Linking child care and health: An exploratory study of child care directors\u27 and health professionals\u27 perceptions of consultation and collaboration

This study examined the nature of health consultation between child care center directors and health professionals. Utilizing symbolic interactionism, and specifically role theory, as a theoretical framework, factors which promote or inhibit a collaborative relationship were explored. The influence of these factors on the health consultant role was also investigated.^ The study consisted of two parts. In Part One, 133 child care center directors and 118 health professionals, of which 100 directors and health professionals were paired, completed self-administered questionnaires about their health consultation experiences. In Part Two, ten pairs of directors and health professionals, five with collaborative working relationships and five with conflicted working relationships, were interviewed to further explore their experiences. Each director and health consultant was interviewed individually.^ Descriptive analyses of data in Part One of the study revealed that 85% of the child care directors rated health consultation as important or very important, and 76% of the health professionals believed that the directors considered consultation important or very important. There was high concordance across the two groups in terms of their perceptions of the importance of a broad range of health issues. The health consultant role description was similar to the tasks delineated in the child care regulations; however, there was some discrepancy across the groups in terms of goals, knowledge of each other\u27s background and expertise.^ In Part Two of the study, a grounded theory approach to data collection and analysis was employed. Based on the findings, a conceptual model, Collaborative Health Consultation: A Developmental-Symbolic Interactionist Model, was created. Consistent with the tenets of symbolic interactionism and role theory, the process of developing a collaborative health consultation relationship was dependent on reaching mutually agreeable identities during the process of role taking and role making. Identity bargaining was influenced by past experiences and attitudes and the critical and interrelated themes of open and active communication, comprehensive commitment, mutual respect, and congruent philosophy and values in the relationship. The director and health consultant pairs who achieved a collaborative, consultative relationship developed an expanded health consultation role which exceeded regulations; whereas, those pairs who were unable to negotiate a collaborative relationship described a limited health consultant role which met the minimum requirements of regulations.