Models of Inclusion: Standing at the Cross Roads. Building Inclusive Child Care Through Child Care Development Funds

The passage of the Americans with Disabilities Act (ADA) in 1990 has produced a growing recognition that children with disabilities have the same rights as other children to participate in community-based child care settings (Whitney, Grozinsky, & Poppe, 1999). But even a legal mandate is not sufficient to guarantee access to realistic and suitable child care options for every family, particularly those having children with emotional or behavioral disorders (National Child Care Information Center [NCCIC], 1997). The presentation addressed governmental policy and planning efforts to include children with emotional or behavioral challenges in settings with typically developing children. Particularly, presenters discussed the policy and planning context that resulted in current Child Care Development Fund plans, reported preliminary results of a content analysis of the plans, discussed a family member’s perspective on child care arrangements, and outlined some strategies for and barriers to inclusion gathered from directors of model programs

Inclusive Child Care: Challenges and Strategies

Responding to the need for research regarding models of inclusion in child care, the Research and Training Center on Family Support and Children\u27s Mental Health is in the process of conducting a series of studies aimed at guiding the design and implementation of inclusive child care policies and programs. In the course of previous research studies, our research team found that there did exist quality programs and family care arrangements that successfully included children with emotional or behavioral challenges in child care settings (Brennan, Rosenzweig, Ogilvie, Wuest, & Ward, 2001). Our goal was to learn more about the provider and setting characteristics associated with these successful programs. As a first step in the current research, state child care administrators, child care resource and referral agencies, and family organizations were sent a request to nominate programs that successfully included children with emotional or behavioral challenges in child care; this resulted in nominations of 104 programs across the United States. Personnel at thirty-four of the nominated programs participated in a survey designed to learn more about their challenges and strategies for inclusion. We were particularly interested in five key areas: (1) the types of services these programs offered, (2) the needs of the families they served, (3) the inclusion strategies they employed, (4) the barriers staff reported facing, and (5) their view of the role of families in their programs

Cigarette Smoking Interferes With Treatment of Hypertension

• We retrospectively analyzed two studies to determine whether smoking affected the treatment of hypertension. In a study of the effects of propranolol hydrochloride (a hepatically metabolized β-blocker) vs hydrochlorothiazide, 108 smokers and 232 nonsmokers were randomized to the propranolol treatment group. The propranolol-treated smokers tended to be younger, taller, thinner, and were more likely to be black. This group also had an initial blood pressure reduction (± SD) of -7.9 ± 12.9/ -8.7 ± 8.4 mm Hg compared with -10.7 ± 13.0/ -10.9 ± 7.1 mm Hg for the nonsmokers. Blood pressure increased less during the one-year maintenance period for the nonsmokers. However, when analyzed by race, this effect was seen in blacks, but not in whites. Diastolic blood pressure tended to be reduced more in nonsmokers (vs smokers) receiving hydrochlorothiazide (-12.1 ± 6.7 vs -10.7 ± 6.7 mm Hg, respectively). The second study compared the effects of nadolol (a renally excreted β-blocker) with bendroflumethiazide. There were no significant effects on blood pressure for either of these drugs. In both studies, there was a greater tendency for smokers to be terminated from the study irrespective of drug group. We conclude that cigarette smoking does interfere with the treatment of hypertension in general, and especially with reduction of blood pressure by propranolol in black patients.(Arch Intern Med 1988;148:2116-2119

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery