Child Care Health Education Broome County Health Department

1. Child Care Health EducationBroome County Health Department

2. Who are we? • Susan Blythe RN, Kathy Cerny SPHN, Jean Hardik PHN, and Marie Shafer PHN • Trained as Child Care Health Consultants by the NYSDOH • Certified Medication Administration Training Trainers • Work closely with Sue Verity, Dental Hygienist

3. Who do we serve? • Infants and Toddlers 6 weeks to 3 years. • Caregivers • 25 Centers • 16 Family based • 3 Group family based • 1 Drop-in Center • Parents

4. Infants and Toddlers Served Total = 419

5. Caregivers Served Total = 241

6. Families Served Total = 678

7. What do we do? • Utilize the nursing process as it applies to child care sites • Assessment • Nursing diagnosis • Goals • Interventions • Outcomes • Revision of care

8. Assessment Needs Assessment Survey of Training Topic Interests Health and Safety Checklist ITERS/FDCRS Record Review Direct Observation/ Conversation with Staff

9. NEEDS ASSESSMENT ISSUES/CONCERNS: Staff Safety Infection control/communicable disease   Nutrition Immunization/lead testing Children Parents Other

10. Survey of Training Topic Interests Results • First Communicable Diseases/Exclusion Criteria Diapering/Toileting • Second Infant Mental Health Developmental Concerns Hand Washing • Third Children with Special Needs Emergencies in Child Care

11. Nursing Diagnosis Knowledge deficit related to…as evidenced by…

13. Diapering and toilet learning Health Insurance Abuse and Neglect Mental Health   Children with special needs (medical) Health Care Plan Oral Health   Behavior/Discipline Emergencies in childcare Communication with parents/ Physicians   Fire Safety   Smoking cessation   Staff health   SIDS And more…  “Other” Category Includes…

14. Goals • To introduce “best practice” health, safety and nutrition standards to child care programs in Broome County.

15. Goals Caregivers verbalize increase in knowledge of health, safety and nutrition. Increase in… immunizations and lead tests documented adequately documented medication-related information number of current well-child physicals documented emergency contact information number of children with special needs with special care plans Decrease in incidents

16. Interventions

18. Record Review, Notices to Parents, Immunization Posters  Lead Testing Notification and Signature Forms and handouts Tickler System  Sample Health Care Plan  Sample emergency plan Free copy of Model Child Care Health Policies and Preparing for Illness Free choke tubes Interventions (Services Offered)

19. Ages and Stages Questionnaires  Special Care Plans  Health, Safety and Infection Control Posters  Infant Menu Template and nutrition information Wide range of informational handouts on health, safety, infection control and nutrition topics Referral to Community Agencies   “Questions for the Nurse” posters  Assist with program improvement plans and ITERS/FDCRS. Interventions (Services Offered)

20. 1.Asthma 2.Caring for the Health and Safety of Child Care Staff 3.Childhood Illnesses and Immunizations (for parents) 4.Communicable Diseases 5. Daily Health Checks 6.Developmental Assessment of Infants and Toddlers 7.Diapering and Toilet Learning 8.Early Childhood Mental Health 9.Effects of Loud Noise on Infants and Children (done with parents) 10.Germs (for kids) 11.Hand Washing and How Diseases Spread 12.Head Lice 13.Immunizations 14.Infant Nutrition 15. Lead 16. MAT 17.Nutrition, Birth to Three Years 18. Playground Safety 19.Shaken Baby Syndrome Available Trainings

21. Total = 591

22. CommunicableDisease Training • Number of child care providers trained to date: 63

23. Communicable Diseases • contagious • can be spread from one person to another

24. Caused By • Viruses • Bacteria • Parasites Infants and toddlers are highly susceptible because…...

25. Infants and toddlers are highly susceptible because…... • They have not been exposed to most common germs • Poor health habits • Some lack adequate immunizations

26. Method of Transmission Different diseases are spread in different ways • Direct contact • Respiratory Transmission • Fecal-Oral Transmission • Blood Transmission

27. Ringworm

28. Exclusion • Child care providers need policies for preventing and handling illness • Exclusion may be necessary to prevent the spread of contagious disease • Children who have fever and are behaving normally do not need to be excluded • Children with colds who are behaving normally do not need to be excluded

29. Exclusion Criteria • Children have often already exposed others before becoming obviously ill - or are not contagious after beginning treatment

30. Exclusion Criteria • Child not well enough to participate in the usual activities of the program • Staff not able to care for the sick child without interfering with the care of other children • Child has any indication of contagious disease or immediate need for medical evaluation

31. Medication Administration Training • Number of Child Care Providers Trained to Date: 101

32. Competency based training course • Certifies day care providers to administer medications in a child care setting for seven routes: oral, topical, inhaled, medicated patches, eye, ear, and emergency injection using an auto-injector device.

35. Health Information Update Request • Child Care Provider Name _________________________________ • Child’s Name ____________________________________________ • Dear Parent(s), • In order to foster the best health possible for all children in our care, our records must be kept current. We need your assistance in doing this, and appreciate your cooperation. • The following need to be updated as soon as possible: • ٱ No child health assessment form in record • ٱ No child health assessment form within the last year • ٱ Emergency card not updated within past 6 months • ٱ Immunization record not up to date • ٱ Hepatitis B (1st, 2nd, 3rd dose) • ٱ Diptheria, Tetanus and Pertussis (1st, 2nd, 3rd, 4th, 5th dose) • ٱ Haemophilus Influenzae Type b (1st, 2nd, 3rd, 4th dose) • ٱ Inactivated Polio (1st, 2nd, 3rd, 4th dose) • ٱ Measles, Mumps and Rubella (1st, 2nd dose) • ٱ Varicella • ٱ Pneumococcal (1st, 2nd, 3rd, 4th dose) • ٱ No record of lead test at age 1 and/or 2 years of age • “All children, regardless of lead exposure risk, should be screened with a blood lead test at one and two years of age as part of routine primary care” –Physician’s Handbook on Childhood Lead Poisoning Prevention, NYS Department of Health and American Academy of Pediatrics, 2002 • Thank you for your cooperation! • Record reviewed by ______________________________________ Date ______________

36. Lead Testing Notification and Signature Form Child Care Provider Name _________________________________ Child’s Name ____________________________________________ Dear parent(s), In order to foster the best health possible for all children in our care, our records must be kept current. We need your assistance in doing this, and appreciate your cooperation. ٱ No record of lead test at age 1 and/or 2 years of age “All children, regardless of lead exposure risk, should be screened with a blood lead test at one and two years of age as part of routine primary care” –Physician’s Handbook on Childhood Lead Poisoning Prevention, NYS Department of Health and American Academy of Pediatrics, 2002 I understand that lead testing at age 1 and 2 is public health law and is advised by the American Academy of Pediatrics. I also understand that my child can be lead tested at his or her pediatrician’s office or at the local health department (778-2839). Children older than age 2 and younger than age 6 should be screened for lead poisoning risk factors and tested if at high risk. Parent signature ________________________________________ Date _______________ Thank you for your cooperation!

37. Tickler System Child’s Name:_____________________________DOB: _____________ Child Health Assessment Form (yearly): Dates______ _____ _____ ______ ______ _____ _____ _____ _____ Emergency Card Updated (every 6 months): Dates______ _____ _____ _______ _____ ______ ____ _____ _____ 2 mos 4 mos 6 mos 12 mos 15 mos 4-6 yrs DtaP 1_____ 2_____ 3_____ 4_____* 5_____ EIPV 1_____ 2_____ 3_____* 4_____ Hib* 1_____ 2_____ 3_____ 4_____* Hep B* 1_____ 2_____ 3_____ MMR 1_____* 2_____ Varicella 1_____* PC7* 1_____ 2_____ 3_____ 4_____* Lead Screening 1 year old_____ 2 years old_____

38. Tickler System *Notes: DtaP #4 15-18 months EIPV #3 6-18 months Hib #4 12-15 months. If child gets Comvax (Hep B/Hib combo) only needs 3 Hibs; in this case, Hib #3 must be after 12 months of age. Hep B if not Comvax: Hep B #1 Birth - 2 mos (Birth dose of Hep B Hep B #2 1-4 mos is counted in series) Hep B #3 6-18 mos Hep B if Comvax: Hep B #1 2 mos (Birth dose of Hep B Hep B #2 4 mos not counted in series) Hep B #3 12-18 mos MMR #1 12-15 months Varicella #1 12-18 months Pneumococcal #4 12-15 months - Pneumococcal not required for daycare; recommended for health. Pediarix (DtaP/Hep B/IPV combo) 2,4 & 6 months. Still need DtaP #4, DtaP #5 & EIPV #4. Birth dose of Hep B not counted in series.

39. Outcomes Record Review Results Per site Cumulative

46. Revision of Care

47. Revision of Care (for ELO II) • Develop and offer trainings related to safety and emergency preparedness • Introduce revised child health assessment form that includes height and weight to identify growth concerns i.e. obesity • Include informational handout with each lead testing notification form

48. Revision of Care (for ELO II) • Provide on-site assessment and recommendations regarding: • Emergency preparedness (1st aid kits, disaster kits, emergency numbers, staff trained in CPR and first aid) • Cleaning and disinfecting (procedures, schedules and staff assignments) • Medication documentation and handling, special health care plans and daily health checks

49. Revision of Care (for ELO II) • Provide on-site assessment and recommendations regarding • Safety (incident study, and health and safety mock inspection) • Food Safety • Use of Ages and Stages Questionnaires (ASQ) and ASQ: Social Emotional

50. The ultimate goal is to create an environment that will cultivate warm, responsive, health-conscious caregivers. We do this by supporting the caregiver.