1. Promoting quality care.
An intervention program
based on improving
caregiver’s sensitivity
at child care centre
Elena Lopez de Arana
Alexander Barandiaran Arteaga
Iñaki Larrea Hermida
Alexander Muela Aparicio
Jose Ramon Vitoria Gallastegi

2. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

3. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

4. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
We came from Mondragon University
Who are we?

5. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
We came from Mondragon University
It is located in The Basque Country
Who are we?

6. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
We came from Mondragon University
It is located in The Basque Country
At this university there is The Humanities and
Education College/Faculty
Who are we?

7. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
We came from Mondragon University
It is located in The Basque Country
At this university there is The Humanities and
Education College/Faculty
Where there is a research team called Hazitegi
that it means seedbed
Who are we?

8. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

9. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?
Sensitivity is the ability for consistent
recognition and accurate interpretation of
child’s signs, which are reflected in a
contingent and appropriate response (Ainsworth et
al., 1974; Mason and Cherry 2001; Kivijärvi et al., 2004;
and Shin et al., 2006).

10. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?
Sensitivity is the ability for consistent
recognition and accurate interpretation of
child’s signs, which are reflected in a
contingent and appropriate response (Ainsworth et
al., 1974; Mason and Cherry 2001; Kivijärvi et al., 2004;
and Shin et al., 2006).
Child care research has demonstrated that
caregivers’ sensitivity affects children’s
well-being (Gunnar et al., 2010) and healthful
development (Ahnert and Lamb, 2003; Love et al.,
2003; NICHD Early Child Care Research Network, 2000
and 2002).

11. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?
Sensitivity is the ability for consistent
recognition and accurate interpretation of
child’s signs, which are reflected in a
contingent and appropriate response (Ainsworth et
al., 1974; Mason and Cherry 2001; Kivijärvi et al., 2004;
and Shin et al., 2006).
Child care research has demonstrated that
caregivers’ sensitivity affects children’s
well-being (Gunnar et al., 2010) and healthful
development (Ahnert and Lamb, 2003; Love et al.,
2003; NICHD Early Child Care Research Network, 2000
and 2002).
Because of that some researchers have
developed different intervention programs
to improve caregive’s sensitivity (Fukkink
and Tavecchio, 2010; (Groeneveld, Vermeer, van
IJzendoorn and Linting, 2011).

12. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
Why this program?

13. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
So, we pay attention on all those behaviors
related to
Why this program?
attachment
attachment

14. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
So, we pay attention on all those behaviors
related to
Why this program?
attachment
attachment
explorationexploration

15. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
So, we pay attention on all those behaviors
related to
Why this program?
attachment
attachment
explorationexploration
escape
escape

16. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
So, we pay attention on all those behaviors
related to
Why this program?
attachment
attachment
explorationexploration
escape
escape
avoidance
avoidance

17. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
So, we pay attention on all those behaviors
related to
Why this program?
attachment
attachment
explorationexploration
escape
escape
avoidance
avoidance
aggression
aggression

18. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
As others intervention programs which attempt to
improve the sensitivity, this one also is
supported on attachment theory, originated by
John Bowlby (1969).
So, we pay attention on all those behaviors
related to
Why this program?
attachment
attachment
explorationexploration
escape
escape
avoidance
avoidance
aggression
aggression
affiliationaffiliation

19. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The intervention program is based on video
feedback. These feedbacks are organized in four
sessions (wich takes 90 minutes) as the intervention
program design by Fukkink and Tavecchio (2010).
Why this program?

20. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The intervention program is based on video
feedback. These feedbacks are organized in four
sessions (wich takes 90 minutes) as the intervention
program design by Fukkink and Tavecchio (2010).
Why this program?
Wellcome
moment

21. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The intervention program is based on video
feedback. These feedbacks are organized in four
sessions (wich takes 90 minutes) as the intervention
program design by Fukkink and Tavecchio (2010).
Why this program?
Welcome
moment
Free play
moment

22. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The intervention program is based on video
feedback. These feedbacks are organized in four
sessions (wich takes 90 minutes) as the intervention
program design by Fukkink and Tavecchio (2010).
Why this program?
Welcome
moment
Free play
moment
Meeting
moment

23. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The intervention program is based on video
feedback. These feedbacks are organized in four
sessions (wich takes 90 minutes) as the intervention
program design by Fukkink and Tavecchio (2010).
Why this program?
Welcome
moment
Free play
moment
Meeting
moment
Psychomo-
tricity
moment

24. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The intervention program is based on video
feedback. These feedbacks are organized in four
sessions (wich takes 90 minutes) as the intervention
program design by Fukkink and Tavecchio (2010).
For video feedback, we record two kinds of
contexts: ones which permitted children’s free
play and other ones with structured and directed
Why this program?
Welcome
moment
Free play
moment
Meeting
moment
Psychomo-
tricity
moment

25. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
In the first two video feedback sessions we focus
on helping the caregiver to recognize and
interpret accurately children’s signs.
Why this program?

26. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?

27. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
In the video we have seen that when Aimar (a child)
arrives, he realizes that there is something
different, that there is a person who does not know.
So he goes inside very slow and looking at the camera.
His steps become lighters in front of the caregiver.
Then he sits in a corner with the back protected by
furniture. He looks the camera continuously.
We collected this sequence and we told to the
caregiver: “The way that Aimar is getting closer to
the group, the place that he takes in the group
protecting his back, the way that he looks the camera
are signs of fear.
When there is something new in the environment, which
disturbs us, that frightens us because it is unknown,
we assess it as threatening, risky or dangerous. So,
it used to be necessary to have under control, knowing
where is it and finding the distance we need to feel
Why this program?

28. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
In the last two video feedback sessions we focus
on recognizing the caregiver as a competent
professional. For this, our attention is focusing
only on caregiver’s sensitivity interactions.
Why this program?

29. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?

30. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
In the video we have seen that Markel (a child) points
at the camera while the caregiver is welcoming them.
Markel continues looking at the camera.
We collected this sequence and we told to the
caregiver: When children point at an object or a
person, this indicates that they are interested on it,
that they want it, that they need some explanation
about it, that it worries them.
In this case Markel points at me, someone who is
unknown for him, it does not know why I am in the
classroom and what I am doing. This sing could be
interpreted as a mystery that needs solving or as a
surprise at new situation. The novelty tends to
Why this program?

31. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The caregiver realized about Markel’s emotional
situation and told him sensitivitly: "Markel is a
little surprised with the camera".
It is very important to respond to children's
curiosity because if their necessity to know is not
satisfied they will return one and again to ask about
what they don't understand, about what they want to
know, about what surprises them...
In addition, pay attention to children’s emotional
situations shows that we understand them, that we know
what they are feeling, and we show them that we are
there for what they need. This is very important for
the bond between the child and caregiver.
Also speak about emotions helps children to go
identifying and naming different emotions. This is the
first step to be able to express them verbally.
Why this program?

32. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

33. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The aim of this case study was to put into
practice an intervention program and analyze if
it is suitable to improve caregiver’s
sensitivity at child care centre
What was our aim?

34. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
The aim of this case study was to put into
practice an intervention program and analyze if
it is suitable to improve caregiver’s
sensitivity at child care centre
What was our aim?
So, we hoped that the intervention program will improve
caregiver’s sensitivity

35. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

36. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
What was the methodology?
The
participants
were: one
caregiver and
thirteen 2
years old
children from
a Basque child
care centre’s
classroom
We are
presenting
a case study

37. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?
Case description
The caregiver of this case showed a very
cooperative and very proactive attitude

38. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?
Case description
The caregiver of this case showed a very
cooperative and very proactive attitude
The caregiver responded sensitively, showing
availability and accessibility, to obvious
signals or demands. However, it was difficult
for her to perceive all those signs which
were more subtle or not so explicit.

39. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Why this program?
Case description
The caregiver of this case showed a very
cooperative and very proactive attitude
The caregiver responded sensitively, showing
availability and accessibility, to obvious
signals or demands. However, it was difficult
for her to perceive all those signs which
were more subtle or not so explicit.
We also found that during children’s play
her responses were not intrusive at all.
But it is true that she did not get close
to children with the intention of enquire
what process are following or with the
intention of helping to structure.

40. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
What was the methodology?
We used NCKO Sensitivity Scale (De Kruijf et al.,
2007) to measure caregiver’s sensitivity.
Sensitivity ratings are presented on a seven-
point scale, ranging from (1) very low to (7)
very high. Scoring was based on ten minutes
video-fragment.

41. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
What was the methodology?
We used NCKO Sensitivity Scale (De Kruijf et al.,
2007) to measure caregiver’s sensitivity.
Sensitivity ratings are presented on a seven-
point scale, ranging from (1) very low to (7)
very high. Scoring was based on ten minutes
video-fragment.
We used a semi-structured interviewed to know
caregiver’s perception about the impact of the

42. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
What was the program’s procedure? Methodology
Procedure

43. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
What was the program’s procedure? Methodology
Procedure
Intervention
program
Last meeting
•Video taping
sensitivity
•Interview
Contexts
for free play
Contexts
with structured
and directed
activities
First
meeting
First video tape
•Sensitivity
•Profile

44. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
What was the methodology?
In reference to the ethical considerations we
should explain that we get parents’ written
consent to record children and that we codify
all participants: child care centre, caregiver
and children.

45. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

46. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Did we get our aim?
About the
caregiver’s
sensitivity any
difference was
found after the
program’s
implementation.

47. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Did we get our aim?
About the
caregiver’s
sensitivity any
difference was
found after the
program’s
implementation.
0
1
2
3
4
5
6
7
Caregiver
sensitivity
Pretest
Postest

48. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Did we get our aim?
When we
assessed the
program with
the caregiver,
she reported
that...

49. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Did we get our aim?
When we
assessed the
program with
the caregiver,
she reported
that...
The intervention
program was useful to
change her view, the
way that she
interpreted the
children’s signs

50. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Did we get our aim?
Due to the program we
realized that the
caregiver was less
intrusive (more
sensitive) in the
context where free play
was permitted, but she
was more intrusive
(less sensitive) in the
context with structured
and directed activities

51. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Did we get our aim?
Due to the program
we realized that the
caregiver was less
intrusive (more
sensitive) in the
context where free
play was permitted,
but she was more
intrusive (less
sensitive) in the
context with
structured and
directed activities
Free context offers to
children the opportunity
to choose what they are
able to do at this
moment. Children have
the chance to auto-
regulate themselves, to
ask to the caregiver
what they need, and the
caregiver can respond to
their personal needs.
The caregiver is not
obliged to give to all
the children the same
answer at the same time.

52. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
 Who are we?
 Why this program?
 What was our aim?
 What was the methodology?
 Did we get our aim?
 Which conclusion did we get?

53. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Which conclusion did we get?
We CAN’TCAN’T affirm that the
intervention program we have
presented it is suitable to
improve caregiver’s sensitivity at
child care centre

54. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Which conclusion did we get?
We CAN’TCAN’T affirm that the
intervention program we have
presented it is suitable to
improve caregiver’s sensitivity at
child care centre
But we CANCAN affirm based on the
perception of the caregiver that the
intervention program we have
presented is suitable to change her
view, the way that she interpreted
the children’s signs

55. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Which conclusion did we get?
NCKO Sensitivity Scale’s scoring was based
on one video-fragment; perhaps it could be
better…
•If scoring is based on more video-fragments

56. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Which conclusion did we get?
NCKO Sensitivity Scale’s scoring was based
on one video-fragment; perhaps it could be
better…
•If scoring is based on more video-fragments
•If we use the inter-raters’ reliability

57. Promoting quality care
An intervention program based on improving
caregiver’s sensitivity at child care centre
Which conclusion did we get?
In the future it would be interested to…
The CaregiverThe Caregiver
InteractionInteraction
Scale (Arnett,Scale (Arnett,
1989)1989)
NCKONCKO
Well-Well-
BeingBeing
ScaleScale
Compare this caseCompare this case
study with anotherstudy with another
case studiescase studies
Continue withContinue with
video feedbackvideo feedback
method tomethod to
increase theincrease the
sensitivitysensitivity
Research toResearch to
know witchknow witch
contextscontexts
guaranteeguarantee
caregivers’caregivers’
sensitivitysensitivity

58. Promoting quality care.
An intervention program
based on improving
caregiver’s sensitivity
at child care centre
Elena Lopez de Arana
Alexander Barandiaran Arteaga
Iñaki Larrea Hermida
Alexander Muela Aparicio
Jose Ramon Vitoria Gallastegi