Effect of child care subsidies on price and quality of care for low -income families

This dissertation examines the effect of regulations, resource and referral agencies, and subsidies on price and quality of care in child care centers. This research is based on a carefully developed conceptual framework that incorporates the factors affecting the demand and supply of child care. The first step in developing this framework is sketching out the structural equations. The structural equations help us understand the underlying behavior of individuals and firms making a decision. The exogenous variables are vector of attributes relating to family characteristics, child characteristics, regulations, subsidy, community characteristics and prices of inputs. Based on the structural equations, reduced form equations are estimated to find the effect of each of the exogenous variables on each of the endogenous variables. Reduced form equations help us answer public policy questions. The sample for this study is from the 1990 Profile of Child Care Settings (PCCS) data in which 2,089 center based programs were interviewed.^ Child/Staff Ratio (Group Level). Results indicate that among subsidies, only the state subsidy per child in poverty has a significant effect on the child/staff ratio at the group level. Presence of resource and referral agencies also increase the child/staff ratio at the group level. Also when the maximum center group size regulation for 25-36 months becomes more stringent, the child/staff ratio at the group level decreases.^ Child/Staff Ratio (Center Level). When the regulations for the maximum child/staff ratio for age groups 13-24 months and 37-60 months become lax, the child/staff ratio for the center increases. As the regulation for maximum group size for infants becomes stringent, the child/staff ratio decreases. An interesting finding is that as the regulations for maximum group size for age groups 13-24 months and 25-36 months become stringent, the child/staff ratio for the center increases. Another significant finding is that when a center is located in a rural area the child/staff ratio is significantly lower.^ Center Weighted Average Hourly Fees. Maximum group size regulations for age groups 25-36 months and 37-60 months have a negative effect on center hourly fee. Maximum child staff regulations for age groups 13-24 months and 37-60 months have a negative effect on center hourly fee. Maximum child staff regulations for age groups 0-12 months and 25-36 months have a positive effect on center hourly fee. Findings also indicate that the center average hourly price is lower when there is a resource and referral agency present. Cost adjusted prekindergarten funds and JOBS child care subsidies have a negative effect on average hourly fee. Cost adjusted social services block grant and state subsidy per child in poverty have a positive effect on the average hourly price. A major finding of this dissertation is the interaction of subsidy and regulatory variables.^ Another major finding is that child/staff ratio at the group level is lower when there is an interaction between geographic location and nature of center sponsorship. ^

Occupational therapists' attitudes toward family -centered care

The purpose of this study was to examine pediatric occupational therapists attitudes towards family-centered care. Specific attributes identified by the literature (professional characteristics, educational experiences and organizational culture) were investigated to determine their influence on these attitudes. Study participants were 250 pediatric occupational therapists who were randomly selected from the American Occupational Therapy Association special interest sections. ^ Participants received a mail packet with three instruments to complete and mail back within 2 weeks. The instruments were (a) the Professional Attitude Scale, (b) the Professional Characteristics Questionnaire, and (c) the Family-Centered Program Rating Scale. There was a 50% return rate. Data analysis was conducted in SPSS using descriptive statistics, correlations and regression analysis. ^ The analysis showed that pediatric occupational therapists working in various practice settings demonstrate favorable attitudes toward family-centered care as measured by the Professional Attitude Scale. There was no correlation between professional characteristics and educational experiences to therapists' attitudes. A moderate correlation (r = .368, p < .05) was found between the occupational therapists attitudes and the organizational culture of their workplaces. A factor analysis was conducted on the organizational culture instrument (FamPRS) as this sample was exclusively pediatric occupational therapists and the original sample was interdisciplinary professionals. Two factors were extracted using a principal components extraction and varimax rotation, in addition to examination of the scree plot. These two factors accounted for 50% of the total variance of the scores on the instrument. Factor 1, called empowerment accounted for 45.6% of the variance, and Factor 2, responsiveness accounted for 4.3% of the variance of the entire instrument. Stepwise regression analysis demonstrated that these two factors accounted for 16% of the variance toward attitudes clinicians hold toward family-centered care. These factors support the tenets of family-centered care; empowering parents to be leaders in their child's health care and helping organizations become more responsive to family needs. ^ These study findings suggest that organizational culture has some influence on occupational therapists attitudes toward family-centered care (R 2 = .16). These findings suggest educators should consider families as valuable resources when considering program planning in family-centered care at preservice and workplace settings. ^

Effect of child care subsidies on price and quality of care for low -income families

This dissertation examines the effect of regulations, resource and referral agencies, and subsidies on price and quality of care in child care centers. This research is based on a carefully developed conceptual framework that incorporates the factors affecting the demand and supply of child care. The first step in developing this framework is sketching out the structural equations. The structural equations help us understand the underlying behavior of individuals and firms making a decision. The exogenous variables are vector of attributes relating to family characteristics, child characteristics, regulations, subsidy, community characteristics and prices of inputs. Based on the structural equations, reduced form equations are estimated to find the effect of each of the exogenous variables on each of the endogenous variables. Reduced form equations help us answer public policy questions. The sample for this study is from the 1990 Profile of Child Care Settings (PCCS) data in which 2,089 center based programs were interviewed. Child/Staff Ratio (Group Level): Results indicate that among subsidies, only the state subsidy per child in poverty has a significant effect on the child/staff ratio at the group level. Presence of resource and referral agencies also increase the child/staff ratio at the group level. Also when the maximum center group size regulation for 25-36 months becomes more stringent, the child/staff ratio at the group level decreases. Child/Staff Ratio (Center Level): When the regulations for the maximum child/staff ratio for age groups 13-24 months and 37-60 months become lax, the child/staff ratio for the center increases. As the regulation for maximum group size for infants becomes stringent, the child/staff ratio decreases. An interesting finding is that as the regulations for maximum group size for age groups 13-24 months and 25-36 months become stringent, the child/staff ratio for the center increases. Another significant finding is that when a center is located in a rural area the child/staff ratio is significantly lower. Center Weighted Average Hourly Fees: Maximum group size regulations for age groups 25-36 months and 37-60 months have a negative effect on center hourly fee. Maximum child staff regulations for age groups 13-24 months and 37-60 months have a negative effect on center hourly fee. Maximum child staff regulations for age groups 0-12 months and 25-36 months have a positive effect on center hourly fee. Findings also indicate that the center average hourly price is lower when there is a resource and referral agency present. Cost adjusted prekindergarten funds and JOBS child care subsidies have a negative effect on average hourly fee. Cost adjusted social services block grant and state subsidy per child in poverty have a positive effect on the average hourly price. A major finding of this dissertation is the interaction of subsidy and regulatory variables. Another major finding is that child/staff ratio at the group level is lower when there is an interaction between geographic location and nature of center sponsorship.

Effects of Family, Child, and Teacher Demographics on Prekindergarten Children's Access to and Use of Numeracy and Spatial Materials in the Early Education Setting

Florida’s Voluntary Pre-Kindergarten program (VPK) aims to ensure that all 4-year-olds are prepared to excel in K-12 mathematics. Early numeracy/spatial skills are predictive of success in K–12 mathematics. No research has examined whether VPK classrooms are equipped with the materials necessary to teach numeracy/spatial skill. The Pre-Kindergarten Numeracy and Spatial Environment Survey was created to examine the frequency of access to and use of numeracy/spatial materials in VPK classrooms. The 69-item survey was completed by the lead educator from a sample of 62 pre-kindergarten classrooms in Miami-Dade County. Regression analysis results suggest the location of the pre-kindergarten center, the sex distribution of the children in the classrooms or the number of years of experience that the educator has as a lead teacher along with the extra training courses undertaken by the teachers does not affect the access to or the use of, numeracy and spatial materials in the classrooms.

Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

Readiness for school: A study of parent, teacher, and preschool provider perspectives

A possible gap exists between what parents and preschool providers know concerning children's readiness for school and what they should know when compared to teacher expectations. Students are experiencing difficulty in early schooling as a result of this gap in perspectives. This study's purpose was to describe, explain, and analyze the perspectives of parents, teachers, and preschool providers concerning school readiness. The qualitative strategy of interviewing was used with six parents, six teachers, and two preschool provider participants. Interview transcripts, field notes, member checking, and document analysis were used to interpret data and support findings. Categorization and coding organized data and aided in theory development. ^ Major findings of the study include: (a) All participant groups stress social skills, communication skills, and enthusiasm as most valuable for school readiness; (b) All participant groups agree parents have primary responsibility for readiness preparation; (c) Many participants suggest variables concerning family, economics, and home life contribute to a lack of readiness; (d) Parents place greater value on academic skills than teachers or preschool providers; (e) Preschool programs are identified as having the potential to significantly influence readiness; (f) Communicating, providing positive learning experiences, and providing preschool experience are valuable ways to prepare students for school, yet, differences were found in the types of experiences noted; (g) Participant perspectives indicate that informing parents of readiness expectations is of major importance, and they offer suggestions to accomplish this goal such as using public libraries and pediatrician offices as houses for written information and having kindergarten teachers make presentations at preschools. ^ This study concludes that parents and preschool providers do have knowledge concerning readiness for school. They may not, however, be in a position to carry out their responsibilities due to the intervening variables that inhibit the amount of time, interaction, and communication they have with the children in their care. This study discloses the beliefs of parents and preschool providers that children are ready for school, while teachers conclude that many children are not ready. Suggestions for readiness preparation and information dissemination are significant findings that offer implications for practice and future study. ^

The impact of the changing weaving industry on the culture and socioeconomic development of Maya women in Guatemala

Growing demand for handwoven Maya textiles from Guatemala parallels recent international fascination with Maya civilization. This thesis surveys the effects of increases in demands for artisan textiles in Guatemala, and explores the reactions of women involved in Aj Quen, a weavers' association. The hypothesis is that the well-being of Maya women depends on their participation in the association. This is tested by using indicators of the weavers' attitudes defined as their "well-being" regarding (1) health, (2) education levels, (3) child care practices, and (4) economic stability. Interviews were conducted with 127 Maya women. Data were documented, providing a crucial missing link in the current literature of "women in Guatemala." The results of this study yield baseline data demonstrating that health and child care practices are not directly related to women's participation in the association. Their education levels increased as a direct result of working with the association, as did economic stability, although less consistently.

The relationship between prekindergarten social and emotional development and academic success among Hispanic children from low-income families

Social and emotional development has been considered an important factor in child development which has been placed at the end of the learning spectrum due to high stakes testing. Social and emotional development consists of the relationships an individual has with others, the level of self-control, and the motivation and perseverance a person has during an activity (Bandura, 1989). This study examined the relationship between Hispanic children’s prekindergarten social and emotional development and their academic success. Hispanic children from a large southeastern city whose parents were receiving subsidized child-care were followed from their prekindergarten year through third grade (N=1,978). Several hierarchical regressions were run to determine the relationship between children’s social and emotional development, during their prekindergarten year using the DECA (Devereaux Early Childhood Assessment), and the their academic success, as measured by kindergarten through third grade end of the year reading and mathematics academic grades, second grade SAT (Stanford Achievement Test) scores, and third grade FCAT (Florida Comprehensive Assessment Test) and NRT (Norm Referenced Test) scores. Hierarchical regressions were conducted for each grade and subject in order to control for demographics and prior achievement. The results of this study revealed that for Hispanic children from low-income families, the best predictor for academic success was the children’s prior academic achievement. Social and emotional development showed no significant predictive value for the third grade criterion variables as well as end of the year academic grades in second grade and kindergarten reading. Evidence did suggest that for first grade end of the year academic grades and kindergarten math, social and emotional development had a small predictive value. Further research must be conducted as to why social and emotional development, after controlling for demographics and previous academic achievement, bears such a small predictive value when it is clear that many professionals feel it is the most important factor for school readiness.

The impact of the changing weaving industry on the culture and socioeconomic development of maya women in Guatemala

Growing demand for handwoven Maya textiles from Guatemala parallels recent international fascination with Maya civilization. This thesis surveys the effects of increases in demands for artisan textiles in Guatemala, and explores the reactions of women involved in Aj Quen, a weavers' association. The hypothesis is that the well-being of Maya women depends on their participation in the association. This is tested by using indicators of the weavers' attitudes defined as their "well-being" regarding 1) health, 2) education levels, 3) child care practices, and 4) economic stability. Interviews were conducted with 127 Maya women. Data were documented, providing a crucial missing link in the current literature of "women in Guatemala." The results of this study yield baseline data demonstrating that health and child care practices are not directly related to women's participation in the association. Their education levels increased as a direct result of working with the association, as did economic stability, although less consistently.

Elder malnutrition: A meta analysis of studies using the nutrition screening initiative determine checklist

To demonstrate the extent of elder malnutrition risk in this country, a meta analysis of 30 studies that used the Nutrition Screening Initiative's "DETERMINE Your Nutritional Health Checklist" was conducted. The studies were divided into three categories: Elder Populations in Healthcare Related Systems (HS), Elder Meal Program Participants (MP), and General Community Residing Elder Population (GC). HS was sub-divided into Hospital Inpatient/Clinic Outpatient and Long Term Care/Home Care. The MP population were identified as Congregate or Home Delivered meal participants. Overall, results indicate that 63% of elders are at moderate (32%) or high (31 %) risk of malnutrition. Home Delivered Meal Participants and Hospital Inpatient/Clinic Outpatients are most likely to be at high risk of malnutrition (49.5% and 49.1%, respectively). Individuals least likely to be at high malnutrition risk are the General Community Residing Elder Population (17.5%) and Congregate Meal Participants (22.5%).

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

Children with Special Health Care Needs: Comparison of the Effects of Home Care Setting, Prescribed Pediatric Extended Care Setting, and Long-Term Care Setting on Child and Family Health Outcomes and Health Care Service Use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL TM Generic Core Module for child health and functioning, PedsQL TM Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

It Takes a Village to Educate a Child: Guiding Parents on How to Implement FCAT Strategies With Their Children During Home Learning

The purpose of this study is to examine the effects of parental involvement on students' academic achievement. This research further proposes to investigate the effects that reading comprehension workshops for parents will have on the level of their involvement. Moreover, results from the study will contribute to the establishment of effective structures of family involvement. The following research questions will guide the study: Is there an increase in parents' confidence in their abilities to help their child in school as a result of parent workshops? Will there be a gain in parents' understanding of FCAT strategies through the use of parent workshops? Will there be an improvement in students' test scores because of parental involvement in parent workshops?