An Examination of How California’s Institutions of Higher Education Prepare Students to Implement Continuity of Care

Project Category: Preparing a Highly Qualified 0-3 Workforce 

Sarah Garrity, Ed.D.
Assistant Professor, Department of Child and Family
San Diego State University

Introduction: Continuity of care occurs when programs assign a primary care teacher at the time of enrollment and continues this relationship until the child turns three or leaves the program (Lally & Signer, 2003). This practice supports and nurtures the important relationship between the teacher and the child, recognizing that children develop within the context of relationships. Research indicates that the quality of teacher-child relationships uniquely predicts children’s concomitant functioning and subsequent development across multiple domains, including academic performance, motivation, and engagement in school, and psychosocial functioning (Howes, Hamilton, & Matheson, 1994; Pianta & Stuhlman, 2004; Pianta, Steinberg, & Rollins, 1995).  Although continuity of care is a best practice recommendation for early care and education (ECE) programs serving infants and toddlers (National Association for the Education of Young Children, 2015; Zero to Three, 2008), the limited research on the prevelence of continuity of care suggests that it is rarely practiced in the United States. Research suggests that the beliefs and attitudes of teachers and administrators, as well as a lack of professional development opportunities and time, are barriers to continuity of care.

In their qualitative case study, Garrity and colleagues (2015) described how one California State University (CSU) campus child development center successfully implements continuity of care despite its complexities and found that the education, lab, and work experiences provided by the university’s Department of Child and Family Development were essential to the successful implementation this practice.  Given the key role of the CSU in preparing the ECE workforce, it is critical to examine the extent to which the CSU offers coursework specifically related to infants and toddlers and the degree to which students are given opportunities to bridge theory to practice via field experience placements at centers that implement continuity of care. By providing future ECE professionals with the knowledge, skills and dispositions required to implement continuity of care, the CSU system has the potential to impact the field by preparing an ECE workforce that can implement a practice that is based on neuroscience.

Methods: A descriptive research design was used to learn more about how the CSU system prepares students to work with children 0-3 and their families. A phone survey was conducted with 22 campus child development programs to determine if 1) the center implemented continuity of care and 2) if students completed lab work at the center. In addition, document analysis of CSU course catalogs was used to identify undergraduate coursework that specifically addresses the infant toddler developmental period. Courses were included only if they specifically contained the words infant or toddler in the title and were exclusively dedicated to the prenatal to age 3 age group.

Results: Of the 22 CSU’s included in this project, only two, CSU East Bay and Sonoma State University, did not have coursework specifically related to infant and toddler development listed in their course catalog. Twenty CSU campuses have at least one campus-based child development center. Nine of these centers (45%) reported that they implement continuity of care, and of the centers that implement continuity of care, 7 (78%) reported having lab students placed at the center. Two universities, CSU Long Beach and San Diego State University, have a class designed solely to provide students with field work experience in an infant toddler setting that is offered in conjunction with a course on infant toddler development. Two universities, Cal Poly Pomona and CSU Stanislaus, require field work as part of an infant toddler course. Descriptions for three courses (at CSU Chico, CSU Dominguez Hills, and CSU Sacramento) indicated that observation, in addition to lecture, is a course requirement, and the description for a course at CSU Los Angeles indicated that 3 hours of lecture and 3 hours of activity are course requirements.

Discussion: Data from the phone survey indicated that less than half (45%) of the centers surveyed implement continuity of care. This finding points to an important research to practice gap, as research clearly indicates that children develop in the context of warm, responsive relationships that extend over time. Document analysis of CSU course catalogs indicated that, overall, departments responsible for preparing the ECE workforce offer coursework specifically related to the infant toddler developmental period, with the majority (90%) providing between 1-3 undergraduate classes related to infants and toddlers. There are several limitations to this study that must be taken into consideration. Although the phone calls made to the campus child care programs provided useful information about whether the center practices continuity of care and has lab students placed at the center, much more information is needed to determine the model of continuity of care that is used by the center and the level of involvement of lab students. It is also important to note that course description found in course catalogs provide a limited snapshot of course offerings and do not offer the same level of detail as course syllabi.

While this project represents an initial foray into understanding the role of infant toddler coursework and the role of field experiences and campus child care centers, much more work is needed to explore the complexity of this issue. Future research should include in-depth interviews with administrators of campus child care programs to learn more about 1) why continuity of care is not practiced or 2) the model of continuity of care that is practiced and 3) the role of lab students. These interviews will also provide more information about how field experiences are used to help students bridge theory to practice and be prepared (or unprepared) to implement continuity of care when they enter the workforce.

Dr. Sarah Garrity
5550 Campanile Dr.
San Diego, CA 92182-4502


Aguillard, A. E., Pierce, S. H., Benedict, J. H., & Burts, D. C. (2005). Barriers to the implementation of continuity-of-care practices in child care centers. Early Childhood Research Quarterly, 20(3), 329-344.

Bornfruend, L. (2011). Getting in sync: Revamping licensing and preparation for teachers in pre-k, kindergarten, and the early grades. New America Foundation.  Retrieved from www.

Clawson, M. & Couse, L. (1998). Service learning as a teaching strategy in human development and family studies courses. Family Science Review, 11(4), 336-353.

Cryer, D., Hurwitz, S., & Wolery, M. (2001). Continuity of caregiver for infants and toddlers in   center-based child care: Report on a survey of center practices. Early Childhood Research Quarterly, 15(4), 497-514.

Cryer, D., Wagner-Moore, L., Burchinal, M., Yazejian, N., Hurwitz, S., & Wolery, M. (2005). Effects of transitions to new child care classes on infant/toddler distress and behavior. Early Childhood Research Quarterly, 20(1), 37-56.

Edwards, C. P., & Raikes, H. (2002). Extending the dance: Relationship-based approaches to infant/ toddler care and education. Young Children, 57(4), 10–17.

Garrity, S., Longstreth, S., Alwashmi, M. (2016). A qualitative examination of the implementation of continuity of care: An organizational learning perspective.  Early Childhood Research Quarterly, 64-78.

Howes, C., Hamilton, C.E., & Matheson, C.C. (1994). Children’s relationships with peers: Differential associations with aspects of the teacher–child relationship. Child Development, 65, 253–263.

Lally, J.R., & Signer, S.M. (2003). Introduction to Continuity. Sausalito, CA:  WestEd, The Program for Infant Toddler Caregivers.

Lally, R. (2009). The science and psychology of infant-toddler care: How and understanding of early learning has transformed child care. Zero to Three, 30 (2), 47-53.

McMullen, M. B., Yun, N. R., Mihai, A., & Kim, H. (2016). Experiences of Parents and Professionals in Well-Established Continuity of Care Infant Toddler Programs. Early Education and Development, 27(2), 190-220.

McNair, S., Sullivan, R., & Hill, D. (2002). Beyond the comfort zone: A curriculum and assessment ‘immersion’ experience in graduate early childhood teacher education. Journal of Early Childhood Teacher Education, 23(1), 11-18.

National Association for the Education of Young Children. (2009). Standards for Early Childhood Professional Preparation. Washington, DC: NAEYC.

National Association for the Education of Young Children. (2015). NAEYC early childhood program standards and accreditation criteria & guidance for assessment. Washington, DC: Author.

Phillips, D. A., & Shonkoff, J. P. (Eds.). (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academies Press.

Pianta, R. C., Steinberg, M. S., & Rollins, K. B. (1995). The first two years of school: Teacher-child relationships and deflections in children’s classroom adjustment. Development and Psychopathology, 7(02), 295-312.

Pianta, R. C., & Stuhlman, M. W. (2004). Teacher-child relationships and children’s success in the first years of school. School Psychology Review, 33, 444-458.

Whitebook, M., Gomby, D., Bellm, D., Sakai, L., & Kipnis, F. (2009). Effective teacher preparation in early care and education: Toward a comprehensive research agenda. Part II of Preparing teachers of young children: The current state of knowledge, and a blueprint for the future. Berkeley, CA: Center for the Study of Child Care Employment, Institute for Research on Labor and Employ­ment, University of California at Berkeley.

Zero to Three. (2008). Caring for infants and toddlers in groups: Developmentally appropriate practice (2nd ed.). Arlington, VA: Author.