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24.2: Continuity of Care as a Caregiving Practice

  • Page ID
    142198
    • Todd LaMarr
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    Implementing Continuity of Care

    Continuity of care refers to the practice of primary caregivers and children staying together for as long as possible, preferably for the children’s first three years (McMullen, 2018). Classrooms, materials and supplies may all change as the children become older, but the one constant is the relationships. Thus, continuity of care is a caregiving practice with relationships at the center, with the goal of creating and deepening relationships between caregivers and children and caregivers and families. Continuity of care contrasts the common practice of moving infants and toddlers to new classrooms based on their age and/or attainment of skills (Cryer, Hurwitz & Wolery, 2000).

    Caregiver holding an infant.
    Figure \(\PageIndex{1}\): Continuity of Care allows deeper relationships to form. ([1])

    There are three ways that programs can create continuity of care systems. Programs may choose a system based on space, materials and resources, staff expertise, and parent and community needs: [2]

    1. Group mixed-age infants and toddlers together by having the same primary caregivers work with classes of mixed-age infants and toddlers. The environment should include equipment and materials based on children’s ages (the age range depends on the current children), interests, needs, and skills. As children move up into preschool, newly enrolled infants or toddlers are added. The same teachers remain in the classroom. Figure \(\PageIndex{1}\) shows an illustration depicting this continuity of care system. In classroom ‘A’ a primary caregiver has a mixed-age group of both infants and toddlers. When the children are old enough to attend preschool, they then move to a new preschool class, classroom ‘B’, and new infants and toddlers are enrolled into classroom ‘A’. [2]
    . In classroom ‘A’ a primary caregiver has a mixed-age group of both infants and toddlers. When the children are old enough to attend preschool, they then move to a new preschool class, classroom ‘B’, and new infants and toddlers are enrolled into classroom ‘A’
    Figure \(\PageIndex{1}\): Continuity of care system #1. ([1])

    2. Keep children of similar age together with the same teacher. As children grow older, the children and caregivers all move to a more age-appropriate space. In this arrangement, teachers work with different age groups over several years. Figure \(\PageIndex{1}\) shows an illustration of this continuity of care system. In classroom ‘A’ the teacher is with a group of infants. As the infants grow, the teacher and children move to a new more age-appropriate room. Classroom ‘B’ shows the same teacher and children as in classroom ‘A’, but now the children are older and they are all in a new classroom together. [2]

    In classroom ‘A’ the teacher is with a group of infants. As the infants grow, the teacher and children move to a new more age-appropriate room. Classroom ‘B’ shows the same teacher and children as in classroom ‘A’
    Figure \(\PageIndex{1}\): Continuity of care system #2. ([2])

    3. Another continuity of care system involves children, of similar age, remaining with the same primary caregiver in the same room. As the children grow older, they stay in the same room with their caregivers, but the caregivers adjust the environment and materials as children’s abilities and interests change. Figure \(\PageIndex{1}\) provides an illustration. In classroom ‘A’, the caregiver and infants are in an age-appropriate room. As the children grow, rather than change rooms, the classroom is adjusted to be age-appropriate for their developing abilities and interests. In this way, the children and caregiver can remain together and stay in the same classroom overtime. [2]

    In classroom ‘A’, the caregiver and infants are in an age-appropriate room. As the children grow, rather than change rooms, the classroom is adjusted to be age-appropriate for their developing abilities and interests. In this way, the children and caregiver can remain together and stay in the same classroom overtime
    Figure \(\PageIndex{1}\): Continuity of care system #3. ([1])

    Continuity of care is rooted in attachment theory research that supports the importance of consistent and secure relationships between caregivers and children, especially infants and toddlers. A classic study by Helen Raikes (1993) is strong evidence for the benefits of continuity of care. Raikes found that the longer infants remained with the same primary caregiver, the more likely the children were to develop a secure attachment. Specifically, of the infants who stayed with the same caregiver for over one year, 91% of them had a secure attachment, compared to infants who stayed with the same caregiver for 9 to 12 months (67% had a secure attachment) and 5 to 8 months (50% had a secure attachment). Toddlers in continuity of care classrooms are rated by their caregivers as having fewer challenging behaviors (Ruprecht, Elicker & Choi, 2016). Having a consistent and stable caregiver supports the development of a strong attachment between children and their primary caregivers (Barnas & Cummings, 1994). Infants and toddlers with more caregiver stability scored higher on social skills later in Kindergarten (Bratsch‐Hines et al., 2020). Indeed, both parents and caregivers report that one of the main benefits of continuity of care is the increase in knowledge caregivers receive of individual children by working with them for a longer period of time (McMullen, Yun, Mihai & Kim, 2016).

    Continuity of Care Benefits

    Continuity of care not only benefits the relationship between caregivers and children, but also the relationship between caregivers and the children’s families. More time together means caregivers and families can potentially develop a deeper understanding of each other with a trusting relationship enriched through experiences over time. Indeed, parents report how continuity of care creates a caregiver-parent relationship of trust and open communication (McMullen, Yun, Mihai & Kim, 2016). Both caregivers and parents reported that their experience with continuity of care created a mutual respect for each other and they both perceived their relationship more as a partnership (McMullen, Yun, Mihai & Kim, 2016).

    Infants and toddlers in a mixed-age classroom. Caregivers handing off young infant with two toddlers in foreground at table.
    Figure \(\PageIndex{1}\): Infants and toddlers in a mixed-age classroom. ([1])

    Not only are there research supported benefits for implementing continuity of care, there are also research supported concerns for not implementing it. When infants and toddlers are transitioned into a new classroom, they exhibit increased distress and anxiety (Cryer et al., 2005; Field, Vega-Lahr & Jagadish, 1984; O’Farrelly & Hennessy, 2014; Schipper, IJzendoorn & Tavecchio, 2004). Other research emphasizes that transitioning from an infant to a toddler class may be experienced differently for each child and is greatly influenced by caregivers (Recchia, 2012; Recchia & Dvorakova, 2012).

    Despite many organizations promoting the importance of continuity of care, few infant and toddler group care programs actually implement it as a practice (Aguillard, Pierce, Benedict & Burts, 2005; Choi, Horm & Jeon, 2018; Cryer, Hurwitz & Wolery, 2000). Research has revealed that programs accredited by NAEYC (​​National Association for the Education of Young Children) were just as unlikely to be practicing continuity of care as group care programs without an NAEYC accreditation (Aguillard, Pierce, Benedict & Burts, 2005). In a large national study with Early Head Start infant and toddler programs, only 29% of children experienced two years of continuity of care (Choi, Horm & Jeon, 2018). Thirty-four percent of children experienced changing primary caregivers at least once while 37% of children experienced changing primary caregivers between two to six times. Caregivers express both benefits and challenges associated with implementing continuity of care (Hegde & Cassidy, 2004; Longstreth et al., 2016). Most of the challenges caregivers express about continuity of care can be reduced and/or solved when accurate information is shared and with strategic planning (Garrity, Longstreth & Alwashmi, 2016; Longstreth et al., 2016; McMullen, 2017; Recchia & Dvorakova, 2018).


    [1] Image by PublicDomainPictures on Pixabay.

    [2]Head Start Tip Sheet: Continuity of Care” is in the public domain.

    [9] Image from Head Start ECLKC is in the public domain.


    This page titled 24.2: Continuity of Care as a Caregiving Practice is shared under a mixed 4.0 license and was authored, remixed, and/or curated by Todd LaMarr.