Efforts to help families raise healthy and capable children require the ability to recognize and treat the types of problems and situations that threaten early development. But what specific characteristics of children, of parents, or of families are indicative of later cognitive and psychosocial lags and problems? And, who do we ask about the well-being of our very youngest children? To address these questions, the present project turned to a broad range of "experts" -- individuals working with, and living with, infants and toddlers. Study participants included parents, early childhood specialists such as pediatricians and nurses, mental health professionals, social workers, family service providers, daycare workers and early childhood educators. Data collection, in the form of interviews and in-person surveys, was guided by the following questions:
Question 1 was addressed through qualitative research with parents and a diverse group of professionals who work extensively with families with infants and toddlers. A method of Nominal Group Process (Van de Ven and Delbecq, 1972) was used to structure several small group meetings. Parent and professional groups met separately, to ensure that parents would feel comfortable voicing their opinions. The groups were led by the principal investigator, a developmental psychologist who had limited knowledge of specific community programs and individuals.
The group meetings were approximately 90 minutes long. At the start, individuals were provided with "Early Warning Signs" matrix worksheets (see Appendix A) and given ten to fifteen minutes to work privately to prepare a list of problems. Following that, the facilitator asked each group member in turn to share one item from his or her list. Problems were defined, clarified, and written on a free-standing flip-chart. The process was repeated until all problems were recorded on the combined list. Each problem was then re-visited, discussed, and ranked on a scale of 1 to 5 in terms of severity (e.g., "When you see a child who is withdrawn and fearful, does it strike you as a very serious marker for later school problems, or not so serious?) and prevalence (e.g., Do you see a lot of children who are withdrawn and fearful, or not so many?).
Questions 2 through 5 were addressed via in-person surveys of primary caregivers of children under three years of age. The surveys were designed specifically for this study. The developmental "concerns" and "problem" checklists included in the survey drew their content (though not specific items) from a number of readily available developmental and behavior inventories and parent-interview strategies (Achenbach, 1986; Brazelton, 1992; Eyberg and Ross, 1978; Greenspan, 1988, 1992; Lieberman and Pawl, 1990; Robinson, Eyberg, and Ross, 1980).
Parent interviews were conducted by the principal investigator or staff members, usually home visitors, with the two participating local family centers: the Project Echo Family Center (Fremont County, Colorado) or Family Focus Lawndale (Chicago, Illinois). All interviewers attended a 90-minute training meeting with the principal investigator. At the training, the interview was discussed question-by-question, and a range of probable responses was scored. A copy of the survey is provided as Appendix B. Responses to Question #1, used to answer many of the subsequent questions, were provided in the form of a deck of cards. Parents chose the relevant response cards and then used this smaller, personalized subset to respond to later questions.
Most of the surveys were conducted one-to-one; occasionally they were conducted in small groups of two or three parents. Two sources of respondents were collected by different means. In Fremont County, Colorado, a group of teen mothers completed the survey as part of a high-school Parent Education class. The survey was explained and monitored by the principal investigator. A second group, Department of Social Services (DSS) consumers who were not involved with any of the local family center programs, completed the surveys on their own. A social worker who was familiar with the survey was available to answer DSS parents' questions, but staffing did not allow one-to-one data collection. The surveys took approximately 45 to 60 minutes to complete. Parents were paid a small cash stipend or received grocery store gift certificates for completing the survey.
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