Primary Caregiving in Early Childhood Settings-Report

Primary Caregiving in Early Childhood Settings

Education Scientist: Lauren Davidson

About Education Scientist Lauren Davidson

Lauren has been an elementary and primary grade teacher in independent and public schools (grades K, 1, 2, and 4) in New Jersey, South Carolina, and Maryland. She is a former Director of a parent cooperative nursery school in Rockville, MD. Lauren is currently the Director of the Early Childhood Program at Stone Ridge School of the Sacred Heart. Lauren holds a Bachelors of Science in Elementary Education from University of Vermont, a Master of the Arts in education (special education) from American University, and is a School Administration and Supervision Certificate program graduate from Johns Hopkins. Outside of school, Lauren can be found cooking, baking, needleworking, gardening, and reading for pleasure.

Abstract

The purpose of this research was to study primary caregiving structure within the early childhood setting of a toddler classroom. Primary caregiving (PCG) is a system of care in which the care of each infant or toddler is assigned to one specific infant and toddler teacher who is principally responsible for that child in the care setting. Responsibilities include fostering the relationship with the child and family, observing and documenting, planning for the child’s development and learning, supporting the child through transitions, carrying out the majority of care routines, and providing emotional support. We sought to answer the question: Will using a primary caregiver structure in the Toddler/Two’s classroom result in a more positive experience for teachers, students and families? We hypothesized the following: Having primary caregivers in the Toddler/Two’s room will result in a more positive experience for teachers, students and families. Specifically we would see reduced negative behavior incidents, timely logging of care, and an increased awareness of student needs and interactions due to reduced need for “teacher talk/discussion.” The active phase of our study spanned two months, one during which we implemented a primary caregiver system of care. Several themes emerged once the data was analyzed: The favorable outcomes were that primary caregiver system had a positive effect on the logistics of our program, fostered stronger child to teacher bonds, reduced teacher stress, and had a positive impact on the children and families in our program. Negative effects were few but included an increased lag time for care events, such as diaper changes, and some difficult transition occurrences.

Step 1: Ask & Inquire

Study Question: Will using a primary caregiver structure in the Toddler/Twos classroom result in a more positive experience for teachers, students and families? I chose to study primary caregiving because I hoped that it would enrich the classroom environment and foster trusting relationships among staff, children and their families.

Hypothesis: Having primary caregivers in the Toddler/Twos room will result in a more positive experience for teachers, students and families. Specifically, reduced negative behavior incidents, timely logging of care, and increased awareness of student needs and interactions due to reduced need for “teacher discussion/talk.”

Step 2: Investigate & Incubate

A review of the literature served to research the topic of primary caregiver systems in early childhood education, particularly as it pertains to infant and toddler care. Several sources were consulted, revealing the following current themes:

Research supports the belief that infants and toddlers are competent learners with their own agendas

• Babies are competent learners who have their own agenda and we, as educators, must respect and understand this (Kibble, Cairns-Cowan, McBride, Corrigan, & Dalli, 2014).
• Babies must explore and interact with objects and people and the care offered must match the baby’s learning agenda (Lally, 2009).
• The practice of placing infants and toddlers in care settings that are intended for older children is detrimental (Lally, 2009).

Research shows that very young children need to develop trusting relationships and secure attachments to thrive.

• Infants need intimate, responsive, trusting relationships to thrive (Kibble, et al., 2014).
• Relationships and experiences with a trusted caregiver are the basis for all learning (Lally, 2009)
• Secure attachments formed with teachers lead to better functioning (Lally, 2009).
• Early life experiences influence brain development (Kibble, et al, 2014).
• The early childhood education teacher is a caring facilitator of emotional, cognitive, language, physical and social development and growth (Lally, 2009).
• Children look to their caregivers for help making sense of their world and to provide security through the maintenance of a safe environment, modeling, help with regulating emotions and with learning the rules we need for living (Lally, 2009).
• Creative Curriculum prescribes assigning a primary teacher to each child in order to maximize the development of secure attachments (Dodge, Rudick & Berke, 2011).

Relationships between caregiver and child are nurtured through care routines.

• Care routines or prime times are sensitive, responsive, cooperative interactions between the caregiver and the child. Trusting relationships are developed during these activities and foster security (Kibble, et al., 2014).
• Care is comprised of the intimate activities that build a trusting relationship. It includes the provision of physical and emotional care (Theilheimer, 2006).
• Secure attachments are formed during care moments providing for gentle, intimate and playful interactions during feeds, sleeps and changes (https://www.myece.org.nz/caring/105-primary-caregiving)
• Sensitive responsiveness includes inviting gestures, verbalizing intended care actions, attention to a child’s pace, rhythm and comfort, unhurried time, being fully present to a child and interactive in the situation, making things visually available to the child (Ainsworth, Lally, & Mangione) (Kibble, et al., 2014).

Primary caregiver systems create environments that foster trust and meaningful relationships thus strengthening secure attachments.

• Caregiver stability leads to more secure relationships with caregivers (Clasien de Schipper, Van Ijzendoorn & Tavecchio, 2004).
• Children had more positive experiences in care when there are fewer switches in arrangements and greater availability of a trusted caregiver (Clasien de Schipper, et al., 2004).
• Time spent with a caregiver increases a secure relationship (Clasien de Schipper, et al., 2004).
• The availability of a dependable adult leads to greater resilience, persistence and independence in children (https://www.myece.org.nz/caring/105-primary-caregiving).
• Primary caregiving establishes an environment that fosters trust and meaningful relationships (Theilheimer, 2006).
• Trusting relationships are fostered when there is a consistent and stable presence, one who has an emotional investment (Theilheimer, 2006).
• Primary caregiving systems are recommended by the Program for Infant Toddler Care (PITC) (Lally, 2009).
• Long term, secure and trusting relationships are an important basis for quality programs for infants and toddlers (Lally, 2009).
• Primary care is a program practice that supports learning and development in infants and toddlers (Lally, 2009).
• Primary caregiver systems create trust that links the teacher with the child. The child believes that her needs will be met so the sense of security in care is maximized (Lally, 2009).
• Primary caregivers are able to communicate without using words through sensing as a result of shared experiences established in the primary caregiving relationship (Kibble, et al., 2014).

Primary caregiver systems need the support of a competent team to be successful

• This system needs a primary and a secondary caregiver. Teamwork is essential. Teachers must support each other (Lally, 2009).
• The caregiving team acts similarly. A secondary caregiver uses the same language and routines that the primary uses. There is a consistency of style and both caregivers have a good relationship with each other (Theilheimer, 2006).
• Caregivers work as a team, supporting each other. They need time for communication and secondary caregivers are a must (Kibble, et al., 2014).

Primary caregiver systems foster positive relationships with teachers and families.

• Primary caregiving nurtures teacher-child relationships and teacher-teacher relationships. It is a partnership with the child and the child’s family (Kibble, et al., 2014).
• Primary caregiver system establishes trust and meaningful relationships with families. A primary caregiver gets to know the family too, the shared language, preferences and dislikes, and the home routines. The relationship provides a bridge between the home and the center (Theilheimer, 2006).

Step 3: Develop

The following methodologies were chosen for this study:

• field notes (with activity charts)
• parent surveys
• parent attitude scales
• teacher surveys
• teacher attitude scales
• teacher interviews

These methodologies were chosen in part to help answer the following questions:

• How are the children engaged?
• What is the time between care and the logging of the event?
• How long are transitions taking?
• What is the parent experience?
• What is the teacher experience?

In order to keep the data collection unbiased and accurate my field notes were recorded in an objective manner and stated observations in a clinical tone without emotion or drawing of conclusions. For example, when recording that a child was physically aggressive towards a teacher or other student, this action was documented without articulating possible causes. Additionally, all data from field notes were transcribed onto activity charts. The logging of individual actions of teachers and students was, by nature, unbiased, due to the objective nature of the note taking.

Step 4: Launch

The details of the actual methodology are included here. Both before and after we implemented primary caregiving I observed the class, took field notes and separated actions into commonly observed activities and behaviors (both of teachers and students). These were tallied on charts. I also sent home parent surveys (sample question: Write about your experience with all communication about your child) and attitude scales (sample statement to rate: My child has developed an attachment to one teacher in particular). Teachers completed surveys and attitude scales as well (sample survey question: Identify the most difficult and stressful times of the day (sample statement: rate your level of stress during lunch time). These surveys and scales were completed both before we instituted primary caregiving and after. Finally, at the end of the data collection I met and interviewed each teacher individually and included this interview within my methodology.

Step 5: Analyze & Evaluate

At the conclusion of the study a review of the data was conducted and several common themes emerged:

Theme 1: PCG positively affected logistics

Summary: The primary caregiving system had a positive effect on the logistics of our program.

• The caregiving routines were more manageable because each child had a special adult to advocate for their needs.
• Updating LifeCubby (online tool to communicate with parents) was more manageable and efficient since each teacher only had to keep track of and document 3 children. There was also a tendency to include more details when logging information.

Theme 2: PCG fostered stronger bonds

Summary: The primary caregiving system fostered stronger bonds and nurtured relationships.

• Bonds between teachers and their primary children were strengthened. As teachers focused on and cared for their primary children it helped them to better understand the children’s physical and emotional needs. Teachers felt a connection with their primary children. Children knew who who to turn to first when in need.
• Bonds between primary caregivers and parents of primaries were strengthened. Parents know to whom to speak with information or questions about their children. Families felt a true partnership with the primary caregivers as they share knowledge about the children.

Theme 3: PCG reduced some stress

Summary: Stress was reduced during some challenging times of day.

• Lunchtimes were calmer as each caregiver attended to the needs of only 3 children.
• Reduced conflict between teachers regarding methods of caring for children.

Theme 4: Transitions still stressful

Summary: Some transitions were still stressful.

• Activity clean up with messy.
• Some logistical issues arose sometimes due to space and availability of sinks and changing table (there is only 1 of each).

Theme 5: PCG impact on teacher-teacher intra-relationships

Summary: Primary caregiving had some impact on relationships between and among teachers.

• Discomfort if a teacher noticed an issue with another primary that needed addressing but wasn’t supposed to intervene.
• Difficulty when noting that another teacher has not completed all communication needed as the end of the day neared.
• Missing the team approach to care as this provides more eyes/observers on a situation with feedback that is helpful.

Theme 6: Overall positive impact on children and families

Summary: Overall there was a positive impact on the children and their families.

• Children benefited when their needs were met more efficiently and effectively.
• Children benefited from closer bond with teacher increasing their safety and comfort.
• It was clear to the parents to whom to turn when communicating needs and concerns.
• Children and teachers benefit from balancing tasks with transitioning children to the next activity, and moving three children at a time (instead of 9) is more manageable.

Theme 7: Increased PCG Lag-time between care events

Summary: At times children had to wait for a pcg.

• Negative impact when a child needed something and the pcg was busy.
• Sometimes another teacher is available but not helping because it isn’t her primary. In addition to these common themes, a review of the data reveals several themes that related to the parent experience:

Parent Theme 1: Space/structural challenges

Summary: Through our surveys, parent took the opportunity to share feedback on some space and structural challenges.

• More space needed at entrance
• Climbing structures needed for the playground
• Enclose the entire Carriage House outdoor space for safety.
• Not enough dedicated parking spaces
• Better support for breastfeeding moms

Parent Theme 2: LifeCubby positively impacts communication

Summary: Our survey gave parents the opportunity to provide positive feedback about the use of LifeCubby (a website that is used by both teachers and parents to provide real time communication and updates)

• Lifecubby features (photo sharing, captions, daily sheets, messaging) help families feel connected by facilitating the sharing of events that are happening while children are in school.
• Parents find the information that teachers log on the LifeCubby website to be helpful.

Parent Theme 3: Happy children

Summary: Parent’s shared favorable comments when writing of children’s positive experiences at school.

• Children love coming to school each day to see teachers and friends
• Children are happy at school and love the activities in which they participate
• Children love their teachers

Parent Theme 4: Routines at drop-off provide structure to ease this transition

Summary: Parents are pleased with the routine and process for dropping off children at school each the morning.

• Children are greeted enthusiastically.
• Children are building independence
• The organization and planning of set activities helps to ease the drop off transition

Parent Theme 5: Pick-up transition is easy on parents and children

Summary: Parents are pleased with the routine and process for picking up their children from school at the end of the day.

• Pick-up is smooth
• Supplies are packed up and ready to go
• Children are happy to see their families
• Children are playing happily outside

Much of the data collected was organized into graphs. These graphs are depicted here along with analyses:

Analysis

The Teacher Attitude Scales suggest that the primary caregiving system reduced the level of teacher stress in 5 out of 7 indicators. This is a positive change, indicating the primary caregiving system did create a more positive experience for teachers in reducing stress.

The level of stress remained unchanged and very low during nap time.

The level of stress during clean up times increased during the primary caregiving phase of the study. Teacher survey results addressed this in part: “I still feel as though the most stressful times for me were transition times, particularly from messy activities, and particularly when transitioning to outside. At these times, it still feels difficult to wash up the kids, monitor those already washed, get them ready for the next activity/outside time, and clean up the classroom.” During teacher interviews, 2 out of 3 teachers gave feedback that these transitions were still stressful. One teacher said that she didn’t know if PCG helped because there was “a lot going on.” Another teacher stated that PCG had not helped the stress level at transition time.

Analysis

Negative teacher activities were split. One indicator showed that teachers were less likely to be disengaged from students and classroom tasks during the PCG phase.

On the other hand, observation notes logged more instances of teachers discussing topics that were not related to school and children during the PCG phase.

Analysis

Observations conducted during the PCG phase of the study showed less need for “teacher discussion/talk” about children and fewer unstructured interactions with children. There was also a reduction in the use of email.

Activities showing an increase in occurrence were cleaning, putting away and setting up materials and unpacking students’ bags and lunches.

There was no change in parent interaction occurrences or in teachers leaving the room for personal or job related reasons.

Analysis

7 positive teacher activities showed positive change, i.e. the activity occurred with greater frequency. Observations found teachers engaged more in facilitating mealtimes, changing diapers, helping children wash up, helping children with coats or clothing, logging LifeCubby events or taking pictures, and comforting children or showing them affection than before instituting the PCG system.

2 activities showed negative change, i.e. they occurred with less frequency. Instances of leading a group activity and redirecting/reminding/reinforcing/prompting children were fewer in number than before instituting the change in caregiving. The latter was reduced by more than 100%. It is possible, even probable, that there was a reduced need to redirect, remind, reinforce and prompt behaviors in children during the PCG phase because the new system allowed for more focused teacher attention before problems arose.

1 activity occurrence showed no change: periods of teachers playing and reading with one or more children or helping them with tasks.

Analysis

Observation notes indicate the following occurrences of positive child activity:

• Increased independent/focused play events
• Increased play facilitated by a teacher-this increased by approx. 34%, a most positive impact of PCG
• Small increase in instances of children showing affection and expressing empathy
• Increase in children expressing feelings verbally
• An 85% increase in the number of instances of children helping to clean up
• Decreased joyful moments
• Decreased instances of parallel play
• Decreased observed instances of children following directions but this is directly related to the number of times that teachers give directions (see teacher activity graphs showing redirecting/reminding/reinforcing/prompting behaviors)
• Playful interactions between teacher and student remained the same

Analysis

The data shows that there were fewer accidents and fewer instances of children eating and drinking during the PCG phase of the study. Care events increased during this time.

Analysis

The following is indicated:

• Fewer observed instances of negative behavior directed at other students.
• Fewer observations of children not following directions.
• Fewer tantrums.
• Significant decrease in the instances of children dumping and throwing toys-This is of particular interest because it indicates more meaningful play.
• Disputes over toys increased.
• Increase in the number of children taking a break.
• Increase in children wandering the classroom-While this seems to indicate a lack of focus, this wandering was typical of one student in particular who usually traveled with one or two toys that he would briefly engage with at various stops.
• Increase in negative behavior directed at a teacher-Perhaps as children become closer to one teacher they are more likely to act out?

Analysis

The final analysis of post study data shows that after instituting the primary caregiver system:

• More parents strongly agree that teachers are very knowledgeable about their children’s developmental level.
• More parents strongly agree that teachers are very knowledgeable about children’s likes and dislikes.
• More parents strongly agree that teachers are very knowledgeable about family dynamics and routines.
• More parents strongly agree that teachers are very knowledgeable about children’s overall well- being.
• More parents were satisfied with the drop off routine.
• More parents strongly agree that they are satisfied with the pick up routine.
• More parents are satisfied with the amount of information communicated about their children.
• More parents strongly agree that LifeCubby information is communicated in a timely manner.
• A significant decrease in the number of parents who are unsure of which teacher to talk to about their children.
• More parents strongly agree that their children have developed an attachment with one teacher in particular. Research show that this attachment is important to healthy development.

The data collected from the study concurs with much of the information about primary caregiving that already exists in the field. Examples include the need for the support of a competent team for a successful primary caregiving experience, the fostering of positive relationships and experiences through primary caregiving, and the development of secure attachments through care routines as a part of primary caregiving.

Although the results of this study were primarily positive and in support of primary caregiving, there were limitations to this study. First and foremost, the length of time (1 month) during which we practiced primary caregiving was brief in relation to the length of the school year. We were also limited by the work schedules of the teachers as they arrive and leave in a staggered format, and thus may not be at school when one of their primary children arrives or leaves. Additionally, it was difficult to get 100% participation from all of the families in terms of signing the release and/or submitting surveys and attitude scales. Finally, it was difficult initially to get buy-in from members of staff who were resistant to changing our routine.

The F Word

This study also helped us to identify elements that create challenges to using best practice in our program. The first: As mentioned above, getting buy-in from staff. It is human nature for some to resist change whether due to fear of the unknown, or anxiety about learning a new method. Through research and subsequent sharing with staff everyone was encouraged to take a risk and keep an open mind.

Another challenge was having teachers work with fidelity to the primary caregiving structure. When I was present there was more faith to the process, but there were other times when teachers would resort to doing what they felt was easier.

There were other challenges as well. As mentioned above, work times for the teachers are staggered, so if a child arrived early, sometimes the primary caregiver was not at school yet and another teacher had to be the contact for the family.

Another challenge for us is our space and the size of our group. One sink and changing table are rarely enough to care for the needs of 9 children. Additionally, through the parent survey we learned that parents are challenged too by our space, specifically the indoor entrance area which gets cramped when more than one family enters at a time. Parents also expressed concern for outdoor safety since we are located right on the loop road and the area in front of the building is not completely enclosed. Parents also expressed that parking is problem. We only designate 2 spots in a busy lot and they typically have to juggle toddlers, infant carriers, and bags through a parking lot and up a hill to our building.

Lastly, research shows that it is best practice to have a child retain the same primary caregiver throughout the early years. Our program is not set up for this. Our Infant teachers stay in the Infant room, Toddler teachers in the Toddler room year by year. It would be a huge change to have teachers travel with their primary children but perhaps a challenge we will take on in the future.

Step 6: Ideate & Call for Action

Taking what we have learned from our action research study, our early childhood team has agreed to implement primary caregiving in all of our classes next year (Infants, Toddlers and Twos). It’s important to make the move toward this new structure since research and our own study has shown this to be best practice. We are currently discussing how to manage this change and will begin with hosting individual meetings with each family. We will use this time to begin to get to know each other and to learn about the dynamics of each family that make them unique. This meeting will be an opportunity for parents and children to be introduced to the teacher who will be the primary caregiver. Throughout the year as we meet as a faculty we will include time for discussion about the effects of primary caregiving. It’s my recommendation that all early childhood centers institute primary caregiving. It truly gives our youngest students more of what they need to develop trusting relationships and secure attachments, helping them to thrive in our care.

Citations

Administration for Children and Families. (2017, January). Six Essential Program Practices-Primary Care, 1–3. Retrieved from

https://childcareta.acf.hhs.gov/sites/default/files/public/pitc_rationale_-_primary_care_508_1.pdf

Clasien de Schipper,J., Van IJzendoorn, M., & Tavecchio, L. (2004). Stability in Center Day Care: Relations with Children’s Well-being and Problem Behavior in Day Care. Retrieved from https://pdfs.semanticscholar.org/b452/adc89aeab6d67b15af198cfc8b72a3de8d9c.pdf

Lally, J. (2009, November). The Science and Psychology of Infant-Toddler Care. Zero to Three, 47–53. Retrieved from http://silversprings.njuhsd.com/documents/young%20parents/infant%20toddler%20care/lally_30-21.pdf

Lally, J. & Mangione, P. (2017, May). Caring Relationships: The Heart of Early Brain Development. Young Children. Retrieved from

https://www.naeyc.org/resources/pubs/yc/may2017/caring-relationships-heart-early-brain-development

Lally, J., & Mangione, P. (2006, July). The Uniqueness of Infancy Demands a Responsive Approach to Care. Young Children, 1–6.

Theilheimer, R. (2006, January). Molding to the Children: Primary Caregiving and Continuity of Care. Zero to Three, 50–54.