Continuity of Care in Infant and Toddler Programs:

1
Continuity of Care in Infant and Toddler
Programs

• Lessons Learned From Teacher Training, Program
  Practices and Teacher Interviews
• Melissa Wilhelm, M.A.
• Mary Jane Chainsky, M.A.
• Debra Pacchiano, Ph.D.

2
OVERVIEW

• What is Continuity of Care?
• What have we done?
• Lessons Learned from our Teachers
• Implementation

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What is Continuity of Care?

• A program model which emphasizes minimal
  disruption to the relationship between teacher
  and child and teacher and parent

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Continuity of Care Program Models

• Mixed Age
• Group of children representing more than one age
  grouping
• teaching team stays the same, in the same room
• children enter and leave as age appropriate
• Cohort
• Group of children who are all within a relatively
  narrow age grouping
• same children and teaching team stay together for
  a period of years

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Why is Continuity of Care important?

• Early relationships are key to social-emotional
  development
• Healthy social-emotional development often
  determines whether a child is successful in
  school and life
• Children do not learn well when they do not feel
  safe and loved

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Overview of Attachment Theory

• Bowlby strong attachment leads to healthy
  social-emotional development
• Research shows importance of secure relationships
  in infancy
• Up to 50 of families living in poverty may have
  less than secure attachments (vs. 30 of all
  families)

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Overview of Attachment Theory

• Stressors may lead to less secure attachments
• High quality child care is an effective
  intervention for distressed and/or disorganized
  families
• Children experience stress when moved to new
  classrooms
• Stress interferes with development and the
  ability to learn--especially language

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Considerations for Program Design

• Relationships are the basis for healthy
  development for children
• Families, especially those under stress, also
  benefit from ongoing relationships
• Stress, caused by change and disruptions,
  interferes with development

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What have we done?

• Fall 2001 One mixed-age room
• Fall 2002 One cohort group
• Fall 2004 Six cohort groups and one mixed age
  group

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Why is it hard to do?

• Licensing/logistics/environment
• Staff buy-in
• Family buy-in

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What results have we seen?

• Language development isnt interrupted
• Family/staff relationships arent disrupted
• Staff develop broader understanding of child
  development
• Staff experience greater emotional satisfaction
  from longer-term relationships
• Healthy emotional development for children is
  promoted

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The Role of Family Support

• What are the advantages of having family support
  stay with a family for the entire stay in
  program?
• What are the complications?

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Whats Next?

• Lessons Learned From Teachers

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Lessons Learned for Training

• Teachers want to understand why CoC is important
• Teachers want reassurance they are doing the
  right thing

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Lessons Learned for Training

• Teachers want to understand why children who
  have a difficult time leaving their classroom may
  be stronger later
• Importance of CoC and childrens socio-emotional
  health
• Importance of CoC and application to attachment
  theory

16
Lessons Learned For Training

• A child development training focused on
  extending teachers practicing specialty is
  needed
• Expertise may be compartmentalized
• Expertise may not extend to bridge developmental
  stages between 0-3 3-5

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Lessons Learned For Training

• There are identifiable factors that influence
  the within group CoC transition Process
• Teachers want training on how to identify and
  work with different group dynamics
• Each CoC cohort is compose of children that are
  different
• When equipped with knowledge to identify
  individual markers-greater success in supporting
  CoC process

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Lessons Learned for Training

• Size of group has impact
• Children regressed when there wasnt a child that
  took the leadership role
• Special needs children must be given care in the
  group dynamics
• Identifying different learning styles of the
  children and how behavioral/learning styles
  manifest is critical

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Lessons Learned for Training

• Training Focused on engaging and fostering
  relationships with parents is needed
• Opportunity to partner with family support

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Lessons Learned for Training

• Trainings on routines and limits

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Lessons Learned for Implementation

• Encouraging Parental Involvement of CoC is
  important
• Extra Support is needed in Lesson Planning
• Additional support is needed to reduce paperwork
  demands!

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Lessons Learned for Implementation

• Teambuilding strategies for 0-3 3-5 Teaching
  staff is needed to foster comfort in
  exchanging/information about CoC children
• Fine balance in exchanging childs information

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Implementation What is the Role of Leadership?

• Setting Expectations
• Building community
• Encouraging support

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Lessons Learned for Implementation

• Factors influencing distressed children must be
  identified and processed
• Problem solving supports must be in place
• Reflective Supervision

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Lessons Learned for Implementation

• Pragmatic Preparations for 3-5 classrooms
• Encompass Developmental needs of transitioning
  children
• Materials and processes for toilet training
• Identified and incorporated PRIOR to transition
• Reflective Supervision