School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item Estimating the Prevalence and Timing of Events Along the Pathway to Identification of Autism in the US 2016–2018(2021) Hanley, Allison; Nguyen, Quyhn; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The prevalence of autism spectrum disorder (ASD) has risen rapidly in the past decade. Estimates on factors associated with developmental screening and the timing of events along the diagnostic pathway can inform early identification efforts. This dissertation uses cross-sectional data from the 2016–2018 National Survey of Children’s Health to achieve 3 aims: 1) evaluate individual- and state-level sources of variance between states in developmental screening rates via multilevel models, 2) evaluate characteristics associated with the ages at which children with ASD are first diagnosed, receive an intervention plan, and begin intervention, and 3) evaluate differences in lengths of time between these events by cohort. Aim 1: The national rate of developmental screening for children ages 9 months to 5 years is 34.4% (95% Confidence Interval (CI), [34.3, 34.4]). Rates varied between states by 38%. Individual-level factors explained 6% of the variance, while income inequality and a state’s choice to track developmental screening did not explain any variance between states. Aim 2: Linear regression models adjusted for individual and household characteristics showed that compared to children aged 3–5 years at the time of the survey, children 6–11 were 18 months older at first services (? =1.49, 95% CI, [1.18, 1.81] and children aged 12–17 were 38 months older at first ASD diagnosis (? =3.16, 95% CI, [2.72, 3.60]. Aim 3: Analyses using identical models showed that compared to children aged 3–5 at the time of the survey, the interval between first plan and first services was 4 months longer for children 6–11 (? =0.34, 95% CI, [0.07, 0.61]; and 8 months longer between first ASD diagnosis and first services for children aged 12–17 (? =0.67, 95% CI, [0.28, 1.06]. Today’s children with autism receive their first diagnosis, intervention plans, and developmental services at younger ages than in the past and are moving between events with less delay compared to older children. However, the low rate of developmental screening nationwide represents missed opportunities for even earlier identification. Research is needed to identify the macro-level factors that explain the variance between states on developmental screening rates.Item "It's like we're raising that child together:" Parents, center-based child care providers, and the work of creating relationships(2011) Speirs, Katherine Elizabeth; Anderson, Elaine A; Roy, Kevin M; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Today, most children experience some form of non-parental child care before entering school. The popularity of child care has led scholars to investigate its impact on children's development. In particular, researchers and theorists agree that children benefit when parents and providers form partnerships that include frequent and constructive communication. However, less is known about how parents and providers establish and maintain partnerships. I used a qualitative approach to examine how parents of young children and center-based child care providers understand the parent and provider roles and establish and maintain relationships. During a year of field work at two privately-owned child care centers, I generated 112 sets of field notes from participant observations and conducted in-depth semi-structured interviews with 23 parents and 17 child care center staff members. Using both observations and interviews allowed me to witness parent-provider relationship formation firsthand and explore parents' and providers' perspectives. Additionally, generating several different types of data from multiple sources allowed for triangulation and a rigorous research design. I used a modified grounded theory approach to analyze my data. My findings suggest that parents and providers saw five components to the provider role: physical caregiving, emotional care, teaching, fostering development, and family support. The parent role had two main components. Child care providers and parents expected that parents would be involved in the child care center through the donation of goods, money and/or time. In addition to involvement in the center, parents also felt responsible for monitoring and directing the providers' caregiving. I identified five distinct parent-provider relationship types: basic familiarity, working relationships, partnerships, independent relationships, and discordant relationships and present a model that explains how these relationships are established and maintained. Research and theory suggest that children benefit when parents and providers form partnerships. However, I found that establishing and maintaining partnerships requires time, effort, and a specific skill set from parents and providers as well as opportunities for regular communication. Class-based patterns emerged from my data which suggest that middle-class parents may be in a better position to form partnerships with their providers. Therefore, it may be unrealistic to expect all parents and providers to work collaboratively. Rather, the benefits of alternative relationship types should be explored. Implications for future research, early care and education programming and the design of measures to assess the quality of parent-provider relationships are discussed.