Even though the majority of the world’s under 5-year-olds live in low- and middle-income countries (LMIC), our knowledge about the systems and architectures which support and sustain ECEC workforce quality is dominated by evidence from high-income countries (HIC). Drawing on a three-round Delphi study of consensus around essential training needs for early childhood staff in low-resourced contexts conducted among fourteen global experts over a period of four months, this paper highlights challenges faced when resources for teacher preparation are severely constrained, and unique approaches for sustaining quality in workforce preparation in such contexts. Key findings that inform efforts to build a strong ECEC workforce in resource-constrained contexts, include consensus among experts around (i) clear professional pathways which offer practitioner-centred flexibility through initial training, followed by on-going mentoring and supervision. A strong emphasis on the importance of strong systems of high-quality and supportive mentoring and supervision reflects recognition that initial training in such contexts is often relatively short-term; (ii) recognition of the importance of diverse roles (for example, community-based practitioners) in working with communities to deliver ECEC in complex communities; and (iii) systems supported by centralised financing, budget allocation and established professional pathways, but open to support and involvement of non-government entities in supporting workforce development.

ObjectivesWhile early diagnosis is fundamental to the development of children with developmental disabilities (DD), limited attention has been paid to immigrant parents' experience of early encounters with systems when they begin seeking supports for their children with DD. This study aimed to contribute to better understanding of immigrant parents' experiences of early encounters with services for families and children with suspected or diagnosed DD.DesignA longitudinal, qualitative approach was adopted. Over 12 months, multiple interviews were conducted with four immigrant families with children aged between two and four years who were attending a mobile playgroup offering early learning supports for children with suspected or diagnosed DD in communities with low access to formal supports. During the first three months of the study, families were accompanied by the first author on weekly visits to the playgroup. Participant observations and informal discussions with staff delivering early intervention supports via the playgroup provided further insight into families' initial and on-going encounters with services and supports. During the remaining nine months, multiple interviews were conducted with participating families, to document their on-going experiences and encounters with medical practitioners and therapists.ResultsThematic analysis of data generated four key themes: Initial encounters with medical professionals, Confusion and 'missed' diagnosis, Gaps in understanding, collaboration and communication, and Families' desire to learn and implement strategies.ConclusionFamilies made concerted efforts to locate appropriate supports. They also faced barriers including a lack of openness and genuine consultation, particularly in their encounters with health professionals. These barriers resulted in a level of mistrust and detachment from formalised supports. Results highlight the critical importance for health professionals of 'tuning into' family concerns through relationship-based approaches, in order to establish shared understanding and mutual respect between professionals and families, particularly for immigrant families seeking support for their young children.

Despite growing acknowledgment of the role of early childhood care and education (ECCE) in reducing social inequality, there is limited understanding of the relation between ECCE expansion and inequality in access to ECCE in low- and middle-income countries. This study explored the relation between national enrollment rates in ECCE and inequality in access to ECCE in 30 low- and middle-income countries, using enrollment data among 3- and 4-year-olds (N=303,344) from the Multiple Indicator Cluster Survey and Demographic and Health Survey collected between 2001 and 2021. We found that higher ECCE enrollment rates were associated with lower inequality in access to ECCE, measured by concentration indices (r = -.31). Among 20 countries with significant increases in ECCE enrollment rate over time, six countries demonstrated a significant reduction in access inequality to ECCE. However, 13 countries did not show substantial changes. In addition, we demonstrated how four factors related to income-related inequality in access to ECCE, such as family wealth, maternal education, gender, and urbanicity, were associated with increases in ECCE use. A review of policies in selected countries provides a more nuanced understanding of the findings. Implications of our findings for ECCE expansion in low- and middle-income countries are discussed.

This paper presents a conceptual framework for understanding 'innovation' in early childhood education as a process for addressing issues around social justice and inclusion. The framework is used to analyse innovative aspects of two unique, localised early childhood programmes implemented to support ethnic minority children in Northern Thailand and children of migrant labourers in urban India. Drawing on contemporary critiques that point to the global predominance of universalised models of teaching and learning, the paper highlights these contextually-responsive programmes as crucial in demonstrating the importance of 'emergent' pedagogical approaches for achieving equity and inclusion. To promote greater acknowledgement of programmes such as these, the paper presents a case for shifting the current focus on 'innovation' in education away from an emphasis on effectiveness for supporting greater efficiency of standardised, pre-determined learning outcomes, to encompass small-scale, localised approaches that support children from marginalised backgrounds.

Background The role of parents in supporting early intervention for young children with disabilities is critical. Indeed, models of family centered care (FCC), which emphasis strong partnerships between health professionals and families in disability health services delivery are now widely associated with best practice. While FCC is consistently argued to be an appropriate model for disability service delivery, its utilization is limited primarily to Western countries such as Australia and the United States. Countries such as the United Arab Emirates (UAE) have prioritized early childhood development and are thus in search of best practices for delivery of early intervention for children and their families. Objective The aim of this study was to explore the appropriateness of the FCC model in disability service delivery in the UAE. This study was conducted from the perspectives of health professionals who are involved in disability diagnosis, referral and ongoing support for families and children with disabilities. Method A total of 150 health professionals were recruited from health facilities, rehabilitation centers and schools in the Emirates of Abu Dhabi. The 27-item Measure of Process of Care for Service Providers (MPOC-SP) was used for data collection. The data were subjected to confirmatory factor analysis to confirm applicability of the model to this context. Multivariate analysis of variance and moderation analysis were also conducted, to ascertain the relationship between participants’ satisfaction levels with their ability to diagnose, refer and provide on-going support and their likelihood of practicing key components of FCC. Result Computation of confirmatory factor analysis provided support for applicability of the MPOC-SP in the UAE context. Further inspection showed moderate to large correlations between the four components of FCC measured by MPOC-SP, providing further support for utilization of FCC in disability health service delivery in the UAE. Conclusion The study concludes with a call to policymakers in the UAE to consider developing disability health policy based on key components of FCC. This could be supplemented by development of training modules on FCC to upskill health professionals involved in disability diagnosis and rehabilitation.

BACKGROUND Services to support nurturing care through early childhood development (ECD) in low- and middle-income countries are hampered by significant workforce challenges. The global early childhood workforce is both diverse and complex, and it supports the delivery of a wide range of services in extremely diverse geographical and social settings. In the context of contemporary global goals for the universal provision of quality early childhood provision, there is an urgent need to build appropriate platforms for strengthening and supporting this workforce. However, the evidence base to support this work is severely limited. METHODS To contribute to evidence on how to strengthen the ECD workforce in low- and middle-income countries, this study used a Delphi methodology involving three rounds of data collection with 14 global experts, to reach consensus on the most critical training needs of three key early childhood workforce groups: (i) health; (ii) community-based paraprofessionals, and (iii) educational professionals working across ECD programmes. RESULTS The study identified a comprehensive set of shared, as well as distinct, training needs across the three groups. Shared training needs include the following: (i) nurturing dispositions that facilitate work with children and families in complex settings; (ii) knowledge and skills to support responsive, adaptable delivery of ECD programmes; and (iii) systems for ECD training and professional pathways that prioritise ongoing mentoring and support. CONCLUSIONS The study's detailed findings help to address a critical gap in the evidence on training needs for ECD workers in low-resource contexts. They provide insights into how to strengthen content, systems, and methods of training to support intersectoral ECD work in resource-constrained contexts.

This paper reports findings from an ethnographic study of families from culturally and linguistically diverse (CALD) families in Australia caring for children with disability. The study aimed to contribute insights into the unique experiences, challenges and supports that characterise experiences of families of a child with disability living in a country where the mainstream culture is different from their own. Four families from different cultural backgrounds participated in the study over a period of nine months. During this time, they participated in a series of semi-structured interviews during which they shared their encounters with formal early intervention services and reflected on important informal supports. Findings presented here indicate three key areas associated with accessing informal supports that can pose challenges for families who hold values that are different from those of the dominant culture: lack of social support; cultural adaptations, and socialization problems and coping strategies. The findings indicate that formal services could ameliorate feelings of social isolation by enabling parents to access informal supports such as parenting groups.

Traditionally, early childhood education and special education needs policy developments have held a low status in national and international political agendas. However, over the recent decade, there has been an intense surge of political interest at international and national levels. This surge has resulted in an unprecedented number of educational policy reforms, policy documents, and opportunities for practice to develop and respond to these changes. Due to the considerable international interest in early childhood, paralleled with similar international interest in inclusive policies, this chapter aims to examine the way early childhood care and education (ECCE), early childhood education and care (ECEC), and/or early childhood education (ECE) policy shapes the attitudes and actions of those working with babies and young children. The chapter will open by introducing early childhood provision in the international context before moving to inclusion, defining inclusion, assumptions, attitudes, perceptions, and including children.

A global goal for early childhood education and care is to ensure universal, “quality” provision that reaches all children. Achieving this goal requires a well-prepared workforce that is equipped to adapt to and deliver early childhood programs across the vastly diverse contexts and communities where children are growing up around the world. Yet currently there is a severe shortage of early childhood workers, particularly in “low resource” and complex communities. Evidence to support appropriate training for such workers is also lacking. In response, this paper presents findings from a case study of a large-scale training program for community-based early childhood workers in central-east India. A total of 650 community-based Village Communicators were trained to deliver a responsive caregiving package to parents of young children. Data collected over 3 months highlight how the unique contextually grounded, caring and reflexive approach to training resulted in profound personal and professional change among training participants. The findings are of significance in informing policy and practice associated with global goals for early childhood. First, they challenge the technical, programmatic approaches to training that are commonly adopted for preparing this workforce. Second, they evidence the potentially transformative, long-term impact of person-centered approaches to training that facilitate knowledge-sharing to understand local needs and attitudes. Third, they provide insight into ways in which training programs can support enhanced local relevance and effectiveness of early childhood services implemented for children and families across diverse contexts.

Bakgrund: Vald i nara relationer definieras som fysiskt, psykiskt och/eller sexuellt vald utfort av en partner i en nara relation. Tretton kvinnor i Sverige dodas varje ar av en man som de har elle ...

Health professional Continuing Professional Development (CPD) courses often aim to change practice; understanding which training techniques drive behavior change can help educators facilitate this. The 93-item Behaviour Change Technique Taxonomy (BCTT) describes behavior change techniques (BCTs) used in behavior change interventions but was not designed for understanding CPD; it is necessary to explore how best to use the BCTT in this context. This study aimed to explore the BCTs used by CPD course educators to change healthcare practice and to develop and pilot an e-tool, based on the BCTT, to enable course designers and educators to understand which BCTs are in their training. This understanding could lead to enhanced CPD and an experimental approach to assessing the benefits of including a variety of BCTs in CPD. Two psychologists, trained in using the BCTT, observed three postgraduate medical CPD courses. In Phase 1, the BCTT was used to code 26 hours of observations. An e-tool including observed BCTs was developed and used to code 35 hours of observations in Phase 2. Feedback was collected through short discussions with educators from each course. The tool was further refined in Phase 3. Thirty-seven BCTs were identified in Phase 1, a further four in Phase 2, and a further two in Phase 3. The final e-tool comprised 43 BCTs with examples of their use based on course observations to aid identification, since educators fed back that they would value an uncomplicated tool with practice-related examples. A coding tool to understand the active ingredients in health professional CPD could enable educators to maximize the impact of CPD on practice. Further work should explore whether educators themselves are able to use the tool to code their training interventions.

Objectives: To examine the extent, and nature, of impact on junior doctors' career decisions, of a proposed new contract and the uncertainty surrounding it.Design: Mixed methods. Online survey exploring: doctors' future training intentions; their preferred specialty training (ST) programmes; whether they intended to proceed immediately to ST; and other plans. Linked qualitative interviews to explore more fully how and why decisions were affected.Setting: Doctors (F2s) in second year of Foundation School (FS) Programmes in England.Participants Invitations sent by FSs. Open to all F2s November 2015-February 2016. All FSs represented. Survey completed by 816 F2s. Sample characteristics broadly similar to national F2 cohort.Main outcome measures: Proportions of doctors intending to proceed to ST posts in the UK, to defer or to exit UK medicine. Proportion of doctors indicating changes in training and career plans as a result of the contract and/or resulting uncertainty. Distribution of changes across training programmes. Explanations of these intentions from interviews and free text comments.Results: Among the responding junior doctors, 20% indicated that issues related to the contract had prompted them to switch specialty and a further 20% had become uncertain about switching specialty. Switching specialty choice was more prevalent among those now choosing a community-based, rather than hospital-based specialty. 30% selecting general practice had switched choice because of the new contract. Interview data suggests that doctors felt they had become less valued or appreciated in the National Health Service and in society more broadly.Conclusions: Doctors reported that contract-related issues have affected their career plans. The most notable effect is a move away from acute to community-based specialities, with the former perceived as more negatively affected by the proposed changes. It is concerning that young doctors feel undervalued, and this requires further investigation.

This brief summarises findings from an extended literature review on the current status of early childhood development (ECD) cadres training and a Delphi survey of expert consensus on training needs for different ECD cadres operating in low-resource contexts (Pearson et al., 2017) titled Reaching expert consensus on training different cadres in delivering early childhood development at scale in low-resource contexts. The work was funded by DFID and led by a team at Bishop Grosseteste University in collaboration with colleagues from The University of Hong Kong, McGill University, University of Nebraska, University of Wollongong and University College London. The following overarching questions guided this study: • To whom does the term ‘ECD cadre’ most usefully apply, given the wide range of settings and aims of early childhood development programmes? • What are expert views on essential knowledge and skills required of ECD cadres working in different contexts? • What are expert views on appropriate methods for delivery of training, and post-training follow-up, for ECD cadres? • What are expert views on the necessary conditions for effective scale-up of ECD cadres training?

Objectives This study draws on an in-depth investigation of factors that influenced the career decisions of junior doctors. Setting Junior doctors in the UK can choose to enter specialty training (ST) programmes within 2 years of becoming doctors. Their specialty choices contribute to shaping the balance of the future medical workforce, with views on general practice (GP) careers of particular interest because of current recruitment difficulties. This paper examines how experiences of medical work and perceptions about specialty training shape junior doctors’ career decisions. Participants Twenty doctors in the second year of a Foundation Training Programme in England were recruited. Purposive sampling was used to achieve a diverse sample from respondents to an online survey. Results Narrative interviewing techniques encouraged doctors to reflect on how experiences during medical school and in medical workplaces had influenced their preferences and perceptions of different specialties. They also spoke about personal aspirations, work priorities and their wider future. Junior doctors’ decisions were informed by knowledge about the requirements of ST programmes and direct observation of the pressures under which ST doctors worked. When they encountered negative attitudes towards a specialty they had intended to choose, some became defensive while others kept silent. Achievement of an acceptable work-life balance was a central objective that could override other preferences. Events linked with specific specialties influenced doctors’ attitudes towards them. For example, findings confirmed that while early, positive experiences of GP work could increase its attractiveness, negative experiences in GP settings had the opposite effect. Conclusions Junior doctors’ preferences and perceptions about medical work are influenced by multiple intrinsic and extrinsic factors and experiences. This paper highlights the importance of understanding how perceptions are formed and preferences are developed, as a basis for generating learning and working environments that nurture students and motivate their professional careers.

This paper presents a thematic analysis of documents produced during a recent ‘Regional Policy Forum on Early Childhood Care and Education (ECCE)’, attended by over 200 participants including representatives from key international donor organisations and high-level officials from over 30 countries across the Asia Pacific region. The paper begins by providing a brief overview of international developments in ECCE over the past two decades, highlighting a growing argument that points to the need for a shift in policy and programming agendas away from target setting at international levels, towards the promotion and support of localized, contextually grounded approaches to supporting policies and programmes in ECCE. In an attempt to find ways of establishing empirical support for this argument, the paper explores the extent to which key messages delivered by international donor organizations and representatives at the Policy Forum can be seen to reflect the current activities and concerns of countries within the region (as expressed through individual country reports presented during the forum). Based on results of this analysis, the paper concludes with recommendations for balancing the ‘local’ and ‘international’ influence on policy making and agenda setting as countries in the Asia Pacific region move forward with provision of formalized ECCE post-2015.

The early childhood education workforce plays a pivotal role in expanding and improving early childhood care and education. However, there are many challenges associated with producing, attracting and retaining well-trained early childhood educators. This report begins by highlighting some of these challenges. Next, using examples from four regions, it illustrates how policies and / or initiatives related to early childhood teacher/carer education have addressed some of these challenges in the past decade. Effective government policies have to be context sensitive and these examples illustrate strategies that have enhanced both teacher quantity and quality in different parts of the world.

The purpose of this article is to provide broad-brush insights into current developments in early childhood care and education (ECCE) across the various and diverse regions of our world. These developments have given rise to a wide range of concerns, ranging from pragmatic issues in service delivery, funding and core principles for service provision to scholarly debates around pedagogical approaches, and philosophical orientation in programming. They also present opportunities for innovation and renewal through greater responsiveness to sociocultural needs and priorities in programming. The article uses examples of programs currently being implemented across some of the world regions to highlight some of these issues and opportunities. The article begins by highlighting some of the important and significant developments that ECCE has seen during the early years of this twenty-first century. It then details some major recent developments for ECCE in the world regions, along with some of the key challenges for ECCE that have emerged in recent years, as highlighted in the Moscow Framework for Action and Cooperation. These are illustrated through the use of reference to ECCE initiatives from countries within the world regions that might not commonly be represented in dominant scholarly circles. The article concludes with a brief summary of issues raised and possible steps forward in achieving high-quality, equitable ECCE provision for children inhabiting the world regions.