Exploring Primary Caregiving and Continuity of Care Peter Mangione and Alicia Tuesta Developed by Peter Mangione and Alicia Tuesta. © 2017, WestEd, The Program for Infant/Toddler Care. This document may be reproduced for educational purposes.

Exploring Primary Caregiving and Continuity of Care Agenda Introduction Personal Meaning of Relationships in the Context of Care (Reflection and Discussion) Attachment Issues in Infant/Toddler Care (Overview of Research) Definitions of Primary Care and Continuity of Care (Group Discussion) Exploring Implementation Strategies and Issues (Small Groups) Report Back from Small Group Work Close

Exploring Primary Caregiving and Continuity of Care Scenario You are recovering from an illness and during this recovery period will need assistance with feeding, bathing, and using the restroom. Keeping this information in mind answer the following questions: Would you prefer to stay at the hospital during your recovery or to be at home. Please explain why. When it’s time to receive assistance with your feeding, bathing and restroom needs, who would you like to be assisted by? A nurse, a relative, a friend? Please make a list of people you would allow to give you a sponge bath. What characteristics would you like the person that is caring for you to have?

Infant Attachment Indicator of the quality of infant’s relationship with a caregiver Attachment security is often indicated by child’s secure base behavior Attachment security ranges from secure to insecure

Development of Relationships In a secure attachment, the caregiver is consistently emotionally available to the infant Development of attachment security depends on time together and sensitivity of the caregiver Infants can have more than one attachment relationship (Hierarchy of attachment relationships - primary, secondary, and so on)

Attachment Disorders Disorder of Nonattachment Disordered Attachment Disrupted Attachment Disorder Source: Lieberman, A.F., & Zeanah, C.H. (1995, July). Disorders of attachment in infancy. Child & Adolescent Psychiatric Clinics of North America, Vol. 4, No. 3, 571-587.

Atypical Attachment in Infancy The general approach to studying attachment security (secure base behavior) must be expanded to take into consideration differences in infant functioning. Source: Vondra, J. I., & Barnett, D. (Ed.). (1999). Atypical attachment in infancy and early childhood among children at developmental risk. Monographs of the Society for Research in Child Development, 64, (3, Serial No. 258).

PITC Program Policies Recommendations Inclusion Primary Care Continuity of Care Small Groups Personalized Care Cultural/Family Continuity

Primary Care System Assignments Relationships Routines Recordkeeping Families Teaming Transitions

Continuity of Care Definition The concept of continuity of care refers to the policy of assigning a primary care teacher to an infant at the time of enrollment in a child care program and continuing this relationship until the child is at least three years old.

Handout II.3A Three Ways to Achieve Continuity of Care Same Age Continuity A group of children close in age stay with the same infant care teacher until age three. The environment is made developmentally appropriate as the children grow older, or the whole group moves together to a new space. Children who leave are replaced by new children of the same age. Mixed Age Continuity Groups have a wider range of ages. Newly enrolled infants and toddlers of any age can be added to the group. The environment is interesting and flexible enough for different developmental levels. Family Care Continuity Often one person cares for a small group, making it easy to provide continuity. If a larger program, children are assigned to one infant care teacher and stay with that infant care teacher from infancy to preschool. Adapted from: WestEd. (2014). The Program for Infant/Toddler Care Trainer’s Manual, Module II: Group Care, 2nd edition (p. 42). Sacramento, CA: California Department of Education. This document may be reproduced for educational purposes.