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. 2023 Apr 27:1–13. Online ahead of print. doi: 10.1007/s10643-023-01491-x

Caring for Whole Families: Relationships Between Providers and Families During Infancy and Toddlerhood

Kyle DeMeo Cook 1,✉, Eleanor Fisk 2, Caitlin McPherran Lombardi 2, Kevin Ferreira van Leer 3
PMCID: PMC10136389  PMID: 37360604

Abstract

Caring relationships among families and providers are at the heart of high-quality early care and education (ECE). This study examines relationships between parents and providers in a nationally representative sample of infants and toddlers and their families (N = 527) enrolled in the two-generation Early Head Start (EHS) program in the U.S. EHS’ primary services include home visiting and center-based early education, taking a whole family approach to provide comprehensive services within caring and trusting relationships. Using weighted lagged regression models, we found that parent and provider reports of their positive relationships with one another at age 2 years were related to some child and family outcomes at the end of their EHS experience at age 3 years. Providers who reported better relationships with parents rated children as having lower behavior problems and enhanced social competence, language comprehension, language production, and home environments. Parents who reported better relationships with providers also reported lower parenting stress and family conflict. Findings suggest that caring relationships between providers and parents are a key part of high-quality ECE within an environment dedicated to an ethic of care not just for children, but for the whole family.

Keywords: Parent-provider relationships, Ethic of care, Early head start, Home visiting, Early care and education, Infants toddlers

Introduction

Learning and development occur within the context of caring relationships. This is particularly true for young children, making positive interactions between early care and education (ECE) providers and children key markers of high-quality early learning experiences (McNally & Slutsky, 2018). We also know from decades of research on family-school partnerships and parental engagement in education that relationships between educators and parents are important to children’s success in education settings (Domina, 2005; Sheridan & Kim, 2015), and that these relationships can be very important for young children (Lang et al., 2016). However, less research has focused on the ways in which caring positive relationships between ECE providers and parents of very young children may have benefits to the whole family, not just children’s educational and developmental outcomes. This study examines the associations between caring relationships between parents and providers in the Early Head Start (EHS) program in the U.S., and child and family outcomes. EHS is a two-generation program that provides home visiting and center-based early education services to infants and toddlers from families experiencing low-income, as well as comprehensive services to the whole family based on their needs (e.g., job training, referrals to community services).

The EHS program is an important context in which to study parent-provider relationships. Started in 1995, EHS serves over 200,000 pregnant women, infants, toddlers, and their families annually, with the goal of improving both child and family outcomes (Office of Head Start, 2020). EHS explicitly believes that comprehensive services for the whole family will support parental roles, parent–child relationships, and self-sufficiency of families (Office of Head Start, 2021). EHS’ primary services are home visiting and center-based ECE. Over the three years (infancy through age 3) during which a child is eligible for EHS, families may receive one of these services or a combination of them. The relationships between home visitors and parents, as well as those between teachers and parents, are important ways to foster relationships with the family and to improve both child and family outcomes. Because families may have home visitors and/or teachers as their primary providers, we will use the term “provider” in this study to be inclusive of both.

Theoretical Framework

This study draws upon two theoretical frameworks to consider the importance of the relationships between providers and parents in settings serving families with infants and toddlers: an ethic of care framework (Noddings, 1984, 2005); and ecocultural theory (Fuller & García Coll, 2010; McWayne et al., 2013; Weisner, 2002). Caring is relational (Noddings, 1984, 2005) and for young children, continuity of positive care between and across settings and over time is important to their development (Bronfenbrenner & Morris, 2006). This study draws upon Nell Noddings’ (2005) framework of an ethic of care as necessary for supportive learning environments to meet children’s needs, and the imperative that an ethic of care can and should be applied to ECE (Goldstein, 1998). We extend this work to consider how, for very young children in particular, an ethic of care must support the whole family, not just the child. EHS is an important context to study these relationships as the program is already set up to support many of Noddings’ (2005) key components of an ethic of care in education. For example, EHS programs are set up for relational continuity (Noddings, 2005), serving children and their families in the same programs from infancy (and sometimes starting during pregnancy) through age three, often with the same providers and children over that extended time period.

Since children in EHS receive center-based and/or home-visiting services within a two-generation framework that focuses on both the needs of the child and the whole family, the relationship between the provider and the parent are key features of the services. Through these services, families receive supports meant to advance the child’s developmental needs, as well as the needs of the parents and whole family. EHS providers nurture relationships with parents as they support the important role they play in their child’s life. We suggest that within an ethic of care, the concept of relational continuity is important across a young child’s education and home environments (and their providers and parents). Thus, relationships between parents and providers are important areas to study in order to better understand how these caring relationships may relate to children’s positive learning and development, and positive outcomes for whole families. Understanding that relationships are two sided and both the carer and cared for must play certain roles in order for there to be a true caring relationship (Noddings, 2005), it is important to consider both the parent and provider perspectives in this relationship. Given that parent and provider reports of positive relationships may indicate relational continuity, in terms of better communication between, understanding of, and alignment of children’s home and educational settings, we hypothesize that stronger relationships between parents and providers may predict positive outcomes for both children and their families.

We also hypothesize that there may be differences within and across racial/ethnic subsamples. Basis for this hypothesis is derived from ecocultural theory (Weisner, 2002). The relational continuities across a child’s education and home environments may be influenced by shared cultural values and goals between these settings (Weisner, 2002). Ecocultural theory emphasizes the role of culture in driving individual’s beliefs, perceptions and behavior (Weisner, 2002) and in guiding the everyday activities of families (Fuller & García Coll, 2010; McWayne et al., 2013). This theory directs attention to the role of cultural congruency across the parent-provider relationship. Positive, caring relationships may signal shared cultural values between providers and home environments and in turn, positive child and family outcomes. Differing values, parental expectations, and socialization goals across cultural groups suggests these relationships may look different across racial/ethnic groups. Given this research, our study seeks to examine relationships between parents and providers across and within racial/ethnic subsamples. Together, the ethic of care framework and ecocultural theory provide a novel way of considering the importance of provider-parent relationships for families with very young children and guide this study.

Importance of Caring Relationships for Infant/Toddler Development

This study also draws upon existing research and theory on the importance of caring relationships between parents and providers (Forry et al, 2011), specifically within infant and toddler settings where parents and providers can be conceptualized as providing cocaring relationships for the child (Lang, et al., 2016). For EHS settings in particular, program evaluations and research have found that there are both long and short-term benefits for children and parents, in some cases with benefits of the EHS program related to parenting practices and, in turn, better child outcomes (Love et al., 2013). This is consistent with decades of research that has shown that parenting matters for family and child outcomes (National Academies of Sciences, Engineering, & Medicine, 2016; Sanders & Mazzucchelli, 2013; Teti et al., 2017), and that two generation programs that target the needs of parents as well as children can have positive outcomes (Chase-Lansdale & Brooks-Gunn, 2014). Programs that support parents may be particularly important for families facing distress due to low-income, and mental health concerns such as maternal depression and internal family conflict. Distress can lead to parenting challenges and emotional and behavioral concerns for children (Goodman et al., 2011; Teti et al., 2017; Yeung et al., 2002). In addition, conflict within families has also been shown to contribute to challenging parenting practices (McCoy et al, 2013) and negative child outcomes including children’s behavior problems (Cummings & Davies, 2002). Family- stress models (Conger & Donnellan, 2007) and research on families living in low-income contexts (McLoyd, 1998; McLoyd et al, 2014) have shown that financial distress and living in poverty can have direct effects on child outcomes and parenting practices, as well indirect effects through maternal depression, and other concerns (Duncan et al., 2010; Votruba-Drzal, 2006; Yeung et al, 2002). Presently, families face new and exacerbated challenges brought on by the COVID-19 pandemic. Emerging research has shown that families with young children have faced unprecedented challenges and disruptions in navigating their ECE needs within a context of limited availability of program options and closings (Chen et al., 2021; Cook et al., 2022; Hanno et al., 2022; Lee & Parolin, 2021). These challenges have had implications for child and family well-being (Hanno et al., 2022; Patrick et al., 2020). The current context makes it even more important for research to understand the key features of ECE that support not only children, but whole families.

Positive relationships between providers and parents can help model supportive parenting practices, provide continuity between home and education environments for children, and provide parents with the support and resources they need to improve parenting practices (Lang et al., 2016; Reedy & McGrath, 2010). These positive relationships between providers and parents of young children have been found to be linked to children's social emotional skills, reduction in problem behaviors, lesser risk of expulsion, academic skills, and child health and well-being (Forry et al., 2011; Zulauf-McCurdy & Zinsser, 2021). In addition to beneficial child outcomes, positive relationships between parents and providers have been shown to lead to positive family outcomes, such as parental mental health and more parental engagement with services for their child (Forry et al., 2011). Relatedly, a large body of literature has documented the positive influence of increased parent engagement on children’s educational outcomes such as literacy skills (see Garbacz et al., 2017 for a brief review and commentary on parent engagement research). However, less research has focused on how parent-provider relationships may support positive outcomes for the whole family, such as increased supportive parenting practices, lower family conflict, and lower parental stress.

Role of Race/Ethnicity in Caring Relationships Between Providers and Families

While a large body of research has shown that relationships matter for infant and toddler development, recent research has indicated that relationships within education settings may vary for children and families from different racial and ethnic groups. Researchers have documented the role of race/ethnicity in child and family outcomes in ECE settings. For example, Bates and Glick (2013) found that kindergarten teachers report of children’s externalizing behavior differed by child’s race/ethnicity, with Black children receiving more negative ratings on externalizing behaviors. Similarly, in their examination teacher-reported externalizing behavior of students, Accavitti and Williford (2022) found that Black preschools were rated as demonstrating greater inattention than White children across teachers in their sample of preschools in the southeastern U.S. Separately, researchers have documented high rates of preschool suspensions and expulsion for Black children, especially Black boys (Gilliam, 2005; Giordano et al., 2021). Gilliam and colleagues (2016) assessed how early education providers observed students in a classroom when no problem behaviors were present utilizing eye-tracking technology and when providers were prompted to identify potentially challenging behaviors found that that provider observed Black children for more time than White children in the classroom. The provider-parent relationship may be protective against this, though, with Zulauf-McCurdy and Zinsser (2021) finding that ECE teachers’ ratings of the parent-teacher relationship were negatively associated with the child’s risk of expulsion, an association that was strongest for Black children. Together, these suggest that the racial context of educational environments matter for children and families.

Present Study

Using data from a nationally representative study of families enrolled in EHS, we examined relationships between EHS providers (both center-based and home-visiting based) and parents and whether these relationships were associated with child and family outcomes at the end of the EHS experience, addressing the following questions:

  1. Are parent-provider relationships associated with child and family outcomes at the end of EHS?

  2. Are associations between parent-provider relationships and child and family outcomes different for children from different racial/ethnic backgrounds?

Method

Data and Sample

This study is a secondary data analysis of the nationally representative, Early Head Start Child & Family Experiences Study (Baby FACES) 2009–2012 (Vogel et al., 2015). The Baby FACES study was funded by the U.S. Department of Health and Human Services, Administration for Children and Families to study the experiences of children and families in EHS across the country in order to support research efforts and program and policy improvement. The data include information on children (e.g., demographics, assessments of language and social-emotional skills), their families (e.g., structure, mental health), their program leaders and providers (e.g., program size, quality, staff backgrounds) from 89 EHS sites starting in spring 2009 (N = 976). Data were collected when children were about 1 year old (wave 1), 2 years old (wave 2), and 3 years old (wave 3). The analytic sample for this study is 527 children who remained in the sample at age 3, at the end of the EHS experience, and who had a positive, non-missing sample weight provided by the Baby FACES study team. Leaving EHS was the primary reason exiting the sample before age 3 (Caronongan et al., 2014). Sample weights (WX_R3) are used in all analyses to account for differential attrition and sample design, and analyses accounted for clustering at the program level. Multiple imputation using chained equations was conducted to address missing data on individual measures.

Table 1 shows weighted descriptive statistics for all child and family characteristics and outcomes for the full sample and by racial/ethnic subsamples. Across the full sample, families identified their children as white (36%), Black (18%), Latinx (35%), or mixed race/another race (11%). Families could enter EHS and the study when their child was an infant (16%) or around 1 years old (84%). During the final wave of data collection, children were on average 36 months old. Children across the full sample had the following characteristics: 64% lived in urban areas, 29% had at least one parent who was an immigrant to the U.S., 42% spoke a language other than English at home, and their mothers were 24 years old on average at the time of their birth. Households had 1.5 earners, on average, and 2.5 children. Children and families were enrolled primarily in a center-based EHS model or a home visiting based model, with families in the center-based models averaging 100 days in centers over three years, and 25 home visits over three years. Forty-one percent of families had the same provider across all three years in EHS.

Table 1.

Characteristics of the full sample and racial/ethnic subgroups

Full Sample (N = 527) White Subsample (n = 164) Black Subsample (n = 106) Latinx Subsample (n = 198)
Child characteristics
 Race/ethnicity
  White 36.13
  Black 18.24
  Latinx 35.08
  Mixed or another race 10.79
 Male 51.69 56.53 47.88 49.86
 Home language other than english 42.29 13.36a 10.72b 89.24ab
 Cohort (entered study as 1 year old) 84.12 88.55a 77.76a 87.49
 Age (at age 3 in months) 36.31 (1.49) 36.47 (1.52) 36.36 (1.46) 36.14 (1.43)
Family characteristics
 Immigrant parent(s) 29.23 5.77a 8.06b 68.70ab
 Urban 63.89 48.50ab 75.90a 75.68b
 Mother’s age at child’s birth (in years) 24.21 (4.99) 23.78 (4.46) 23.43 (5.15) 24.92 (5.21)
 Income-to-needs (averaged ages 1–3) 0.86 (0.47) 0.98 (0.49)ab 0.77 (0.40)a 0.81 (0.45)b
 Number of earners (averaged ages 1–3) 1.45 (0.50) 1.56 (0.54)a 1.34 (0.42)ab 1.49 (0.47)b
 Number of children (averaged ages 1–3) 2.47 (0.97) 2.32 (0.96)a 2.34 (1.05)b 2.73 (0.89)ab
 Maternal depression (averaged ages 1–3) 4.38 (4.58) 5.07 (4.59)a 5.15 (4.84)b 3.04 (4.20)ab
 Marital status (number of waves married) 1.10 (1.36) 1.19 (1.37)a 0.57 ( 1.13)ab 1.34 (1.39)b
EHS characteristics
 Number of days in center (ages 1–3) 99.73 (132.60) 94.77 (142.63)a 162.49 (120.05)ab 79.11 (121.78)b
 Number of home visits (ages 1–3) 25.43 (29.64) 30.52 (30.17)a 9.67 (7.90)ab 24.36 (30.15)b
 Same provider all waves 41.27 48.08ab 33.79a 34.82b
Parent-provider relationship (age 2)
 Provider report 4.29 (0.79) 4.27 (0.73) 4.13 (1.00)a 4.44 (0.61)a
 Parent report 4.56 (0.62) 4.62 (0.61)a 4.42 (0.66)a 4.60 (0.57)
Outcome measures (age 3)
 BITSEA problem behaviors 6.88 (5.98) 7.32 (5.92) 8.59 (6.78)a 5.95 (5.20)a
 BITSEA social competence 16.70 (3.51) 16.75 (3.44) 16.26 (3.53) 16.54 (3.58)
 CDI comprehension 64.90 (25.52) 70.81 (21.67)ab 62.86 (24.00)ac 55.80 (27.61)bc
 CDI production 42.67 (27.59) 49.27 (26.09)ab 41.32 (24.05)ac 32.40 (27.04)bc
 Parenting stress (standardized) −0.00 (0.90) −0.13 (0.70) 0.03 (0.89) 0.06 (0.74)
 Family conflict 1.43 (0.43) 1.45 (0.43) 1.41 (0.47) 1.39 (0.40)
 Home environment (HOME) 18.71 (3.01) 19.20 (2.74)a 17.43 (3.31)a 18.63 (2.84)
 Supportive parenting 4.42 (0.81) 4.56 (0.84)a 4.21 (0.82)a 4.41 (0.74)
Lags of outcomes (age 1)
 BITSEA problem behaviors 6.13 (4.77) 5.56 (4.14)a 7.07 (4.96)ab 5.85 (4.62)b
 BITSEA social competence 12.86 (3.55) 12.59 (3.60) 12.94 (3.69) 12.98 (3.58)
 CDI comprehension 29.71 (20.71) 34.39 (19.65)a 28.56 (21.12) 24.10 (20.81)a
 CDI production 2.65 (5.93) 3.33 (6.81)a 3.92 (8.16)b 1.43 (3.74)ab
 Parenting stress (standardized) −0.03 ( 0.85) −0.27 (0.68)ab 0.03 (0.81)a 0.22 (0.92)b
 Family conflict 1.37 (1.40) 1.27 (1.39) 1.26 (1.41) 1.55 (1.39)
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Mean (Standard Deviation) or percentage reported. Descriptive statistics are drawn from 20 imputed datasets and are weighted with a child-level weight (WX_R3). Subgroup analyses are only completed on the white, Black, and Latinx subsamples given the small n reporting mixed/another race. Lags are included for outcome measures for which they were gathered. The sample size numbers reflect unweighted sample sizes and the percentages reflect weighted descriptive statisics, therefore some raw sample size numbers do not reflect the same percentage of the sample in some cases. Italicized superscript letters indicate statistically significant differences (p < 0.05) between racial/ethnic groups

Measures

Parent-Provider Relationships

Parents and providers separately completed a shortened version of the parent-caregiver relationship scale at age 2 (Parent-Caregiver Relationship Scale Short Form; Elicker et al., 1997). Based on concerns about item appropriateness and validity, the Baby FACES study team that collected the data decided to use 13 of the original 35 items to create measures of parent-reported parent-provider relationship and provider-reported parent-provider relationship. These select items addressed important areas and had acceptable internal consistency and reliability (Vogel et al., 2012). These measures assessed parents’ and providers’ perceptions of their relationship with the other person in regards to trust and confidence, communication, respect/acceptance, caring, competence/knowledge, and shared values on 5-point scales (1 = strongly disagree to 5 = strongly agree; Cannon et al., 2014). The parent-reported measure was a composite of seven items (examples include “staff always talks about child’s problems promptly” and “staff provides valuable advice about child”). The staff-reported measure was a composite of six items (examples include “I feel child’s parent genuinely cares for child” and “I like to work closely with parent”). The parent reports and the caregiver reports were not strongly correlated with one another (r = 0.11), therefore the two measures were considered separately in all analyses.

Child and Family Characteristics

Parents reported on several time-invariant characteristics: child’s biological sex, age in months at the age 3 data collection, if they spoke a language other than English at home, whether either parent was an immigrant to the U.S., whether they lived in an urban area, mother’s age at the child’s birth in years, and the child’s race/ethnicity. At each age, parents also reported on time-varying family characteristics. For the following variables, we averaged the reports from the three time points: number of earners in the household, the number of children in the household, the family’s income (created into an income-to-needs ratio by the Baby FACES study team), maternal depression (Center for Epidemiologic Studies Depression Scale—Short Form; Cole et al., 2004) and the parents’ marital status.

EHS Program Experiences

Children received home visiting services and/or center-based services across their time in EHS. We used a continuous measure of the number of days in center-based services across the three ages, and a separate measure of the number of home visits a family received across the three ages. Both variables were created by the Baby FACES study team. We also created a variable to indicate whether children and families had the same provider (center-based or home visiting) across their three years in EHS.

Child Outcomes

All child outcome variables were measured at age 3, when the child was approximately 3 years of age. We also included versions of each variable collected at age 1 as control variables in our analyses (lagged dependent variables). Children’s language comprehension and production were measured separately by the MacArthur-Bates Communicative Development Inventories—Infant Short Form (CDI; Fenson et al., 2000), which was completed by their EHS provider.

The Brief Infant–Toddler Social and Emotional Assessment (BITSEA; Briggs-Gowan & Carter, 2006) was used to measure social competence and problem behaviors. EHS providers reported on children’s empathy, prosocial behavior, and compliance across 11 items (α = 0.77) that were summed into a composite social competence score by the Baby FACES team (Vogel et al., 2015). EHS providers rated children’s aggression, defiance, overactivity, negative emotionality, anxiety, and withdrawal across 31 items (α = 0.84) that were summed by the Baby FACES team into a composite problem behaviors score.

Family Outcomes

All family outcome variables were measured at age 3. We also included versions of each variable collected at age 1 as control variables in our analyses (lagged dependent variables). Parenting stress was assessed with the Parenting Stress Index – Short Form (Abidin, 1995). Completed by parents, it consisted of two subscales: Parental Distress, with scores ranging from 5 (low distress) to 25 (high distress), and Parent Child Dysfunctional Interaction, with scores ranging from 6 (low dysfunction) to 30 (high dysfunction). The two subscales were moderately correlated (r = 0.59), so they were each standardized and averaged together to create one parenting stress measure.

Supportive parenting was assessed using three scales (sensitivity, positive regard, and cognitive stimulation) from the Parent–Child Interaction Rating Scales for the Two-Bag Assessment-Parent Scales (Mathematica Policy Research, 2010, averaged into a composite (α = 0.71), following previous research (Cherry et al., 2019; Vogel et al., 2015).

Family conflict was measured with the Family Environment Scale (FES; Moos & Moos, 2002) at age 3 only, and therefore a lag is not included in models in which family conflict is the outcome variable. The FES aims to capture anger, aggression, and interactions laden with conflict in the family via primary caregiver ratings of items such as “We fight a lot” and “We sometimes hit each other” from 1 (low level of agreement) to 4 (high level of agreement). The FES had previously been used in the EHS Research and Evaluation Project and been shown to have acceptable reliability with EHS families (α = 0.64).

The total score from the Home Observation for Measurement of the Environment (HOME; Caldwell & Bradley 1984) serves as a measure of the quality of the home environment. The HOME involves both parent report and observer report of parental emotional responsivity, support of language and learning, absence of punitive interactions, and physical environment in the home.

Analysis

To address our research question of whether parent-provider relationships are associated with child and family outcomes, we used weighted lagged Ordinary Least Squares (OLS) linear regression analyses. Each analysis was conducted separately for each outcome variable, controlling for child and family characteristics and for a lagged version of the outcome variable (when available) at age 1. Given the potential for findings to differ for Black, white, and Latinx children, analyses were conducted for the full sample and within child racial/ethnic subsamples separately (Black, white, Latinx). All analyses were conducted on 20 imputed datasets to address item level missing data.

Results

Our findings provide a new way of looking at relationships between providers and parents to better understand how these relationships support an ethic of care (Noddings, 2005) in settings that serve children with infants and toddlers and how continuity of care and cultural continuity play important roles in these relationships. To assess whether parent-provider relationships are associated with child and family outcomes, we conducted OLS regression analyses that included both the providers’ report and the parents’ reports of their relationships (age 2) as separate independent variables predicting child and family outcomes (age 3) for the full sample and individual subsamples (White, Black, Latinx). All models controlled for the child and family characteristics described above. When available, all models included versions of the outcomes variables at age 1 as control variables. Before conducting regression analyses, descriptive analyses were conducted on the three subsamples in order to better understand how characteristics and experiences differ within racial/ethnic subsamples. We examined descriptive statistics for the White, Black, and Latinx subsamples separately (the sample size for the mixed/another race category was too small to do separate analyses). Latinx children were more likely to speak a language other than English at home and to have at least one parent who was an immigrant to the U.S. compared to White and Black children. Black and Latinx families were more likely to live in an urban area and have lower income–to-needs ratios. White and Latinx families had higher numbers of earners in their household and had married parents for more time points across the three years compared to Black families. Latinx families had more children on average and lower maternal depression levels compared to White and Black families. White families were more likely to have the same provider across all three years compared to Black and Latinx families. Black families experienced higher numbers of days in center-based services, and white families received more home visits. See Table 1.

Child Outcomes

Shown in the top section of Table 2, we found that provider reports of their relationship with the child’s parents consistently predicted child outcomes in the full sample. Providers who reported better relationships rated children as having lower behavior problems (0.15 SD) and better social competence (0.21 SD), language comprehension (0.13 SD), and language production (0.16 SD). Parent reports of their relationship with the child’s provider were not associated with children’s outcomes in the full sample.

Table 2.

Parent-provider relationship at age 2 predicting child outcomes at age 3

BITSEA problem behaviors BITSEA social competence CDI comprehension CDI production
B SE B SE B SE B SE
Full sample (N = 527)
 Provider-reported parent-provider relationship −1.12* 0.48 0.94** 0.25 4.23* 1.93 5.55** 1.99
 Parent-reported parent-provider relationship 0.35 0.50 −0.48 +  0.25 −0.52 2.06 −1.60 2.63
 Covariates
  Lag 0.13 +  0.1 0.10* 0.04 0.34** 0.07 0.37 0.23
  Black 0.36 1.00 −0.70 0.50 −7.90* 3.57 −11.06** 3.93
  Latinx −1.04 1.32 −1.16 +  0.59 −2.88 4.96 −4.22 5.40
  Mixed/Another race −1.58 0.99 0.58 0.45 7.47 +  3.96 7.57 5.40
  Male 1.63** 0.55 −0.85** 0.31 −3.98 +  2.35 −4.67 +  2.57
  Home language other than english −0.84 0.85 0.47 0.46 −4.27 3.77 −6.41 4.40
  Cohort (entered study as 1 year old) −0.41 0.65 −0.90 0.44 −2.99 3.62 −6.41 +  3.76
  Age (at age 3 in months) 0.11 0.18 −0.21 +  0.11 −0.14 0.75 0.42 0.93
  Immigrant parent(s) 0.71 1.10 0.28 0.53 −15.14** 4.31 −16.60** 4.71
  Urban 0.91 0.62 −0.20 0.32 9.57* 3.70 7.09* 3.3
  Mother’s age at child’s birth (in years) −0.02 0.08 −0.05 0.04 0.09 0.29 −0.04 0.32
  Income-to-needs (averaged ages 1–3) 1.04 0.66 0.20 0.35 0.62 2.78 2.03 3.53
  Number of earners (averaged ages 1–3) −0.14 0.59 −0.32 0.36 0.64 2.37 −1.05 2.72
  Number of children (averaged ages 1–3) 0.03 0.53 0.12 0.25 −2.05 1.71 −2.13 1.96
  Maternal depression (averaged ages 1–3) 0.14 +  0.08 −0.11* 0.04 −0.64 +  0.34 −0.46 0.35
  Marital status (number of waves married) 0.12 0.32 0.11 0.14 0.30 1.07 0.35 1.18
  Number of days in center (ages 1–3) 0.00 0.00 0.00 0.00 0.02 0.01 0.02 0.01
  Number of home visits (ages 1–3) −0.02 0.01 −0.01 0.01 0.07 0.07 0.02 0.07
  Same provider all waves −1.30 0.74 0.66 +  0.37 −2.95 3.08 −4.91 3.75
Separate analyses by subsamples
 White (n = 164)
  Provider-reported parent-provider relationship −1.80 +  0.90 1.03* 0.48 8.94** 3.13 8.76* 3.29
  Parent-reported parent-provider relationship 0.07 0.99 −0.65 0.41 −1.29 3.98 −4.00 3.84
 Black (n = 106)
  Provider-reported parent-provider relationship −0.13 0.63 0.86 +  0.43 3.21 3.27 5.20 3.45
  Parent-reported parent-provider relationship 0.54 1.08 −0.31 0.52 −4.55 3.77 −6.92 4.39
 Latinx (n = 198)
  Provider-reported parent-provider relationship −2.11* 0.92 1.24* 0.47 −0.33 3.85 1.51 3.62
  Parent-reported parent-provider relationship 0.77 0.72 −0.83 +  0.45 0.70 4.43 −0.34 4.47
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Ordinary least squares regression analyses conducted on  20 imputed datasets and are weighted with a child-level weight (WX_R3). Lags are included for outcome measures for which they were gathered. All subsample analyses included the same set of covariates shown for the full sample results (coefficients not shown here)

 + p < 0.10, *p < 0.05, **p < 0.01

The pattern of findings in the full sample for provider reports of their relationship with the child’s parents appear to be largely driven by associations within the White and Latinx subsamples. Results for each race/ethnicity subsample are presented in the bottom section of Table 2. For White children, better provider reported relationships with parents were associated with high social competence scores (0.22 SD), higher language comprehension (0.30 SD), and higher language production scores (0.25 SD). For Latinx children, better provider reported relationships with parents were associated with lower behavior problem scores (0.31 SD) and higher social competence scores (0.35 SD). There were no statistically significant findings within the Black subsample. Similar to the full sample, parent reports of their relationships with their provider were not predictive of children’s outcomes in the White, Black, or Latinx subsamples.

Family Outcomes

OLS regression models examining associations between the parent and provider reports of their relationships and family outcomes are shown in Table 3. Findings for the full sample are shown in the top section of Table 3. Providers who reported better relationships with parents also rated them higher on home environment scores (0.16 SD). Parent reports of their relationships with providers were significantly related to family reports of lower parenting stress (0.18 SD) and lower family conflict (0.13 SD).

Table 3.

Parent-provider relationship at age 2 predicting family outcomes at age 3

Parenting stress Family conflict Home environment Supportive parenting
B SE B SE B SE B SE
Full sample (N = 527)
 Provider-reported parent-provider relationship 0.06 0.07 − 0.02 0.03 0.60* 0.28 0.10 0.07
 Parent-reported parent-provider relationship − 0.26* 0.10 −0.09* 0.04 0.26 0.33 0.10 0.07
 Covariates
  Lag 0.25** 0.08 0.06 0.04
  Black 0.07 0.14 −0.02 0.08 −1.54* 0.65 −0.36** 0.13
  Latinx 0.09 0.17 0.00 0.09 −0.23 0.72 −0.16 0.20
  Mixed/Another race 0.15 0.20 0.09 0.10 0.58 0.65 −0.17 0.15
  Male 0.08 0.09 −0.04 0.06 −0.25 0.38 −0.05 0.09
  Home language other than english 0.08 0.14 −0.03 0.08 −0.30 0.51 0.01 0.13
  Cohort (entered study as 1 year old) −0.02 0.14 −0.04 0.07 0.24 0.51 0.06 0.11
  Age (at age 3 in months) −0.03 0.03 0.01 0.02 −0.15 0.11 0.01 0.03
  Immigrant parent(s) 0.06 0.17 −0.03 0.08 −0.11 0.52 −0.12 0.14
  Urban −0.13 0.11 0.07 0.06 −0.13 0.48 0.06 0.09
  Mother’s age at child’s birth (in years) 0.01 0.01 0.01 0.01 0.06 0.04 0.03* 0.01
  Income-to-needs (averaged ages 1–3) −0.14 0.12 0.10 0.07 0.52 0.38 0.09 0.10
  Number of earners (averaged ages 1–3) −0.06 0.11 0.11 0.07 −0.42 0.35 −0.18* 0.09
  Number of children (averaged ages 1–3) 0.05 0.07 −0.01 0.03 −0.59* 0.31 −0.03 0.07
  Maternal depression (averaged ages 1–3) 0.06** 0.01 0.03** 0.01 −0.03 0.04 −0.02* 0.04
  Marital status (number of waves married) −0.00 0.04 0.05* 0.02 0.18 0.16 0.03 0.04
  Number of days in center (ages 1–3) 0.00 0.00 −0.00 0.00 0.00 0.00 0.00 0.00
  Number of home visits (ages 1–3) 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.00
  Same provider all waves −0.02 0.11 0.01 0.06 −0.16 0.38 −0.06 0.10
Separate analyses by subsamples
 White (n = 164)
  Provider-reported parent-provider relationship 0.09 0.11 −0.02 0.06 0.62 0.47 0.10 0.14
  Parent-reported parent-provider relationship −0.16 0.15 −0.03 0.07 −0.01 0.45 0.06 0.14
 Black (n = 106)
  Provider-reported parent-provider relationship −0.03 0.13 −0.04 0.05 0.67 0.48 0.13 0.13
  Parent-reported parent-provider relationship −0.25 0.15 −0.12 +  0.07 −0.09 0.71 −0.06 0.13
 Latinx (n = 198)
  Provider-reported parent-provider relationship 0.07 0.11 −0.02 0.06 0.66 0.44 0.00 0.10
  Parent-reported parent-provider relationship −0.31 +  0.17 −0.10 0.08 0.43 0.57 0.10 0.13
Open in a new tab

Ordinary least squares regression analyses conducted on N = 20 imputed datasets and are weighted with a child-level weight (WX_R3). Lags are included for outcome measures for which they were gathered. All subsample analyses included the same set of covariates shown for the full sample results (coefficients not shown here)

 + p < .10, *p < .05, **p < .01

All analytic models were also run separately within the White, Black, and Latinx subsamples, shown in the bottom panels of Table 3. There were no statistically significant associations between parent and provider reports of their positive relationships and the family outcomes within the White, Black, or Latinx subsamples.

Discussion

Overall, we found that parent and provider reports of their positive relationships with one another were related to positive outcomes for both children and whole families. A more nuanced look at the findings suggests that parent reports of relationships with providers and providers reports of relationships with parents were not substantially related to one another and were often associated with different outcomes. In addition, some differences within racial/ethnic subsamples suggest considerations for policy and practice and implications for future research.

Parents and Providers May Have Different Views of Their Relationships with Each Other

Baby FACES collected reports of the provider-parent relationship from both the parent perspective and the provider perspective. Provider reports and parent reports of their relationships with one another were minimally correlated (rs = 0.06–0.18), therefore we examined them as separate variables in the same analytic models. These relationships also looked slightly different within the racial/ethnic subsamples. While all correlations were small, relationship reports from parents in the Black subsample had slightly higher correlations with their providers (r = 0.18), compared to the full sample (r = 0.11). Meanwhile, White and Latinx families had slightly lower correlations between their reports with their providers (r = 0.06 each). This did not necessarily mean the relationships were more positive for Black children and families. While more correlated, Black parents reported lower positive relationships with providers compared to White parents; and staff reported lower positive relationships with Black parents compared to Latinx parents. Positive relationships reported by providers were related to higher social competence and language scores for white children. For Latinx children, positive relationships reported by providers were associated with lower behavior scores and higher social competence scores. These findings are important and consistent with past research showing that teachers may rate children of different races differently (Bates & Glick, 2013; Downer et al., 2016). Our findings suggest that positive relationship between providers and parents may be particularly buffering for social emotional development, less bias ratings of children’s development by providers.

Implications for Policy and Practice

Our models looked at how parent-provider caring relationships (provider report and parent report as separate variables) predicted child and family outcomes, while controlling for each other and other child and family characteristics. Findings suggest that the provider reports of their positive relationships were more closely related to positive child outcomes, and parent reports of their positive relationships were more closely related to family outcomes. These findings are not necessarily surprising, however, they do provide a chance to consider why parent and provider reports may differ and how this can inform policy and practice. Our findings that positive parent-provider relationships were related to enhanced child and family outcomes suggests that increased support for practices that cultivate caring relationships with parents are worthwhile in settings serving infants and toddlers. We find that positive relationships with providers reported by parents was associated with lower parental distress and lower family conflict. As parent stress has been found to influence the child-parent-relationship and can negatively influence parenting (e.g. Teti et al., 2017), increasing supports for positive relationships may be beneficial for children and parents.

Relatedly, we find that provider reports of positive relationships with parents were associated with children’s decreased problem behaviors, and increased scores in social competence and language skills. Provider report of positive relationships may signal greater communication and correspondence between educational settings and home environments, a type of “relational continuity” (Noddings, 2005). Given the two-generation approach of EHS, provider reports of positive relationships with parents may signal greater communication and correspondence between providers and parents in supporting their children’s development. Prior research has considered the role of the parent-provider relationship, and specifically within that, open communication, as a protective factor against negative outcomes such as ECE expulsion (Meek & Gilliam, 2016; Zulauf-McCurdy & Zinsser, 2021, 2022). Our findings complement this by showing that parent-provider relationships may be promotive of positive child outcomes, as well as protective against negative ones.

Our findings that these relationships looked slightly different within racial/ethnic subgroups also indicates that it is important to further study this topic both across and within groups to better understand how cultural continuity may play a role when considering ecocultural theory (Fuller & García Coll, 2010; 2013; Weisner, 2002). In addition, more research is needed to better understand if provider characteristics (and/or match between provider characteristics and children/families) play a role in how parents and providers develop relationships. Past research using these data did not find that racial/ethnic match between providers and children was related to outcomes, however, other areas of match and provider characteristics need further exploration.

When considering ways to improve relationships in the future, some interventions designed to improve relationships between parents and providers have shown to be successful and more research and attention could be paid to them in the future. As an example, the “Getting Ready” intervention for EHS families centered parent-professional relationships and gave providers training and coaching. The intervention was successful in demonstrating that specific training on building positive relationships for providers can be effective (Knoche et al., 2012). More research is needed on effective and culturally responsive interventions in this area.

Limitations

While considering implications of our findings, it is also important to acknowledge the limitations. Our full sample including a nationally representative group of children and families in EHS programs in the U.S. This large sample (N = 527) provided adequate power to detect statistically significant associations. Based on past research showing that the race and ethnicity of children play a role in ECE settings (Bates & Glick, 2013; Cook et al., 2023; Gilliam et al., 2016; Saft & Pianta, 2001) as well as parental engagement in ECE (Markowitz et al., 2020), we conducted our analyses within white, Black and Latinx subsamples. We believe this was an important step and we did find some differences between analyses. However, the subsample sizes were small (ns = 106–198) potentially limiting our ability to detect some of the associations that may exist within these subsamples (particularly the Black subsample). Selection bias is also a consideration in our study. We addressed this by controlling for family and child characteristics. However, due to limitations with statistical power, we did not include provider characteristics as additional covariates. In addition, our study is a correlational study and no causation can be determined from our models. Finally, this research provides a good overview of provider and parent relationships in a nationally representative sample of children and families in EHS, however, qualitative research is needed in the future to better unpack how these relationships function to support both family and child outcomes, why parents and providers often do not agree on the quality of their relationships, and both parents’ and providers’ perspectives on ways to improve their relationships in the future.

Conclusion: Ethic of Care Extends to Relationships Between Providers and Parents

This study extends Noddings (2005) work on ethic of care to include not only the important caring relationships between children and their providers, but for very young children, the importance of caring for the whole family. As Noddings (2005) notes, caring is relational and both parties must engage in their role. If the carer, in this case the EHS provider, believes they are providing a caring relationship for families, but the families do not agree that they are being cared for, then it cannot be a truly caring relationship. In our study, we examined both the providers’ perspective on their positive relationship with families, and the families’ report of their relationship with the provider in order to account for both sides of this relationship. It is noteworthy that they were often not very correlated with one another. However, positive relationships reports were related to many child and family outcomes. These findings suggest that it is in fact important to take into account both perspectives of the relationship. This research is consistent with some past research showing that consistency between parent and teacher reports of their positive relationships were important for children’s adjustment to school (Cook, et al., 2018). However, more research is needed to explore these relationships in families with infants and toddlers.

We found that these caring relationships between parents and providers not only can influence family outcomes such as parental distress, supportive parenting practices and family conflict, but also how families set up their home environment and child outcomes. These findings suggest that caring relationships between providers and families may also support caring relationships within families (parents and children) through modeling responsive caring relationships (Noddings, 2005), and continuity of care across settings (parents and providers, home/ECE setting). These are all important tenets of an ethic of care, and help show that relationships with families, beyond just children are an important part of the caring environment in ECE settings, particularly for very young children. We believe the study findings add to the literature by providing a better understanding of how relationships support both child and family well-being and positive outcomes.

Author Contributions

All authors contributed to the study in substantial ways. KDC, PhD conceptualized this study and designed research models, and lead the writing and editing of the paper. EF, conducted all analyses and contributed to writing and editing the paper. CML, PhD and KFvL, PhD contributed to the study design, writing, reviewing and editing of the paper. The final manuscript was approved by all authors.

Funding

No specific funding for this project.

Declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study received Institutional Review Board approval. This study was performed in line with the principles of the Declaration of Helsinki.

Consent to Participate and Publish

This study used secondary data from the Early Head Start Family and Child Experiences Survey (Baby FACES) Spring 2009-Spring 2012 data (Vogel et al., 2015), made available with a restricted data license through the Inter-University Consortium for Political and Social Research (ICPSR). For more information visit: https://doi.org/10.3886/ICPSR36074.v1. The Baby FACES study team followed procedures for informed consent to participate and publish based on this data.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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