Mary A. Roach

The beginning of conversation: Early patterns of mother-infant vocal responsiveness☆

Abstract Microanalytic techniques were used to characterize the structure of the prespeech communication of 4-month-old infants and their mothers. Two observers continuously recorded the interactive behavior of mothers and their infants during hour-long observations in the homes of 25 families. Loglinear models were used to examine the extent to which the vocal behavior of one person was conditional upon the vocal behavior of the partner. Within the limits of this microanalytic approach, analyses indicated that patterns of mother-infant vocal exchange were structurally similar to patterns of adult conversation. Initial vocal responses were followed by suppression of vocalization, allowing the partner to join the conversation. The comparative effectiveness of vocal behavior as an elicitor of vocalization and as a response to vocalization was shown for mothers and infants relative to the other behaviors observed. Vocalization served as a modulator of visual attentiveness: When the partner was not visually attentive, vocalization elicited visual attention.

Creating Champions for Health Care Quality and Safety

Patient safety and quality of care are public concerns that demand personal responsibility at all levels of the health care organization. Senior residents in our graduate medical education program took responsibility for a capstone quality improvement project designed to transform them into champions for health care quality. Residents (n = 26) participated alone or in pairs in a 1-month faculty-mentored rotation at the Veterans Administration Hospital during the 2007-2008 academic year. They completed a Web-based curriculum, identified a quality-of-care issue, applied Plan—Do—Study—Act cycles, authored a report, and engaged colleagues in their innovations during a department-wide presentation. Results indicated that residents demonstrated significantly enhanced knowledge and attitudes about patient safety and quality improvement and provided consistently positive faculty and rotation evaluations. In addition, residents generated 20 quality improvement project proposals with a 50% rate of hospital-wide implementation, leading to meaningful changes in the systems that affect patient care.

The Impact of Low-risk Prematurity on Maternal Behaviour and Toddler Outcomes

This short-term longitudinal research project was designed to compare the maternal behaviour of mothers whose toddlers had been born preterm with the maternal behaviour of mothers whose toddlers had been born at term; the outcomes for the toddlers were also assessed. Twenty-one toddlers who had been born preterm with low medical risk (1460-2420 grams) were compared with 21 term toddlers who were matched in terms of social class. The heightened maternal responsiveness that had been observed during the first year with preterm infants had disappeared by 12 months, and by 20 months it was the mothers whose infants had been born at term who were more vocally responsive. During the second year, the mothers of preterm toddlers were characterised by more maternal control behaviour than were the mothers of term toddlers. Assessments of cognitive and language performance at the gestationally corrected ages of 12 and 20 months did not differentiate the toddlers who had been born preterm and term. In terms of play skills, reflected during interaction with their mothers at 12 and 20 months, the preterm toddlers were more actively involved than were the term toddlers. Despite the successful adjustment of these low-risk preterm toddlers, maternal behaviour was affected by the circumstances of preterm birth, even after 20 months.

Mothers' speech to their 1-year-old infants in home and laboratory settings

The speech of mothers and their 1-year-old infants was compared in the home and in the laboratory playroom. The home and laboratory settings were similar for measuring the number of actual words that infants spoke and were similar for measuring the complexity of the mothers speech, including the number of different words, the type-token ratio, and the length of the utterances. Infants vocalized at similar rates in the two settings, but mothers spoke at a faster rate in the laboratory playroom. The usefulness of a preliminary warm-up period was supported by the finding that for the second half of the sessions, mothers slowed their rate of speech and increased the complexity of their speech.

Resident Self-Assessment and Self-Reflection: University of Wisconsin-Madison’s Five-Year Study

BACKGROUNDChart review represents a critical cornerstone for practice-based learning and improvement in our internal medicine residency program.OBJECTIVETo document residents’ performance monitoring and improvement skills in their continuity clinics, their satisfaction with practice-based learning and improvement, and their ability to self-reflect on their performance.DESIGNRetrospective longitudinal design with repeated measures.PARTICIPANTSEighty Internal Medicine residents abstracted data for 3 consecutive years from the medical records of their 4,390 patients in the University of Wisconsin-Madison (UW) Hospital and Clinics and William S. Middleton Veterans Administration (VA) outpatient clinics.MEASUREMENTLogistic modeling was used to determine the effect of postgraduate year, resident sex, graduation cohort, and clinic setting on residents’ “compliance rate” on 17 nationally recognized health screening and chronic disease management parameters from 2003 to 2007.RESULTSResidents’ adherence to national preventive and chronic disease standards increased significantly from intern to subsequent years for administering immunizations, screening for diabetes, cholesterol, cancer, and behavioral risks, and for management of diabetes. Of the residents, 92% found the chart review exercise beneficial, with 63% reporting gains in understanding about their medical practices, 26% reflecting on specific gaps in their practices, and 8% taking critical action to improve their patient outcomes.CONCLUSIONSThis paper provides support for the feasibility and practicality of this limited-cost method of chart review. It also directs our residency program’s attention in the continuity clinic to a key area important to internal medicine training programs by highlighting the potential benefit of enhancing residents’ self-reflection skills.

Moving Toward Family-Centered Early Care and Education: The Past, the Present, and a Glimpse of the Future

Over the past 4 decades, early care and education programs in the United States have struggled to overcome obstacles to active parent and family participation, especially in the wake of recent welfare reform guidelines requiring parents to work outside the home. This article highlights the vision and activities of four Wisconsin Early Childhood Centers for Excellence, which offer family-centered services along with services to young children. Using various strategies, these programs have empowered parents and strengthened bonds between parents and professionals. Their success suggests that new models based on family-centered goals can improve the overall quality of early care and education for young children.

Adjustment to Motherhood by Single Adolescents

The psychological adjustment of adolescent mothers was compared with that of adolescent nonmothers single adult mothers and married adult mothers. Individual differences within the sample of adolescent mothers were also explored. Adolescent mothers reported greater enjoyment with life and well-being than adolescent nonmothers but reported more mental health problems and less well-being than married adult mothers. For adolescent mothers a positive relation existed between their mental health and the assistance they received with caregiving. (authors)

Single mothers and their infants: factors associated with optimal parenting

This article examines factors that may influence optimal early parenting by Caucasian single mothers. The parenting of 53 single mothers was assessed using the Home Observation for Measurement of the Environment (HOME). Optimal parenting was linked with older maternal age, fewer maternal psychological symptoms, and less difficult infant temperament. Less optimal parenting was characteristic of mothers from disrupted families of origin and mothers who lived with adult relatives. The particular needs of the single mother should be considered when formulating public policy, identifying psychological risk factors, and designing intervention programs.

Impact of a Statewide Collaborative on Strengthening Families Through Early Care and Education

Research Findings: Research suggests that early care and education programs are most effective when they include strong components of family involvement. The Center for the Study of Social Policy recommended that early care and education programs build family-centered practices to strengthen families and reduce the incidence of child abuse and neglect. This article summarizes a statewide effort to implement this strategy, called Strengthening Families through Early Care and Education. We analyzed program self-assessments submitted by 186 early care and education programs. Analyses revealed that Head Start programs had better support systems in place for families than did “mainstream” (non–Head Start, non-accredited) early care and education programs. Results also showed that a small amount of state and local funding provided enough incentive for programs to improve their family-strengthening practices. Commitment and collaboration at the state level led to a sustainable impact by infusing “strengthening families” concepts into the early care and education field statewide.

Section III - Policy Affecting and Evaluation of Quality: From Research to Policy: In Search of an Affordable Statewide System for Rating Child Care Quality

State governments are beginning to institute systems to rate the quality of child care programs, both as a service to consumers and as an incentive for quality improvement. More states might experiment with such systems if they believed that valid ratings could be assigned without burdensome costs. The current study used survey data to construct an indirect rating of child care quality and then test whether that rating predicted observed quality. The results showed a moderate association between indirect and observed ratings of quality (r = .43, p < .001), but more importantly, it opened the door to a statewide conversation about child care quality improvement. Applied research is never sufficient to create policy change, but with fortuitous timing and careful attention to practical concerns, research can add meaningfully to the public policy process.