12/21/2012

The First Borns Sub-Study

Department of Child & Adolescent Health

University of the West Indies, Mona

JA KIDS The Jamaican Birth Cohort Study 2011

ContentsIntroduction...............................................................................................................................................3

Participants............................................................................................................................................5

Instruments.............................................................................................................................................6

Demographics........................................................................................................................................9

Analytical Approach.........................................................................................................................14

Total HOME......................................................................................................................................14

Domain Scores..................................................................................................................................14

Ages & Stages Questionnaire Summary..........................................................................................23

Domains............................................................................................................................................23

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Introduction

Recent research on the impact and long term benefits of Early Childhood Development has highlighted the importance of providing optimal physical, socio-emotional and cognitively enriching environments for children in the earliest years of life. In particular, the home environment has been shown to be an influential factor in the overall development of children (Iltus, 2006). In evaluating the quality of the home environment, researchers have focused on early family relationships/interactions and the availability and quality of resources for learning and playing. Research has shown that the quality of the physical environment of the home as well as the frequency and quality of parental interactions with the child impact the cognitive and social development, intelligence and literacy skills of children in a positive way (Iltus, 2006). Children reared in stable and enriching environments are more likely to successfully accomplish developmental milestones and have experiences that set the foundation for positive development throughout childhood (Jones Harden, 2004). In addition, the home environment acts as a buffer against a wide range of potential negative influences including poverty, low birth weight and poor health (Klebanov, 1998).

A 3-year longitudinal study conducted with 119 children (1 to 4-years) indicated a positive correlation between cognitive development and home stimulation variables (measured by parent involvement and availability of stimulating materials and toys) (Gottfried & Gottfried, 1984). Similarly, Lee, Super and Harkness (2003) found that the accessibility of play objects, reading books and other educational materials were a significant predictor of children’s perceived competence in a sample of 750 children from kindergarten through seventh grade. In fact, research has shown that the quality of the home environment in providing stimulation for preschool children was the single best predictor of intelligence in the preschool years (Molfese, DiLalla & Bunce, 1997).

In developing countries, research has consistently demonstrated that the quality of the home environment is positively correlated with children’s cognitive and social development (Iltus, 2006). For example, a study conducted with 305 South African children ages 24 – 30 months showed that home environment scores were significantly related to mental development, independent of socioeconomic status (Richter& Grieve, 1991). In Jamaica, research has demonstrated that malnourished children who receive stimulation in the home environment in early childhood have higher IQs than matched controls at age 16 years (Granthan-McGreggor, Powell, Walker, Chang & Fletcher, 1994).

Overall the research strongly suggests that the home environment in the early years of life profoundly influences developmental outcomes including academic achievement, cognitive, social and emotional development. As young children spend the majority of their time in the home, it is imperative that we comprehensively explore these environments including the relationships, experiences, and skills of children 0 – 3 years.

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This report summarizes findings from the Firstborns Project, a sub-study of JA KIDS: The Jamaican Birth Cohort 2011. The overall aim of the Firstborns Project is to document the growth and development, home environment and family interaction patterns of the firstborn JA KIDS at 16 months.

The main objectives of the Firstborns Project are:

1. To evaluate the quality of the home environment in which these children are reared.2. To assess child health and development outcomes in relation to family interaction patters and

parenting practices3. To assess the developmental competence (including cognitive and language development and

executive function)of children at 1 year4. To develop a short documentary on the experiences of the firstborn JA KIDS.

JA KIDS: The Jamaican Birth Cohort Study 2011

JA KIDS is the second national birth cohort study of Jamaican children. The first birth cohort study took place 26 years ago, and included 10,500 births in Jamaica in September and October 1986. These children were identified at birth and their mothers interviewed at delivery and 6 weeks later. Follow-up studies were conducted at ages 11 – 12, 15 – 16 and 20 – 21 years to better understand the factors that impact Jamaican children’s development, behaviour and academic achievement. These studies had significant impact on policies, programmes and interventions for children and the public. For example,

Development of referral high-risk clinics Redesign/construction of new labour wards at referral hospitals Increased paediatric service provision Modernization of Registrar General’s Department National Parenting Policy developed Improvement of cross-sectoral services for children birth to 6 years Behavioural interventions to address childhood aggression and exposure to violence.

In 2011, the University of the West Indies (UWI) embarked on a new birth cohort study called JA KIDS. This new study has expanded the scope of the original study, placing greater emphasis on the development and behaviour of children from 0-2 years of age and collecting data during the antenatal period, looking at the family/supportive environment, collecting data on fathers as well as mothers, and collecting biological samples.

The goal of the JA Kids Birth Cohort Study is to improve the health and well-being of Jamaica’s children by providing valuable data on the relationships among a wide range of family, school, community, environmental and individual variables. It will also contribute to our understanding of the various factors that influence health, disease and development in young children. Specifically, JA kids will provide national data on maternal health and well-being; pregnancy; paternal well-being and involvement; children's status at birth and at various points thereafter; and children's experiences and growth from 0

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– 2 years. The identification of these factors will enable the country to build on its existing strengths and to target interventions and policies to mitigate risks in populations where they are found.

The JA KIDS Birth Cohort Group consists of all the children born in all fourteen parishes across Jamaica from July 1 to September 30, 2011 .

From March to September 2011, data was collected from pregnant women (who were due to give birth in July, August or September 2011) attending private and public clinics throughout the island. Five thousand two hundred and four mothers participated in this phase of the Study. The Birth phase of the study commenced on July 1, 2011 and ended September 30, 2011, with twenty-six (26) public and private hospitals participating. In total, 9,766 mothers and 3,413 fathers were enrolled in the Study. Eighty-seven percent (87%) of all mothers delivering during the study period were enrolled. The next contact with parents was when the study child was 9 – 12 months (April 16, 2012 to September 14, 2012). Parents were interviewed via the telephone about their baby's health, well being and development. Seventy-nine percent (n = 7754) of the 9766 mothers enrolled at birth were interviewed during this sweep. This 9-12month contact involved a detailed follow-up of children’s health and development, family functioning, maternal and paternal health and well-being, parental stress, home learning environment and child-care arrangements.

The Firstborns Project

The Firstborns Project will follow-up with the firstborn children in each parish using a variety of observational methods, developmental tasks and interviews. The use of mixed data collection methods will enhance the findings in the overall cohort study and provide a richer perspective on the lives and experiences of Jamaican children and their families. In addition, this will provide valuable information on the physical, socio-emotional and cognitive environments of the children.

Methodology

ParticipantsInitially 20 families were selected for participation in the Firstborns project. The criteria for participation were previous enrolment in the JA KIDS study, parish of birth and residence as well as birth date. Specifically, the research team attempted to select the first child born in each parish during the cohort period (July 1 – September 30, 2011) using hospital delivery registers and the JA KIDS enrolment database. In the larger parishes more than one family was selected to capture the diversity that exists in these areas. If the first born child in the parish was not enrolled in the JA KIDS study or was not willing to participate in the Firstborns Project, the research team approached the next eligible family. Although many families were interested in participation there were several issues that prevented their involvement. For example, the time constraints for completing filming of all families limited

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participation. In addition, some parents became difficult to contact after initial discussions.

Seventeen families from 13 parishes were interviewed and filmed. Appendix A has detailed descriptions of each family and a demographic profile of the participants is presented in the Results section of this report.

InstrumentsThe Home Observation for Measurement of the EnvironmentThe Home Observation for Measurement of the Environment (HOME) was developed to measure the type and quality of stimulation given to children in the early years in the family environment. The HOME consists of four modules; infant HOME inventory, early childhood HOME inventory, middle childhood HOME inventory and the adolescent HOME Inventory. Each module consists of six scales - responsivity of parent; acceptance of child’s behaviour; organization of physical environment; provision of appropriate learning materials; parental involvement with child; and opportunities for variety of stimulation. The Infant HOME was used in this project. It consists of 45 questions and is used for children birth to three years. The HOME inventory has been found to be both valid and reliable in US (Bradley & Caldwell, 1984) and Jamaican (Grantham-McGregor et al., 1994) populations.

Ages and Stages QuestionnaireThe Ages and Stages Questionnaire (ASQ; Squires & Bricker, 2009) is a simple questionnaire used as a screening and monitoring tool for child development. It is completed by a parent or caregiver at home. The ASQ can be completed by many parents/caregivers because the reading level of the questionnaire spans from fourth to sixth grade. This questionnaire is based on the age of the child and asks specific developmental questions to determine the child’s development in six domains:

1. Communication: examines the child's language skills (expressive, receptive and comprehension). 2. Gross motor: examines large muscle movement and coordination. 3. Fine motor: examines smaller muscles in hand and finger movement and coordination. 4. Problem solving: examines the way a child plays with toys and his/her problem-solving skills. 5. Personal social: examines the child's basic self-help skills and interactions with others. 6. An Overall section focuses on general parental concerns.

The ASQ consists of 21 questionnaires spanning from 1 month to 5 1/2 years of age. Each questionnaire includes 30 questions under the domains mentioned above. The response categories for each developmental task range from yes (indicating that the child does the behaviour all the time), to sometimes (indicating that the child occasionally does the behaviour), to not yet (indicating that the child does not yet do the behaviour). The ASQ has already been used in Jamaica and found to be culturally appropriate for our population.

Parent InterviewA parent interview was developed specifically for this project to capture more detailed information on the daily lives and parenting experiences of study families. The interview was semi-structured and consisted of six sections. The interview probed parents about their family life, daily routines, parenting

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practices and child’s development. This interview was designed for use with mothers and fathers and was administered to whichever parent was present (in some cases parents were interviewed together). These interviews usually took one hour to complete. Please see Appendix B for a copy of this interview.

Structured ActivitiesSix activities were used to assess parent-child interaction and aspects of the child’s development. These activities were selected so that each developmental domain (i.e. gross motor, fine motor, language, socio-emotional and cognitive) and various parent-child interaction variables (e.g. responsivity, attachment, communication and stimulation) could be evaluated. The instructions for the structured activities were simply that parents were to play with their children for 3 – 5 minutes as they normally would, using the materials provided. If parents expressed difficulty in starting the activity or did not usually engage in these types of activities with their children, they were asked to improvise for the duration of the activity. The research team avoided making too many suggestions as the goal of these activities were to observe the typical parent-child interaction. The activities included: ReadingFamilies were provided three books to choose from; Splash, My First 1-2-3, and Farm Babies Piglet. Families were also allowed to use a favourite book that the child enjoyed. Parents were asked to look at or read the book with their child.

Board PuzzleFamilies were either presented with a three-piece board puzzle with animals or an 8-piece board puzzle with fruits. These puzzles were age appropriate with easy-grasp knobs and matching pictures underneath. Parents were simply asked to play with their child using the puzzle board.

Shape Sorter

The shape sorter is a toy that allows children to explore colours, shapes and sizes. It comprises of an orange cross, yellow hexagon, navy blue semi-circle, red triangle, purple circle and light blue square. It also has a house with a door on two sides which may be opened and closed by the user, as well as cut-out of each of the six shapes in the roof of the house to allow the user to push the shape through. Parents were asked to play with their child using the shape sorter.

ColouringFamilies were given eight jumbo non-toxic crayons and large picture of an apple and a large picture of a banana to colour.

Stacking BlocksFamilies were given a set of nine blocks to play with. These blocks were brightly coloured with portions

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of pictures on them. If assembled correctly, these blocks would create a scenic picture.

Outdoor ActivityThe research team also wanted to observe outdoor play activities. Families were given the choice of using a ball, blowing bubbles or playing outside with their own toys or games.

Procedure

Once participants were identified, the research team telephoned each family to tell them about the project and determine interest and availability. During these phone calls, participants were informed about the goals of the project, provided with detailed information about what participation would entail and a date/time established for a home visit. In addition, the research team requested information on the child’s development, daily routines and location of each family to facilitate filming and other research activities and ensure minimal disruption to the participants on the day of the visit.

The research coordinator trained the research team on completing the ASQ, HOME questionnaire and parent interview. Training also included discussions on ethical considerations in research with children/families and issues related to conducting research in naturalistic settings. Members of the film production team also provided research assistants with guidelines for filming research activities including film etiquette and set safety protocol.

On the day of each visit, parents were again informed about the project activities and asked to sign consent and release forms. Parents were asked to consent for themselves and their child. In addition, any other family member who would appear on camera was asked to sign release forms.

At each visit, there were a number of activities to be completed including filming the home and surrounding areas (specifically rooms/areas used by the child); observing the child/family in unstructured activity; observing the child being bathed or fed; completion of structured activities and the parental interview. All activities/tasks were filmed by the production team. The order in which activities were completed depended on the needs and schedules of each family and the weather. Each visit lasted approximately 5 hours. At the end of each visit, families were thanked for their participation and presented with a gift bag which included family-friendly products.

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Results

Demographics Seventeen families participated in the Firstborns project. Ten of the children have been boys, and five girls. The ages of the mothers at the time of the visit ranged from 18 years to 40 years, with the average being 28.7 years. Of the seventeen families, eight mothers are currently working, nine are unemployed.

Household sizes range from three to fifteen, with the average size being 6. Of these households, seven fathers live with their children, nine live elsewhere and one is deceased. Of the sixteen fathers who are alive, twelve are actively involved in their children’s lives, four are not. Seven fathers were interviewed on camera for the project (one of whom is not actively involved in his child’s life) and two were interviewed via telephone. Please note that only sixteen of seventeen families participated in the evaluation of the HOME environment.

Parent Interviews

Mother’s Interview Summary This section will summarise responses with regard to the their experiences parents .1.Experiences as a parent so farEight of the seventeen mothers interviewed reported that their experience as a parent was good. One mother noted that she was happy to be the "source of safety and security" for the baby and another reported that parenting was fun and exciting. Six mothers however also indicated that they had experienced challenges and frustration since becoming a parent but had to find ways to cope. Reported challenges included "staying up at night", "being unsure of what to do" and "not being able to go out".

2. Thing most enjoyed as a parentFour of the seventeen mothers interviewed reported that they enjoyed nurturing and caring (feeding, bathing and clothing) for their child the most. Seeing the baby's rapid development and having the baby say "mommy" was also identified as a source of pleasure. Mothers also indicated that they enjoyed spending time / having fun with and going out with their baby. As stated by one mother, "the baby makes me laugh".

3. Challenges faced as a parentFive of the seventeen mothers interviewed indicated that they had not faced any undue challenges while two mothers indicated that they were facing financial challenges. Other mothers indicated that they struggled to spend enough time with the baby due to the challenges faced in trying to balance work and parenting. Two mothers indicated that they wished that their child's father could spend more time

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with, and have a closer bond with the baby.

4. Regrets since the birth of the JA KID ( Anything they had to give up)Four of the seventeen mothers interviewed reported that they had no regrets about the timing of the baby's birth as they had planned for the child. One mother indicated that she had a son and wanted to "try for a girl". Another mother indicated that she had no plans that she had to alter however; six mothers reported that they had to delay or defer plans to further their education. One mother reported that she started an Associate's Degree but dropped out since the birth of her child. Regardless of whether births were planned or unplanned most mothers indicated that they intended to further their education.

5. What mothers like to do the most with their JAKID Ten of seventeen mothers indicated that they liked to spend time playing games with their baby. They also indicated that they like to engage in activities such as singing, naming things and taking walks. Mothers also reported that they like to have quiet time with their baby where they would could rest, sleep or cuddle.

6. Hopes and dreams for JAKIDThe mothers interviewed had high aspirations their children; hopes and dreams which were primarily focused on academic achievement having a successful career. Mothers indicated that that they wished for their children to attend private schools, traditional high schools and university. One mother indicated that she wanted her child to be "brilliant" and another indicated that she wished for her child to be "multitalented". Having a good job was also deemed important as ten of the seventeen mothers interviewed indicated that they wished their child would pursue a traditional career (law, medicine, nursing, teaching etc) while another mother wanted her child to play football. Mothers also indicated that they wished their child would have attributes such as wisdom and a social conscience. Above all, mothers wished for their children to be happy and successful.

7. What mothers would change about JamaicaFourteen of seventeen mothers interviewed stated they would decrease the crime rates in Jamaica. The others mothers had concerns about the education system and wanted teachers to be more caring and wished that there was a facility for free education at the tertiary level. 8. Message to ParentsThe JA Kids mothers interviewed want other parents to know that parenting is challenging and parents should seek help wherever they can. They also wish for parents to know that it is their responsibility to care for their children as best as possible. It was recommended that parents should pay attention to their children and set boundaries. Two mothers emphasised the importance of planning for a child emotionally and financially. The role of fathers was also mentioned as critical to the child rearing process. One mother expressed the view that she wanted parents to know that "showing love is not dependent on material things".

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9. What mothers hope this study will contribute to Jamaica.Most of the mothers interviewed hope that the study will contribute to Jamaica by providing information and support to parents and potential parents.

Father Interview Summary Of the seventeen children who participated in this project, sixteen of the children's fathers are still alive. Eight of the sixteen fathers were interviewed for this project - six in person and two via the telephone. Of the eight fathers interviewed, three live in the same household with their children and one lives abroad. With the exception of one father, all of the fathers interviewed are very involved with their children's lives; providing financial, social and/or emotional support to the mother and spending time when possible with the child. While it was not explicitly asked during the interview, two of the families made it clear to the research team that the parents of the study child were no longer in a relationship, despite the father’s participation in this project. In both cases, the relationship between the parents are visibly strained to any onlookers. One of these fathers happens to be the father who is not currently involved in their child’s life.

It is evident that all the fathers interviewed want the best for their children. They all consider their roles as a father to be important as they consider themselves to be the providers for their families - whether it be the provision of financial, social or emotional support.

In the sections below, questions that best illustrates the fathers' views of themselves have been extracted from the interview. All of the responses provided by the fathers have then been summarized in an attempt to provide a brief overview of their self-perceived roles. It is important to note that some fathers chose not to respond to all of the questions asked of them.

1. Experiences as a parent so farSeven of the eight fathers stated that their experiences as a father have been positive to date. One father stated that he has been unable to be the father he would like to be due “nothing not going on for him” which has proved to be economically challenging to him. Most of the fathers expressed pleasure in being able to spend time with their children.

2. Thing most enjoyed as a parentFour of the eight fathers say that they enjoy playing with their children the most. Other responses included; going for walks, teaching the child new things, watching the child grow up.

3. Thing least enjoyed as a parentThree fathers' least enjoyable moments as a parents related to the child's temperament. More specifically, seeing the child sad or when the child cried and when the child gave trouble. Other responses indicated that the father’s least enjoyable moments as a parent were more related to their own current situations and the dissatisfaction at being unable to provide social, emotional and/or financial support for their child/family in a manner in which they would like. Responses included;

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frustrations with the inadequate healthcare facilities in Jamaica in trying to obtain the best care for their sick child; not being in the same country with their family; and not having sufficient funds to care for their family.

4. Greatest struggle as a parentTwo fathers said that they had no struggles as a parent. Three fathers said the inability to provide the level of financial care they would like was their greatest struggle, with one of these fathers saying he did not have “steady employment to maintain his family." Two fathers indicated that their greatest struggles came as a result of not being able to spend sufficient time with their children.

5. Regrets since the birth of the JA KIDAll fathers except one said they had no regrets. Some sentiments shared by the fathers included, “life was lonely without" before the family and the child “was planned." The regret expressed by the one father reflected his frustrations at not being able to provide for his family as he would wish, as he said he had hoped to be able to purchase his own vehicle which he would have used as route taxi.

6. The JAKID's favourite thing to doSix of the fathers said their child loves to play the most, some with footballs/balls and one with goats. One father said his child loved to watch children’s programmes on the computer the most. Additionally, some fathers also said their children loved to laugh and eat.

7. What fathers like to do the most with their JAKIDA few fathers indicated that they considered more than one activity as a favourite past time. Five of the fathers enjoyed taking their children for walks. Three enjoyed playing with their children. Other responses included; spending time with their child, going to the library with the child, feeding and bathing the child.

8. A father’s roleAll of the fathers stated that their role as a father was to be a provider to their child and family. The definition of what should be provided however varied. All of the fathers believed it was their responsibility to financially support their children. Two believed it was their responsibility to be a role model to their children - one saying as a father he needed to teach his child to enjoy life. Responses also included; spending time with the child, and being present in every aspect of the child’s life.

9. Hopes and dreams for JAKIDAll of the fathers who participated in the project ultimately wanted the best for their children. Three fathers simply wanted their children to be successful in the future. Three fathers expressed a desire to see their children complete their education, while a father hoped his child would be able to travel and visit various countries. Possible careers fathers hoped their children would aspire to included two doctors, an athlete, a journalist, and a footballer.

10. What fathers would change about Jamaica

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Unanimously, all fathers stated they would decrease the crime rates in Jamaica.

11. What fathers hope this study will contribute to JamaicaThe fathers responses to this question also varied. Ultimately the responses have one key thing in common; all of the fathers hope that this study will have a positive impact on children and their parents. Responses included; training parents on issues related to child development; developing out-of-school programmes; demonstrating that parents can love their children and help to prevent them from getting in trouble in the future; showing that both parents should play a role in their child’s life; illustrating to other parents how other children are growing/developing in Jamaica.

12. Advice to other fathersLike responses to other questions, the responses to this query varied. While specific responses were different, they proved to be similar by the common theme of all the fathers wanting to encourage other fathers to take care of their children - regardless of how they defined "taking care of." Two fathers each said; fathers should not run away from their responsibilities as a father; they should prepare their children for the world; and be a part of their lives. Three fathers said all fathers should support and look out for their children. Other responses included; love your child unconditionally; raise your child in a way that ensures they will not get into trouble; and children did not ask to be here therefore frustrations should not be taken out on them. Additionally, two fathers stated that they wished their own fathers had played a more integral role in their lives. These fathers stated that they believed that their own lives would have had a more positive outcome if they had this paternal involvement.

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Quality of the Home Environment

Analytical Approach The quality of the home environment was measured using the Infant Toddler Home Observation for Measurement of the Home Environment Scale. The measure measures an infant's home environment in six domains – Responsiveness of Parents, Acceptance, Organization, Learning Materials, Involvement and Variety of learning environment. The presence of each item in each domain was marked by a plus sign which equals a score of 1 and the absence a minus sign (equal to a score of zero). The scores for each item within the domain are then added up. The scale does not use cut off scores to determine families that are 'at risk' but higher scores indicate a more stimulating environment for the child. The manual indicates that the scores should be analysed in relation to the median score as the scores are left skewed. Scores that fall below 2 -3 points below median indicate a possible area for concern while scores that fall below 5 points indicates a family that may need additional support.

Total HOME The average total home score was 25.5 which is 6 points below the median. There were twelve households that received total home scores below the median while four households received scores that were above the median.

Domain Scores Table 1: Domain Scores

Subscale Highest Possible Score Median Average Score JA Kids Moms

Responsivity 11 9 9.7

Acceptance 8 6 4.5

Organisation 6 5 3.6

Learning Materials 9 7 3.3

Involvement 6 4 2.5

Variety 5 3 2.5

Total Score 45 32 25.5

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Analysis of the scores in keeping with the parameters stipulated in the manual indicates that there are generally four domains of concern for the families observed. These are Organisation, Learning Materials and Involvement. The sections below will provide a summary and analysis of items in each domain.

ResponsivityThe parents in this sub study had displayed high levels of affection and praise as measured by the responsivity domain. The average score for this domain was 9.7 which is above the median of 9. This means that in general parents were observed to be physically affectionate and had good levels of verbal interaction with their babies. The parents were observed talking to their children and also responding to the words and vocalisations made by the babies.

Table 2: Responsivity DomainResponsivity # Households

observed# Households not observed

1. Parent permits child to engage in messy play

15 1

2. Parent spontaneously vocalises to child at least twice

12 4

3. Parent responds verbally to child's vocalizations or verbalizations

15 1

4. Parent tells child name of object or person during visit

14 2

5. Parents speech is distinct, clear and audible

14 2

6. Parents initiates verbal interchanges with Visitor

14 2

7. Parent converses freely and easily 14 2

8. Parent spontaneously praises child at least twice

15 1

9. Parent 's voice conveys positive feelings toward child

15 1

10. Parent caresses or kisses child at least once

12 4

11. Parent responds positively to praise of child offered by visitor

14 2

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AcceptanceAcceptance refers to the parents' ability to cope with their child's negative behaviours. The mean score for this domain is 4.5 which is 1.5 points below the median. The majority of households did not have a pet (11/ 16) and in the majority of cases the research team did not observe parents engaging in negative behaviours with their child. Shouting and scolding was observed in 5 / 16 households.

Organisation # Households observed

# Households not observed

1. No more than 1 instance of physical punishment during past week

6 8

2. Family has a pet5 11

3. Parent does not shout at child 10 4

4. Parent does not express overt annoyance with or hostility to child

9 5

5. Parent neither slaps nor spanks child during visit

9 5

6. Parent does not scold or criticize child during visit

9 5

7. Parent does not interfere with or restrict child more than three times during visit

9 5

8. At least 10 books are present and visible

1 13

OrganisationThe organisation domain has items that are related to how well parents structure the children's physical environment and daily schedule. The mean score for this domain was 3.6 which falls below the median score of 5. The scores based on the observations are presented in the table below. It should be noted however, that item 2 may have limited cultural relevance as some persons, especially in rural areas, rarely procure groceries from the supermarket. Persons may get groceries from a local wholesale or corner shop. It was reported that most children were regularly taken out side of the home (14/16) and for well child visits (15/16). While most play environments observed (12/ 16) were described as safe, only 5/16 children had a special place to keep their toys and treasures.

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Table 3: Organisation DomainOrganisation # Households

observed# Households not observed

N/A

1. Child care, if used, is provided by one of 3 regular substitutes

8 5 3

2. Child is taken to grocery store at least once per week

4 12

3. Child gets out of house at least 4 times per week

14 2

4. Child is taken regularly to doctor's office or clinic

15 1

5. Child has a special place for toys and treasures

5 11

6. Child's play environment is safe 12 4

Learning Materials The learning materials domain focuses on the type of toys and learning materials that are present in the home environment. The types of toys specified are those that foster development in infants and toddlers. This domain was found to be an area of weakness in the households observed as children did not have many developmentally appropriate learning resources and there was limited adult involved play. The mean score for this domain was 3.3, well below the median of 7.

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Table 4: Learning Materials Domain

Learning Materials # Households observed

# Households not observed

1. Muscle activity toys or equipment5 11

2. Push or pull toy8 8

3. Stroller or walker, kiddie care, scooter or tricycle

6 10

4. Cuddly toy or role playing toy7 9

5. Learning facilitators – mobile, table and chair, high chair, play pen

3 13

6. Simple hand eye coordination toys 8 8

7. Complex eye hand coordination toys 3 13

8. Toys for literature and music6 10

9. Parent provides toys for child to play with during visit

7 9

Involvement The involvement domain assesses how much parents interact with babies during everyday activities and how play time is structured and managed. This was also a low scoring domain with a mean score of 2.5 which was below the median of 4. A breakdown of observation scores are presented in the table below. It is interesting to note that only three of the households were observed to have toys present that challenge children to develop new skills.

Table 5: Involvement DomainInvolvement # Households

observed# Households not observed

1. Parent talks to child while doing household work

8 8

2. Parent consciously encourages developmental advance

8 8

3. Parent invents in maturing toys with value via personal attention

5 11

4. Parent structures children's play periods 2 145. Parent provides toys that challenge child

to develop new skills 3 12

6. Parent keeps child in visual range, looks at often

12 4

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Variety  The variety domain has items related to diversity in the child's experiences in the home environment. The average score on this domain is 2.5 which slightly below the median of 3 points. This indicates that this is not generally an area of concern for our families. Two items stand out based on the low number of households observed where children have 3 or more books of their own (4/16) and where parents read at least 3 times per week to the child (2/16).

Table 6: Variety DomainVariety # Households

observed# Households not observed

Not Applicable

1. Father provides some daily care 9 6 1

2. Parent reads stories to a child at least three times per week

2 14

3. Child eats at least once meal a day with a parent

14 2

4. Family visits relatives or receives visits once a month or so

11 5

5. Child has three or more books of his / her own

4 12

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Parent Child Interaction

Structured Activities

Mothers were the primary participants in each of the six structured activities. If the fathers were present during the interview, they were more likely to participate in structured activities that involved playing with the child outdoors (five of the seven fathers present played outdoors). One of the fathers interviewed did not participate in any of the activities with the child due to his limited involvement in the child’s life.

ReadingSixteen of the mothers read to their child. One of the children was read to by his nanny. In addition to their mothers, three children were also read a story by others in their household during the visit; two fathers and one older sister. Children’s level of engagement and interest in this activity was largely dependent on how interactive the reader was.

One of the children remained engaged longer than the allotted time of five minutes. Eleven of the children remained engaged for five minutes, one child for three minutes, one child for two minutes, and two children for one minute. Most readers read the story as it was presented in the various story books (two of the mothers had low literacy skills). To keep the child engaged, twelve individuals modulated their voices, nine used facial expressions, eight gesticulated, and six named objects and counted. Three were distracted during this activity. Fourteen babies were generally interested in the reading exercise. All seventeen babies made sounds, twelve turned the pages and seven imitated the reader.

Board PuzzleTwelve mothers played with puzzles with their child. While another three played with their father, and one with a nanny and one with a family friend. Fifteen of these adults showed the baby how to correctly place the puzzle pieces in the correct slot and named objects, twelve used language interaction, ten gesticulated and four counted. Four individuals were distracted during this activity.

Fourteen children were generally interested in this activity with nine children being engaged for five minutes, three for four minutes, four for three minutes and two for one minute. All seventeen babies grasped the puzzles and attempted to fix the puzzle. Thirteen made sounds, eight tried to imitate the adult, and four used gestures.

Shape SorterThe shape sorter is a toy that allows children to explore colours, shapes and sizes. Fourteen of the children showed interest in this activity; eleven were engaged for five minutes, four for four minutes, one for three minutes and one for a minute. Twelve mothers did this activity with the child. Another

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four children played with their fathers and one with their nanny. Sixteen individuals showed the child how to play with the shape sorter by doing things such as demonstrating how to open the doors or putting the shape in the appropriate slot on the base of the house or roof. Thirteen individuals used gestures, eleven praised the child, nine used language and three counted.

Fifteen babies grasped and oriented the various shapes, fourteen attempted to place a shape in the correct slot, ten made sounds and explored, ten imitated the individual they played with and three gesticulated.

ColouringThirteen mothers, three fathers and one nanny interacted with the child during this activity. Twelve children demonstrated general interest in this activity. Nine were engaged for five minutes, one for four minutes, five for three minutes and one for two minutes. One child expressed no interest at all and did not participate in this activity. Thirteen individuals demonstrated to the baby how to colour, twelve used language to interact with the baby, nine praised the baby and six used gestures. Two individuals were distracted during the activity.

Of the children who participated in the activity, all (sixteen) were able to grasp the crayon, while fourteen actually coloured with the crayon. Fifteen made sounds, six exhibited some creativity and four used gestures.

Stacking BlocksThirteen mothers participated in this activity, in addition to two fathers, and one nanny and one family friend.

Children’s interest in this activity was lower as compared to other activities (nine children were generally interested). Seven children were engaged for five minutes, four for four minutes, three for three minutes, one for two minutes and one for one minute. One child exhibited no interest in this activity and did not participate. One child stacked five blocks, three stacked three blocks, four stacked two blocks and nine stacked none. Sixteen children made sounds, fifteen grasped the blocks, fourteen had animated facial expressions, seven imitated the individuals they were playing with and two used gestures.

Twelve adults showed the child how to stack the blocks, nine used language to interact the child, five counted the blocks, three named pictures on the blocks and two gesticulated. Three adults were distracted during this activity.

Outdoor ActivityFamilies were given the choice of using a ball, blowing bubbles or playing outside with their own toys or games. Two children did not participate in the outdoor activities as a result of the rainy weather and one child utilized both the bubbles and the ball. As a result of an unsafe outdoor environment, one mother requested that the outdoor activity be done in the same location as the other activities (on a bed indoors).

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Ten mothers played with their child during the outdoor activity, while one sister and one nanny played with the children. Five of the six fathers present during the interview played outdoors with their child. During the activity, all adults, except one, interacted with the child and used language.

This is the activity that children exhibited the most interest in. Of the fifteen children who participated in the outdoor activity, twelve were engaged for five minutes, one for one minute, one for three minutes, and one for one minute. Eleven children played with balls (either provided by JAKIDS, their own or a combination), four children blew bubbles, one child played with his car, and another played with gravel (the activity the child normally engages in with his father). Of the children who played with a ball, all threw or kicked the ball. Nine of the children tried to catch or caught the ball. All four children who played with the bubbles tried to pop them. Fourteen children showed animated facial expressions and seven used language to interact.

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Child Development Status

Ages & Stages Questionnaire Summary

DomainsOverall, most families scored normal to above normal in all domains. However, in four categories there were children who fell in “approaching normal” or “below normal” categories (i.e. Communication, Fine motor, Problem Solving and Personal Social).

This result is unsurprising in the Jamaican context because Jamaican parents rarely encourage their children to engage in activities to develop fine muscles in the hand and fingers. The reasons for this vary from parents thinking their child is incapable of scribbling to the fear that child will use the crayons on the walls and furniture. In relation to problem solving, parents do not challenge their children puzzles and shape sorters which were two activities we encouraged the parents to do with their child and was observed that most children had never seen a puzzle or shape sorter and some parents did not know what to do with these toys either. There were a few children who based on parental report were placed in the below normal category, these domains were fine motor, problem solving and personal-social.

Domain ScoresItem Normal or Above

Normal Approaching Normal

Below Category

1. Communication 16 1 02. Gross Motor 17 0 03. Fine Motor 7 9 14. Problem Solving 11 4 25. Personal Social 16 0 1

CommunicationOverall, 80% of our children are doing great in communication domain. 94% of the children were reported as being able to carry out simple gestures of pointing and patting while all the children were able to say a one word in addition to mama or dada while only 47% were able to say four words or

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more. It is widely known that many Jamaican parents encourage language development and models speech for children to imitate.

Therefore, children are stimulated and encouraged from as early as 6 months to imitate speech. 70% of the children were able to follow a one step command and only 47% were able imitate a 2 word sentence. Between 6% and 18% of the children were unable to gesture and perform a one step command while six (7) or 41% and 53% of the children were unable to imitate a two word sentence and say four words including “mama” and “dada”.

Item Yes, Always

Some times

Not yet

1. Does your child point to, pat or try to pick up pictures in a book?

12 4 1

2. Does your child say for or more words in addition to 'mama' and 'dada'

15 2 0

3. When your child wants something, does she tell you by pointing to it?

14 3 0

4. When you ask your child to, does she go into another room to find / toy object?

12 2 3

5. Does your child imitate a 2 – word sentence? 8 2 7

6. Does your child say four more words in addition to 'mama' and 'dada'?

8 0 9

Gross Motor Jamaican children are encouraged and sometimes even coaxed to walk, run and climb at an early age before other children in developing countries some even walk as early as 10 months, therefore, they are expected to do better in this domain and over 96% of children were reported as being able to complete these gross motor skills.

Gross Motor Skills is greatly encouraged by parents especially if the child has older siblings or relatives they are prompted to go out and interact with them. Jamaican parents think it’s extremely important for children to play outside in the open to help build muscles, balance and coordination also, the layout of lots in Jamaica caters to this.

Item Yes, Always

Sometimes Not yet

1. Does your child stand up in the middle of the floor by himself and take several steps forward?

15 1 0

2. Does your child climb onto furniture or other large objects such as large climbing blocks?

17 0 0

3. Does your child bend over or squat to pick up an object from the floor then stand again without support?

17 0 0

4. Does your child move around by walking, 17 0 0

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rather than crawling on his /her own hands and knees

5. Does your child walk well and seldom fall? 16 1 06. Does your child climb on an object such as a

chair to reach something s(he) wants?11 2 3

Fine MotorAll the children were capable of throwing a small ball with the forward arm motion. In homes where fathers are present throwing, catching and kicking are games played regularly so children will master these tasks quicker. All the children who participated in the study were reported as being able to help turn pages of a book, while 94% were able to turn pages on their own, this is compared to only 6% who were able to stack block.

Toys in the home environment were rare only 5 or 29 % of 17 families were observed to have toys. Culturally, children are neither taught to stack objects/blocks nor are they given crayons for reasons discussed earlier.

Item Yes, Always

Sometimes Not yet

1. Does your child help turn the pages of a book? 17 0 0

2. Does your child throw small ball with a forward arm motion

14 3 0

3. Does your child stack a small block or toy on top of another one?

5 4 8

4. Does your child stack 3 small blocks / toys on top of each other by him / herself

4 0 13

5. Does your child make a mark on the paper with a tip of crayon (or pencil / pen) when trying to draw?

12 5 0

6. Can your child turn the pages of a book by himself?

15 2 0

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Personal Social

It was reported by parents that 89% of the children were able to perform some sort of self help skills with all being able to feed self with spoon with some spills and be able to undress self. 70% of the children were reported as offering a toy to his own image in a mirror, getting parent’s attention by pulling hand or clothing and getting assistance with unscrewing a lid from a jar.

Item Yes, Always

Sometimes Not yet

1. Does your child feed himself with a spoon, even though she may spill some food?

12 5 0

2. Does your child help undress him / herself by taking off clothes like socks, hats or shoes?

15 2 0

3. Does your child play with a doll or stuffed animal by hugging it?

15 1 1

4. While looking at him / herself in the mirror, does your child offer a toy to his own image?

12 2 3

5. Does your child get your attention or try to show you something by pulling on your hand or clothes?

12 1 1

6. Does your child come to you when she needs help, such as with unscrewing a lid from a jar?

12 2 3

Overall ConcernsItem Yes No Not

Stated

1. Do you think your child hears well? 13 3 12. Do you think you child talks like other toddlers

his / her age?13 3 1

3. Can you understand most of what your child says?

13 4 1

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4. Do you think your child walks, runs and climbs like other toddlers his / her age?

14 3 1

5. Does either parent have a family history of deafness or hearing impairment?

3 12 2

6. Do you have concerns about your child's vision 4 11 1

The majority of parents reported not being concerned about their child’s hearing, gross motor skills receptive and expressive speech. However, 24% of the parents’ worry about their child’s vision while 18% reports a family history of deafness or hearing impairments. Six parents reported having some worry about hearing, gross motor skills and receptive and expressive language.

Conclusion

Home EnvironmentThe families were observed to have strengths in the “Responsiveness” domain which focuses on affection and verbal interaction between parent and child. This is evidenced by the affection and communication observed between parents and children during the visits. However, many of the households had few items which could be used as learning materials (e.g. toys and books); and in general parents did not use existing resources within the home for stimulation. As a result, parents were generally observed, to have less than the optimal scores in the domains of “Learning Materials and Involvement.” While it is a small sub-sample, the first findings are encouraging as parents are demonstrating responsiveness towards their children. Children benefit from growing up in warm and loving environments where parents quickly respond to their needs. However, there are concerns regarding the availability and quality of learning resources in the home environment. Research has consistently shown that all aspects of child development are enhanced by cognitively enriching environments, especially in the earliest years of life.

Child DevelopmentThe children who participated in this project all exhibited good gross motor skills. This is very typical of Jamaican children who often reach gross motor milestones earlier than children in other countries. All of the children are walking without falling and squatting, and many are kicking and throwing balls. This may be attributed to the fact that Jamaican parents are more likely to encourage children to engage in activities that develop gross motor skills such as outdoor play. In this sample, there were concerns with children’s development related to the fine motor domain. Many of the challenges exhibited within the fine motors skills domain may be attributed to the fact that many of the children had never been

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exposed to these activities (e.g. stacking blocks, colouring).

Attitudes Towards ParentingMothers see parenting as a positive experience that are however filled with many challenges. Most of the mothers interviewed stated they enjoyed spending time with their children and wished the best for them. While the mothers often spoke of spending quality time, many of them did not see the benefits of interacting with and stimulating their young children, a few even said their child was “too young to learn.” Many of the mothers who are currently working, expressed a difficulty finding a work-life balance, often expressing that they did not have enough time to spend with their children. Regardless of whether or not the mothers were working, they all stated that they desired more parenting information and support (both formal and informal). This is evident because many mothers expressed a wish to share their own parenting successes and challenges with other parents throughout. This is very timely, considering the recent development of Jamaica’s National Parenting Policies and the implementation of Parents Places by the Ministry of Education and the Early Childhood Commission.

While not explicitly calling the birth of their child a regretful experience, many mothers expressed disappointment in having to defer their education. They all stated a desire to return to school and further their education. All mothers wanted their children to be successful academically and professionally. Most stated specific professions (e.g. lawyer, doctor, nurse, teacher). A few spoke about the desire for their children to become good citizens and socially responsible. However, based on observations, there seems to be a gap between parental educational aspirations and some of their current child-stimulating practices. Crime and violence in Jamaica and its potential effect on their children, is a prevailing concern amongst the mothers. Interestingly, all fathers expressed concern about crime and violence. A few mothers were concerned about the access to quality education in Jamaica. Many mothers expressed their wish to see fathers play a greater role in their children lives.

All of the fathers interviewed deemed their primary responsibility as one who provides support. The fathers however varied on how they defined “support.” Overwhelmingly, they all believed that the key form of support to be provided by a father should be financial.This attitude is not surprising as this is a prevailing attitude throughout the Jamaican society. Often, fathers within the Jamaican society are marginalized and often thought of as only financial providers and therefore are not often encouraged to interact with their children in stimulating ways. A few also believed they were responsible for providing emotional and social support. With the exception of one father, they all expressed having a positive experience towards parenting. Interestingly, the father with a negative experience also happens to be the father who currently has little involvement in his child’s life. Additionally, all fathers except one, had no regrets about parenting.

Parent-Child InteractionChildren were most interested in the outdoor activities (either playing with a ball, bubbles or their own

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special toys/activities). If present, fathers were more likely to engage in outdoor play with the child. The JAKIDS’ research team observed that many of the toys introduced were not only new to the children, but also to the parents. This sometimes resulted in the parents being unsure of what to do with the toys which may have influenced how they then interacted with the child and toy. The JAKIDS’ research team also observed that very few children had toys, with even fewer having toys/games that was made from their home environment/existing resources. This lack of resources, may have further affected the level of interaction between parents and children, as not only were the toys new, but the activity of actually playing with a toy was also new in many cases. Additionally, very few of the children were observed with books specifically for babies. A few families who owned baby books admitted to the JAKIDS’ research team that they had deliberately chosen not to read to their children at such a young age because they believed that their child was too young to learn and therefore would not understand.

References

Bradley, R. H., & Caldwell, B. M. (1984). 174 children: A study of the relationship between home environment and cognitive development during the first 5 years. In A. M. Gottfried & A. E. Gottfried (Eds.), Home environment and early cognitive development (pp. 5–56). New York: Academic Press.

Gottfried, A., & Gottfried, A. (1984). Home environment and early cognitive development. Orlando, FL: Academic Press.

Grantham-McGregor, S., Powell, C., Walker, S., Chang, S., & Fletcher, P. (1994). The long-term follow-up of severely malnourished children who participated in an intervention program. Child Development, 65, 428–439.

Iltus, S. (2006). “Paper commissioned for the EFA Global Monitoring Report 2007, Strong foundations: early childhood care and education”

Jones Harden, B (2004). Safety and Stability for Foster Children: A Developmental Perspective. Children, Families, and Foster Care, 14, 1, 31 – 47.

Klebanov, P.K., Brooks-Gunn, J., McCarton, C., & McCormick, M.C. (1998). The contribution of neighbourhood and family income to developmental test scores in the first three years of life. Child Development, 69, 5, 1420 – 1436.

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Lee, J., Super, C. M., & Harkness, S. (2003). Self-perception of competence in Korean children: Age, sex and home influences. Asian Journal of Social Psychology, 6, 133-147.

Molfese,V.J., DiLalla, L.F. & Bunce, D. (1997). Prediction of the intelligence scores of 3 to 8 year old children by home environment, socio-economic status and bio-medical risks. Merrill Palmer Quarterly, 47, 219 – 234.

Richter, L. M., & Grieve, K. W. (1991). Home Environment and Cogitative Development of Black Infants in Improvised South African Families. Infant Mental Health Journal, 12, 2, 88-102.

Squires, J., & Bricker, D. (2009). Ages & Stages Questionnaires: A parent-completed child monitoring system, Third Edition (ASQ-3). Baltimore: Paul H. Brookes Publishing Co., Inc.

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Appendices

Terms of ReferenceRG-K1235

Sustaining the Impact of PreschoolJamaican Case Study on Firstborns

I. Background

From 1986 to 1993, a birth cohort study was carried out by the University of the West Indies (UWI) and Jamaica’s Ministry of Health to look at perinatal morbidity and mortality. It followed up on the participants of the study at ages 11-12, 15-16 and 20-21. This became one of the first longevity studies in Latin America and the Caribbean. The findings have significantly shaped policies and legislation in Jamaica. They have also contributed to the international body of knowledge on Early Childhood Development (ECD), and to a better understanding of factors that impact child development, behaviour and academic achievement.

In 2011, the UWI embarked on a new birth cohort study. This new study has expanded the scope of the original study, placing greater emphasis on the development and behaviour of children from 0-2 years of age and collecting data during the antenatal period, looking at the family/supportive environment, collecting data on fathers as well as mothers, and collecting biological samples. In total, 9,766 mothers and 3,413 fathers were enrolled in the study. This research also includes a cord blood sub-study, a sub-study on neo-natal and maternal deaths, and close follow-up of the first boy and girl born at each hospital during the cohort period. Data collected from the Firstborns will provide valuable information on the physical, socio-emotional and cognitive environments of the children.

The study on Firstborns is a unique opportunity to document the growth and development, home environment and family interaction patterns of a sub-set of children from a comprehensive birth cohort. The research is in line with the IDB’s analytical agenda for ECD, as it will provide new quantitative and qualitative information obtained with high methodological rigor. The findings of the study are expected to further support evidence-based decision making in Jamaica and across the LAC region on ECD.

II. Objectives of the Consultancy

The aim of the study is to document 20 one-year olds and their families and to develop a paper and a documentary using the findings. The research will look at the following aspects:

Quality of the home environment Child health and development outcomes as they relate to parenting strategies Cognitive and language development

III. Characteristics of the Consultancy

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Type: Direct contracting – University of the West IndiesDuration: October 15, 2012 to December 31, 2012. Location: Jamaica Qualifications: At least 15 years of experience in research of lead researcher on early childhood development.

IV. Activities / Scope of Works

To carry out the study, the team will:

Determine the best methods and instruments for gathering and recording the data in the different settings and for the three different aspects of the research

Identify the families to be used in the study, selecting from the group of 50 first girls and boys (Firstborns) born in Jamaica between July 1 and September 30, 2011

Apply the instruments and carry out the interviews and observations of the children and their families

Process and analyze the data Write a paper that summarizes the work to date on the new birth cohort study Use the observations and video clips to develop an approximately one-hour documentary on the

Firstborns Develop a dissemination plan for sharing the findings of the research.

V. Reports/ Deliverables

A draft proposal and implementation plan An academic paper on the three aspects of the research, within the context of the broader birth

cohort study A documentary on the families studied, and a dissemination plan for sharing the documentary

and research findings.

VI. Payment Schedule

40% at signature of contract 30% at submission of draft report 30% upon acceptance of final report and documentary

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VII. Coordination

The consultancy will be coordinated by Aimee Verdisco (EDU/CBO), phone (591) 2217-7745, email: aimeev@iadb.org and Cynthia Hobbs (EDU/CJA), phone (876) 764-0823, email: cynthiah@iadb.org.

Mother’s ID No. [__] [__][__] [__][__] [__] [__][__][__][__] Date of Filming [__][__] [__][__] [ 2 ][ 0 ][ 1][2] (day) (month) (year)

JA KIDS FIRSTBORNS PROJECT CONSENT FORM

JA KIDS: The Firstborns ProjectYour family has been specially selected to participate in an exciting and unique programme called the JA KIDS Firstborn Project. The goal of this project is to take a closer look at the experiences of a few of our JA KIDS families with babies born at the beginning of our study. This will assist the Jamaican government in the development of health, education and childcare policies which can improve the health and development of our Jamaican children.

Participants:We have selected at least one (1) representative from each parish, and your baby has been chosen to represent your parish.

Procedures:If you agree to participate in the JA KIDS Firstborn Project, a team of three to four persons will visit your home, at a time convenient to you between November 1, 2012 and December 15, 2012. The visit will last for approximately five (5) hours. During this time they will observe parenting techniques and ask a few questions. This will be video recorded and a segment of this recording may be shown on national television for other families to learn from your example.Specifically, you will be asked to:

1. Do an interview:

a. Parents of the JA KIDS’ firstborn will be interviewed about their experience as parents and daily parenting activities. This interview will take about 60 minutes to complete.

Engage in Interactive Tasks with your baby:

a. The study team will set up a series of simple tasks for you and your child (e.g. playing with blocks) and observe for 3 – 5 minutes. These tasks will take about 60 minutes to complete.

Allow the study team to film activities 1 & 2, as well as:

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a. Your child’s bath and/or feeding timeb. Selected areas inside and outside of your homec. These tasks will take about an hour

Together with the set up and breakdown of our filming and other equipment, which is expected to take about 1 hour each at the beginning and ending of our time with you, we will spend a total of 5 hours with you in your home.

Benefits of Participation There may not be direct benefits to you as a participant in this study. However, we hope to learn more about children and their families. This knowledge will enable the Government of Jamaica to better provide services for children.

Risks of Participation There are risks involved in all research studies. This study includes minimal risks. You may have some individual discomfort when questions are being asked about you and your family or when your child is doing the developmental tests.Cost /Compensation The study will take approximately five hours in total. To thank you for your participation, a token will be provided for your family.

Rights as a Research ParticipantFor independent advice on your rights as a research participant, please contact Professor Horace Fletcher, Acting Dean, Faculty of Medical Sciences, University of the West Indies, Mona Kgn. 7 at 876-927-1620.Contact Information:If you have any questions or concerns, please feel free to contact us at 876-618-0180 or jakids2011@gmail.comVoluntary Participation Your participation in this study is voluntary. In addition, your child/ward’s participation in this study is voluntary. You may refuse to participate or to have your child participate in the whole study or in any part of this study. You may withdraw or may withdraw your child/ward at any time without affecting your relations with The University of the West Indies or the University Hospital of the West Indies.

Written Consent to the study

I have read the above information or it has been read to me. I have been given time to consider its contents. I understand its contents and agree to participate in the part(s) of this study, as

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indicated by my signature below. I am at least 18 years of age. I have been given a copy of this form.

2) I ______ agree I ______do not agree

I attest that I have voluntarily agreed to be interviewed/filmed

3) I _______ agree I _______ do not agree

I agree to participate in further firstborns project activities (questionnaires and additional filming as my child grows and develops)

4) I _______ agree I _______ do not agree I agree to allow my child _________________________ to

participate and be filmed

5) I _______ agree I _______ do not agree

I agree to allow my child to participate in further firstborns project activities (questionnaires, tasks and additional filming as he/she grows and develops)

6) I _______ agree I _______ do not agree

I agree that the Documentary may be edited and otherwise altered at the sole discretion of UWI (in keeping with project goals) and used in whole or in part for any and all broadcasting, non-broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world.

Signature of Participant: ____________________________ Date____________ Name (printed):_________________________________ Address: _____________________________________________________________ Signature of JA KIDS Interviewer: _________________________ Date____________ Name (printed):________________________________

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THE UNIVERSITY OF THE WEST INDIES

Mona Campus

PHOTOGRAPH AND VIDEOGRAPHY RELEASE FORMI hereby grant to The University of the West Indies, Mona Campus the irrevocable and unrestricted right to use and publish photographs/video footage of me and my child/ward, or in which I or my child/ward may be included, for University publications, electronic reproductions (web sites, video productions) and/or promotional materials or any other University purpose and in any manner or medium. In addition, I grant my permission to alter the same without restriction. I hereby release The University of the West Indies, Mona Campus from all claims and liability relating to said photographs.Printed Name: ___________________________________ Date: _________________Signature: ______________________________________________Phone:______________Address: ______________________________________________________________________Faculty: Medical Sciences Department: Child & Adolescent Health

Profile of Participant Families

Mother #1T.N (mother) [GIRL - A.L] - Spanish Town HospitalT. N is very pleasant. She was very accommodating of the team (willingly allowing the seven members of the team to enter her small dwelling with muddy shoes). In spite of T. N’s difficulty with reading (she asked her oldest daughter read the consent forms to her; MICO reading list 1 score = 10/15; list 2 score = 5/15; list 3 score = 2/20; list 4 score = 1/20), she is very well spoken, mostly using proper grammar. In spite of this, she “reads” with A.L by describing the pictures to her. During the reading activity, T. Nugent was very interactive, using a lot of descriptive words and gestures ensuring that

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A.L’s attention was captured. It is clear that she loves her children very much as she has very close and loving relationship with both of her daughters. During the visit, T. N was observed breast-feeding A.L. During this time she was very attentive and interactive with A.L., talking with her during the feeding and. Several times during the visit, T. N was observed having conversations with A.L, patiently responding to A.L each time A.L. said something to her (whether she used actual words of baby-babble).

The house is located in the rural community of St. Catherine. Community is relatively quiet. House is located a few yards from the main road and is only accessible by walking along a narrow dirt-pathway. At the time of the visit, it had been raining intermittently causing the pathway to become extremely slippery and muddy. House is located on property that has another house on it which is occupied by T. N’s mother. No inquiries were made to determine who else lives in the home with T. N.’s mother. The property has many trees and other greenery. The home is a one-room dwelling with a small area that is used as a kitchen attached to it. The room is relatively dark, with a bed, dressing unit (or a piece of furniture or other items assembled and used for that purpose). Because of the small space, the room is relatively crowded. There is no indoor plumbing (T. N. told team that she and her older daughter bathes in a nearby river). Neither of the girls has any toys; additionally no children’s books were evident. There were several stuffed animals on the bed, but they seemed more decorative than actual items that were played with (T.N. says A.L loves to play with teddy bears). No reading material was evident. Despite the darkness, the room is colourfully decorated. There are several colourful bouquets of artificial flowers hanging prominently around the room (including from the ceiling). Certificates displaying the academic achievements of her oldest daughter are hanging throughout the room. There is a television in the room, but T. N. says that it has not functioned since the passing of Hurricane Sandy on October 24, 2012.

The room/home is shared by T. N. and her two daughters. During the visit the team was able to interact a lot with her 11-year old daughter. She seems to be a well-adjusted young lady, was very articulate and intelligent. She will be sitting GSAT during this school year and hopes to attend Jose Marti High School. At the end of the visit, she told the team that her mummy was very nice, responsible and loving. She said that even though she gave trouble sometimes, that her mother never hit her, but spoke to her to let her know why she was wrong. Specifically she said, “she sits me down and talks to me and hugs and kisses me a lot.”

Mummy #2D. M. [GIRL – J.G.] Spanish Town HospitalD. M. lives in St. Catherine with fourteen of her family members, including JA KID J.G.. The home is situated on property that is not easily accessible by vehicle. Because of the many individuals living in the home, many of the rooms have two beds within them as well as another piece of furniture or equipment that is not often associated with bedrooms (e.g. refrigerator or dining table). As a result

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the home is somewhat overcrowded, but however neat. The family is currently building additional rooms onto the home. In addition to the many family members who live within the home, there are relatives who also live nearby to D. M. The family is close-knit and loving. While they are very affectionate, they are also very physical and as a result they use slaps to both reprimand and as a means to play.

D. M. has two older sons who are 10 and 15 years old. Both also live in the home with her. As her only girl, J.G is doted on by her mother. Because of her strong feelings towards J.G., D. M. rarely leaves J.G. in the care of any of her family members, although they would be willing to care for her. As a result, she sometimes takes her to work where she serves as a domestic worker. In spite of her bond with J.G., D. M. was not very interactive with J.G during our visit as she does not often play with her using toys or by going outdoors. J.G. has many young cousins, and these children are her usual playmates. Although there are many children residing there, there are no toys within the home.

J.G’s father has eight children - with J.G. being the youngest. Although her father was present for the interview, he does not play an active role in J.G’s life. During the interview he stated that he believes the role of a father should be to financially support their children. However, he has had issues with gambling in the past and as a result, is not able to provide financially for J.G. He also stated that he does not like to see any child get hit, including his own, and when he does see a child being hit, it often brings tears to his eyes. While he does not agree with D. M. hitting J.G, he says he does not say anything to her or try to prevent her from hitting J.G.

Mummy #3C. G. [BOY – D.R.] - May Pen Hospital

C. G. is currently living in a quiet neighbourhood in Clarendon. She has four children including JA KID, D.R. The house is occupied by fourteen individuals of varying age (eldest being C. Gs’ mother and the youngest being D.R.). This household is however not close-knit. At the time of the visit, no one was employed and they were being assisted by family members who lived overseas. In spite of the many people living in the home, the house did not seem crowded at the time of the visit. The interior of the home was slightly dark. The front of the yard provided a safe place for D.R. and others to play, but there were hazards such as sheets of zinc located in the backyard. Neither D.R., nor any of the other children living in the home has toys.

Unfortunately, this family tragically lost D.R’s father on July 31, 2011, who died as the result of being accidentally electrocuted. He was the father was of C. G’s three youngest children (including D.R.). C. G. received counselling at the time of the death, but is naturally still grieving for the man who she described as a good father who took care of his children. Her grief was sadly evident as she started to cry during her interview and requested that no additional questions be asked of her pertaining to him.

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C. G. was not very attentive to D.R. during the visit. She rarely spoke to him, and her only interactions with D.R. were as a result of the structured activities. As a result of C. Gs’ limited playful-interaction with D.R. on a daily basis, it was difficult for her to fully engage him in the activities which resulted in him having challenges focusing on the tasks presented to him. D.R. most often plays with his older siblings or cousins, resulting in them participating in some of the structured activities.

Mummy #4C. B [BOY – D. F.] - May Pen HospitalC. B. lives in Clarendon, with her three sons and their father. At the time of the visit, the boys were ages six years, sixteen months, and two weeks. The house is a small one room home, with a small kitchen attached. The interior of the home is dark and overcrowded. The family is currently in the process of building additional rooms onto the home. There is a small patch of grass to the front of the home which makes a nice play area for the children. There is however barbed wire around the small property and no gate to prevent D.F. from wandering from the property. The neighbourhood is quiet and scenic, and very close to a major thoroughfare.

The young family is a close-knit, pleasant and loving family, with the father playing an integral role in the upbringing and caring of his young sons. While he is not comfortable holding the youngest child because of his fear of holding newborn infants, he has assumed additional duties in caring for the older children. The father is solely responsible for feeding D.F. and is the one who plays with D.F and his older brother.

The father stated that he feels like a man when he is able to take care of his children and interact with them. He went on further to state that he did not feel as if he was properly cared for by his own father, which in turn motivates him to be the best father possible to his own children. During the structured activities, the father was extremely attentive and patient with D.F. The father also demonstrated the importance of quality interactions when he provided D.F. with a handful of gravel to play with. When this was done, D.F. quickly discarded a small ball that JA KIDS had brought to his home (and which he had been very attached to until that point) at the prospect of playing his favourite game with his father. Father and son then played with the pebbles.

Mummy #5S.S. [BOY – J.B] - Victoria Jubilee HospitalS. S. is a nurse by profession who is living in Kingston. The yard is small with items that would be a potential hazard to young children. The home is shared by several people, including J.B’s

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parents, siblings, grandparent and a cousin. This has caused the home to be overcrowded and dark. In spite of this, J.B is a happy, pleasant and very energetic child. S.S. is a very pleasant lady. She was very accommodating of the team and laughed often.

S. S. has three older children ages ten, twenty and twenty-four years and says she was caught by surprise when she learned she was pregnant with J.B. She is very loving and affectionate to him - hugging, kissing and praising him often. She says she tries not to get frustrated when J.B. is being curious because she knows that is how he learns at his young age. Of the fifteen families visited to date, J.B. is the only child who is sleeping in a crib. He also has a few books and toys which are primarily located on the verandah. S.S. reads often to J.B. and plays with him everyday. It is her hope that he is able to attend university in the future.

Mummy #6S.W [BOY – A. B.] - Falmouth HospitalThe family currently lives in Trelawny. The house is located in a fishing village very close to the sea. While quiet during the time of the visit, S. W. says that it sometimes gets loud as the neighbours often argue with each other. The house has two levels; the bottom level is utilized as a guest house that is run by A.B’s father and the top level serves as the primary dwelling for the family. The home is, well-lit and fairly modern design with two bedrooms a large bathroom. Both the master bedroom and the living room opens onto a large terrace that overlooks the sea. This terrace is used as outdoor space by the family and is where A.B. often plays. The home is shared by both parents and their two sons; ages twelve years and sixteen months.

Both parents are pleasant and were very welcoming of individuals in their home. S. W. works on the wharf in Falmouth. The father lived in Canada for thirty-two years. He retired from his previous employment in Canada and has been in Jamaica for the past six years. As a result, he is A.B’s primary caregiver who spends the most time with him. Because of this arrangement, S. W. says raising A.B. is easy, especially when compared to their first son, since she was his sole caregiver until his father’s return. S. W. is clearly proud of both her children as she repeatedly said that her "children were a cut above the rest." Despite this, she was not as attentive to A.B, as the father was.

A.B is often taken for walks by his parents, and also watches a lot of children’s programming which his father downloads from the internet. Both parents made it clear that it was the father who interacted the most with A.B. As a result, a decision was made to have both parents interact with A.B during the structured activities to see what the interaction between each parent and A.B was like. It seemed as if S.W. was not as interested in ensuring A.B was engaged during the activities she did with him, so little was done by her to keep him interested in the activities she was doing. The father, however seemed to be more attentive to him.

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Mummy #7S. D [BOY – A.S] - Princess Margaret HospitalS. D. is an Assistant Teacher at a Basic School in St. Thomas. She is well educated and has two children in addition to A. S. S.D. and her children live in a ‘family yard’ in rural St. Thomas. The interior of the home is somewhat dark. The family does not have constant access to running water resulting in S.D going inside for a bottle of water to fill A.S’s bath. A.S’s father does not live in the same home, but lives nearby.

The family seems to be warm and welcoming. S. D attends classes three times weekly to professionally advance herself. She is attending school while teaching five days a week. A.S. is a shy boy who is accustomed to receiving affection and was often in the arms of either his mother or father. Like his son, A.S’s father is shy and was initially reluctant to participate in the interview. Despite his reservations to be on film, he was very engaged and interactive with A.S. during the visit.

A.S loves water and loves to bathe. He was immediately attentive once his mother filled the basin with water in preparation for his bath. He immediately stepped into the basin and began to splash. While bathing A.S, ate the soap from his hands and shoulder. He also took the soap and rag and began to soap himself. He was very reluctant to get out of the water and fussed a little.

Mummy #8Y. B. [Girl - A.G.] - Cornwall Regional HospitalY. B. lives in St. James in a home she shares with her father, brother and her daughter. The home consists of two bedrooms, one bathroom, a kitchen and an unfinished room. One of the rooms contained two beds; one bed used by both Y. B. and her daughter and the other bed used by Y. B’s brother. Generally, the home was very tidy, but slightly overcrowded. The exterior of the home is a rocky and steep terrain. The area which Y. B. says A.G. normally plays was very narrow and rocky. The neighbourhood was quiet and the houses were very near to each other. The roads leading into the community are not well paved making it difficult to access via vehicle.

A.G. was extremely friendly as she smiled and opened her arms to be lifted up by individuals in the team. Y. B’s father is very attentive to A.G. and she seemed quite comfortable with him. On more than one occasion, the baby kept reaching for her grandfather to lift her up. He was affectionate as he spoke with her and hugged her. Y. B’s brother did not interact with the child at any time during our visit.

A.G. was slapped by Y. B. as a form of discipline while on camera during the reading exercise. A.G. seems to have a good relationship with Y. B’s friend who lives next door and is the same age as Y. B. The friend seemed to be more attentive and patient with A.G. during structured activities.

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Since this friend usually plays with A.G. more than her mother, she participated in the structured activities in addition to Y. B. She struggled to respond when asked to describe herself and A.G.

Mummy #9S.A [BOY – R.C.] - Port Maria HospitalS. A. lives in St. Mary with R.C. Unfortunately, the team was unable to visit the their home, as S. A. was reluctant to show the research team her actual home as it had suffered major damage from hurricane Sandy (October 2012). As a result, the visit was done at S. A’s aunt home, which is located nearby to S.As’ home. R.C’s father also lives in St. Mary.

At the time of the visit, R.C. was suffering from a cold and was not very receptive to strangers, causing him to be moody and drowsy. However, his father was very engaging and attentive to R.C. R.C’s parents do not seem to have an amicable relationship, resulting in a lot of tension between the two during the visit. During the father’s interview, S. A. interrupted quite a few times to try to “help” him with answering questions about the baby. This tension also spilled into some of the activities; namely the reading and the outdoor activity, as R.C. seemed confused and not able to understand the commands that both parents were issuing simultaneously during the activities. Despite this, both parents seem to have a good relationship with the R.C.

Mummy #10R.B. [GIRL - A. W.] - St. Ann’s Bay HospitalThe family lives in a small quiet townhome located in the community of St. Ann. The people in this community as the neighbours were very friendly and came to say hello to the team, bringing along their own babies and toddlers. The home is located on the second floor of an apartment building, and is quite airy with a lot of natural light. The home is very organized with a list of duties for each room posted on the kitchen wall. The home is safe and free of hazards.

A.W. has a small area designated for play in the general living space. Her toys, books and blocks were stored on a blanket in this area. Lots of toys that made sounds were present in the home. A.W. is frequently breastfed by her mother, however, there was a high chair around the dining table for her. It was explained by R.B. and aunt that whenever the family has meals, A.W. prefers to be sitting at her high chair with her own food and utensils, so that she can enjoy her meal just like everyone else. The baby was very talkative and was able to do many things which her mother instructed her to do, such as pass a book and take a toy off the ground.

A.W’s father lives abroad, where he is a Guidance Counsellor at a High School and was interviewed via Skype. R.B. also lived abroad until she was six months pregnant with A.W, at which time she returned to Jamaica. R.B. is also a teacher at Islington High School. It was evident that though the parents were in a long distance relationship, the family is a close knit one, and mother and father have an extremely close relationship. The research team was amazed by the

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camaraderie between mother and father while they interacted. The family interacts daily via Skype, it was especially notable that while being breastfed, A.W stopped and took a look at the computer when she realized that a Skype call (to her father) was being conducted. Aunty and cousin who lives next door are also very involved in the lives of A.W and her six year old sister. A.W. was able to say the name of every member of the family. It was mentioned in the pre-interview that she loves to play “peek-a-boo”. This was demonstrated during our visit as upon arrival to the bedroom, baby was quick to cover her face with a blanket so that she could play the game with mom.

Mummy #11C. M. [GIRL – T.J] - Savanna-la-Mar HospitalC. M. is a funny mother of three children. She resides in the beautiful hills of Westmoreland where she lives with her father, mother, nephew and three children. They have more than ten dogs and some goats. The view from their home is very beautiful providing a view of the sea, hills and terrains. She has a visiting relationship with her father’s children, O.B, who plays a vital role in the upbringing of their children. C. M. enjoys bathing and combing T.J’s hair and taking care of her whenever she is ill. She describes parenting as a great experience that comes with some challenges. Some of these challenges include the difficulty sometimes experienced when providing for her children. T.J’s father shared that same sentiment but added that “one had to do what they had to do.” Although he does not live with the family, he ensures that their needs are well provided for and is self employed so that he is better able to do so. He occasionally takes the children to stay with him.

C. M. was very reserved and somewhat quiet during the interview while T.J’s father was more communicative and out-going. While the team was there T.J. would not interact with the team, but would stick close to her family. C. M. describes her as a funny and playful child who enjoys spending time with her uncle. Her father describes her as a friendly, bouncing baby girl who loves to play with the goats. She also loves peanut porridge and dislikes cornmeal porridge. They both agreed that she dislikes playing with her older sister.

C. M. wants other parents to know that it is their duty to take care of their children and treat them the best way they can so that they will be better individuals in the future, while T.J’s father wants them to know that they had to stay focused and do all they need to do to make things work.

Mummy #12T.L. [BOY – J.L.] - Nuttall HospitalT. L. is a swimming instructor. She was very articulate and willing to engage. In addition to J.L, she also has a twelve year old son. The family of four lives in a spacious, uncluttered home

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located in St. Andrew. The majority of the rooms receive a lot of natural light. The home also had a pool, safely fenced off where T. L. gives lessons on Saturdays and Wednesdays. J.L. has his own bedroom and bathroom, and sleeps in a bed in the shape of a car.

J.L is a true fighter. His family almost lost him when T. L. was involved in a car accident when 20 weeks pregnant. In his short life Jacob has been seriously ill; he was diagnosed with Bronchopneumonia and later Kawasaki disease. However J.L. is far from one’s idea of a sickly child. He loves nothing more than kicking a ball around. Throughout the whole visit he could be heard requesting ‘ball’. J.L. seems used to affection. He spent most of the visit in his Nanny’s, arms. J.L. spends most weekdays in the company of nanny’s while T. L. is working. T. L says she was devastated the first time J.L. crawled out of her arms to go to the nanny. However, she acknowledges that now she takes comfort in J.L’s affection for the nanny, seeing it as testament that he is being well cared for. Despite T. L’s assertions that when the nanny is around J.L. is only interested in her (the nanny) however, over the course of the visit Jacob called out for ‘Mommy’ several times.

T. L. and the nanny seem to have a permissive attitude to handling J.L. T. L’s voice was always full of affection and infused with excitement when speaking to or about J.T. Even when correcting him, the nanny and T. L. never shouted or spoke in a harsh voice and they were quick to praise him. J.L. himself seemed always in good spirits never crying despite seven stranger being in the house. J.L’s father and brother were not present at the interview but are reported to have a good relationship with him. His father was very disappointed to have missed the visit and obviously takes an active role in the family. J.L’s older brother also seems to be an important figure in his life. On more than one occasion J.L. spontaneously asked for him saying ‘Brother’ only to be told that he was not here.

Mummy #13R.M. [BOY - R.W.] - University Hospital of the West IndiesR. M. livse in a violence-proned community in St. Catherine. It is a community which is often associated with gang violence. Because of this, she refused to answer some questions pertaining to her community in fear that her response might be viewed negatively by her neighbours. Despite this, R.W. appears to be a very happy, energetic toddler who enjoys playing with his cousin and other neighbours.

Like the rest of her friends and family, R.W. refers to his mother by the nickname name she is most commonly called. She describes herself as a very fun-loving, caring, out-going parent who is strict at times. R.W. is described as being very exciting and tiring but she enjoys the experience nonetheless. Having him with her is always a joy for he makes her smile.

R. M. works an average of 40 hours per week as an Administrative Assistant, and is overwhelmed by the amount of energy it takes to care for R.W. This is compounded by the fact that she has to

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work some Saturdays, and often does not sleep throughout the night because R.W. does not always sleep through the night.

Before giving birth to R.W., R. M. began her Associates Degree, but was unable to complete it due to pregnancy. She is still focused on completing her study, but feels that it is best to wait until her son is older. She hopes that one day he too will attend college, get a degree and be whomever he chooses to be. She would love for him to do his study in Medicine and become a physician some day, or whichever career he chooses in the future. She implores parents to pay close attention and listen carefully to their children. In her words “they are the foundation of tomorrow…instill in them the right from now and be a confidant.” R. M. wants all mothers to reassure their children about how much they love them.

R. M’s greatest challenge is not having R.W’s father playing a more active role in his life. She admits that he is there as a father but she would love if he is there to build a greater relationship with his son so that he becomes a confidante as well. R.W’s father was at work during the visit (on a Sunday), but he called and inquired about the status of the interview. R. M. hopes that JA KIDS will be able to provide workshops for future parents so they will be provided with parenting tips and best practices to help their children to develop to their fullest potential.

Mummy 14 K.W. [BOY - J.M.] – Mandeville Regional HospitalK. W. is a mother of two living in St Elizabeth. She has been living there all her life and would love for her children to grow up there as well. The community feeling and nice neighbours are what keeps her there despite the occasional noise from the dances being held nearby. She lives with her mother, who is blind from sugar, her daughter, brother and another tenant.

For K.W, being a mother is great because she is able to enjoy herself with her children, have fun and they always make her laugh. Before giving birth to her son she had a daughter, who is now eight (8) years old and who was very sickly. Because of this she waited and gave all the necessary time and attention to her before going for another child. Her plans worked out and she gave birth to J.M. for she was advancing in age and “one child is not a child.” She describes J.M. as an active child who loves to smile and is very excited when he sees his father, but hates to sit down. Parenthood has been the best experience she has ever had. According to K.W, the challenges are expected in the future because at this stage he is just beginning to learn and socialize. Being such an active child she has to be constantly watching him to ensure that he does not harm himself. J.M’s dad was at work while we were visiting the family but seems to be involved in his son’s life. He called a few times to check on the progress of the study and his family s well.

While we were filming, J.Mavis fell from the stairs and hit his forehead. While the crew was worried, K.W. was calm and had everything under control. Within seconds he was wrapped in his mother’s arms and soon after he was running around again. He then went on to play in his big red car, something he did majority of the time we were there.

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K.W. describes herself as a very nice parent who has a lot of joys, but once J.M. misbehaves she disciplines him by firmly saying “no” or slapping him (something she does not do quite often due to the abuse of slapping from her mother). He is rewarded with a kiss, hugs and verbal praises once he does something deserving of such. She is not working at present because she now has two children to care for at home and this proved difficult while she was working. Before J.M. was born she was working at a restaurant with her sister. She is in the process of opening a grocery shop but it has not been stocked with products yet.

K.W. wants J.M. to finish school, get his subjects and grow to become a brilliant man in the future. Her dream career is for him to become a paediatrician, but for all this to be possible she yearns for crime and violence to become a thing of the past.“Parents need to know that growing a child is something you have to be dedicated about… children need love and care.”“Having a father in your child’s life is very important as well…mothers cannot do it alone…responsibilities have to be shared…both of you made the child’s existence possible so both need to contribute to the outcome,” she said.For JaKids, they need to help parents understand their kids and teach them how to socialize with them.

Mummy #15T. D. [GIRL - A.S.] - Black River HospitalSince the death of her grandfather less than a year ago, T. D. has been living in St. Elizabeth with other relatives. Prior to this, she was living with the father of her children in another community in St. Elizabeth, but was forced to leave due to the violence and disagreements between herself and her children’s father’s relatives. Unfortunately, while at that residence, there was constant physical and verbal fights between T.D. and her ‘mother-in-law’ during her pregnancy with A.S. While happy to be removed from the physical abuse, she is not happy with her present living conditions. She is currently living in a house shared by many family members, who allow strangers to enter frequently. The community hosts a lot of dances and functions so there is constant noise pollution. While we were there filming, we were constantly disturbed by loud sounds, caused by cars, bikes passing or houses playing loud music. T. D. would like her children to be raised in a quiet neighborhood where she can instill certain values in them and bring them to church.

Although unemployed, T. D. is a very proud mother of two young children. She currently receives money from her mother and father and gets clothes from other family members. She occasionally is able to secure odd jobs as a domestic worker washing clothes.T.D. says that whenever A.S’s father is asked to contribute he fusses and makes excuses. T. D. finds it difficult to be a mother of two at such an early age, especially when they give her trouble. However, she states that it was good to know that she could carry and deliver children since many are unable to naturally conceive and deliver children. According to her, she is a very kind young woman who cannot say ‘no’ whenever she can assist another and is good at being herself. A.S, on the other hand, is a fussy child who is funny and nice. She enjoys playing with her mother and older sister, who is three years old. A.S. dislikes when things are taken from her and shows her dissatisfaction by throwing herself to the floor, crying and biting her sister. T. D. disciplines A.S. by slapping her on her hand, like her own mother did to her when she was younger. To reward A.S, she takes her

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out to the beach, hugs and kisses her. When she gets older T. D. would like her to become a teacher or nurse, but overall she wants her to grow to be a good individual. A.S’s father was not available at the time of the interview, but was very interested in the process and called frequently during the visit.

T. D. believes that crime and violence is Jamaica’s major problem. She encourages all mothers to talk to their children and help them to grow. T. D. hopes that JA KIDS will be able to encourage young mothers and young women on a whole, not to have too many children and to wait until they are older. She also hopes that JA KIDS will be able to assist mothers with dealing with stress.

Mummy #16R.W. [GIRL – S.V.] - Black River HospitalR.W. is a 21 year old mother of three (3) living in Portland. Two of her threechildren live with their grandmother while our Jakid S.V. lives at home with both parents. When we arrived at R.W’s home, S.V. was left in the care of her aunt while her mother accompanied the other children to school. Daddy was not present because was in Kingston for a few weeks working on a construction. Upon arrival, one could see tears in S.V’s eyes because she just had a bath, the aunt pointed out that having a bath was one of the things that she really disliked. One of the beautiful things about R.W’s home was the river across the road and a beautifully decorated ackee tree in the middle of the yard which provided adequate shade and peace. There were ducks walking around, a dog lying lazily under the ackee tree, cats and goats.

While speaking to R.W we found out that the two previous fathers of her older children were initially not involved in the financial and social lives of her other children. She said that she had to bring the first child’s father to court because he refused to provide financial support his child. The other father was also reluctant in financing the second child but she did not bother to bring him to courts. They are both now playing their role in the children’s lives. Her present baby’s father is now the ‘father figure’ to her children. He does not have a stable income but occasionally finds work in construction. R.W, on the other hand, is unemployed and seemingly satisfied.

During the interview she appeared to be very shy would not say much. She pointed out, during the interview, that teachers need to be sensitive in terms of how they dealt with students. Her major concern about S.V’s development was her expressive language as she did not have as many words as other children her age. S.V. only says ‘mommy’ and ‘daddy’ and this worried R.W. While we were present, R.W. did not interact much with S.V. R.W. used mostly commands with her such as ‘come’ or ‘colour.’ R.W. did not even read one of the books for S.V. during the structured activity section. Instead of reading she showed her a few pictures and named two of the animals for her. In turn S.V. would try to repeat those names. S.V. had no toys with which to interact and so she found pleasure in playing in the dirt.our toys.

In conclusion, the environment appeared to be safe and R.W. would like for S.V. to grow there as she had been living there for eleven (11) years. Once she get older, her hope and dream for S.V. is for her to go to a good school, finish her education and become a lawyer or teacher. R.W. wanted to go to Heart to enroll in training in hairdressing or food and beverage. She was not able to do so for she was pregnant with S.V. at that time but she remains without regrets.

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Mummy #17A. D [GIRL – K.P.] - Black River HospitalA.D. is a 20 year old single mother who lives in Hanover. Prior to living here she lived in Prosper but left to escape the noise from loud music being played by neighbours and parties nearby and the frequency of people invading the privacy of her home. Although K. is not able to play outdoors due to the unsafe wires and hilly structure, A.D. is more comfortable with the environment and the fact that there are no close neighbours. A.D. works as a Secretary and Accountant from the hours of 8:30-4 pm. This she says is unfair to K. because she does not get to bond with her as much as she would hope. She ‘catches up’ with time by waking and bonding with K. before leaving for work and in the evenings after work. On the weekends she would carry her out for a treat in the town or stay at home playing and teaching her new things.

During our visit it was evident that mannerism was an essential part of the teaching for K.P. said ‘thank you’ after being given items and while handing it over to her mother. She was also making sounds as if she was singing and A.D pointed out that she was mimicking a popular tune she sings to her many times. A.D. wants K.P. to be multi-talented and accomplish all the things she could not. Her greatest struggle is not having K.P’s father with her to share responsibilities. She desires to be married but insists that he becomes a baptized Christian. A.D. encourages all to get their lives together before thinking about bringing a child into the world. She also says they need to make sure that they are employed and, if possible, married before such and always be there for their child or children. For fathers, she said they should be careful not to go around having too much babies.

Despite her struggles, she enjoys being a parent and teaching her child what she can now. According to A.D, K.P. enjoys the freedom that she allows her to have, and loves to push her teddy around in her prom. She despises everything that is good for her, with the exception of sweet which she is not fond of either. What keeps A.D. going is keeping her eyes on the future and all the things she wants for K.P She has been accepted to attend a school which teaches Theology and will be moving to Kingston with K.P. to do so.

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