Lessons from the Nursery: A Case Study of Childcare in an Intervention Study

Background and Purpose: Any intervention aimed at disadvantaged mothers should include the provision of child care to facilitate access (Marsh, Cao, & Shin, 2009).  However, in intervention studies, such care usually takes a back seat to the actual intervention; rarely do we know how auxiliary services are provided and what such support means to program participants.  This paper presents an ethnographic case study of a childcare service that was offered to Spanish-speaking immigrant mothers enrolled in an intervention study to treat maternal depression.

Early in the study, problems in childcare threatened client engagement but also created an opportunity to examine elements in ancillary care that reinforced participation.  By reframing participant dissatisfaction with the current childcare arrangements as “barriers to service,” the study aimed to understand the meanings that the childcare held for participants and how those connotations differed from that of other key stakeholders vested in the success of the intervention and childcare. 

Methods: Field notes were kept over a ten month period by the childcare coordinator who recruited, trained and managed 10-12 childcare volunteers to care for the children while their mothers attended a group session.  In addition, the researcher team used meeting minutes, participant-observations, and unstructured interviews with child care volunteers and other members of the intervention research team.  Throughout the data collection process, the researchers engaged in “progressive focusing” (Stake, 1995) to interpret data from critical events that took place during the program.  This iterative and reflective approach lead us examine these events from the perspectives of key stakeholders and develop therapeutically-orientated interpretations that would improve the mother’s satisfaction with the childcare. The following techniques were used to increase the validity and reliability of the interpretations: (1) data were reviewed and triangulated by the research team to identify the aims of various stakeholders, (2) we reflectively privileged the perspectives of the mothers, and (3) we examined the perspectives of the volunteers when they encountered difficulties with the children and the mothers.  Only those interpretations that received full consensus among the research team were considered valid as therapeutic agents.

 Findings: Three interrelated themes developed from the data.  First, the mothers viewed the childcare as an extension of the intervention.  Thus, any negative (or positive) interaction between the volunteers and the mothers about their children or the care they were receiving reverberated back into their experience of the intervention.  Second, other key stakeholders—the childcare volunteers and the intervention team—needed help understanding the symbolic meaning that the childcare held for the mothers; tensions arose when the mothers were perceived as unnecessarily critical.   Third, changes in the childcare that addressed the mother’s complaints coincided with an increase involvement in their group sessions. 

Conclusion and Implication: This case study illustrates the complexity that underlies childcare when it functions as an ancillary to a mental health service. Thus, researchers and service providers need to reconsider the provision of childcare under these circumstances; it can engender or thaw goodwill among participants and affect the intervention’s outcomes.