Understanding Factors That Enable or Hinder Parent and Early Childcare Provider

Communication About Developmental Concerns Using the LTSAE Materials

Kris Barnekow, PhD, OTR/L,Department of Occupational Science & Technology, University of Wisconsin-Milwaukee
Gail Chodron, MA, PhD (expected August 2015), Waisman Center, University of Wisconsin-Madison
Sabrin Rizk MS, OTR/L Department of Occupational Science & Technology, University of Wisconsin-Milwaukee
Paige Mission, MS, Waisman Center, University of Wisconsin-Madison
Alexandra Puk, BS, Waisman Center, University of Wisconsin-Madison

Learn the Signs. Act Early. Sample Materials

Problem Statement

Preliminary Findings

It is estimated that 1 in 68 children has an autism spectrum disorder and 1 in 6 has a

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developmental disability of any type. The majority of these children enter kindergarten
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with unidentified delays and without having accessed early intervention. Early
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intervention helps children with developmental delays maximize developmental gains.
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Over half of U.S. children under the age of 5 attend some form of childcare, therefore,
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childcare providers play a key role in early identification of delays. The Centers for Disease
Control and Prevention (CDC) provides research-based resources to educate parents and
early childhood professionals through the Learn the Signs. Act Early. (LTSAE) campaign.
LTSAE is designed to increase knowledge about developmental milestones, facilitate
conversations about child development, increase awareness of red flags, and increase
knowledge of next steps to take when there is a concern. There is a need for research on
implementing LTSAE in community programs, including childcare settings.

How providers and parents communicate

Related to research questions 1 and 2, we found that childcare providers and parents currently use a range of
mechanisms to communicate about child growth, learning, and developmental concerns. We categorized
these mechanisms as formal or informal types. By formal we mean planned and scheduled communication
mechanisms (e.g., newsletters, parent-teacher conference). By informal we mean unscheduled communication occurring during normal daily childcare operations (e.g., communication at child drop off or pick up).

Methods
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Data Collection: Focus group methods were used. A childcare provider and a parent
focus group was held in each of two Midwestern cities, for a total of four focus groups.
Open-ended and follow-up questions were used in each 90-minute focus group.
Participants: Parents (N=17) and childcare providers (N=11) attending center- or familybased childcare programs
Parents
10 Mothers, 7 Fathers
13 White or Caucasian, 3 Black or African American, 1 Multiracial
16 non-Hispanic, 1 Hispanic
4 High School or Associates Degree, 13 Bachelors or Post-Graduate Degree
Childcare providers:
11 Mothers
11 White or Caucasian and non-Hispanic
2 High School or Associates Degree, 9 Bachelors or Post-Graduate Degree
Analytic Strategies: Three members of the research team reviewed and coded different
focus group transcripts for factors that inhibit or enable communication. Coding was
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refined through the constant comparison method. Specifically, team members reviewed
coding decisions and discussed until consensus was reached.

Table: Typical quotes illustrating factors that enable and inhibit communication
Enabling

Childcare Provider

The purpose of this study was to solicit and describe input from childcare providers and
parents about using LTSAE in childcare settings to monitor, and support conversations
about, how children are developing. The specific research questions are:
1) How do providers and parents communicate about the childs growth and learning?
2) How do providers and parents communicate when there is a concern about how a
child is reaching developmental milestones?
3) What do providers and parents say went well during this communication?
4) What do providers and parents say could have gone better in this communication?

I would say that were more able to build a

relationship with the parents, and then theyre
more receptive to concerns in the future because
weve built that relationshipto speak with them
keeping that honesty and being comfortable
and not being the know it all
trust is important
be kind and caring in how you bring something
up, and how you talk about it
I think it helps when the teachers are upfront and
direct. When they dont just drag it out or try to
sugar coat it.

Parent/guardian

Research Purpose and Questions

What providers and parents say went well and what could have gone better
Related to questions 3 and 4, we found that childcare providers and parents described similar factors that
enable or inhibit communication. By enable we mean factors that allowed a conversation to occur that parents and providers perceived went well. By inhibit we mean factors that impeded communication from occurring or were associated with parents and providers perceiving that communication did not go well. Based
on our method of coding, preliminary findings suggest that a trusting and respectful relationship was a key
factor for both childcare providers and parents. We found indications that childcare providers and parents differed in their view of what makes a relationship trusting and respectful. In the table below, we provide typical
quotes for enabling and inhibiting factors for both childcare providers and parents.

I think it would be nice if they gave a copy of

everything that we went over. Like a written out
version or something. Just, like, for my own record.

Inhibiting
What we find is hard too is when you
might have something that might be
difficult for parents to hear is for them
not to only accept it.hear you say that
but just how to handle their reaction
cause weve had families who will flat
out deny it in the midst of the issue occurring and also just like kind of snub
us

one challenge about that is that

sometimes there are other families or
other kids around, and it just seems like, I
dont know, it kind of depends on how
many other people are around as far as
how much detail I get.

framing it in that way is very helpful and feels

supportive as opposed to evaluative.
And I like the fact that she not only makes things for
her to work on but she also throws in some positive
things throughout the week that has happened.

For more information, contact Kris Barnekow at krisb@uwm.edu or Gail Chodron at chodron@wisc.edu

Discussion
Family engagement and communication are important topics in the field of early
childhood care and education today. Our finding that childcare providers and parents
currently use a range of mechanisms to communicate about child growth, learning, and
developmental concerns is consistent with the existing literature on parent-provider
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communication in childcare settings. The existing early childhood literature suggests
providers need a greater awareness of the complexity of communication with parents
surrounding developmental concerns, and there is a need for more research regarding
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communication styles. Research on using LTSAE to support communication about
developmental milestones and concerns is emerging, however there appears to be
insuffienct information about the factors that enable or inhibit communication
surrounding developmental concerns. In our study, providers and parents reported a
range of enabling and inhibiting factors, and we found important overlap between
factors reported by both types of participant. Further research is needed to establish
what associations, if any, exist between factors and later referral and child outcomes.
The match or mismatch of provider and parent expectations and preferences regarding
communicative relationships should also receive greater attention. Finally, it will be
important to consider how to use LTSAE in both formal and informal communication.

References
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2008. MMWR Surveillance Summary. 61(3), 1-19.
2. Boyle, C.A., Decoufle, P. & Yeargin-Allsopp, M. (1994). Prevalence and health impact of developmental disabilities in U.S.
children. Pediatrics, 93(3), 399-403.
3. Croft, C. (2010). Talking to families of infants and toddlers about developmental delays. Young Children, 44-46.
4. NSECE Research Brief, OPRE Report 38. (2013)Number and Characteristics of Early Care and Education (ECE) Teachers
and Caregivers: Initial Findings from the national Survey of Early Care and Education (NSECE),October.
5. Tips for Child Care Providers to Communicate with Parents Concerns about Children's Development. (2011, December 2).
www.extension.org/pages/28228/tips-for-child-care-providers-to-communicate-with-parentsconcerns-about-childrens-development

retrieved on July 3, 2015.

6. Krueger, R., & Casey, M. (2015).Focus groups: A practical guide for applied research(5th ed.). Thousand Oaks: Sage.
7. Glaser, B., & Strauss, A. (1967). Discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine Press.
8. Sices, L., Egbert L., & Mercer, M. B. (2009) Sugarcoaters and straight talkers: Communicating about developmental delays
in primary care. Pediatrics, 184(4). e705-e713.

This poster was supported by the Disability Research and Dissemination Center (DRDC) through its cooperative agreement number 5U01DD001007 from the Centers for Disease Control (CDC) and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the DRDC or the CDC. The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH
National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.