Nutrition Education Resources in North Carolina-Based Head Start Preschool Programs: Administrator and Teacher Perceptions of Availability and Use.

OBJECTIVE: The purpose of this study was to provide new insight into common barriers to the availability and use of nutrition education (NE) resources in Head Start preschool programs based on administrator and teacher perceptions. METHODS: In-depth, semistructured phone interviews (n = 63) were conducted with administrators (n = 31) and teachers (n = 32) from North Carolina-based Head Start programs. Interviews were audio-recorded and transcribed verbatim. Data were analyzed qualitatively using content analysis to identify common themes. RESULTS: Five emergent themes were identified within the areas of NE resource availability and use and barriers to NE resource availability and use. Participants expressed desire for greater organization of existing NE material resources, increased community support, and professional development opportunities for teachers specific to NE. Funding and time constraints were reported as affecting NE resources. CONCLUSIONS AND IMPLICATIONS: Creative strategies for addressing NE resource availability and use and barriers (eg, NE integration with educational standards) in Head Start are needed.

Classifying infants and toddlers with developmental vulnerability: who is most likely to receive early intervention?

BACKGROUND: Infants and toddlers with developmental difficulties represent a heterogeneous group who often receives early intervention (EI). Notable population heterogeneity exists and complicates unmet need and effectiveness research. However, a mix of relatively homogeneous clinically policy relevant 'subgroups' may create the apparent heterogeneity. To date, methodological challenges have impeded identifying these potential groups and their policy-relevance. METHODS: From the 2005-2006 National Survey of Children with Special Health Care Needs, we derived a sample (n = 965) of infants and toddlers with parent-reported developmental difficulties. We used latent class analysis (LCA) to identify subgroups of developmental vulnerability based upon functional, social and biological characteristics that would make children eligible for EI. Mixture modelling estimated the likelihood of each subgroup receiving parent-reported EI, controlling for race/ethnicity, child's age, and state of residence. RESULTS: LCA identified four distinct subgroups of developmental vulnerability: developmental disability (Group 1), mild developmental delay (Group 2), socially at risk with behaviour problems (Group 3), and socially at risk with functional vision difficulties (Group 4). Black, non-Hispanic children are significantly more likely than their white counterparts to be in Group 3 (ß = 1.52, P = 0.001) or group 4 (ß = 1.83, P < 0.001). Compared with children with a mild developmental delay (Group 2), children in group 1 (ß = -0.61, P < 0.001), group 3 (ß = -0.47, P = 0.001) and group 4 (ß = -0.38, P = 0.009) are significantly less likely to receive EI. CONCLUSIONS: Racial and ethnic differences exist with regard to membership in developmental vulnerability subgroups. Observed inconsistencies in access to EI suggest the need for improved surveillance, referral and outreach.

Can state early intervention programs meet the increased demand of children suspected of having autism spectrum disorders?

OBJECTIVE: To determine whether Early Intervention programs have the capacity to accommodate the expected increase in referrals following the American Academy of Pediatrics' 2007 recommendation for universal screening of 18- and 24-month-old children for Autism Spectrum Disorders (ASD). METHOD: We conducted a telephone survey of all state and territory early. Intervention coordinators about the demand for ASD evaluations, services, and program capacity. We used multivariate models to examine state-level factors associated with the capacity to serve children with ASD. RESULTS: Fifty-two of the 57 coordinators (91%) responded to the survey. Most states reported an increase in demand for ASD-related evaluations (65%) and services (58%) since 2007. In addition, 46% reported that their current capacity poses a challenge to meeting the 45-day time limit for creating the Individualized Family Service Plan. Many states reported that they have shortages of ASD-related personnel, including behavioral therapists (89%), speech-language pathologists (82%), and occupational therapists (79%). Among states that reported the number of service hours (n = 34) 44% indicated that children with ASD receive 5 or fewer weekly service hours. Multivariate models showed that states with a higher percentage of African-American and Latino children were more likely to have provider shortages whereas states with higher population densities were more likely to offer a greater number of service hours. CONCLUSION: Many Early Intervention programs may not have the capability to address the expected increase in demand for ASD services. Early Intervention programs will likely need enhanced resources to provide all children with suspected ASD with appropriate evaluations and services.

Community management of intellectual disabilities in Pakistan: a mixed methods study.

BACKGROUND: Pakistan has one of the highest reported rates of childhood intellectual disabilities (ID) in the world. Prevalence estimates vary from 19.1/1000 for serious ID to 65/1000 for mild ID. METHODS: We surveyed carers of persons with ID (n = 100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers (n = 16) and key primary health providers (n = 10). We also carried out focus groups (n = 7). Data were triangulated and interpreted in light of peer reviewed literature. RESULTS: There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean Self-Reporting Questionnaire score 8.4; 95% CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with ID contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for ID. CONCLUSIONS: Our findings suggest that there is significant delay in detection of ID especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost-effective, community level interventions, which can be integrated into existing healthcare systems.

Atendimento a portadores de visäo subnormal: estudo retrospectivo de 317 casos / A retrospective study of 317 cases of low vision

A eficiência no uso do resíduo visual é de suma importância para pessoas portadoras de visäo subnormal (VSN). Atualmente, observa-se um crescente empenho de profissionais da área de saúde e educaçäo especial, tanto no sentido de minimizar os severos atrasos do desenvolvimento, bem como melhorar a utilizaçäo da visäo residual. O uso indiscriminado do termo cegueira tem frequentemente dificultado o reconhecimento das necessidades do paciente deficiente visual desencorajando-o a usar o potencial de visäo que ainda possui. Em alguns casos esses indivíduos säo treinados para usarem apenas o tato e a audiçäo. Os autores analisaram os prontuários de pacientes portadores de visäo subnormal, considerando idade, sexo e patologias encontradas nos primeiros 317 pacientes atendidos no Departamento de Visäo Subnormal, enfatizando a importância do precoce atendimento oftalmológico especializado

Changing demographics: past and future demands for early childhood programs.

This article provides a historical analysis of how demographic changes in the organization of American family life from the mid-1800s to the present have shaped the demand for programs to complement the efforts of families to educate and care for their children. The author asserts that the United States is in the midst of a second child care revolution. The first occurred in the late 1800s, when families left farming to enable fathers to take jobs in urban areas and when compulsory free public schooling was established for children age six and above. The second has developed over the past 55 years as the proportion of children under six living in families with two wage earners or a single working parent has escalated and propelled more and more young children into the early childhood care and education programs discussed throughout this journal issue. Looking to the future, the author sees indications that the demand for early childhood care and education programs will continue to grow while the needs of the children to be served will become increasingly diverse. To meet these dual pressures, the author argues that public funding for early childhood programs--like funding for public schools--is justified by the value such programs have for the broader society.

Links between early childhood programs and maternal employment in three countries.

Early childhood programs are usually viewed as a service that promotes children's development. In addition, these programs often serve a broader purpose of enabling mothers with young children to join the paid labor force. Therefore, government policies relating to the provision and use of child care programs reflect such economic and social factors as the demand for women workers in the labor market; expectations of the relationship among government, family, and the private market; and the value placed on maintaining traditional family structures with a breadwinner, a homemaker, and children. This article examines the evolution of policies toward maternal employment and child care provision in the United States, Sweden, and the Netherlands--three countries that differ sharply in the extent of government involvement in child and family policy, and in the emphasis government leaders place on promoting or discouraging maternal employment. This analysis shows that child care policy is best viewed as but one element among many that make it more or less likely that mothers of young children will be employed and will need to rely on early childhood programs to care for their youngsters. The design of tax codes, labor laws, parental leave policies, and cash assistance programs combines with child care policies to shape women's choices about employment.