Infant & Toddler Group Care Continuity of Care During this session, we are going to explore Continuity of Care.

Learning Objectives Participants will be able to: Discuss how continuity of care assignments support the development of close, caring relationships between teacher/child, child/peers, teacher/parents. Identify the benefits over the first 3 years of keeping the same care teacher assignments to children, parents and care teachers. Explore how continuity of care might be implemented in your early care and education program. This slide shows the learning objectives for Continuity of Care which is one of the six PITC Essential Policies. Continuity of Care is the most challenging of the 6 essential policies to implement largely due to staff resistance and high staff turn-over. Our goals for the session is that you understand what continuity of care is and why it is so important. We also want to provide suggestions for how to address the barriers to implementing continuity of care.

Definition of Continuity of Care The concept of continuity of care refers to the policy of assigning a primary caregiver to an infant at enrollment in the child care program and continuing the relationship until the child is at least 3 years of age. With continuity of care, the same children stay together over the time of enrollment in the program. In addition to keeping teachers and children together over the entire time the child is in your program, there should be continuity between how the child is cared for in the home and how caregiving routines are carried out in the program.

Continuity of Care Provides a secure base during the rapid changes in the first 3 years of life. Is often built into the family child care model. The secure base—a teacher with close caring relationships with each child, is key to optimal development in all learning domains. In family child care programs continuity happens naturally.

Activity: Exploring the Importance of Continuity How important is continuity in your own life? Reflect on situations (a) and (b) and answer the following questions: What feelings were you experiencing as you read the situations? What would your response be to these situations if they really happened? How does this experience relate to continuity of care in infant/toddler care. Using the handout posted under this topic on PITC.org: Importance of Continuity of Care, Challenges and Benefits discussion, ask the participants to form dyads to reflect on and discuss both Situation A: Restaurant and Situation B: Doctor Visit. How does their experience relate to continuity of care in their I/T program?

Activity: Exploring the Importance of Continuity (cont’d) Step 1: Discuss how you might relate these feelings and thoughts to the experience of an infant or toddler in care who must move to a space and a new teacher. Discuss how continuity of care assignments support the development of close, caring relationships between teacher/child, child/peers, teacher/parents;

Activity: Exploring the Importance of Continuity (cont’d) Step 2: a. Identify benefits of providing continuity of care on the worksheet provided; b. Identify challenges and list them on the worksheet; c. Brainstorm and write down possible solutions to the challenges you identified on the worksheet.

With continuity … The infant is not moved to a new group; either the entire group moves with the care teacher to another, more appropriate space, or the caregiver modifies the environment to meet the children’s changing needs. There are several ways to approach continuity of care teacher assignments. We are going to explore which way might work best in your situation? It is important to note that teachers also become attached to their classrooms. It takes time and emotional energy to move to a new space and get all the furnishing and equipment where the teachers feel comfortable.

Together in Care: Continuity of Care We are going to view Together in Care DVD Chapter on Continuity of Care starting at 8:50. Together in Care: Meeting the Intimacy Needs of Infants and Toddlers in Groups, 1992

With continuity… The most important relationship to continue is the one between the child and the primary care teacher, but promoting long-term relationships with other caregivers and with other children in the group is also important. Having continuity of the teaching team is also important. It takes time to learn other teachers’ styles and preference and to develop a good communication system between the teachers. Continuity is also important to the children’s relationships. As they get to know each other’s style, they are be more relaxed since they know what to expect from their peers.

Intimate caregiving relationships … Lay the foundation of trust, providing predictability, regulating attention, and creating interest for infants. Raikes (1993) hypothesizes that “time with teacher”— the length of time a high-ability teacher cares for an infant — is an indicator of quality for the infant-teacher relationship. There is an increasing amount of research that supports the impact of continuity of care in infant/toddler program quality.

Attachment Theory and Research Children take a significant amount of time to form attachments to caregivers, so they are less likely to form attachments if frequent caregiver changes occur. More frequent changes in primary caregivers have been associated with negative child outcomes, including withdrawing behaviors and higher levels of aggression as preschoolers (Howes & Hamilton, 1993). Getting used to a new care teacher is stressful for an infant and the teacher. The new teacher cannot read the child’s cues as well. The child has to work harder to communicate her needs. The teacher has to work harder to understand the infants cues.

Implementing Continuity: Structuring infant/toddler programs to promote long-term relationships often means reorganizing the environment, staffing, admissions policies, and training. Implementing continuity raises logistical questions that require each program to find its own solutions. Note to IT Specialist about Continuity: Continuity of care teacher assignments is beginning to be more frequent since 2000. For example, the state of Indiana requires continuity. The concept of keeping the same teacher and children together has even been used in some schools in Kindergarten and early primary grades. However, the concept of continuity is most likely to encounter resistance because it is a relatively new idea. In a study of child care centers across the US, the practice of continuity was found to be rare. (Cryer, Hurwitz, & Wolery, 2000). There is no universal recipe for implementing continuity. It takes time to transition a program to continuity of care. In some states the licensing laws require that infants are moved from one group to another at frequent intervals. Arizona moves infants at 12 months. We all need to advocate for licensing laws and regulations that support close, caring relationships.

One teacher’s experience “Continuity of care is the best new idea to come into this profession in my entire 25-year career. After the children and families get comfortable with the care, the teacher’s job is much easier. Personally, I do not have to spend a half a semester at the beginning of each and every year gaining the trust of the children and their parents. The children I get are happy to be with me, they are not “mourning” the loss of last year's teacher. The parents get to know and trust my judgment so when I have difficult things to discuss with them it is much easier and the child gets the needed help much quicker. It is much better for the child, and after all, isn’t that why we are all here?” —Dawn Celyan, Toddler Teacher Dawn is a Toddler Teacher at the PITC Demonstration Program at GROSSMONT COLLEGE CHILDREN'S CENTER in San Diego As part of becoming a PITC demonstration program, Grossmont sought to create intimate care settings that reflect the PITC philosophy and policies. Children and families now stay in the same small groups with their primary infant/toddler care teachers from six months through the end of their third year. The infant/toddler care teachers and children move together to a new space at the beginning of each academic year. In effect since 1999, this approach to providing continuity of care allows relationships between children and infant/toddler care teachers and between the children’s families and infant/toddler care teachers to develop and deepen over time. In a nutshell, to support the children’s development and learning, this program engages in relationship planning instead of lesson planning. Relationship planning is a critical component of the PITC philosophy of care.

Three Ways to Implement Continuity Primary care teacher stays with the similar age group of children by moving “up” to the next classroom with them. Primary care teacher stays with similar age group of children by staying in the classroom and changing furnishing and equipment to meet the new developmental needs of the children. Primary care teacher stays with a mixed-age group (similar to family child care). When a child leaves the program, a young infant would be placed in the group and stay in the group until he/she ages out or leaves the program. Here are three typical ways that programs do continuity. One of the biggest questions for each model is the span of the age range in the group. The next questions is at what interval do you move the teacher and her primary care group to the “next” room. Some programs have two age groups B-18 months and 18 to 36 months, others have three age groups-young infants, mobile infant (6-18 months) and toddlers 18 to 36 months.

Activity: Problem-Solving Barriers to Implementing Continuity In small groups, review together the handout “Implementation of Continuity of Care in Infant/Toddler Programs. Discuss which barrier your program may encounter and the suggested solutions for your program. Now we are going to have some time for you to explore implementing continuity of care in your programs. The handout provides the major barriers typically experienced by programs trying to implement continuity of care as well as lists many possible solutions. To help you work toward implementing Continuity of care in your program, here are some helpful tips: (These are also tips that can be discussed in a directors meeting to support the concepts) When hiring new staff, include an interview question or two about the person's ability and intention to stay with your program for several years. Work toward hiring staff who are committed to and enthusiastic about participating in continuity of care. 2. Be clear with new hires that there is an expectation that they will participate in your program's practice of continuity of care. If the program states this intention up front, more staff are likely to see it as the norm at the center. Staff will understand at the time of their hire, that continuity is something that is not a choice, but instead all staff are involved in supporting the highest level of continuity. 3. Become familiar with all of the benefits of continuity of care for children, staff and families. If you are an enthusiastic endorser of continuity of care, others will catch your excitement and want to try it. 4. Start small. One strategy is to ask for volunteers from among the staff who are willing to give it a try. It is better to try a 'pilot' cycle of continuity of care than to force the whole staff to do something that they are not familiar with or enthusiastic about. Inevitably, the enjoyment, enthusiasm and lack of stress on the part of the staff who 'piloted' the continuity of care cycle will spread to the rest of the staff. 4. Read, below, the story of one program's experience of implementing Continuity of Care on a programmatic level. GROSSMONT COLLEGE CHILDREN'S CENTER: SAN DIEGO

Developing an Action Plan.. Determine which solutions are most viable for your program. Identify the major steps that will need to be taken to implement the selected model. Program leaders and care teachers should work together to develop and implement the action plan .

Review of Learning Objectives Participants will be able to: Discuss how continuity of care assignments support the development of close, caring relationships between teacher/child, child/peers, teacher/parents. Identify the benefits over the first 3 years of keeping the same care teacher assignments to children, parents and care teachers. Explore how continuity of care might be implemented in your early care and education program. Lets take a look at our Learning Objectives for this session. Looks like we covered each of them. Does anyone have any additional questions or comments they would like to add?