Family Practice; Studies from L. Rourke et al add new findings in the area of family practice

According to a study from Canada, "The Rourke Baby Record (RBR) - -is a freely available evidence-based structured form for child health surveillance from zero to five years (see also Family Practice). Family physicians/general practitioners (FP/GPs) doing office based well-baby care in three Ontario Canada cities (London, Ottawa, and Toronto) were randomly sampled to study the prevalence and utility of the RBR and documentation of well-baby visits."

"Database with telephone confirmation was conducted to assess the prevalence of use of the RBR. Part 1: Questionnaire mailed to a random sample of 100 RBR users. were utility of, helpfulness of, and suggestions for the RBR. Descriptive analysis was employed. Part 2: Retrospective chart review of well-baby visits by 38 FP/GPs using student t-tests and factor analysis. were well-baby visit documentation of growth, nutrition, safety issues, developmental milestones, physical examination, and overall comprehensiveness. The RBR was used by 78.5% (402/512) of successfully contacted FP/GPs who did well-baby care in these 3 cities. Part 1: Questionnaire respondents (N = 41/100) used the RBR in several ways, and found it most helpful for assessing healthy child development, charting/recording the visits, managing time effectively, addressing parent concerns, identifying health problems, and identifying high risk situations. The RBR was seen to be least helpful as a tool for managing or for referring identified health problems. Part 2: Charts from a total of 1,378 well-baby visits on 176 children were audited. Well-baby care provided by the 20 FP/GPs who used the RBR compared to that by the 18 non-users was statistically more likely to include documentation of type of feeding (p = 0.023), discussion of safety issues (p < p =" 0.001)," p =" 0.097)," p =" 0.828).">

The researchers concluded: "The Rourke Baby Record has become a de facto gold standard clinical practice tool in knowledge translation for pediatric preventive medicine and health surveillance for primary care pediatric providers."

Rourke and colleagues published their study in BMC Family Practice (The Rourke Baby Record Infant/Child Maintenance Guide: do doctors use it, do they find it useful, and does using it improve their well-baby visit records? BMC Family Practice, 2009;10():10).

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PacifiCord Now Offering Free Prenatal Classes in Los Angeles

Dedicated to serving the private cord blood banking needs of Southern California, PacifiCord ( today announced it is now offering free prenatal classes in Santa Monica and Sherman Oaks in addition to the classes held weekly at the Irvine, Calif., headquarters--which has been offering prenatal classes such as preparation for childbirth, baby care basics and breastfeeding basics since March of 2009.

"Providing quality prenatal classes is a great way for us to not only give back to the community but also introduce PacifiCord and family cord blood banking to expectant couples in a very non-threatening manner," said Wendy Spry, LVN, CPSS and PacifiCord's Healthcare Educator. "For many families, it's their first time hearing about their cord blood banking options. For others, it's a great opportunity to learn more."

"PacifiCord's business is rooted in providing an unparalleled level of service to expectant parents," said Bob Kurilko, president and CEO of PacifiCord. "Providing free prenatal classes is a natural extension of our Cord Blood Concierge(TM) Service that includes free in-person consultations, complementary tours of our working laboratory in Irvine, Calif., and hand-couriered cord blood pick-up for families in the Southern California area."

In the near future, PacifiCord is looking to expand its free prenatal class offerings to San Diego. "We're in the final stages of securing a class location. Our plan is to be up and running in San Diego by September," said Spry.

For class locations, schedules and to enroll in one or more of PacifiCord's free prenatal classes in Irvine, Santa Monica and/or Sherman Oaks, please visit:

About PacifiCord

Based in Irvine, Calif., PacifiCord is part of the HealthBanks Biotech Group, which for nearly 10 years has been a leader in cord blood stem cell processing, storage and research. PacifiCord and HealthBanks Biotech were the first family banks in the world to adopt the optimum methods and technologies of the world's leading public cord blood programs, thereby setting a new standard that few other family banks can match.

PacifiCord is a California state-licensed cord blood bank and an FDA-Registered Human Cell, Tissues and Cellular and Tissue-Based Products (HCT/P) Establishment. coupon sitemap

Parent Mentoring and Child Anticipatory Guidance with Latino and African American Families

Poor health and developmental outcomes for children are linked to scarcity of economic resources, various barriers in the delivery of health services, and inadequate parenting. To mitigate such adverse effects and address the needs of 50 high-risk, low-income Latino and African American families receiving well-baby care at an urban primary care health center, a collaborative team from the social work, nursing, and education fields piloted a preventive two-year parent mentoring project. The intervention was theoretically anchored in the transactional model of child development. The mentoring practices used an activity-based approach for strengthening child anticipatory guidance and meeting family needs. Thirty-five intervention families completed the project. Compared with a matched community sample, intervention families showed positive statistically significant changes in parent and child outcomes. The discussion addresses the practical benefits of the intervention, limitations of the evaluation design, and implications for collaborative multidisciplinary practice.KEY WORDS: clinical social work intervention; early childhood guidance; high-risk families; infant development; parent mentoring

Early childhood constitutes a relatively short period of human development, yet it is disproportionately important in setting the stage for optimal health and development across the life span (Starfield, 2004). Specifically, a child's health status, parental child-rearing choices around early developmental milestones, and the family environment set the stage for child well-being, create long-term developmental consequences for school-based learning, and affect risks for develop- ing chronic diseases (Borkowski & Weaver, 2006). The centrality of the family environment in early child development forms the conceptual base for strengthening young children by providing their families with anticipatory child guidance and promoting family-centered care in the delivery of well-baby health services (American Academy of Pediatrics, 2003). Recendy, however, the U.S. Pre- ventive ServiceTask Force found that the amount of time required for delivering all of the needed child well-health preventive services, including necessary support and guidance for families, is not feasible during routine well-baby visits (Yarnall, Pollack, Ostbye, Krause, & Michener, 2003). Research has also revealed that a large proportion of young chil- dren living in poverty receive inadequate preventive health care, with the most frequent barriers being providers' lack of comprehension of family needs and lack of sufficient time for service (Zuckerman, Stevens, Inkelas, & Halfon, 2004).

Although family-centered interventions have long been central in social services provision (Kilpatrick & Holland, 2006), developmentally sensitive interventions for families of very young children are relatively new and require extensive multidisciplinary collaboration (Applegate 6c Shapiro, 2005). Thus, a team of professionals from the social work, nursing, and education fields created and implemented a two-year preventive intervention project of parent mentoring designed to strengthen the anticipatory child guidance of 50 Latino and African American families at an urban primary health care center in Washington, DC.This article presents the pilot intervention, the evaluation process, findings for parents' and children's outcomes, and lessons learned.


Four conceptual domains affect infant development (Sameroff, McDonough, & Rosenblum, 2004) and frame parent mentoring during early childhood.


Infant development is a product of continuous dynamic transactions between developmental processes and caregiving experiences. Indeed, recent studies on brain development confirm that infants' dependence is so pronounced that early inadequate or harmful parenting practices yield persistent negative developmental effects (DeBellis, 2005; Osofsky, 2004). To mitigate these risks, current research suggests that preventive interventions need to be directed at infants, parents, and family home environments (Borkowski & Weaver, 2006).

Social Environmental Resources

Within this transactional model of child development (Sameroff & Chandler, 1975), poor health outcomes are linked to a paucity of family economic resources, gaps in parental education and child development knowledge, and barriers in access to health care (Borkowski & Weaver, 2006). Research has also found that children's well-being and early school readiness are compromised by parents' depression, substance abuse, domestic discord, harsh child-rearing practices, and child neglect (Bradley & Corwyn, 2002). Such risks are particularly prevalent in poor families, and they pose even greater risks in poor immigrant families (McLanahan, 2005). Poverty is also the most significant factor associated with low rates of vaccination and receipt of basic medical care (Rodewalt & Santoli, 2001).

Well-Baby Care

Routine well-baby health care represents a universal opportunity for early engagement of parents in monitoring infant health and growth and learning through anticipatory child guidance.The well-baby care contacts between health care providers and parents serve as focal contact points during which providers and parents share a focus on the well-being of the infant. In turn, this mutual focus creates a therapeutic leverage for developing a working alliance between parents and providers (Brazelton & Greenspan, 2000).

Parent Guidance

As a major Ufe change for adults, the transition to parenthood requires adequate life skills and resilience (Bornstein, 2002). Review of the research reveals a striking consensus on major parental prebirth factors that exert a negative influence on postnatal parenting development and create risks for child development (Borkowski & Weaver, 2006). Parents whose mental health is compromised or who lack persistence or sensitivity in their approach to general problem solving tend to have incompetent self-regulation and insufficient empathy to sustain relationships. Others have inadequate basic education for meeting their own or their family's needs. Such parents tend to show a lack of resilience in meeting life's demands, have unrealistic expectations and rigidity toward children's behaviors, manage children's developmental needs poorly, and often maltreat their children (Landy & Menna, 2006).


In this project, Brazelton's (1992) Touchpoints approach served as the educational practice model for mentoring and strengthening parents' anticipatory guidance during routine well-baby health care. The parent mentoring was carried out by two bilingual (in Spanish) college-educated (in early childhood development) parent coaches. To ensure delivery of a quality intervention, the entire project team (social work clinical research director, nursing health center director, administrative education director, parent coaches, coaches' supervisor, project manager, and data manager) was trained in the promotion of the transactional approach to parent- child interaction and guidance through video-based training delivered by an on-site Keys to Caregiving consultant (Barnard, 1994). This week-long training included guided viewing of six instructional videos (addressing infant state, behavior, cues, temperament, feeding interaction, and provider-parent communication), completion of study guides, and engagement in role play using five parent handouts. The videos demonstrated various preferred parent provider and infant transactional behaviors.The study guides provided scaffolded information about parent-child interaction, guidance for facilitating self-reflective practice in mentoring parents, and questions for assessing comprehension of the video vignettes. The parent handouts were used to demonstrate preferred parent- child interactions at different stages of infant development. In addition, to ensure fidelity to Brazelton's developmental method of teaching parents about infant development and ensure reliability of infant observations during the delivery of well-baby health care and parent mentoring, all project team members participated in an intensive three-day training at the Brazelton Institute in Boston or locally.These training experiences ensured the buy-in of all project personnel and the relevant educational knowledge and skill sets needed across disciplines.

The parent mentoring intervention was implemented with individual families through a systematized protocol. In implementing this protocol, each parent coach first met with a family during a planned health center visit. A two-hour home visit followed two weeks later. There were multiple phone contacts throughout. Visits started at birth and continued until the child reached 18 months of age. The well-baby visits at the health center followed the requirements set by the Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) protocol (Centers for Medicare and Medicaid Services, 2003). This protocol is based on infant developmental progression, with designated time periods serving as critical anticipatory guidance and assessment points at which infant health, development, and caregiving are reviewed for progress, needs, and treatment planning.

First, during the EPSDT health center visit, parent coaches participated in the child health and developmental assessment and observed parenthealth provider communication and interaction. Parent coaches used the knowledge gained in their subsequent mentoring during home visits. Overall, coaches structured their mentoring contacts to meet three goals: (1) to strengthen the parent-health provider relationship and communication about the focus child's development and health, (2) to educate parents about the importance of nonharsh parent-child interactions and age-appropriate child behaviors, and (3) to increase families' knowledge and use of community resources to meet their needs. To accomplish these goals, the project first manualized all EPSDT planned contacts between coaches and families on the basis of normative developmental expectations for infant physical and socioemotional functioning. The planned contacts had separate activity components for well-health visits at the health center and follow-up visits at home. Typically, the planned contacts had an associated educationally planned activity to enhance parent skills in infant stimulation or behavior management, promote positive parent-child interaction and attachment, give parents sufficient time to ask questions about their child or related family needs or issues, and allow parents to explore feelings about recommendations made for their child's health or development. The components of these contacts were often sequenced into child health or development training, home safety, and parenting practices.

Second, in all planned contacts from four to 18 months, coaches used the Ages and Stages Questionnaire (ASQ) (Bricker & Squires, 2002), an interactive activity-based system to help parents evaluate, understand, and anticipate their child's unfolding growth and socioemotional competencies as well as explore options for intervention. Within this ASQ activity-based system, coaches used penciland-paper questionnaires to help parents assess their infant's competencies. They also used videotaped vignettes to guide parents in learning about developmental benchmarks and the meaning of infant normative behaviors, explore various beliefs and common myths about child-rearing practices, teach parents how to anticipate the progression in their infant's physical and socioemotional competencies, and model for and practice with parents sensitive interaction with their child (for examples, see Squires & Bricker, 2007).

Third, to increase parental sensitivity to infants' emotional regulatory needs, coaches used culturally skilled dialogue in providing developmental guidance and information in a respectful, sensitive, collaborative, and nonjudgmental manner. Starting at enrollment, coaches asked about parents' comfort level in speaking, reading, and writing English. Coaches followed the parents' lead in using English, Spanish, or both during visits and with informational materials. Coaches initiated parent dialogue in a way that encouraged parents to identify what they considered important for their child's care. Before addressing any other concerns, coaches asked parents what questions or concerns they had about their child's health, development, or needs, thus allowing parents to lead the conversation in their preferred direction. Coaches used natural opportunities that presented themselves during contacts to reflect and comment on parents' competencies and strengths. Coaches sought to validate parents' feelings by using reflective language, offering compliments on care or attunement, and helping parents interpret the meaning of infant behavior and utterances (for dialoguing, see Barrera & Corso, 2003).

To facilitate use of community resources, coaches helped parents to secure instrumental resources (toys; basic equipment such as cribs, high chairs, and car seats) by identifying low-cost stores, securing donations through local charities and foundations, and directly showing parents how to find these resources. Coaches also provided information on accessing legal and immigration services and using available resources for employment, education, health insurance, housing, and public transportation. When necessary, coaches provided referrals to appropriate support services for parental coping with substance abuse, mental health issues, and domestic violence. Although coaches followed the EPSDT schedule for regularly planned mentoring, they also provided parents with emotional support through frequent follow-up phone calls. To support family diversity of lifestyle and choices, coaches were expected to be flexible in finding times convenient to parents for visiting, to engage in conversations relative to parents' preferred issues, and to link these conversations to the jointly established goals for promoting adequate care and healthy development.

To ensure fidelity in providing a quality intervention, monitoring the developmental needs of focus children, providing support to coaches, and coordinating information, the project included weekly individual supervision of coaches, meetings with the entire project staff, and meetings of the directors from the three disciplines to review developmental progress. All parent contacts were documented in a confidential case record accessible only to selected staff. For all contacts, coaches completed a structured form that tracked time, location, purpose, objectives, people involved, activity or accomplishments, and coaches' perceptions of strengths and barriers present. This information was entered into a password-protected database and regularly reviewed by directors. For health care quality assurance, the nursing director also reviewed medical records and coaches' reports monthly to monitor children's progress. Each quarter, selected staff made random calls to spot-check families' satisfaction with services. Every six months.families completed an anonymous satisfaction questionnaire. These internal reviews served to ensure consistency, maintain quality of service delivery, and triangulate coaches' and parents' reports with health center staff observations in the child's medical record.

In addition, different team members coordinated various project-related tasks. For example, the social work director grounded the intervention's clinical practices in theory and research, designed and implemented the evaluation, and guided coaches' family-centered mentoring practices in home visits and use of community resources. The nursing director supervised coaches' well-child health center visits and provided education about child health and illness. The education director worked with an advisory body, monitored administrative reporting, and facilitated coaches' practices in mentoring parents who had cognitive impairments.

To ensure the project's saliency to local community needs, quarterly meetings with a community advisory group provided further input and periodic oversight. This advisory group was composed of health, education, and social services professionals and parents of young children. Overall, the project used parent mentoring to provide parents with anticipatory guidance in child health and development. For parents, the project outcomes focused on strengthening adequacy of family needs and resources, increasing knowledge of nurturing practices, and promoting personal resilience. For children, outcomes focused on ensuring timely child immunization and age-appropriate developmental and language progress.


To assess intervention benefits, outcome data were collected for two research questions: (1) Do focus children evidence positive changes in child development-related outcomes? (2) Do intervention families evidence positive changes in parent-related outcomes?


The project enrolled 50 families, with 30 of the focus children (60 percent) enrolled during their mothers' last month of pregnancy and the remainder enrolled during their first month of age. Thirty-five families (70 percent) were fully served over the designated evaluation period from enrollment to when the focus child turned 16 to 18 months of age. Eleven dropped out by the end of the first year because their home was too far from the primary health center. Four moved out of state. There were no statistically significant differences in baseline characteristics between fully served families and those who left.

The project enrolled an equal number of boys and girls with a medically normal birth (that is, there was no special medical intervention following birth, and both mother and baby were discharged within three days). Seventeen focus infants (34 percent) were only children; 18 (36 percent) had one older sibling under 18 years of age, and 15 (30 percent) had two or more siblings. Of the 33 infants with siblings (66 percent), 17 (52 percent) also had half siblings residing elsewhere.

At enrollment, the mother's average age was 23 years (SD - 5.6), and the partner or spouse's average age was 25 yean (SD = 6.9). Nine mothers (18 percent) were legally married with a spouse living at home; 20 (40 percent) occasionally lived with a spouse or partner after having legally separated or divorced, and 21 (42 percent) had never been legally married but occasionally lived with a partner. Twenty-eight infants (56 percent) had regular daily or weekly contact with their biological father.

Nineteen families (38 percent) had close relatives residing nearby, 10 (20 percent) had family relatives living elsewhere in the United States, and 21 (42 percent) had relatives living abroad. Thirty-five farmlies (70 percent) had immigrated from South or Central America or Puerto Rico. In 25 of these Latino families (71 percent), both parents were immigrants. Ten mothers (29 percent) had been born in the United States of immigrant parents. Although most of the Latino immigrant families preferred to speak their native Spanish, about half were able to convene and write in basic EngUsh.The remaining 15 families (30 percent) in the project were U.S.born African Americans.

Although family income level made the focus children eligible for Medicaid, half did not have health insurance at enrollment. In most families, parent education was minimal. Thirty mothers (60 percent) had not completed high school; the rest were in the process of obtaining a GED. Twentyfour biological fathers (86 percent) did not have a high school diploma.

Design and Sampling

The project evaluation used a quasi-experimental nonequivalent group design with a static comparison group. The one-group pre- post evaluation compared targeted parenting and child outcomes of intervention families with a comparison group of 30 matched families. Self-selected intervention farmlies were enrolled on a first-come first-served basis by referrals from hospital clinics. The comparison families were recruited from the health center catchment area through invitational fliers and provided with information about the evaluative survey and project enrollment availability. To create a comparative sample, matching criteria for comparison and intervention families included project recruitment criteria: focus child's medically normal birth status and age and mother's age (17 years or older at the time of child's birth), education (less than high school), and race or ethnicity. The comparison family could not be receiving any parent mentoring. These criteria stemmed from early prevention research (Borkowski & Weaver, 2006) The project was approved by the participating university and hospital Internal Review Boards. All intervention and comparison families completed informed consent forms prior to participation. As a reward for completing evaluation assessments, all families received toys and books for their focus child, calendars, and grocery gift certificates.

Data Collection

All family data were collected through structured interviews by parent coaches at enrollment baseline and at exit. Some data were also collected when the child turned 12 months old. Mothers were the primary informants; however, both parents sometimes negotiated the one answer they wished to provide during evaluation. All reasonable efforts were made to interview the same individuals at each assessment point and in their preferred language.

Data Analysis

The Statistical Package for the Social Sciences (SPSS 13.0) was used for all analyses. Measures of central tendency and percentages described participants. Paired t tests were used to evaluate the mean outcome change in the intervention group from pre- to posttest. Independent t tests were used to compare the mean change between the intervention and comparison groups at posttest.

Outcome Variables

Parent and child outcomes were based on previous research noting the negative impact poverty and poor parenting practices exert on child development and on scale appropriateness, brevity, and ease of completion (DelCarmen- Wiggins & Carter, 2004). All instruments had appropriately developed Spanish versions (Chavez & Canino, 2005).

The three parent variables were as follows: (1) Adequacy of family needs and resources was measured by the Family Resource Scale (Dunst & Leet, 1987), which has research-adequate criterion validity and consistency. The five-point scale responses were aggregated into usually inadequate (rated as never, rarely, or sometimes) and adequate (rated as usually or most of the time). (2) Parenting knowledge of nurturing practices and childrearing beliefs was measured by the Adult-Adolescent Parenting Inventory (AAPI-2) (Bavolek & Keene, 1999), which has researchadequate construct validity and consistency. (3) Personal resilience was measured by an adapted brief version of the Resiliency Attitude Scale (Briscoe & Harris, 1994). This five-point, 30-item adapted scale has basic content validity achieved through expert review and pretesting. All measures had good research reliability (Cronbach's α = .75 or better) during administrations.

The three child variables were as follows: (1) Completion of infant immunizations was measured through the health center's standard medical records documenting compliance with the EPSDT immunization schedule. (2) Achievement of age-appropriate developmental milestones was measured with the ASQ (Bricker & Squires, 2002). (3) Emerging language competency was measured by parent reports using the MacArthur Communicative Development Inventories (CDI) (Level I, Short Form);the brief-screening CDI is used widely to assess children's normative vocabulary accumulation in understanding and producing words (Fenson et al., 2000). The screening derives vocabulary percentile achievement scores that are normed for age and gender. The ASQ system and CDI short form have established adequate research validity and reliability and current alphas of .70 or above.


Parent Outcomes

Baseline reports on adequacy of basic instrumental, parenting, and interpersonal needs and resources reflected family struggles with poverty. At baseline, the average total scale score for the majority of intervention families (87 percent) reflected having usually inadequate resources. By project exit, as Table 1 shows, the positive mean changes and robust effects that occurred strengthened the overall resources of these families.

Baseline findings about nurturing and child-rearing beliefs revealed that some parents evidenced abusive beliefs and practices on the AAPI-2 scale (seeTable 2). At exit, five of the completing families did not complete these data due to family illness or scheduling conflicts. Thirty completing parents provided information about their nurturing and evidenced a statistically significant positive mean improvement in parenting practices, showing a modest positive effect (seeTable 2). Because the project actually collected AAPI-2 data at three time points (baseline, 12 months, and exit), a repeated-measures analysis of variance general linear model was used to compare the mean total scores across these time points. The findings revealed that the three mean AAPI-2 scores were statistically significantly different from each other [baseline M^sub 1^ = 1.57, SD = 1.40; 12-month M^sub 2^ = 0.97, SD = 1.00; exit M^sub 3^ = 0.63, SD = 0.76; between-subjects effect: F(2, 29) = 42.31, p = .000, partial η^sup 2^ = .59; multivariate tests: Pilai's trace = .39, p = .001, partial η^sup 2^ = .39]. Pairwise comparisons specifically revealed that the M^sub 1^AAPI-2 failure score was statistically significantly different from the M^sub 2^(p= .001) and M^sub 3^ (p = .003) failure scores.The M^sub 2^, however, did not significantly differ from the M^sub 3^ (p = .230) .These findings suggest that parents' positive and powerful impact on their child's life was most evidenced by the first year, a finding that is not surprising given the short time (four to six months) between the second assessment point and exit.

Of the 35 mothers who completed the project, 28 (80 percent) provided information on their personal resilience. At enrollment, these mothers did not significantly differ in their demographics or mean outcomes from other completing mothers in the project. Twenty-four had a total baseline score that was less than 60 percent of the total possible (highest) score. On the basis of previous studies reported by Biscoe and Harris (1996), such results suggest that these mothers were having many life-skills-related difficulties in their personal resilience. At exit, these mothers evidenced a moderate to strong positive effect on their resilience [M^sub 1^ = 102.2, SD = 13.3; M^sub 2^ = 108.5, SD =11.0; ΔM = 5.0, paired t (27) = -11.1, p = .000, η^sup 2^ = .85]. Seven mothers did not complete an exit resiliency measure due to scheduling conflicts; however, they did not significantly differ in their baseline measures from the remainder.

As shown in Table 3, independent t-test analyses were used to further compare all mean parent outcomes of intervention and matched comparison families at exit. These findings suggest beneficial significant changes for intervention farmlies. Notably, the mean levels of parent outcomes for comparison families did not differ significantly from baseline levels of intervention families.

Child Outcomes

At exit from the project, infants were 16 months old on average (SD = 1.9). All 35 intervention children who completed the project and 11 who did not were appropriately immunized on the basis of the EPSDT schedule by project exit. No information was available for the four children whose families moved away. To ensure child immunizations, coaches averaged four to five additional phone calls (SD = 5) beyond the planned EPSDT contacts.They also encountered various barriers in assisting parents with children's immunizations. For example, to address parents' fears or myths about immunizations, coaches used several strategies to provide accurate information and guidance. First, they explored and listened to parents' stories of their own upbringing and tales about immunizations. Second, they provided emotional support when parents expressed their concerns.Third,they reflected on positive and challenging aspects of the current state of knowledge on child immunizations, helped parents synthesize and comprehend the published health information (for example, information available through the Centers for Disease Control and Prevention or the American Academy of Pediatrics), and explored consequences of different decisions. To overcome transportation barriers during health center visits, coaches taught parents how to navigate the local metro train and bus connections and provided tokens on the basis of need.

In addition, at enrollment all families received a bilingual monthly calendar (developed by the project) that described parent-guiding activities for promoting infant development during the first year and also included childhood immunization requirements through adolescence.The calendar offered note space and phone numbers for the parent coaches, the health center, and other community resources. Coaches used these calendars for setting appointments with families and in commenting on children's overall progress. At exit, all parents reported positively on the calendars' usefulness in scheduling health visits, keeping notes, and sharing specific information about their child with other family members. Comparing immunization between intervention and comparison children revealed that 25 percent of the parents in the sample of 30 matched children could not provide evidence of their child's immunizations. These comparison families were also subsequently assisted in having their children appropriately immunized.

Almost three-quarters of the intervention children (74 percent) completed all six ASQ developmental assessments by project exit, and no child received fewer than four assessments. The coaches, families, and health care staff viewed the ASQ assessments as beneficial in fostering parents' understanding of their child's developmental and socioemotional needs.The coaches particularly liked the way the ASQ system helped parents concretely demonstrate their child's developmental progress. In addition, three children were identified early by the ASQ system as being at risk for delayed development. This identification fostered a prompt pediatric assessment and referral for early intervention. Of the 11 intervention children whose families dropped out, six completed at least the first two ASQ assessments at four and six months.

To examine children's language development on the CDI, the evaluation took into account whether the child was in home- or center-based child care at project exit (Borkowski &Weaver, 2006) .Twenty Latino intervention children (57 percent) were in home-based child care with their own mother; the remaining 15 (seven Latino, eight African American) children (43 percent) were in center-based care. Of the intervention children in home-based child care, 12 scored within the normative range for age and gender in vocabulary understanding and production. Three children scored below the normative range and were thus identified as at risk for delayed language development. These children were also identified as being at risk by the ASQ developmental assessments and referred for early intervention. With parent permission, CDI vocabulary assessments were also obtained for intervention children in center-based child care. The results for these children revealed that their normative vocabulary understanding and production did not significantly differ from those of intervention children in homebased care.

The matched comparison sample children were all in home-based child care. Therefore, only 20 Latino children were matched with and compared with 20 intervention children in home-based child care. Five comparison children scored below the normative range for age and gender in understanding words, and 12 scored below the normative range in producing words. Five comparison children also scored below the normative range in both. On average, intervention children evidenced a statistically significant mean difference in knowing nine more words and producing 1 0 more words than the matched comparison children (seeTable 4).


The nature of infant development, the findings from prevention research about the pervasive effects of inadequate parenting in the context of poverty, the lack of available time during well-health care for engaging in anticipatory child guidance, and a local need for service constituted the basis for developing and implementing parent mentoring with the high-risk Latino immigrant and African American families in this study. Two bilingual parent coaches individually mentored parents during their wellbaby health care and home visits. The intervention followed children's developmental progression during their first 18 months. The mentoring child guidance focused on helping parents to recognize and comprehend their children's needs and competencies, manage distress or unwanted behaviors, and anticipate children's future growth. Coaches also provided concrete assistance in accessing community resources and guided parents in effective communication of their perceptions and wishes to health providers. All mentoring activities promoted the personal resilience needed for effective and sensitive parenting. Coaching practices included educating, counseling, obtaining resources, and emotionally supporting parents in child guidance and meeting family needs. Coaches relied on the ASQ activitybased developmental assessment system in fostering and facilitating parents' knowledge and child-rearing skills. They also used developmentally based toys, books, and calendars to enrich families' resources and promote sensitive, nurturing parent- child interaction. The ASQ system became instrumental in facilitating early identification of children's suspected developmental delays. The overall project was supported by input from a community advisory body. In evaluation of outcomes, the families who completed the project evidenced increased family resources, stronger nurturing and sensitivity in meeting their child's developmental needs, and better personal resilience.Their focus children were appropriately immunized and demonstrated ageappropriate development and language vocabulary. For children who were identified as being at risk for developmental delay, the intervention process ensured early recognition and timely service delivery. In contrast, the matched comparison sample of families evidenced parent outcomes that were statistically similar to the baseline levels of intervention families, suggesting no gains.The matched comparison Latino children evidenced lower levels of vocabulary than intervention children, and a substantial proportion of these children were not immunized.

The project results are in Une with findings in other preventive health- related home visiting trials (Olds et al., 2004). That is, the project showed that to be successful in mentoring, parent coaches need to have strong knowledge of and appreciation for parent-child interaction and to use a mentoring approach that is collaborative, family centered, and culturally sensitive. Their approach also should incorporate reflective communication along with hands-on activities to impart child guidance knowledge and assist in obtaining resources. Only then is mentoring likely to make a positive impact (Weatherston,2000).

This project yielded several important lessons for practice. First, the multidisciplinary collaborative approach to project execution heralds the necessary knowledge and oversight for prevention practices in early childhood development. Second, the low-cost use of the ASQ system provides assessments that easily convey information to parents and social services, health, and education providers; systematizes parent- mentor contacts; concretely illustrates child development through anticipatory guidance; and easily links assessment to intervention options in a meaningful way. Third, the timing of the project during universally present well-baby health care services leverages therapeutic goals and benefits. These lessons further imply that work with families of very young children requires that social workers develop the capacity to integrate specialized knowledge of child development, healthy parenting practices, and prevention research in a context of delivering services through multidisciplinary teamwork.

The results of the project are, however, subject to methodological limitations.The quasi-experimental nonequivalent group design precludes a determination that the intervention can be solely credited with the observed beneficial impacts (Rubin, 2008) The use of a static comparison group was a response to funding limitations and is one of the internal validity biases that compromise the causal inference of intervention benefits. The results of outcomes derived from matched comparisons and the triangulation of coaches' reports, ASQ assessments, and parental satisfaction with the documentation of child development and health in medical records, however, support the promising nature of the project's positive short-term findings.

Recommendations for future research include using a randomized experimental design for replicating the effectiveness of parent mentoring and exploring intervention effects with different family variables (culture, caregiver's gender, other family demographics) , different caregivers (grandparents, foster parents) , and different levels of parent coaches' training and experience. Research also needs to examine the long-term impact of this and other such short-term interventions with young children. Indeed, engaging in more multidisciplinary practice research is a necessity in this era of increasing complexity of knowledge and practice issues.

Infant mauled by dog faces 'long recovery'

7-month-old boy in Newport News mauled by a pit bull terrier will live but "has a long recovery ahead of him," a city police spokesman said.

The infant, whose name police withheld, was bitten by the dog Monday in the home of his baby sitter, Newport News police officer Lou Thurston said yesterday. The baby sitter, who was with the baby at the time, managed to pry the dog off him with the help of her teenage son, Thurston said.

The baby suffered "significant injuries to the face and neck" and remains in critical condition at the Children's Hospital of the King's Daughters in Norfolk, where he was airlifted by emergency helicopter.

The dog, a 1 1/2 -year-old neutered male pit bull, was euthanized at the local SPCA facility at the request of the baby sitter, said city spokeswoman Kim Lee.

Police would not identify the baby sitter and said they were trying to decide whether to charge her with child neglect.

The dog attacked around 7:30 a.m. Monday as the baby lay on his stomach on the floor of the baby sitter's home, police said. It's not clear what set the dog off, Thurston said, but the baby sitter, with her son's help, stopped the dog before it could shake the baby.

Lee said the dog had no record of violent behavior. The baby sitter, who also owns two Rottweilers and a Chow, readily gave up the pit bull to be euthanized, Lee said.

The baby was rushed to Riverside Regional Medical Center in Newport News and quickly flown by helicopter to the trauma center at Sentara Norfolk General Hospital. He later was transferred to the Children's Hospital of the Kings Daughters.

Nursing Mothers Aloft

No longer are there tales of airport security guards forcing a breastfeeding mother to pour a two-day supply of her baby's milk into the garbage or another to taste her own milk. But a business trip still presents an array of challenges for breastfeeding mothers.

The first remains airport security. While the Transportation Security Administration has updated its rules since those well-publicized incidents involving rules about carrying liquids aboard a plane, the latest guidelines are purposely unspecific to give the security officer discretion. They allow women to take a "reasonable quantity" on board, said Christopher White, a T.S.A. spokesman.

But Caren Begun, a public relations executive in Jersey City who had a baby last year, said the lack of specificity made it difficult for her to figure out what to do. "On the Web site, they say you can travel with reasonable quantities of breast milk, but what does that mean?" Ms. Begun asked. "How much milk can I bring on board? What about ice packs? Will I have to taste the milk to show it's safe? I got a different answer from everyone."

And as they travel, many women still have to find a private place to pump their breast milk. Jenny Davis, a meeting planner in Fargo, N.D., for instance, recalled a business trip to San Diego.

"I went up to the flight attendant with my pump, said, 'I have to go to the bathroom now,' and pointed at the pump," recalled Ms. Davis, who manages events and publications for the Partner Channel, a marketing management company.

"She didn't understand what I meant, even after I repeated it," Ms. Davis continued. "Finally I said, 'I have to go to the bathroom now and use my pump.' Then she got it."

Although it is not known how many breastfeeding women travel for work, statistics suggest it is not uncommon. The most recent figures from the Census Bureau show that slightly more than half of all American women with a baby under a year old are in the work force. And nearly one-third of infants in the United States are fed nothing but breast milk for the first three months of their lives, according to the Centers for Disease Control and Prevention.

"At many companies, working mothers can request to travel less, but some women have no choice," said Suzanne Riss, editor in chief of Working Mother magazine in New York City.

Every year, Working Mother compiles a list of the 100 best companies for working mothers. Two companies from the list in 2008, Ms. Riss said, were noteworthy for their support of breastfeeding employees who must travel.

Ernst & Young, the New York City financial services company, provides free travel kits so that women on business trips can ship milk home to their babies. And the Boston Consulting Group, a management consulting firm based in Boston, helps women bring their babies on business trips by covering travel expenses for the infant and a baby sitter.

Ms. Riss called such programs "very cutting edge" and noted that they "go a long way" toward creating loyal employees. "But they're still the exception, not the rule," she added.

Several working mothers spoke of looking for a place to pump breast milk. Often, a bathroom was the only option.

When her first daughter was born a few years ago, Annemarie Reilly was the regional director for seven countries in southern Africa for Catholic Relief Services, an international relief agency based in Baltimore, she said.

"I couldn't really do my job well without traveling," Ms. Reilly said. As a result, she found herself pumping milk in unusual places -- airplane bathrooms, airport bathrooms and African villages where electricity was often limited.

"I once had a meeting at the Vatican and had to pump there," Ms. Reilly said. "During breaks, I couldn't network with my colleagues because I had to go pump."

Barbara Mastroddi, a meeting planner in River Edge, N.J., said she had been on both sides of the traveling-while-breastfeeding divide. She has requested a private room to pump milk while she was on site planning a conference, and she has accommodated similar requests from her attendees.

"We let a new mom attending one of my programs use our office twice daily so she could pump," said Ms. Mastroddi, who coordinates events for Columbia University Medical Center. "She was just attending for the day so she didn't have a hotel room, and we were happy to help out."

Ms. Mastroddi suggested that mothers attending meetings request a private room in advance from the organizers. "A lot of people who haven't pumped think, 'Oh, you can just use the bathroom,' but there's really no way to do that, plus it's not very sanitary," she said.

As to carrying breast milk through airport security, Mr. White of the T.S.A. said the amount was determined case by case, based on the security officer's conversation with the passenger. "If you're traveling say, for one day, but you're bringing back a gallon of breast milk, that might not be allowed," he said.

Mr. White said that ice packs were allowed and that sending breast milk through the X-ray machine was mandatory. But, he said, this "absolutely does not harm breast milk or any other food. It's very low radiation." Any passenger was welcome to speak to a supervisor.

He added that the guard who made a woman taste her own breast milk in 2002 worked for a private company. And, he said, in 2006, when an agent poured out another woman's breast milk, no liquids were allowed in carry-on luggage.

Ms. Begun remained critical. "I understand the need for security measures," she said, "but the guidelines need to be more specific and consistent."

She suggested a toll-free hot line for people with questions about traveling with breast milk and infants in general. "It's difficult enough to travel without your child without the added stress of not knowing what to expect," she said.

City teen to face trial as adult in attempted rape: Youth confessed to assault on baby-sitter after break-in

A Baltimore teenager who has confessed to attempting to rape a 22-year-old baby-sitter during a random home-invasion and robbery will be tried as an adult, a Baltimore Circuit Court judge ruled Thursday.

While drunk and high on Ecstasy, Donnell Sampson, 17, is accused of donning a mask and breaking into a home on the same block he lived in on the north side of Patterson Park in December. After "getting spooked" by the baby-sitter's presence, Sampson and the other armed robber fled, prosecutor Amy Helbig said.

But according to Helbig, Sampson returned with a knife, forced the baby-sitter onto a bed and attempted to rape her, an attack the prosecutor described in detail during an emotional hearing in which Sampson's mother wept repeatedly.

"He made a choice," Helbig said of Sampson. "He made a decision to come back."

Sampson told Judge George L. Russell III, "I regret everything. I need another chance." And his attorney, Jane Loving, argued that the teen should be tried as a juvenile because he has no criminal history, has excelled in school and basketball in Delaware, but then fell in with "the wrong crowd" after his father died and he moved to Baltimore to live with his mother.

But Russell angrily asked Sampson: "What if someone had climbed into your mother's house wearing a mask and tried to rape her? How would you want me to deal with him?"

Sampson's mother told Russell that she partially blamed herself. She had been less strict than her son's father and, having grown up on the Eastern Shore, was unaware of the drugs and violence surrounding him at school and on the street.

"I didn't spend enough time with him," she said through tears.

But Russell turned to Sampson and blamed him, calling the act "vile," "heinous" and "stupid," and telling his mother that criminality can't always be attributed to parents.

"Look at your mother," Russell told Sampson. "She's dying."

10 years after baby sitter disappeared, police revisit case

The Major Case Squad once again will investigate the disappearance of 12-year-old Heather Kullorn, who was last seen 10 years ago this week at a Richmond Heights apartment where she was baby-sitting a family friend's infant.

Detective Sgt. Douglas Schaeffler, of the Richmond Heights police, said Saturday that the squad would begin by reviewing old investigative notes.

The length and breadth of the unit's investigation will depend on what it finds, Schaeffler said.

On Saturday, Heather's family gathered to remember her at a relative's home in south St. Louis. Her mother, Christine Kullorn, said she holds out hope that someone with important information about the case will come forward.

"You don't have to give your name, just give me my daughter," said Christine Kullorn, 44. "Somebody out there has got to know where she is, and if they have a heart, they'll bring her home."

Schaeffler said that the disappearance remains an active case, and that police continue to investigate tips as they come in.

He said police will soon use new technology to re-examine physical evidence taken from the apartment where Heather was last seen.

Heather disappeared from the apartment of family friends Dana Madden and Christopher Herbert while baby-sitting the couple's 2-month-old daughter. The baby was found alone and unharmed.

Over the years, police have speculated that Heather was murdered after witnessing drug activity nearby.

Schaeffler wouldn't discuss any motive, but he said police have a few working theories on what happened.

He also said police have identified someone he described as "a person of interest" who has more information about the case.

Schaeffler said he believes others with information about the case haven't come forward, perhaps because they believe their information isn't important or is already known to police.

He urged anyone with who knows anything about the case to call the Richmond Heights police.

Their business is baby-sitting; Northboro boys put skills to work

Will Moore and Brian Hatch know the business of kids - how to entertain them, how to mediate disputes, and how to handle emergencies.

They are experienced and tested, though only 12 years old, and have boiled down the business of being the eldest sibling into an impressive resume to start B and W Babysitting. In an economy where even adults are having a hard time finding jobs, the two friends are putting a professional spin on chores - not just baby-sitting, but lawn mowing, plant watering and pet sitting.

Working with the slogan "Four eyes are safer than two, two heads are better than one," the Melican Middle School students have been friends since the fifth grade.

"We're a team," said Brian.

Brian and Will trained last year in the American Red Cross baby-sitting course, and earlier this summer, they signed on for the Babysitting Faire, sponsored by Northboro Public Library, in search of their first summer jobs.

"They said we should use the marketing skills we have," said Will, adding that their skills have been put to use around their own homes.

The two pre-teens did just that, putting together a resume that could rival the professional presentation of a college graduate - a team-based mission statement, a concise list of education, experience and skills, a list of available references, and a business e-mail, They have also established a sliding-fee scale based on the job.

The two cut their baby-sitting business teeth at their respective homes. Will has been watching his two younger siblings, ages 10 and 4, for five years, and Brian, his two younger brothers, ages 5 and 6, for four years.

"We know what to do when someone gets sick," said Will, with Brian adding, "We know what do to when someone gets hurt."

But they didn't want to limit themselves, and this year, with the summer job market difficult for teens and adults alike, the two decided to take a professional attempt at a nontraditional role - boy baby-sitters.

"We don't always want to be baby-sitting our own family," said Brian. "We wanted to branch out."

The library's fair offered parents the chance to interview prospective teens, and the boys came prepared - with a resume, which they posted at locations throughout town.

"We signed up for the baby-sitting program together and the baby-sitting fair together, so we decided we should work together," explained Will.

Brian and Will are trained in basic care and first aid and age-appropriate problem resolution.

"When kids are fighting, I can separate them to make them stop fighting, and then find a way to make them both happy," said Will. "I have two brothers, and a lot of the time they'll tell me things, so I can handle the situation before it gets to my parents."

They specialize in games for boys, such as tag and touch football, basketball, baseball and bike riding.

"We can watch girls, but we specialize in boys, because we are boys," said Brian.

They are a rare team in the baby-sitting world. According to, a Web site that matches caregivers to needs, 94 percent of the registered sitters, or caregivers, on the site are female, with 6 percent male.

According to Cori Sanzano of, the general minimal guidelines developed by licensed social workers and sitters network is that sitters be at least 13 years old, but parents need to also consider maturity level and training of the potential sitter. has a minimum age requirement of 17 before anyone can register with the site.

Other considerations include a safe, physical environment where the baby-sitting will take place; the length of time, the number of hours, the age and number of children, and the time of day must be consistent with the sitter's age and ability; access to a responsible adult who can offer assistance if necessary; the knowledge of how and when to summon help; and a safety plan for what to do in an emergency.

Will and Brian also offer other services such as being a mother's helper.

"We didn't want to just do baby-sitting," said Will. "Not all people have kids; they need pet-sitting; they need their trash taken out."

In addition to younger kids, the boys also have experience handling the needs of a variety of animals. Will has a dog, a cat and two guinea pigs; Brian has a dog, four ferrets and hermit crabs.

Brian said the boys can bike to jobs in their neighborhood, and transportation will be provided for them to get to other jobs in town, or in the immediate area.

B and W Babysitting is not a temporary summer venture. The boys hope to continue it throughout the school year, so long as it does not interfere with their studies and certain after-school activities.

Maryann Hatch, Brian's mother, said she is proud of the boys' effort in creating B and W Babysitting. "This is something they wanted to do. There aren't many boy baby sitters, and it's a team effort between them."

Red Cross camp trains babysitters

Area families who hire babysitters who complete the Red Cross Babysitter Boot Camp can be certain that those individuals are trained in more than just entertaining a child.

Roger Sack, health and safety coordinator for the River Valley Chapter, said seven young people are midway through the second babysitter boot camp this summer. A third is set for Monday through Aug. 7, and has eight people enrolled so far.

These Babysitter Boot Camps are for ages 11-15, and give participants the skills necessary to provide safe, responsible care for children in the absence of parents or adult guardians, he said.

"In the class, they come out with more than just babysitter certification," Sack said. They learn infant and child CPR, how to use an automated external defibrillator (AED) and first aid.

"They are also taking pet first aid, for dogs and cats, and through the Guard Start program, a pre-lifeguard training program, how to use an asthma inhaler and EpiPens," he said. "They end up coming out with quite a few certifications."

EpiPens are automatic injectors used for emergency treatment of allergic reactions for people who have a history of an anaphylactic reaction.

Not only that, the students are taught about Internet safety. They practice lifeguard training in local pools, at The Shack and BOPARC's Marilla Pool. And they are taught business practices, including how to interview families looking for babysitters.