THRIVE BY 3. Preventive knowledge enhancement & tailored quality-building in daycare to promote development/ mental health in 1&2 year-olds

BACKGROUND: The foundations of cognitive, emotional and social development are embedded in the early years of life when rapid brain development occurs. more than 80% of Norwegian children under 3 years of age spend long days in daycare centers. Many centers do not sufficiently meet high quality standards. Preschool teachers request more knowledge in understanding and handling children under 3 years, and a model for quality building is lacking. Constantly elevated levels of stress hormones may be harmful to the development of nerve connections in the brain of toddlers. Norwegian children under 2 years of age have a higher level of stress hormones (cortisol) when in daycare compared to home, and the level increases during the day for those who have the longest days in daycare. High quality daycare protects and promotes the underpinnings of mental health when brain plasticity is most pronounced. Interventions are called for that may improve and uphold quality in daycare. PROJECT: Thrive by 3 is a universally preventive, multi-component quality enhancement among daycare personnel for 1- and 2- year-olds in 187 toddler departments in 78 daycare centers in 7 municipalities/vicinities in the Oslo area and Mid-Norway. Parents of 1561 toddlers and 794 child-care staff provided data. Relationship quality between staff and toddlers has been observed, scored and the child-care staff received feedback on 8 quality dimensions. Systematized, peer-driven guidance is given to all employees that is tailored to each toddler department's scores on the quality dimensions. Child-care staff have received 3 days of schooling in process quality in daycare and in emotional, cognitive and social development and mental health in 1- and 2-year-olds. Head teachers who give guidance to their employees have had 1 extra workshop on guidance and supervision and they receive guidance themselves from mentors from the municipality, and they again receive guidance from the project leader group. All child-care staff and parents have received comprehensive booklets and access to a website about the same topics that have been developed by the project leader team. Thrive by 3 is designed as a cluster-randomized trial and effects have been measured on a) staff-child relationship quality (process quality), b) child development and mental health, c) levels of stress hormones measured with saliva tests from a subsample of the toddlers d) employees? skills and well-being and e) parents' evaluation of the quality-building (interview data). Data collection from parents' and employees' questionnaires as well as quality observations has been completed for the 4 main measurement points: Sept./oct. 2018 (T1), January 2019 (T2; observation only) June 2019 (T3) and June 2020 (T4; follow up). So far findings indicate that Thrive by 3 is an effective intervention for enhancing the quality of staff-child relationships in Norwegian toddler groups.

Vi har vi utviklet og testet en multikomponent modell, Trygg før 3, for systematisk kvalitetsarbeid i norske barnehager. Modellen har blitt godt tatt imot av deltakerne, oppleves som nyttig, har ført til endret praksis og bedre kvalitet for barna, og er bærekraftig. Virksomhetsledere har fått en modell for å drifte systematisk kvalitetsarbeid i barnehagen. Ansatte har fått økt kompetanse, økt bevissthet på egen rolle, felles språk som utgangspunkt for faglig refleksjon og økt veiledningskompetanse. Alle 7 deltakende kommuner/bydeler har videreført modellen Trygg før 3 etter prosjektslutt. Øvrige resultater har gitt deltakerne innsikt i små barns opplevelse av stress i barnehagen og synliggjort viktigheten av å legge til rette for gode tilvenningsrutiner for å dempe stress ved barnehagestart. Resultatene belyser også sammenhengen mellom barns temperament og trivsel som er av betydning for hvordan enkeltbarn best kan ivaretas i barnehagen.

Mental health problems manifest already in preschool age (Wichstrøm et al., 2012) and continue into middle and late childhood (Mesman, Bongers, & Koot, 2001). However, research strongly indicates that mental health problems appear even among 1-2 year olds (Egger & Angold, 2006). Because 80% of Norwegian under 3 years attend childcare, and stay there for long hours, interventions targeting caregiver-child interactions may prove an important avenue towards universal prevention of mental health problems. Since requirements for high quality is not sufficiently met in many Norwegian childcare centers today, a cost-efficient, sustainable model of intervention is called for to enhance and track the quality of childcare for 1-3 year olds. We will break new grounds by, conducting a cluster randomized control trial of a newly developed comprehensive intervention for promoting mental health among toddlers in childcare, the Thrive by Three. Because, high quality childcare is in a unique position to prevent developmental trajectories leading to mental health problems and to early identify children in need of help, effective quality enhancing interventions will be of great value for the Norwegian society, both on individual, family, community and national level. The primary objective of the project is thus to investigate whether the intervention Thrive by Three will improve childcare quality, and strengthen children?s mental health and development. We hypothesize that intervention will prove superior to the wait-list control after the 10 month intervention period and at 12 months follow-up with respect to childcare quality and children?s mental health, development and well-being. Our secondary objective is to investigate the cost-effectiveness of the intervention and whether effects are moderated by characteristics of the children, caregivers and/or implementation outcomes. User perspectives and experience with Thrive by Three will be captured through qualitative interviews.