AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
MARY KAY KENNEY: Okay. I'm going to talk about addressing parents' concerns about development, development in early childhood development is a time of tremendous growth in all aspects of development, physical, social, emotional, intellectual, and it's a time when early life, quality early life experiences can have a tremendous impact on enhancing a child's resiliency and optimizing its development. It's a time when problems are identified early they can be addressed effectively and some of the long‑term consequences can be reduced or eliminated. And it's a time if there are risks in the social environment, also they can be minimized if early intervention occurs.
This is a model that's often used by the early childhood school readiness field, and it's comprehensive in that it recognizes that there are a variety of factors that influence a child's development.
A child has intrinsic capacities which unfold through sequential stages, each of which has its own goals. But also the family and local and institutions and community also have a tremendous impact on the child's development and those particularly things like pediatric healthcare system and early childhood care and education.
The community material and cultural resources and safety are also factors. What I'm going to talk about is the state, involves the state childhood comprehensive systems. It's a national initiative for states through the Maternal Child Health Bureau to support Title V agencies and MCH agencies to partner with organizations in efforts to strengthen the state's early childhood systems, services for young children.
These grants have five core service components. And they are the mental health and social/emotional development, medical home, parent education, family support services, early child care and education services.
And what states are supposed to do is to scan their environments and look for all the services, programs within the state that address any of these needs and all of these needs, and integrate and coordinate those services so that they have comprehensive programs.
The purpose of this presentation is to demonstrate the feasibility of using data from the national survey of children's health as national and state level indicators for monitoring achievement of the SEECS initiatives. One of the things they'll have to do is to show that they're well managed, but also that they have achieved results, that the interventions that they have generated are making, are providing some benefit to families and making things different for children and families.
So the variables from the national survey that I am going to focus on are variables that are reflected both in the model that I showed you of early school readiness and also reflected in the SEEC initiatives, they're parents' concerns about development and those are specific developmental concerns that parents have in speech and language, gross and fine motor skills, socialization behavior and physical health. And also medical home is one of the programs that MCHB considers a high priority and this is for children to have a healthcare provider that knows them, sees them on an ongoing basis through a cross the development and is in a unique position to coordinate services for them.
Another area is parent coping, and family cohesion. There are a number of variables in the survey that could serve as proxies for these constructs. And I will be choosing a few of them, but there are many. If you learn more about the national survey, you can see a wide variety of questions that address those constructs. And then final early child care and education.
These are the specific questions that parents are asked about whether they have development concerns. The carrier question as shown at the top is: Are you concerned a lot, a little or not at all about how your child and then the center shows the completed questions or the questions that complete that carrier question within three developmental stages. So it covers the stages of infancy, toddler and preschool years.
And in the four to nine month age range, parents are asked: Are you concerned a lot, a little or not at all about how your child makes speech sounds and understands what you say.
On the right hand you can see that comes under the language domain. They're asked how if they have concerns about whether how their child uses hands and fingers, those related to fine motor, small muscle skills and hand eye coordination, and concerned about how he uses his arms or legs. So it's a gross motor skills and how the child maneuvers himself within the environment physically.
In the 10 to 17 month age range, they're asked the first four questions, but also whether they have concerns about the child's behavior, how he gets along with others, and about his learning to do things for himself, which are behavior, socialization and self‑care skills.
So they're asked that group of seven questions. The first seven questions in that age range. From 18 to 71 months, that is the only group that's asked about their learning preschool and school skills.
But there are also the 18 to 71 month old age range there also asked the previous seven questions. So they get all the questions.
Here's some of the findings. In the blue, you see the parents who are unconcerned. They are the ones that responded not at all, that they had no concerns about their children. That's about 73% of all the parents who responded to the question.
In the yellow is the parents who are slightly concerned and those that responded said they were a little concerned about their child's development in one or more areas. And in the red, and that's about 26%.
And then the red is the very concerned parents, and that's parents who responded they were concerned a lot about one or more areas of development. That's about 11% of the parents.
Here are ‑‑ this is a rank ordering of parental concerns from the highest on the left to the lowest on the right. These are all what I'm going to do from this point on is dichotomize into very concerned parents and all other parents. So all other parents include those who are unconcerned and those who are only slightly concerned.
So as you can see, something that's interesting to me but what I should say first is this very small range of difference among the areas that it's between four and six percent, but the area of greatest concern is understanding and speaking.
It's interesting to note that there are about, at the age of around three, there are, it's an incidence of about six percent who have speech and language disorders. And that diminishes to about three percent around the age of six. So there's a wide variability in development of speech and language skills and much of which ameliorates just with development.
Then the other areas of greatest concern are behavior, and learning and socialization. Those are fine and gross motor skills are of least concern.
Turning to the medical home, these are some of the components of medical home. Medical home is a broad issue, involves a number of different aspects. What we would like to see in a medical home is that the children have a personal doctor. So on the left you see the parents who are very concerned and those who all other parents responded that they do, their child does have a personal doctor, with about the same level of frequency and it's not a significant difference.
But when you look at parents, when the parents were asked if they could call their doctor, their personal doctor and receive help over the phone or whether they, if their child was injured or very sick, could they get prompt care, the parents who were very concerned only responded affirmatively to about 69% of the time compared to 82% of parents who were not very concerned and that was a significant difference.
And we do like to see at least the very concerned parents because they generally do have legitimate concerns is that they would be, receive as much prompt advice and care as children of parents who don't have concerns.
This aspect of the medical home deals with specialty care and care coordination. Something with which parents or children who have developmental concerns would probably make more use of. If with regard to specialty care and that is if parents ‑‑ parents were asked if they had any problems receiving specialty care, referrals for special services from their doctor and whether they received care coordination by their medical home.
In the first case, as far as specialty care, the parents, the very concerned parents received more referrals from their personal physician, but there wasn't a significant difference between very concerned parents and those who weren't very concerned. With regard to care coordination also they received more care coordination, which is appropriate. But what is significant about this in general is that around 50% or less of very concerned parents are receiving specialty care and referrals for special care and care coordination in medical home.
Another general question to parents was whether their doctors spent time and explained things to them. And very concerned parents were significantly responded affirmatively, significantly less often.
Again, relating to the medical home, these were parents who had all visited the doctor within the previous 12 months and they were asked if the doctor had asked about their concerns and if they had concerns were they given information about their concerns. And in both cases there's a significant difference between very concerned parents and parents who are not concerned, but again the significant overall picture here is that less than 50% of very concerned parents were asked about their concerns or were given information.
Turning now to parent coping. These are responses of parents who all said they were coping very well and the very concerned parents were not ‑‑ were less frequently or less likely to say that they were coping very well than the other parents.
And specifically they were asked some questions about how often they felt that they were, the feelings of being bothered a lot by their child's behavior, feelings that the child was more difficult to care for than other children, and how often they felt they were angry at their child because of the things that he did. And in all cases there was a significant difference between the parents who were very concerned and those who were not.
And so this would indicate that these children who may be at risk for developmental concerns are experiencing possibly some aggravated parenting which can sort of, it can exacerbate the problems that they may have.
As proxies for family cohesion, the family cohesion construct, there are questions about how many outings the parents are, that the family does together. And these outings can include anywhere from grocery shopping or going to parks, malls, zoos, libraries, that sort of thing, and how many family meals they eat together.
And what I did is I took those who responded that they had four or more family outings a year and compared the very concerned and the unconcerned parents and there was a statistical difference between those, that group and also there's statistical difference between very concerned and not very concerned parents and whether they had five or more meals together a week.
Also with regard to family cohesion, the frequency of the percentage of parents, families who attend religious services regularly, that is, what I chose was once a week or more, was about the same. However, there was a significant difference in the percentage of families that read five or more, read stories to their children five or more times a week.
And this is significant with respect to the developmental concerns that I pointed out earlier, because reading stories is a very good tool to use with children who have understanding and speaking problems. And so it would be an area which parents who are very concerned about that area of development would like to see them doing more of that.
With regard to early child care, there are many more, the trend is for more and more families to be seeking quality child care and it's been shown that good quality child care services can have, it has a modest but important association with cognitive development.
And other areas of development and so what the MCHB is working on trying to develop some standards for the early child care so that parents who have to entrust their child to someone externally, that they have some confidence that their child is going to be cared for properly. And just to give you an idea of how many people, how many children are nonparental child care, this shows that about 65% are receiving nonparental child care as opposed to 35% who are not receiving that.
The survey asked if parents have had any difficulties in making child care arrangements at the last minute or if they have any job‑related problems, job problems that are related to child care, whether they've had to make changes in their job or quit a job for the purposes of, because of the child care issues. And about 67% of parents who need child care said that they had one or more child care issues.
And this is the breakdown of very concerned parents versus other parents. 42% who had one or more child care issues, very concerned parents versus 33, and that was a significant difference.
So I'd like to conclude with some remarks about the data that you've seen. What I've tried to show is that the national survey of children's health provides national and can provide state level estimates for the majority of SECCS focus areas and that sub populations of young children and families with relatively greater needs can be identified from the data.
And also this data has possibilities for providing baselines and for monitoring progress of those SECC initiatives. And that would provide an evidence base for policy decisions related to systems of services for children and their families.
And with that, I will conclude and if you have any questions.