Theory and Research Methods by qlz83622

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									   Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing


                                 Theory and Research Methods

Ecological Model of Human Relationships within Societal Subsystems
To affect systems change requires understanding the multiple and interacting social, cultural,
and political environments that surround a child’s development (Berk, 2006).                  Utilizing
Bronfenbrenner’s ecological theory (1979), five subsystems are relevant to creating a
coordinated system to address social-emotional problems in young children. The child is
affected directly or indirectly by each subsystem; hence each level must be assessed.
Considering      issues    in
one subsystem without
analyzing its affect on
other     subsystems      can
undermine attempts to
fashion             effective
interventions.      Figure 6
represents    the    system
layers, with the child and
family situated at the
center.
                                Figure 6: Ecological model of early childhood development. Adapted
                                from Urie Bronfenbrenner, The ecology of human development:
                                Experiments by nature and design (1979).


For our purpose, the framework has been modified to better represent the subsystems
addressed in this report. At the center are the child’s interactions with immediate family
members. The second ring represents the child’s connections to other family members,
childcare providers, peer group, and local neighborhood. The third ring, “Community Supports,”
captures the community level resources and informal support systems such as churches,
community centers, local markets and fairs. The fourth ring, “Public and Private Agencies,”
refers to the formal organizations that affect the child and family, such as child welfare, the
medical community, and schools. The outer ring, “Systems,” refers to the laws, policies, and
financing mechanisms affecting prevention, early identification and service delivery for social-
emotional behavior of the young child. Culture permeates each of these rings from family to
community to organizations to normative perspectives that are embedded in public policies.




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   Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing

The framework helps organize a complex system and direct efforts more effectively.                     An
effective integrated system must address availability and accessibility of quality services;
cultural responsiveness; education and training of parents, providers, and the medical
community; and policy and financing to create a sustainable system. For example, changes in
the healthcare system such as expanding insurance coverage will be only a partial solution to
improving access if clinics and primary care physicians are not located in neighborhoods with a
high density of vulnerable children. Similarly, community-based healthcare and public education
campaigns that do not adapt to the cultural values and expectations of its target population will
be underutilized and less applicable to the everyday lives of families and daycare providers
who are directly involved with children experiencing social-emotional problems (Huang, 2002;
Conner, 2004; Colorado Institute of Public Policy, 2007).


In addition, the ecological systems perspective is congruent with the transactional model of child
development (Sameroff, 1993) that sees a child as “a product of his or her dynamic interaction
with the family and other components of the social environment” (Simpson, Jivanjee, Koroloff,
Doerfler, & Garcia, 2001: 28). The field of neurobiological research continues to evolve in its
understanding of emotional development as it relates to the young child’s brain development.
Based on new findings in brain development, we now know that the brain develops rapidly
during the prenatal period and from birth to age three. This forms the foundation for children’s
healthy development through life. It is during this time period, that they develop their cognitive,
language, emotional and social abilities through the interaction of brain development and
experience (Shonkoff & Phillips, 2000). Also known is that chronic traumatic stress, abuse, and
neglect affect the brain’s impulse control (Karr-Morse         & Wiley, 1997; Simpson, Jivanjee,
Koroloff, Doerfler, & Garcia, 2001). Throughout the report, the ecological framework will serve
as a template for connecting these pieces.


Data Collection and Analysis
Worchester et al (2008) persuasively argue for the inclusion of family’s experiences raising a
child with challenging behaviors when identifying problems, designing programs, and crafting
policies. Ultimately, the determination of whether a program or system is successful must be
based on the fundamental outcomes families seek: improved quality of life for their child(ren)
and themselves (Osher, 1998; Connor, 2004).




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  Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing

To include the family and provider voice during the research process, CSI partnered with ACY
to collect information from Denver families and providers caring for young children as ACY had
the needed connections and their trust (Connor, 2004). In total, there were 212 participants
(see Figures 1 and 2). The surveys collected information from parents, home-based providers,
and child care center providers through open-ended questions. The surveys and Community
Conversations focused on the experiences and services needed as identified by parents and
providers. The community survey instrument and Community Conversations group discussion
questions are reproduced in Appendix B.


Community Surveys
ACY distributed the community survey at five community group meetings that were already
scheduled during August and September 2008. Using these “natural connections” allowed for
quick access to providers and families, and importantly captured the voices of many who
typically fall through the cracks of standard survey sampling techniques. In total, 87 surveys
were collected.




                  Figure 7. Community groups surveyed and language spoken, n=87.


Forty-one percent of the respondents completed the survey in Spanish, 59% provided the
answers in English. Families were more likely to be Spanish speakers, while over two-thirds of
the providers were English speakers. Unknown is the number of respondents who may have
been bi-lingual. Table 2 below provides this breakdown.




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   Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing

Table 2. Community survey demographics: Type of provider by language spoken
                                      All Providers         English speaker        Spanish speaker
        Respondent Type
                                          (n=84)                 (n=51)                (n=33)
Center child care provider (n=51)          59%                    71%                     29%
Parent (n=22)                              25%                    64%                     36%
Home child care provider (n=10)            11%                    10%                     90%
Other (n=1)                                5%                      0%                    100%
TOTAL                                     100%                    59%                     41%


Community Conversations
A total of 125 people participated in one of 10 Community Conversations discussions. The size
of the groups varied from a low of four participants to a high of 32 participants (see Figure 8
below). Providers and family members participated in the Community Conversations at an
existing        organizational
meeting, e.g., a monthly
meeting, or at a separate
discussion group arranged
by ACY. Daycare and food
were provided to those who
participated outside of a
regular meeting.



Figure 8. Community
Conversations participants,
n=125.




Analysis of Data
The surveys and Community Conversations focused on the needed experiences and services
identified by parents and providers. The surveys collected information through open-ended
questions plus two demographic questions (language spoken and type of provider). The
answers were content coded and analyzed with statistical software.                  The Community
Conversations group discussions were summarized by the ACY facilitator and subsequently
coded by CSI using qualitative data management and analysis techniques. Information from the
key informant interviews conducted by CSI provided detail and up-to-date information on
programs and policies relevant to Denver and Colorado.

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   Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing

The Report
Chapters 1 – 5 provide the results of the input from the community, literature review, and best
and promising programs that are Denver-specific, Colorado-based, other states, and national
models.    While many of the themes are informed by all the sources, there are important
differences in identified needs, resources, and methods for addressing early childhood social-
emotional problems. In particular, people directly involved with children – family members and
childcare providers – bring a set of concerns and solutions not always found in the literature and
best practices. Incorporating the experiences and desired goals of those in closest contact with
a child highlights the importance of addressing systematically the inner rings of the ecological
model (see Figure 6). Table 3 below provides a quick view of the sources that inform the
themes within each chapter.


Table 3. Areas and themes by sources addressed in each chapter




                                                                          Home-based




                                                                                                                 Reports &
                                                                           Providers



                                                                                       Providers




                                                                                                                 Literature
                                                                                                       Members
                                                                                        Center-



                                                                                                        Family
                                                                                        based
 Chapter 1: ACCESS TO & AVAILABILITY OF SERVICES



 Theme 1      Information availability                                       X              X            X          X
 Theme 2      Social marketing                                               X              X            X          X
 Theme 3      Referral sources                                                                           X          X
 Theme 4      Language barriers                                              X                           X          X
 Theme 5      Community-centered                                             X              X            X          X
 Theme 6      Early identification and intervention                                         X                       X
                                                                                        Center-based
                                                                          Home-based




                                                                                                                 Reports and
                                                                           Providers


                                                                                         Providers




                                                                                                                  Literature
                                                                                                       Members
                                                                                                        Family



 Chapter 2: CULTURAL RESPONSIVENESS



 Theme 1      Services                                                       X                           X          X
 Theme 2      Education materials/training                                   X              X            X          X
 Theme 3      Evaluation and assessment                                                                             X
                                                                                        Center-based
                                                                          Home-based




                                                                                                                 Reports and
                                                                           Providers


                                                                                         Providers




                                                                                                                  Literature
                                                                                                       Members
                                                                                                        Family




 Chapter 3: QUALITY of SERVICES



 Theme 1      Good reputations                                              X              X            X



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   Social-Emotional Health of Young Children, Birth – 5 Years of Age: Research, Policy and Financing


 Theme 2      Best and promising practices                                                                            X
 Theme 3      Evaluation for improvement and accountability                                                           X




                                                                                          Center-based
                                                                             Home-based




                                                                                                                   Reports and
                                                                              Providers


                                                                                           Providers




                                                                                                                    Literature
                                                                                                         Members
                                                                                                          Family
 Chapter 4: EDUCATION for ACTION



 Theme 1      Families                                                         X             X            X           X
 Theme 2      Home-based childcare center providers                            X             X                        X




                                                                                          Center-based
                                                                             Home-based




                                                                                                                   Reports and
                                                                              Providers


                                                                                           Providers




                                                                                                                    Literature
                                                                                                         Members
                                                                                                          Family
 Chapter 5: CROSS SYSTEM-LEVEL COLLABORATION,
            MONITORING AND FINANCING


 Theme 1      Coordinated early childhood mental health system                               X                        X
 Theme 2      Building capacity in the early childhood mental health field                                            X
 Theme 3      Strategic financing                                                                                     X
 Theme 4      Data and evaluation                                                                                     X


The Report’s Strengths and Limitations
Finally, it is important to note the strengths and limitations of the research report. Information
collected from the survey and the Community Conversations with Denver families and childcare
providers serves as the foundation for the report and sets the direction for each chapter.
Literature follows and confirms what was learned from Denver’s families and providers. The
literature also adds new information and identifies best and promising practices. A compilation
from recent environmental scans identified over 150 resources in Denver and the metropolitan
area (see Appendix A).


While the list of Denver resources is extensive, the capacity of organizations to provide support
and/or services for early childhood mental health still needs to be determined. In addition, needs
assessments that identify health disparities and geographical mapping of where vulnerable
children live have been conducted; however, missing is an asset-based community assessment
of Denver’s neighborhoods that captures the informal supports on which families rely. The
literature on cultural competency and the best practice, System of Care, argue that community
strengths, not just deficits, need to be known in order to create a true partnership with
communities and effectively address system change.



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                                                                                               June 2009

								
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