The purpose of this descriptive research was to study the actual condition of caregiver perceptions of child health care literacy and prioritize child caregivers’ needs related to child health care literacy. The sample consisted of 389 child caregivers who were working in child development centers under a local government organization. The research instrument consisted of the caregivers’ child health care literacy questionnaire. The reliability of the questionnaire was 0.94 using Omega coefficient. Data was analyzed using frequencies, percentages, means, standard deviation, and modified priority needs index (PNImodified). The findings showed that, regarding the reality of child caregiver perceptions of child health literacy, the overall mean score was high. Considering health literacy, it was found that caregivers had the most access to health information and services. As for nurturing care, it was found that caregivers had provided the most security and safety. The results of the prioritized needs assessment for health literacy found that health knowledge and understanding, communication skills, media-literacy, good health, and adequate nutrition care were the most important needs for literacy of child caregivers in providing early childhood health care. The findings from this study provide basic information about literacy in early childhood health care of child caregivers in child development centers. These findings will benefit local government organizations in more effectively enhancing caregivers’ child health care literacy.
Courtney C. Waltonab* , Margaret S. Osbornecd , Paul Gilberte & James Kirbyfg a Elite Sports and Mental Health, Orygen, Melbourne, Australiab Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australiac Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australiad Melbourne Conservatorium of Music, The University of Melbourne, Melbourne, Australiae Centre for Compassion Research and Training, College of Health and Social Care Research Centre, University of Derby, Derby, UKf School of Psychology, The University of Queensland, Brisbane, Australiag Compassionate Mind Research Group, The University of Queensland, Brisbane, AustraliaCONTACT Courtney C. Walton courtney.walton@orygen.org.auABSTRACTPerformers, such as athletes, actors, dancers, and musicians, function within high pressure competitive and often hostile or critical environments. These individuals can be prone to a range of self-critical cognitions and behaviours which may make them susceptible to mental ill-health and psychological distress. Fostering and nurturing self-compassion is one approach to motivating behaviour and health which may be relevant within training and support settings. Self-compassion has been associated with a range of positive outcomes in the general community, as well as in those functioning in performance spaces, primarily sport. In this commentary, we outline why cultivation of self-compassion may be an increasingly valuable method for psychologists working with individuals from these environments, particularly within the context of a decimated industry during the global pandemic. We provide a brief overview of relevant research, before exploring practical and applied approaches (including transcripts) that can be used within therapeutic settings.KEY POINTSWhat is already known about this topic: Performers such as athletes, dancers, actors, and musicians are exposed to a range of stressors which can increase susceptibility to mental ill-health.Self-compassion can be cultivated in therapy and is associated with better mental health outcomes.Due to a range of hostile self-critical tendencies that are commonly seen in performers, some individuals may be resistant to concepts of self-compassion.What this topic adds: We outline a rationale for why psychologists working with performers should aim to nurture self-compassionate tendencies and practices.We outline methods and practical approaches to doing this in session, as well as describe potential hurdles and barriers for implementation.
Courtney Campbell Walton, Margaret S. Osborne, Paul Gilbert et al.
Concerns have grown regarding the increased prevalence of social, emotional and behavioural difficulties observed in young children in primary school settings. Contributory factors are multiple and varied but one consistent emphasis has been on the negative effects of children’s poor attachments with significant others which, due to contextual factors, may not have developed sufficiently. Some groups of children are more at risk of not developing strong attachments, particularly children in care whose ‘pre-care’ and ‘in care’ experiences make it more likely that their attachments will have been adversely impacted. Reflecting this increasing concern, there has been a growth of school-based interventions that aim to strengthen attachments in order that children can develop social and emotional skills; thus enabling them to be better placed to access learning opportunities and reach levels of educational achievement and attainment similar to their peers. One such intervention is Nurture Groups, modelled on attachment theory. Nurture Group provision is a short-term, schools-based intervention targeted at individual children beginning school who are already displaying social, emotional and/or behavioural difficulties. This article reports the findings of one of the first larger-scale evaluations of the effectiveness of Nurture Group provision in improving outcomes of children, and the first to explore the differential effects of Nurture Groups in relation to school-, pupil- and programme-level characteristics. The evaluation used a non-random control group design, involving a total sample of 384 children, aged 5–6 years, from 30 Nurture Group schools and a further 14 matched schools with no Nurture Group provision in Northern Ireland. The trial found effect sizes ranging in magnitude from g = 0.528 to 1.352 for a range of social, emotional and behavioural outcomes, using the Boxall Profile and the Strengths and Difficulties Questionnaire. However, no evidence of effects was found for academic outcomes. The article discusses the implications for policy and practice of the findings.
Ensuring that the package of services \nprovided during the first 1 000 days is more \ncomprehensive, and includes the services \nenvisaged in the Nurturing Care Framework \nand the ECD Policy, will require substantial \nchanges in how services are organised, \ndelivered and monitored.
Lesley Bamford, Patricia Martin, Wiedaad Slemming et al.
Child poverty and social exclusion affect children from their beginnings. Investing in nurturing care and quality services in children's earliest years is essential for tackling poverty, inequality and social exclusion. The European Child Guarantee, along with other European Union (EU) initiatives, is a huge opportunity to invest in early childhood at the national level and make a real difference to the lives of millions of children across the EU. Every Member State has children at risk of poverty or social exclusion. While every country is different, all must be ambitious and demonstrate strong political will to implement EU policies on the ground.
Investment in early childhood produces healthier and more productive adults, benefiting families, communities and countries.Carers need support in providing nurturing care, but there is little information on what is required to achieve acceptable, affordable and effective early childhood development (ECD) in resource-constrained environments.Uganda has identified human capital development as a key priority.In Uganda, an estimated 75-80 per cent of 3-6-year-olds have no toys and are not engaged in learning.Uganda has established a national Secretariat to support ECD and there is political will to define a multi-sectoral programme with low resource requirements.This study aimed to understand the characteristics of an acceptable, scalable and effective ECD intervention in Uganda.This study finds the discourse around ECD has not yet moved from 'survive' to 'thrive,' with nutrition and child health programming such as immunisation widely conflated with ECD.Intelligence is seen as innate, with carers believing they have little influence over cognitive development.Language and beliefs around child stimulation will need to be carefully constructed, given the significant and persistent negative impact of poverty and malnutrition on both child survival and the potential for child stimulation in this context.
Daniel Llywelyn Strachan, Lydia Kabwijamu, Monica Okuga et al.
Early childhood is the most crucial period for the overall development of children. Adequate health care, nutrition, security, safety, responsive caregiving, and opportunities for early learning during this period are essential for children to achieve their full human potential. Poor health and growth during early childhood has life-long consequences. Children need nurturing care during their early years to grow into healthy, intellectually capable, socially, and emotionally mature individuals. The World Health Organization (WHO) nurturing care framework encompasses five key early childhood development (ECD) elements - health, nutrition, security and safety, responsive caregiving, and opportunities for early learning. Committed to improving the overall development of the state’s children, the state leadership was keen to improve ECD policy, strengthen and expand the outreach of ECD programs at the community level. Learning from the experiences of other states, the Government of Meghalaya specifically wanted to test the feasibility of using the Meghalaya State Rural Livelihood Society (MSRLS) platform to promote ECD at the community level. This report provides a comprehensive description of the technical assistance (TA), the key results and outcomes, and the policy implications. Section one introduces the ECD conceptual framework and provides the background and overview of the TA engagement. Section two, context and rationale for the TA incudes a brief discussion of the need for ECD that highlights the evidence base for ECD interventions and the returns on ECD investments, followed by the current situation of ECD in India and Meghalaya. Section three is dedicated to the description of the feasibility study - its components, methodology, design, implementation, assessment, and results. Section four discusses the dissemination of results, the policy implications and the Government of Meghalaya’s proposal to scale-up ECD interventions in the state.
I have been privileged to participate, lead, or observe countless reports of how the coronavirus disease 2019 (COVID-19) pandemic impacts the well-being of anesthesiologists and a consistent theme is the role of leadership in establishing esprit de corps. I have spent the past few years studying well-being, implementing initiatives, and generally talking, writing, and thinking about wellness. I would like to offer my observations of how the pandemic affects anesthesiologists now, will affect us during the catch-up phase, and how leaders can mitigate that stress. Listening to my colleagues around the country, it is clear that many are far more worried about the personal impact of the recovery than the initial first wave of the COVID-19 pandemic. If we are currently in the “Great Pause,” we will next be entering the “Great Catch-Up.” Morale must be nurtured, and it will likely be greatly strained heading into the slog of “catching up.” Some leaders seem to take morale for granted out of a sense of expected professionalism, forgetting that the best of us can become strained over time. Dedicated professionals stretched too thin for too long can burn out, disengage, get depressed, or tragically even become suicidal.1 The times we find ourselves in are most certainly a strain, but the unknown we will venture into following this will be done without any of the usual comforts of normalcy we have come to rely on for rejuvenation, reassurance, and endurance. The need for compassionate, honest, and servant leadership will be profound, whether you are leading a team in the operating room (OR) or a department. SOURCES OF CHALLENGE Articulating the personal impacts of the COVID-19 pandemic may help us address them. The short list below of stress sources is designed to start the conversation, but integral to meaningful self-compassion is this acknowledgment: whatever you are experiencing is a normal human response to an extraordinary human event. What we do as leaders can open a safe space for people to better express their needs and for us to meet them. The Practice of Medicine Clinicians are no stranger to long hours, death, and tragedy, but for those on the very front lines of this pandemic, those experiences are being amplified and repeated. I won’t even begin to describe the deluge of traumatic daily events many in our ranks are experiencing—I’ll leave that for them to express as only someone who has walked through a thing can. Physical Health Personal risk stokes anxiety about the availability, use, and reuse of personal protective equipment (PPE), risk of illness to self or family, and the emotional impact of caring for a sick colleague. This rightfully has been the primary “wellness” focus during the pandemic. Psychological Safety “Gaslighting,” or attempting to convince someone of something that is contrary to what they know to be true, can be psychologically disorienting. With fluctuating, and occasionally contradictory, local and national recommendations on PPE and practice, one can easily see how this perception can needlessly develop. This highlights the need for honest, transparent, and consistent communication from leadership that acknowledges the unprecedented nature of the challenge, and that we are working outside of what we previously felt was optimized practice (eg, reuse of single-use PPE). There is a vast difference between saying: “You don’t need PPE because this situation is far safer than we thought” and “Look, we don’t have enough masks and we need to think outside the box to conserve them for the very highest risk situations.” Training Stressors Trainees may have either copious free time with limited educational experiences or responsibilities beyond their capabilities, unclear supervisory chains, and taxing duty hours, despite the Accreditation Council for Graduate Medical Education (ACGME) affirming its nonnegotiable commitment to appropriate PPE, supervision, and duty hours.2 Financial Stressors Financial strain affects clinicians from trainees to near-retirees. Trainees may see expected jobs disappear or may find themselves unable to obtain board certifications linked to bonuses. Some practicing clinicians are facing pay cuts or even unemployment. Concerns about the financial effects lingering for months exacerbate clinician’s worries about debt repayment, childcare costs, and anticipated retirement dates. Family Stressors Clinicians at all stages feel familial pressures and limited bandwidth to comfort and serve loved ones. Anyone with small children understands the chasm between a “vacation” and a “family trip.” Families previously relying on daycares, schools, and activities scramble to find solutions while still having work obligations from home. At home, they may need to relieve a partner who has been trying to work from home, learn how to homeschool and reassure bored and anxious children. Some clinicians are directly caring or indirectly monitoring older relatives and may be further stressed by a lack of information. Bringing home illness to the family harangues minute-by-minute behavior when working. Existing familial stressors are aggravated, including sensitive issues of domestic violence, illness, and financial insecurity. Social Stressors Forced home by quarantine, illness or furlough or living away from family, isolation limits life-sustaining connectivity. Also, social distancing and travel restrictions have eliminated countless trips and vacations. For those already experiencing burnout, these are not mere frivolities, but often lifelines and sources of restoration and hope. Professionalism Stressors Lurking feelings of inadequacy or guilt may plague clinicians faced with the accomplishments of colleagues, particularly those who are willingly working outside of their expertise, unable to practice or with minimal patient care-loads. Other activities related to career and promotion are also stalled, including interviews, presentations, and networking at national meetings, visiting professorships, and lectures. SOURCES OF REMEDY I would like to highlight some preferable organizational behaviors. I also want to emphasize that this situation exposes the human toll of what we do and does create an opening for people to be more proactive about their own well-being. We ought to both meet this need and seize this opportunity Occupational Health We all watch the news and understand that there is not enough PPE to use in the manner we have always been taught is “best” for this situation. We must continue to advocate for the safest modes of conservation and limited reuse of PPE, industrious test usage, and meticulous workflows to limit PPE waste. Leaders must openly discuss concerns regarding limited PPE and explain the rationale for their organization’s decisions. Wellness Resources Copious resources are being developed or offered gratis in areas like physical fitness, mindfulness, entertainment, and childhood education. Collation of these resources is being done by nearly every national organization (eg, American Board of Anesthesiologists, American Society of Anesthesiologists, American Medical Association) and these lists, complemented with existing and emerging local resources, should be provided to clinicians. Low utilization of effective resources should not occur due to a lack of awareness. Childcare Emergency childcare is offered through established portals (eg, Care.com) or newly created exchanges (eg, preclinical medical students hoping to help in a tangible way). Departments and organizations should assess the needs of clinicians to establish who is being disproportionately affected by the lack of childcare, especially as we head into periods of “catch-up” work with extended hours when these needs may escalate. Peer Support Peer support is established as a particularly effective method of recovery following traumatic events.3,4 Many departments already have peer support programs, but for those who do not or who have nascent programs, it is critical to encourage proactive informal peer support. Connectivity Varied methods of virtual connectivity reduce isolation and foster community. These can be in the form of virtual daily briefings, social gatherings, education and instruction (I’ve seen everything from meditation to sourdough bread making), or psychological support sessions. Secure messaging applications (eg, Slack) to rapidly disseminate information and encouragement in a way that is too cumbersome through traditional e-mail can also be helpful in organizing the mountains of new information we must master. Career Issues Some are experiencing career-defining periods of rapid academic productivity due to the increase in nonclinical time, while others with primary care giving responsibilities are unable to seize 30 minutes of uninterrupted time and thus find themselves academically stalled. These opportunity disparities must be taken into account moving forward for those in academic medicine, especially when we enter the “catch-up” phase. Offering a grace period of 6–24 months for productivity requirements could address these concerns. Morale Beyond all of these areas, discrete and intentional methods of specifically nurturing morale are vital, especially as we head into the arduous task of “catching up.” Express gratitude a lot. Feed people often. Reach out, be extra kind and extra patient. Listen to and laugh with your colleagues. Ultimately, a happy team is an effective team.5 Leadership Leaders in these times can offer stability in times of great uncertainty. Shanafelt et al6 described the characteristics of leaders associated with lower rates of burnout and found that literally every good leadership practice helped. In a time when people are looking to their leaders more than ever, I would emphasize again a continued commitment to encouraging proactive self-care and utilization of well-being resources according to each’s need. Offer honesty and transparency, knowing how educated those led already are, hopefully avoiding those “gaslighting” moments of false reassurance. Additionally, even the best leaders will have blind spots, so establishing lines of anonymous feedback will yield concerns not previously acknowledged (eg, intermittently monitored, single-question online survey left open as a “comment box”). Finally, just as with our patients, in times of stress, people will often not fully digest everything said to them, so repetition, while sometimes frustrating, is important. Morale is likely high right now due to astounding camaraderie, but that may be challenged on reentry as we wade into our new normal, requiring redoubled well-being efforts going forward. Proactive morale building and connectivity fostering, coupled with transparent and honest leadership, will be critical. DISCLOSURES Name: Amy E. Vinson, MD. Contribution: This author wrote the entire manuscript. Conflicts of Interest: A. E. Vinson is the Chair of the American Society of Anesthesiologists’ Committee on Physician Well-being. This manuscript was handled by: James A. DiNardo, MD, FAAP.
Background: Lack of childcare for children aged 0-3 years has emerged as a global crisis, accentuated by women's increasing workforce participation and recognition that young children require nurturing care. Through this systematic review, we sought to examine associations between childcare centre attendance in low- and middle-income countries (LMICs) and children's health, growth, and development, and to generate childcare centre programmatic and research recommendations for children aged 0-3 years. Methods: We systematically searched PsycINFO, MEDLINE, PubMed, and Cochrane for articles on centre-based childcare for children aged 0-3 years in LMICs, published between 2000 and 2021 in English (or which were translated into English). We excluded articles on specialised subgroups or interventions. We imported the retrieved articles into Covidence for review and assessed them for bias using the National Institutes of Health (NIH) quality assessment tool. Results: Twenty-two articles (24 studies) met the inclusion criteria, encompassing 36 927 children from 10 countries across Mexico and South America (n = 12), Africa (n = 5), and Asia (n = 5). Outcomes included health (n = 12), growth/nutrition (n = 6), and development (n = 6). Study quality assessments were low; 41% exceeded 50% of quality criteria and 45% adjusted for confounders. Associations between childcare attendance and outcome measures were primarily negative for health (n/N = 7/12) and positive for growth/nutrition (n/N = 5/6) and development (n/N = 4/6). Childcare centre programmatic recommendations for children aged 0-3 years included: age-specific policies; program quality, including safety, hygiene, nutrition, and curriculum; access and affordability; parent engagement; financial support; and workforce development. Research recommendations included: study design, including enrolment age, frequency, duration, childcare type, home and childcare sociodemographic and cultural environments, child and caregiver outcomes, and analytical approaches; longitudinal studies; and implementation research. Conclusions: Rigorous primary research in global childcare for young children is urgently needed. Policies, programmes, and investments in high-quality childcare can promote nurturing care for young children, enabling mothers to participate in the workforce. Registration: PROSPERO: CRD42018105576.
Farah Behbehani, Alysse J. Kowalski, Helina Selam et al.
Attachment Biobehavioral Catch-up (ABC; Dozier et al., 2006) is a 10-week, in-home intervention primarily for early childhood aged children (ages 6 months-2 years). The ABC intervention seeks to teach parents how to provide nurturing care and engage in appropriate interactions with their children. ABC has been identified as a Level 1 evidence-based practice by the California Evidence-Based Clearinghouse for Child Welfare. However, to date, there has been no systematic review presenting the overall evidence behind ABC available in a peer-reviewed journal. The objective of this review is to address this gap by synthesizing prior literature and evidence, specifically evidence from randomized control trials (RCTs), regarding the effectiveness of the ABC intervention and to determine the contexts in which the intervention has been implemented. To complete this review, literature was searched across three bibliographic databases and relevant Web sites. Only RCTs examining child outcomes were included in the review. Using identified search procedures, 10 articles discussing RCTs which tested the efficacy of ABC were identified. Findings indicate that ABC is effective, when implemented with child-welfare-involved children, at improving emotion regulation, improving externalizing and internalizing behaviors, increasing normative developmental functioning, and attachment quality. Sample information from the 10 RCTs identified is presented as well as additional study characteristics.
