Thesis (Ph. D.)--University of California, San Diego, 2004. / Vita. Includes bibliographical references (leaves 263-283).

Bakgrunden visar att hembesök till nyblivna föräldrar är en bra och väletablerad metod för personal vid barnavårdscentralen och är en del av det nationella Barnhälsovårdsprogrammet som erbjuds alla barn och deras föräldrar. Syftet med föreliggande studien var att genom intervjuer med distriktssköterskor vid barnavårdscentraler belysa deras arbete med och reflektioner kring hembesök hos nyblivna föräldrar. Metoden var en kvalitativ ansats med en beskrivande design. Åtta distriktssköterskor som arbetar vid barnavårdscentraler runt om i ett län intervjuades med hjälp av semistrukturerade intervjuer. Resultatet visade att samtliga av de intervjuade distriktssköterskorna ansåg att det var viktigt med hembesök till nyblivna föräldrar, då det gav en möjlighet att skapa en relation på ett helt annat sätt än vid enbart besök på mottagningen. Andra fördelar med hembesöket var att distriktssköterskan fick en chans att se familjens hem och relationen mellan såväl föräldrarna som mellan förälder och barn. Det som oftast försvårade arbetet med hembesök var tidsbrist eller brist på kollegor eller färdmedel. Resultatet av intervjuerna utmynnade i ett tema för de tre första kategorierna; Viljan finns att genomföra hembesök, men vissa svårigheter finns för att lyckas. Slutsatsen av denna studie är att de distriktssköterskor som arbetar med BVC-verksamhet och hembesök till nyblivna föräldrar anser att besöken är väldigt viktiga för att kunna etablera en bra relation med familjerna. Det som ibland försvårar arbetet är hur hembesöken prioriteras av såväl ledning och chefer, men även av distriktssköterskorna själva. Andra hinder i arbetet är brist på tid, kollegor och färdmedel. / The background shows that home visits to new parents is a good and well-established method for the staff at the child care center and is part of the National Child Health program offered to all children and their parents. The aim of the present study was through interviews with district nurses at the child health centers highlight their work and reflections on home visits to new parents. The method was qualitative with descriptive design. Eight district nurses working at Child Care Centers around a county were interviewed using semi-structured interviews. The results showed that all of the interviewed district nurses felt that it was important to do home visits to new parents, as it gave an opportunity to create a relationship in a completely different way than the mere visit to the clinic. Other advantages of the home visit were that the district nurse had a chance to see the family´s home and the relationship between the parents and between parents and child. Lack of time, colleagues that could fill in at the center and transportation hindered home visits. The result of the interviews yielded a theme for the first three categories; The desire is to carry out home visits, but some difficulties are present that hindrance full success. The conclusion of this study is that the district nurses who works at the Child Care Centers, and who conduct home visits to new parents, believe that the visits are very important to establish a good relationship with the families. What sometimes complicates the work is how home visits is prioritized by both management and executives, but also by district nurses themselves. Other obstacles in the work are lack of time, colleagues and transport.

U.S. immunization and well child-care rates are below desired levels with lower income individuals being at higher risk for receiving inadequate care. To enhance the understanding of motivating factors to health care utilization, this study explored relationships between a mother's interaction style (secure, anxious, avoidant), her reported experiences with pediatric health care and her child's utilization of pediatric health care. Participants included 126 US-born, English-speaking women with an infant 12 to18 months of age. Linear regression analyses found no bivariate associations between maternal interaction style and reported experiences of care. Poisson regression analyses measured associations of maternal interaction style, reported experiences of care, and moderating variables with health care visits and immunizations received. Main effect models found no associations between maternal interaction style and reported experiences of care. Significant associations were identified between provider ratings and sick visits. There were no associations between provider office ratings and utilization rates. When interaction style and provider/provider office ratings were included in the model, high provider ratings (P<.05) and high anxious interaction scores (p<.0001) were associated with more sick visits while higher avoidant interaction style scores (p<.01) were associated with decreased use of sick visits. Multivariate modeling identified provider rating (p<.05) and anxious interaction score (p<.01) as main effects, child's health rating as a confounder, as well as target child being mother's first, WIC/Healthy Start participation, maternal bonding and feelings about going to the doctor acting as moderators to associations between interaction style and sick/follow-up visits. Secure interaction style scores were associated with increased use of emergency department visits, controlling for the confounding effects of maternal bonding and the moderating effects of child's health status and maternal age. Findings indicate that, in some cases, maternal interaction style is associated with how and when mothers access health care for their children. The confounders and moderators identified also highlight the need for more understanding regarding what motivates individuals. Finally, there were racial and ethnic differences including higher rates of avoidant interaction styles in Black, non-Hispanic mothers. Predicting health care utilization patterns will help better target the specific needs of mothers and ultimately improve health outcomes.

Using the Generations and Gender Survey (GGS) and ordered logistic regression, the relation of intergenerational child care and short-term fertility intentions is explored in the gender-egalitarian Swedish family policy context. Overall, receiving child care help from parents or grandparents does not seem to influence whether women or men with one or two children plan to have another child. The results support the Swedish public child care system's effectiveness in facilitating relatively high fertility and work- and family compatibility, while informal child care is at best complementary. Only women and men aged 18-29 years old with two children were found to be significantly more likely in having another child within three years when receiving intergenerational child care support.

This qualitative study explores six child care teachers’ perceptions of their work as gendered work. The purpose of the study is to understand how the experiences of women child care teachers are connected to the larger issue of gendered teaching embedded in culturally pervasive beliefs about child care teaching. This study answers the following questions: 1) What do child care teachers perceive about their work? 2) How do they conceptualize child care teaching as women’s work? 3) How do they describe the practice of their perceived work as women’s work? Data were collected through in-depth interviews and, following Corbin and Strauss’s (2008) grounded theory methodology, analyzed to find emergent themes. Six themes emerged from the analysis of interview data: 1) child care teaching is not gendered work, 2) child care work is an identification of self, 3) child care teaching is a way of relating to one another, 4) vulnerabilities of child care work, 5) child care is hard work, and 6) contradictions and paradoxes. These themes answer the three research questions. First, these teachers perceive their work to be gender-neutral work, self-identification, mutuality, vulnerabilities, and labor profession. Second, the teachers conceptualize child care work both as gender-neutral and gendered, as creating women’s culture, and as women’s culture being stigmatized. Third, the teachers show paradoxical and inconsistent attitudes about the practice of their perceived child care work as gendered work. The categories about the participants’ conceptions of their work are interrelated and interwoven. They reflect a complexity in the participants’ understandings. The inconsistencies of the teachers’ perceptions reflect the complexity of child care teachers’ reality and their negotiations between dominant beliefs about what child care work means and the elements of their individual and collective experiences that they bring to their profession (Biklen, 1995; Dillabough, 1999, 2005; Murray, 2006; Ryan & Grieshaber, 2005). The findings of this study provide implications for teacher educators. The implications involve the need to utilize contemporary theories and feminist perspectives to better understand the nature of child care teachers’ work and to help teachers develop a critical and more realistic understanding of the nature of their work. / text

published_or_final_version / Social Work / Master / Master of Social Sciences

published_or_final_version / Social Work / Master / Master of Philosophy

The main focus in this thesis lies in the observation of how the public debate is formulating and developing in Finland in relation to the current implementation of the Inquiry on historical child abuse and neglect in out-of-home care. This thesis analyses the testimonies published around the investigation and on historical child abuse, in the public domain. The release of two documentaries broadcasted on National TV (YLE TV1) in 2013 and 2014 triggered a, however scarce, online public discussion with few newspapers’ as well as magazines’ articles covering informatively the inquiry. The online debate has so far seen the participation mainly of the victims themselves of historical abuse. Generally, I found a confirmation that the Finnish individualistic culture is hardly prompt to open discussion on such topics. As S.N., a care leaver, explains in the second documentary: (Lehikoinen, Luurankokaappi, 2014) “the culture does not give space” though people have “the need to speak.” My thematic analysis on this debate has nonetheless disclosed an urge to come to terms with a past of institutional abuse, framed in a general context of public mistrust in the Child Welfare4 system. The care-leavers, narrating their stories in the two TV documentaries, disclosed memories of neglect, violence and systematical isolation of the Poor. Their stories are interpreted through the debate on the media as stories of injustice. Their narration portraits a concept of “child care” very far from nowadays’ standards of child welfare. Care-leaver H.S. points his finger on the Finnish child-care institution where he spent his childhood in the ‘50s: “Only a monster can send a child to such a place!” (Lehikoinen, Varastettu Lapsuus, 2013).

The use of family, friends, and neighbors ("kith and kin") as caregivers for young children is a common practice in many cultural minority and impoverished communities in the U.S. Such caregivers often serve as trusted, familiar, affordable, and accessible sources of care, however, the quality of such "informal" child care is often questioned. This, I contend, is a consequence of the application of narrow constructs of quality derived from the values, practices, and experiences of the dominant class and culture.This dissertation details the roles that kith and kin caregivers fill in the White Mountain Apache community in east-central Arizona, and the functions such caregiving performs. Being in the care of kith and kin is important in giving children a sense of "place" within their extended family and the community. It teaches them their relations as well as the role and importance of family and community and reciprocity, and builds and reinforces family and community networks. It places children in the hands of grandmothers and other individuals with high cultural capital, hence providing a space, time, and opportunity for cultural learning. Kith and kin caregiving thus assists in the preservation of Apache language and culture by providing not only a context for cultural transmission and access to those with the greatest cultural knowledge and linguistic competence, but also by reinforcing a pedagogical role central to Apache culture and emphasizing the importance of family.While important, such functions of kith and kin care are ones not easily accounted for in existing constructions of quality. In order for standards of quality to have any meaning or utility in cultural minority communities, I argue that we need to encourage the development and utilization of culture and context specific definitions of caregiving quality and the inclusion of community standards. Constructs of quality must also speak to the well-being of children in their own communities and cultures. For Native communities, the incorporation of Native culture and language into child care programming and settings is essential to the health, maintenance, and cultural survival of these communities.

This study explored the effectiveness of Handle With Care, a mental health promotion training program for child care practitioners working with children between birth to age 6. Handle With Care program content is based on research evidence. Training units are intended to deepen practitioners’ understanding of how children’s social-emotional development, centre and family connections and positive workplace activities link to children’s well-being and practitioners’ roles in these areas. Fifty-seven front-line practitioners from three different regional groups (Rural, Suburban, Urban) completed Handle With Care workshops and were compared to 56 comparison participants, matched according to region, who were not exposed to training. The evaluation utilized a time series repeated measures design and consisted of mixed quantitative and qualitative measures to determine training outcomes related to practitioner’s mental health promotion knowledge and practices. Findings indicated that child care practitioners who participated in Handle With Care training demonstrated increased mental health promotion knowledge. In particular, they acquired better comprehension of issues concerning practitioner and child attachment relationships, children’s self-esteem, emotion expression and regulation and peer relationships. Training participants significantly differed from comparison participants in their knowledge of these topics. In terms of practices, training participants also evidenced significantly improved practices relative to comparison participants. These gains were especially observed in relation to practitioners building trusting relationships with children, fostering children’s sense of self and competence, positive peer interactions and practitioners promoting their own mental health. In contrast, Handle With Care training did not show the intended consistent outcomes with respect to practitioners helping children with emotional communication, dealing with diversity, changes and transitions and practitioners building relationships with children’s parents. Results tended to be discrepant across regional groups, and in some instances, gains in mental health promotion and knowledge were not sustained over time. Overall, the study suggests that Handle With Care is a useful way to augment child care practitioners’ capacity to consider the mental health of all children in their care and flexibly implement strategies to help children reach their optimal potential. The study also provides important information concerning regional differences and areas of training content that may benefit from revision.