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The work of home visitors in early childhood fields may include addressing many challenges to achieving curricular outcomes, including issues such as maintaining boundaries and managing one's own reactions to children, parents, and overall family situations. Increasingly, reflective supervision and consultation are recognized as a way for workers in home-visiting early intervention and early care fields to address these personal and professional challenges and build competence (Watson, Gatti, Cox, Harrison,Hennes, ). The features of home visiting that make reflective supervision/consultation essential are discussed. Next, results of a pilot project in which a sample of Part C early intervention providers respond to a vignette portraying a challenging parent-child interaction are briefly presented and discussed. Despite often stating the importance of relationships, participants did not identify concrete methods of supporting relationship or demonstrate recognition of parallel process. In addition, providers seldom endorsed the use of reflective skills such as observing, listening, wondering, or reflecting (Weatherston, ), and no providers discussed a need for reflective supervision/consultation. We suggest that these findings illustrate some of the areas in which early intervention home visitors could benefit from participation in reflective supervision/consultation to move from identifying reflective skills as important to actually being able to use such skills in their work with families.

Describes the results of a survey of pediatric psychologists' perceptions of their work settings. Respondents (n = 261) described heterogeneous work settings, professional activities, expectations for workload and administrative arrangements. Clinical activities were prominent, accounting for nearly half the respondents' time. Respondents generally reported high levels of overall satisfaction with their work environments. Highest ranked sources of satisfaction included professional autonomy, patient care, and relationships with colleagues. Highest ranked sources of dissatisfaction included lack of time for research, salary, and patient care workload. Pediatric psychologists in private practice reported higher work satisfaction than those in other settings. Findings have implications for the work-related functioning of pediatric psychologists that should be addressed in research and professional activity.

Over the past 150 years, innovations in immunization practices have dramatically improved the health of children, and parents are increasingly asked to consider and accept new childhood vaccines. We present a conceptual model to frame a review of research on the role of parental attitudes and beliefs in decision making about child and adolescent immunization and describe the historical context of vaccine-related decision-making research. This review focuses on theory-based Social-environmental and parent-specific personal factors as potential influences on vaccine decision making. Relevant Social-environmental issues discussed include media coverage of vaccines, perceived social norms, and the persuasive influence of peer groups. Health care provider recommendations are presented as an exemplar of factors related to the family's interface with the health care system. Personal factors addressed include parental health beliefs, attitudes, and knowledge related to vaccine preventable diseases and immunization, as well as cognitive heuristics that are employed in the decision-making process (e.g., omission bias, protected values, framing of information). Last, promising directions for research and suggestions for clinical practice are presented.

Failure to thrive (FTT) has a long history in pediatric research and practice. In addition, professionals from a variety of professional disciplines who work with maltreated children and children with emotional and developmental problems encounter FTT children in their practices (Drotar, 1988). Initially used to describe infants who were not thriving in institutions (Chapin, 1908) and later in family settings (Patton & Gardner, 1962; Talbot et al., 1947), FTT is a general term that refers to children with severe growth deficiency, defined as weight for age less than the 5th percentile based on national norms (Hammill et al., 1979). Three heterogeneous categories of FTT are recognized: (1) nonorganic failure to thrive (NOFT), in which the child’s growth deficit is primarily influenced by environmental factors; (2) organic failure to thrive (OFT), in which growth is primarily affected by a physical or organic disorder such as malabsorption; and (3) mixed FTT, in which both organic and environmental influences are present (Homer & Ludwig, 1980).

Using a prospective study design, 48 preschool children with early histories of nonorganic failure-to-thrive (NOFT) and 47 physically healthy children of comparable age, sex, birth order, and family demographics were compared on measures of problem solving and personality development (ego control and ego resiliency). In responding to structured measures, NOFT children demonstrated deficits in behavioral organization, ego control, and ego resiliency compared with controls. Parents also identified higher levels of behavioral symptoms in children with early histories of NOFT compared with controls. However, home observational measures of ego control and ego resiliency did not differentiate the two groups. Deficiencies in problem solving and personality development and increased levels of behavioral symptoms in preschool children with early histories of NOFT may affect their future socioemotional development and learning.

The present study assessed the weight for height outcomes of 59 3-year-old children who had been hospitalized for nonorganic failure to thrive (NOFT) as infants (average age of 5 months) and received time-limited outreach intervention. Although the majority of children attained normal weight for height, nearly one-third demonstrated at least mild wasting. Type of outreach intervention did not affect weight for height at outcome. The predictive efficacy of a variable set which included characteristics of NOFT (age of onset and duration), velocity of weight gain subsequent to diagnosis and environmental characteristics (income and home stimulation) was tested. Shorter duration of NOFT prior to diagnosis and greater initial rate of weight gain following hospitalization predicted weight for height at 36 months. The findings underscore the need for close monitoring of physical growth and nutritional status of NOFT children following hospitalization as well as comprehensive assessment and treatment for children who continue to demonstrate nutritional deficits. Additional studies of factors which affect the prognosis of NOFT children are needed.

The home environments of 58 children with early histories of nonorganic failure-to-thrive (NOFTT) who received time-limited outreach intervention after hospitalization were assessed from 12 to 36 months of age. The type of outreach intervention did not affect the quality of home environment as assessed by the Home Observation for Measurement of the Environment inventory (HOME). We tested the efficacy of three sets of variables: characteristics of NOFTT (age of onset and duration), nutritional status (weight for height) at time of diagnosis, and family characteristics (maternal IQ and income) in predicting HOME scores at 36 months. Family characteristics (income and maternal IQ) were the only variables to predict HOME scores. HOME scores were less stable than in the standardization sample. A subgroup of NOFTT children (n = 7) whose HOME scores decreased over the 2-year follow-up period were more likely to have subsequent siblings than children whose HOME scores improved over the same time period (n = 11). Findings suggest the need to identify and provide preventive intervention for NOFTT children whose home environments are vulnerable to deterioration following diagnosis.