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Continuity of Care Research

Indiana University’s School of Education Professor McMullen’s latest research reminds us how special and unique babies really are. The article she based on her studies is titled Continuity of Care with Infants & Toddlers: Identifying Benefits and Addressing Common Concerns.

 
McMullen starts out by quoting renown philosopher Jean-Jacques Rousseau’s saying that “Human babies are not like us”, to remind us of the true uniqueness of the first years of a human being. “Children”, she says, “grow and develop more rapidly during the first three years of life than at any other time”(Shonkoff, & Phillips, 2000). This suggests that the beginning of a person’s life is the most important, as they will be shaped by all experiences they have in those first 36 months of life, whether they were good or bad. (McMullen, 2015).

 

That is why it is not surprising to see the large amount of publications, tv shows, songs, institutions, books, studies, toys, website, etc, dedicated to babies, especially those in their first three years of life. It is crucial to nurture, teach and take care of a child in the right way during that time.’

 
Given this importance to early childhood development, McMullen says that recent discoveries regarding these first three years are crucial to determine what child care should be like. Her main findings were that creating and maintaining healthy relationships that promote growth and learning are very important, as they depend on the caregiver.

 

A “highly qualified infant toddler professional caregiver” (McMullen, 2015), is described by her as someone who has in depth knowledge of child growth and development, and learning from ages zero to three. The person must also be skilled at being sensitive when responding to the “verbal and nonverbal communications” of infants and toddlers. The person in charge of the child has to form respectful relationships with families when setting goals and making caregiving decisions. And of course, the caregiver should get to know the child profoundly in the realms of their family and culture.

 
In order to accomplish all this, a caregiver must be “willing to invest time and energy toward building and maintaining strong interpersonal relationships between and among all of those in the child care environment – babies, professionals, and family members.” (McMullen, 2015). Additionally, there must be certain rules and procedures that back up those relationships, which will end up being the motor of the outside-of-home practices that will provide teachings that will last a lifetime. Quality relationships at this age are much more relevant than later in childhood.

 

Now, regarding infant toddler continuity of care (COC), McMullen says that it is designed to keep very young children together with their team of caregiving people for at least two to three years. To achieve this continuity of care, there are two methods. One involved mixed age grouping, and the other is the looping method. The multi age or mixed age grouping one has children ranging from young infants to toddlers and two year olds together in one room. As they outgrow the group, the kids leave, and younger ones enter it. In the looping model however, caregivers start with a designated group of infants, “sometimes as young as six-weeks old” (McMullen, 2015), and the groups stays together until they all turn three years old, and move on to pre-school. Then a new group moves in. No matter which of the two COC methods are used, the child begins and ends a three year program with the same caregiver and peers for the most part.

 
Less beneficious models however, are discontinuous. They consist of a schedule following a traditional school calendar, where children find themselves more stressed out as the process is not continual (Cryer et al., 2005). Their caregiver changes every year. In the other inconsistent model kids find themselves having to make new friends each year, as they are all evolving and leaving the group, while new ones come in. “Neither form of discontinuous care prioritizes the long-lasting, trusting relationships among caregiving professionals, children, and families known to facilitate attachment security” (McMullen, 2015). The more people who come and go in children’s first three years of life, the harder it is for them to adjust and build new relationships. COC groups on the other hand, create stability for families, children and professional caregivers for a longer period of time, allowing “knowledge of one another to grow and trusting relationships to flourish” (McCullen, 2015).

 

In COC, the relationship between babies and caregivers is much more secure and lasts a longer time. It is highly recommended to ensure productivity during the first three years of a human beings life. In fact, “it has been recommended by nearly all major professional organizations that address infant toddler practices, (…) that [it] demonstrates the lifelong impact of supportive, stable relationships that begin in infancy (Sroufe, 2005).”

 

These are the benefits that Professor McMullen found in her study of successful infant toddler COC (McMullen, Yun, Mihai, & Kim, 2015):

 

· Increased knowledge of child development since cregivers develop a better understanding of how children grow and develop from age zero to three;

 
· Stronger knowledge of individual children because cregivers develop even more in-depth knowledge of each child and their families to make care more individual

 

· Decreased stress, as parents, caregivers (McMullen et al., 2015), and children (Cryer et al., 2005) feel less stressed in COC compared to discontinuous care where they experience go through multiple transitions and frequent breaking and restructuring of important relationships;

 

· Smoother developmental progress, because there is less starting, stopping, and starting over again, children make more steady, even developmental progress, experiencing less regression;

 

· Easier adaptation to preschool since children transitioning to preschool after infant toddler COC do much better knowing how to use the environment and socialize with peers;

 

· Stronger family-caregiver partnerships as parents and caregivers in COC build stronger relationships that value each other’s expertise regarding decision-making and goal-setting;

 

· Parents empowered because COC parents become empowered to be strong advocates for their children, an empowerment that carries through to formal schooling;

 

· Family-like atmosphere where parents and caregivers develop a closeness that is similar to feelings they have for their own family members and close friends;

 

· Increased sensitive-responsiveness because caregivers are more likely to respond in sensitively responsive ways to infants and toddlers (Ruprecht, Elicker, & Choi, 2015);

 

· Improved behavior of children when caregivers in COC identify fewer behavioral concerns for infants and toddlers than those in discontinuous care (Ruprecht, Elicker, & Choi); and

 

· More secure attachments where infants and toddlers in COC with the same caregivers for at least 12 months create stronger, more secure attachments (Raikes, 1993).

 

Despite the notorious benefits, caregivers and families are not used to the COC system. Some think it would be too hard to implement, as it would take physical restructuring, which can be costly and careful replanning. Others think families or caregivers won’t like it, as parents may feel they are “stuck” with the same caregiver for three years, when they haven’t truly developed a positive relationship with them. Some caregivers have expressed fear saying that they are only good with a certain age of toddlers, but when COC was put into practice, they truly enjoyed the advantages of “watching the children in their care develop and took pride in being a part of that growth and change. They also appreciated the opportunity to grow, themselves, as professionals with increased knowledge and skills throughout birth to age three” (McCullen, 2015).

 

Others believe that life is full of change, and children must learn that from a young age, but her studies show that a strong solid base will be better for children as they prepare for their future lives.
McCullen then refers back to Rousseau’s words, “written so long ago that “human babies are not like us.” Infants and toddlers have needs, interests, preferences, and capabilities that are different from those of older children and adults, and thus need to be supported differently.” (2015).

 

It is important to understand the life lasting impact that the role of caregivers has in the first three years of a child’s life. To initiate COC however, a daycare must first make sure it has proper group sizes, safe environments, qualified staff, a consistent program philosophy and strong leadership and administrative structures. (Ackerman, 2009; Garrity, Longstreth, & Alwashmi, 2015; Norris, 2010).
Last but not least, “COC is the icing on the cake for an already strong, quality setting, serving to increase the overall quality and ensure the best possible experiences for children as they live, love, work and play through their days in infant toddler child care settings” (McMullen, 2015). And that is crucial.

 

McMullen, M, Na Ra Yun, Mihai, A, & Kim, H. (2015). Continuity of Care with Infants & Toddlers: Identifying Benefits and Addressing Common Concerns.

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