Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Child and Family Studies


F. Bruce Carter


Early childhood education

Subject Categories



Continuity of care, keeping a primary caregiver and children together throughout the first three years of the infant/toddler period or for the time that the child is enrolled in child care, is assumed to influence infant and toddler development positively. However, strong empirical support is lacking along with wide variation of implementation among early childhood programs. Employing a qualitative design, this study investigated child care center directors' perceptions of continuity of care as a quality indicator and best practice in early care and education programs. Twenty-one child care center directors were interviewed using a list of open-ended questions gauging knowledge of and experience with continuity of care. Interviews were transcribed using Dragon Naturally Speaking voice recognition software and loaded into NVivo 8, a qualitative data analysis software package. Three central themes around directors' understanding of and belief in continuity of care, continuity of care relevant to program operation, and career development emerged from the data. Seventy-one percent of child care center directors defined continuity of care as sameness of caregiving routines, daily schedule, and programmatic rules and policies for parents. Eighty-one percent of directors reported continuity of care as advantageous to the caregiver-child relationship, but were uncertain of the establishment of continuity of care as a policy. Child care center directors encountered an array of administrative challenges on a daily basis and were pressured to make decisions based upon the financial stability of the program. Fifty-two percent of directors did not understand how continuity of care could be implemented into a child care center program and 76 percent of directors did not think continuity of care could be implemented at their particular center due to issues with enrollment, staffing and training. Seventy-six percent of child care center directors reported child care as a critical profession.Child care center directors reported difficulty in hiring and retaining quality staff due to limited earnings potential and substandard benefits and believed offering a higher rate of pay would improve upon the professionalism of the field.


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