use families who employ such services. of the Strange Situation as the primary index Given the impediments to the availability of attachment in evaluating the effects of of high quality yet affordable out-of-home early day care experience must be done with care for young children noted above,I considerable interpretational caution. remain concerned about the growing use of There are other reasons to doubt that the infant day care services in this country. But evidence linking early day care experience not for the reasons Belsky indicates. Instead,

132Attachment Theory and Day Care Research I am concerned that the quality of care which Lamb, ME, Thompson, RA, Gardner, WP, & is normatively accessible to young families Charnov, EL. 1985. Infant-mother attachment. Hills- dale, NJ: Erlbaum does not satisfy the minimal standards which Ruopp, R, Travers, J, Glantz, F, & Coe len, C. existing research indicates fosters healthy 1979. Children at the center. Cambridge, MA: Abt early socioemotional development. But this Associates. remains a research issue, and one which I Sroufe, LA. 1979. Socioemotional development. hope the critics and advocates of early out- In JD Osofsky (Ed.), Handbook of infant deoelopment of-home care will address shortly. (pp. 462-516). New York: Wiley. Thompson, RA. In press (al. Construction and reconstruction of early attachments: Taking perspective on attachment theory and research. References In DP Keating & H Rosen (Eds.), Constructivist perspectives on atypical development and development psy- Ainsworth, MDS, Blehar, MC, Waters, E, & chopathology. Hillsdale, NJ: Erlbaum. Wall, S. 1978. Patterns of attachment. Hillsdale, NJ: Erlbaum. Thompson, RA. In pressfbl. The effects of infant day care through the prism of attachment Barg low, F, Vaughn, BE, & Molitor, N. 1987. theory: A critical appraisal. Early Childhood Research Effects of maternal absence due to employment Quarterly. on the quality of infant-mother attachment in a low-risk sample. Child Development, 58, 945-954. Young, KT, & Zigler, E. 1986. Infant and toddler day care: Regulations and policy implica- Belsky, J. In press. The "effects" of infant day tions. American Journal of Orthopsychiatry, 56, 43-55. care reconsidered. Early Childhood Research Quarterly. Belsky, J, & Rovine, MJ. In press. Nonmaternal care in the first year of life and security of infant-parent attachment. Child Development.

Attachment Theory and Day Care Research 133 Some Further Comments About Infant Day-Care Research

by Peter Barg low, M.D.

In the September, 1986 and February, 1987 meticulous observations can go up in issues of Zero to Three, the subject of day- smokeand Ihave a potential problem care for infants under one year of age was following and recruiting research subjects. discussed extensively and heatedly. Using For instance, one of our project participants Belsky's citation of the soon-to-be-published who mistakingly concluded her baby was work of myself and my colleagues as my "insecurely attached," and therefore "dam- ticket of admission, I want to join the debate aged" on the basis of criticism of our study to ask if we cannot generate more light and in Glamor Magazine, promptly dropped out of I am quite worried less heat when we discuss this topic. I am our follow-up program. Complex ethical questions that urgently about the effect of quite worried about the effect of the recent national publicity generated by our debates, need to be addressed are obscured or left the recent national presentations and publications. When concealed by such public arguments. Do I have an obligation to tell a mother that her members of our child development academic publicity generated baby is insecurely attached, or at risk for community split into factions with leaders by our debates. heightened preschool aggressiveness? If so, that attack Belsky's ideas in public state- this feedback will obviously unpredictably ments such as, "I think it's bunkum" in the influence the psychosocial and developmen- pages of the Wall Street Journal (Ricks, 1987), tal data subsequently obtained. Will I even the publicalways fascinated by internecine get her cooperation for further studies? How squabbleswill suspect thatallof our can we best preserve the fragile observer/ carefully derived findings are ridiculous or study-subject alliance crucial to our work? meaningless. Without delving into the What is to compensate our subjects for the complex subject of how much of our science many hours they spend in filling out tedious is affected by presuppositions and bias, what, (to them) questionnaires and subjecting for example is the casual reader to think themselves to long hours of observation? of the objectivity of a researcher who Our program offers free future years' defiantly dedicates her pro day-care book to developmental consultation to parents her child who "spent his first year in day- whose research infants or their siblings have care so that this book could be written" later emotional difficulties. (When this (Clarke-Stewart, 1982)? When a distin- service is utilized, the subjects' data must ed developmental scientist joints the be eliminated from further study assess- fray by summarizing her view of the Ains- ment.) Goldberg (1979) has started to worth Strange Situation by quoting Rutter's evaluate these crucial questions with respect (1981) single, offhanded comment, question- to longitudinal infant studies. ing it as a "curious procedure ... obscure What can be done to confront the issues to the child" (Chess, 1987), thousands of in a more propitious atmosphere? I think 1

134Some Further Comments About Infant Day-Care Research we should avoid global statements about not day-care puts infants psychologically "at risk. The remark, "Belsky's admonition that risk." Factors relevant to vulnerability, such infant careapparently any nonmaternal as family stress, age at entry to day care, infant careexposes infants to risk quality of care, the infant's ',ender and (Phillips et al., 1987, p.18), raises the red flag physical health status, maternal attitudes of battle for parents, feminists and re- toward parenting and toward work, familial searchers alike, stimulating visions of ethnic and cultural identity, the soundness battered, abused babies, premature low birth of the parental marriage, and the mother's weight infants or offspring of substance separation anxiety, may be crucial. Nor abusing mothers. We need not only to should we overlook infant resilience factors specifyat risk for what(?) but to carefully such as those eloquently described in the limit the notion of what is implied by the Kauai Longitudinal Study (Werner and idea of "risk factor." To say that infants in Smith, 1982). Resilient children exposed to day care are "at risk" implies a concept of chronic, severe poverty, multiple perinatal a one-to-one correlation, a cause and effect risk factors and stress life events could use relationship that has no place in the "ameliorative factors in themselves and in quantitative statistical studies that charac- their caretaking environment" (p.133) on the terize developmentalists' work. The idea that path toward a successful developmental out- a certain specific outcome is due to a single come. This does not mean, however, that variable doesn't even apply in the realm of chronic poverty or "multiple perinatal the strictly biological and physiological. stresses," for example, are not "risk factors" It is unlikely that a Thoman and Becker (1979) have pointed out for the development of certain developmen- single variable, that the use of a single, independent variable tal problems. is invalid even for neurophysiological infant Can thes interacting variables be teased such as day-care, assessment and prediction. Even the seem- apart? We hope the answer is yes, but the can ever be shown process requires more carefully controlled ingly straightforward relationship between to have a one-to- the ingestion of a drug and its physiological and larger studies rather than further heated effect is complicated by such closely linked arguments based on ideology from either one correlation variables as the quantity of the drug side. Our own findings (Barg low, Vaughn with any outcome. administered, the mode of administration, & Molitor, 1987) regarding the effect of full- the time of administration, and interaction time working mothers on infant attachment with other drugs (;'..rn.ner et al, 1972). It were, in effect, serendipitouswe did not is even more unlikely that a single variable, start out studying the matter of day care such as day-care, can ever be shown to have at all, but began as an attempt to study the a one-to-one correlation with any outcome. association of maternal endorphin levels in To discern the effects of day-care requires pregnancy with pain perception during labor. considerably more complex methods than Because of the special characteristics of our does the determination of the physiological sample we were able to control for several effects of a drug. Studies regarding "risk confounding factors, such as low SES, high factors" for specific developmental outcomes familial stress, and the effects of group day- are more like investigations that determine care. Our research assessed 110 infants of if smoking is a risk factor for the develop- affluent, mostly upper-middle class parents, ment of lung cancer. Results are provided half of whom were cared for full-time by in terms of statistical correlations and a hier- the mother, and half of whom had in-home archy of contributants and host factors, not day-care provided by someone other than as single cause-effect relations. the mother because both parents had full- The issue of infant vulnerability in general time paid work commitments: (the mother is another important one not usually was out of the home because of work for addressed by heated debates on whether or a mean of 30 hours per week). I:

Some Further Comments About Infant Day-Care Research135 We unexpectadly found an increased in- subjects were not enthusiastic about inquiry cidence of avoidant attachment among first- directed toward their offspring's relationship born infants of the working mothers. We with the secondary caregiver, probably could not relate this finding to maternal because of a fear that they might have lost demographic, attitudinal, or personality the position of primary love object for their characteristics, or maternal judgments about children. offspring temperament, behavior, or devel- A relevant, recent psychoanalytic article opmental milestones as measured by a reported "estrangement from biological We obtained an battery of accepted psychological assessment mothers and intolerance of intimate relation- instruments. Ina subsequent effort we overall impression ships inanalytic patients with an early obtained preliminary data using Hock's history of primary surrogate mothering" that the alternative (DeMeis et al., 1986) scale, which suggested (Hardin, 1985, p. 628). The generalizability home care provid- that maternal separation anxiety related to of these findings is limited by the use of the mother's leaving her infant in someone ers offered a stable retrospective reviews of the patients' early else's care distinguished between securely lifes vents, rather than by prospective emotional environ- and insecurely attached infants of full-time information gathering with a defined data ment for children. working mothers, although in a counter- base. But care histories of individual children intuitive way, high maternal separation can yield valuable clues informing us "how anxiety was related to secure attachment the infant actually functions in the real (Barg low, Cory & Maloney, 1987). Gender world" (Thoman and Becker, 1979, p. 466). may also exert a significant influence But all the preceding questions become (Vaughn, 1987). harder to answer in a super-charged Obviously, we need to identify other atmosphere of confrontation. Angry charges covariates related to the mother's working and countercharges will not help any of us outside the home. We should, for example, to recruit new subjects that have the random evaluate the effects of the quality of all kinds distribution that we need for statistically of infant care, not just day-care. Such studies valid studies. Further ideological polarization should include evaluation of alternative care- will make the public consider all our research giving persons and the prolonged effect of "bunkum" if that is how we describe one other-than-mother secondary caregivers in another's work, instead of carefully assessing the home as well as in group settings its validity according to established scientific (Brazelton, 1986). Do the infants form criteria. secure attachments to their secondary caregivers? What is the effect of disruptions in that relationship? Possibly, infants with References strong emotional bonds to care providers other than the parents have a different Barglow, P, Vaughn, B, & Molitor, N. 1987. developmental pathway following the Effects of maternal absence due to employment on the quality of infant-mother attachment in a Strange Situation than that considered low-risk sample. Child Development, August, 1987. typical for children exclusively reared by In press. family members (Vaughn et al., 1985, pp. Belsky, J. 1986; 1987. Infant day care: A cause 115-16). for concern? Zero to Three, 6(5): 1-6, and 7(3): 22- In our just-completed study, we obtained 24. an overall impression that the alternative Brazelton, TB. 1986. Issues for working parents. home care providers offered a stable American Journal of Orthopsychiatry, 56, 14-25. Chess, S. 1987. Comments: Infant day-care: A emotional environment for children in the cause for concern. Zero to Three, 7(3): 24-24. home, but we could not quantify this Child Development. 1987. Special section on influence. Inquiry into this subject was structural equation modeling. Child Development, hampered by the fact that our working 58(1): 2-175.

1 :; '). 136Some Further Comments About Infant Day-Care Research Clarke-Stewart,A. 1982. Day-care.In J Bruner, Ricks, TE.1987.Day-care for infants is chal- M Cole & B Lloyd(Eds.), The Developing Child Ser- lenged by research on psychological risks.Wall ies,Cambridge, MA: Harvard University Press. Street Journal, Section2, March 3, 1987. DeMeis, DK,Hock, E, & McBride,SL. 1986. Thoman, EB, & Becker PT. 1079. Issues in The balance of employment and motherhood: assessment and prediction for the infant born at Longitudinal study of mothers' feelings about risk. In TM Field (Ed.),Infants Born At Risk.New separation from their first-born infants. York: SP Medical and Science Books. Developmental Psychology, 22(5): 627-632. Vaughn, BE, Deane, KE, & Waters, E. 1985. Goldberg, S.1979.The pragmatics and prob- The impact of out-of-home care on child- lems of longitudinal research with high risk mother attachment quality: Another look at infants. In TM Field (Ed.), InfantsBorn At Risk. some enduring questions. In I Bretherton & E New York: SP Medical and Science Books. Waters (Eds.),Growing Points of Attachment Theory and Research. Monographs of the Society for Research in Hardin, HH. 1985. On the vicissitudes of early Child Development,No.209, Vol. 50 (Nos. 102), pp. primary surrogate mothering.Journal of the Ameri- 110-135. can Psychoanalytic Association, 33(3): 609-630. Vaughn, BE. 1987. Infant Day-Care and Attach- Kraemer, HC, Korner, AF, & Thoman, EB. ment Security. Paper presentation accepted in 1972.Methodological considerations in evaluat- symposium (J Belsky, Chair),American Psychologi- ing the influence of drugs used during labor and New York City, August. delivery on the behavior of the newborn. cal Association, Developmental Psychology, 6:128-134. Werner, EE, & Smith, RS. 1982.Vulnerable but Invincible.New York: McGraw-Hill. Phillips, D, McCartney, K, Scarr, S, & Howes, C. 1987. Selective review of infant day-care research: A cause for concern.Zero to Three, 7(3): 8-21.

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Some Further Comments About Infant Day-Care Research 137 Infants, Families and Child Care:

TowardaResearch Agenda

Report to the field from a meeting of infant day care researchers convened by the Research Facilitation Committee of the National Center for Clinical Infant Programs

In recent months, experienced researchers College of Columbia University; Kathryn E. have made differing interpretations from Barnard, University of Washington; Jay data about the developmental effects of out- Belsky, Pennsylvania State University; of-home child care begun it-, the first year Alison Clarke-Stewart, University of of life. When reported in the popular press, California-Irvine; Byron Egeland, University these points of contrast may loom as of Minnesota; Ellen Galinsky, Bank Street fundamental disagreements; the scientific College of Education; Stanley Greenspan, community may appear to be creating George Washington University School of uncertainty among parents, professionals Medicine; Thomas J. Gamble, Edmund L. and policymakers rather than clarifying Thomas Adolescent Center, Erie, Pennsyl- important issues. vania; Carol lee Howes, University of California-Los Angeles; Michael Lamb, In order to examine areas of agreement National Institute for Child Health and as well as disagreement among investigators Human Development; Deborah Ann Phil- in the field of infant and toddler child care, lips, University of Virginia; Sally Provence, the National Center for Clinical Infant Yale Child Study Center; Marian Radke- Programs (NCCIP) convened a meeting Yarrow, National Institute of Mental Health; hosted by the National Academy of Sciences Henry Ricciuti, Cornell University; Albert and the Institute of Medicine in the fall of J. Solnit, Yale Child Study Center; Theodore 1987.Seventeenleadingchiidcare D. Wachs, Purdue University; and Edward researchers attended this "summit meeting," Zig ler, Yale University, who chaired the whose goals were: meeting. Also endorsing the statement were 1. to describe areas of agreement, if these T. Berry Brazelton, Harvard University; J. existed, concerning the effects of out-of- Ronald Lally, Far West Laboratory for home care initiated in the first year of life; Educational Research and Development; and and Sandra Scarr, University of Virginia. 2. to formulate, for the benefit of govern- A consensus, with implications for ment and private funding sources, an agenda policy priorities of unresolved research questions and pro- The chief area of consensus reached by mising approaches to investigation. researchers at the meeting involved the Researchers attending the NCCIP meet- importance of the quality of care provided ing included J. Lawrence Aber, III, Barnard to a child.

138Infants, Families and Child Care: Toward a Research Agenda Meeting participants emphasized that the toddlers and have access to stable child care quality of infant/toddler care matters arrangements featuring skilled, sensitive and enormously, whether it takes place in the motivated caregivers, there is every reason home or in a child care setting, and whether to beliebe that both children and families can the caregivers are a child's parents or another thrive. Such choices do not exist for many familiar trusted adult. According to the families in America today, and inadequate research group, both the home and the child care poses risks to the current well-being care environment should provide an infant and future development of infants, toddlers or toddler with: and their families, on whose productivity the country depends. physical protection and attention to The researchers therefore stressed the health and nutrition; urgent need for improved child care options awareness of and respect for individual and services for young children and families. differences in infants and toddlers; They emphasized specifically the need to sensitivity to the infant's cues and improve salaries, working conditions and communication; training for child care providers, whether in center-based or family day care settings. a capacity to shift caregiving practices as the infant develops and changes; and Issues in infal, it day care research warm, loving human relationships As the researchers convened by NCCIP based on constancy of care. began to formulate an agenda of unresolved Child care, the researchers stated, must researchquestionsandpromising be viewed as a support to the whole family. approaches to investigation, they noted a A comfortable "blend" and close collabora- number of factors that have constrained tion between parents and caregivers are infant day care research in this c-untry. important for the well-being and the Basic demographic information on the development of both children and parents. characteristics, employment experience and Throughout their discussion of current child care arrangements of families with efforts to understand the impact of infant infants and on staffing patterns and other day care on the development of children and characteristics of child care settings is lacking. parents, the researchers convened by The federal government began to collect NCCIP were acutely aware of the extremely rudimentary information on child care limited range of child care choices available arrangements of working families only in to most parents of young children. They 1982. noted that both mothers and fathers of During the last 20 years, child devel- young children are experiencing significant opment research in general has become stress and loss of productivity when high increasingly ecological inits approach. quality care for infants is not available and Because limited resources have tended to not affordable, and when staying at home constrain child care research to the exam- to care for an infant is not economically ination of only a few variables among the feasible. The researchers also agreed that complex interaction that characterizes family while further investigations are needed to life, researchers are unable to document, for understand the impact of aspects of child example, the extent to which family pro- care on development, our current state of cesses affect the choice of child care For knowledge provides clear criteria to distin- infants or, conversely, how the experiences guish high quality from inadequate care. of infants and parents with child care alter The researchers agreed that when parents family processes. It is impossible to look at have choices about selection and utilization findings of recent research and to say what of supplementary care for their infants and is cause, what correlation, particularly when

Infants, Families and Child Care: Toward a Research Agenda 139 samples are recruited from families who developmental outcome in unique, shared, have already decided to use supplemental and/or interactive ways, and the relative care for their infants. contributions of various factors to develop- Doubts concerning ecological validity mental outcome. surround some instruments or paradigms Family processes that are evident before in current use in child care research. Because parents decide whether or not to use any single instrument is subject to abuse, supplementary care for their infant (and thus multiple measures, including naturalistic before any given amount or type of care observation, are needed to assess the is chosen) would be a major area of study. complex phenomena that comprise infant Researchers would gather data concerning: and family development and the interaction socioeconomic status, family composi- among infants, parents, and caregivers. tion maternal level of education and other The value:, and attitudes reflected in demographic variables; the framing of research questions and the amount and sources of family stress; design of methodologies and instruments amount and sources of family social must be attended to. One must wonder, for support; example, how research questions change if one regards child care for infants as a parental feelings and attitudes about potential support to the development of separation and about supplemental care for babies and parents rather than as a potential infants; risk to their relationship or to the child's parents' sensitivity to their infant's developmental outcome. cues; Toward a research agenda parents' satisfaction in parenthood; To achieve greater understanding of the the infant's temperament, activity level developmental implications of day care for and other individual characteristics, includ- infants, the researchers convened by NCCIP ing any factors likely to pose a risk to optimal established the need to investigate the development. complex interaction among factors that The quality of care provided to infants influence the development of young children by both parents and supplementary caregiv- and families and the role of day care in the ers would be a second major area of inquiry. lives of infants, toddlers and their parents. Researchers would gather data concerning: The researchers recommended that a group the amount and characteristics of inter- of small, parallel, prospective, longitudinal action between adult(s) and infants; studies be undertaken. These would com- pare groups of children who will experience the stability and continuity of care; a variety of early child care circumstances. the temperament of the caregiver(s); Subjects should be selected at birth or shortly the level of education and specific thereafter, prior to parents' decision about knowledge of child development of care- the use of supplementary care for their giver(s); infant. Because the special interests and talents characteristics of the caregiving envir- of research groups around the country vary, onment, including health and safety, noise investigators participating in these studies level, visual appeal and comfort, amount of would be free to construct their own space, and number of children and adults research questions. In addition, however, all typically present. sites would gather certain common data. The In caregiving settings outside the home, goal of these research efforts would be to researchers would alsogather data discern how various factors contribute to concerning: .1:)6

140Infants, Families and Child Care: Toward a Research Agenda type of care (center based or family day the variables to be measured in this care, regulated or unregulated); collaborative research project and to agree o adult/child ratio; on appropriate measures of developmental outcome. The 1CCIP group agreed that a size of the group in which children are res-arch effort of this scope and duration cared for; would be expensive but urged public and the relationship between child care private funders to invest in an undertaking provider(s) and parent(s). so important to policymakers, scientists and A working group of researchers and parents alike. advisors should be formed to operationalize

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