Overview of Child Care Health Consultation

1. Overview of Child Care Health Consultation Name of Presenter

2. Outline • Role of child care health consultants • Who are they? • What are the benefits? • Where do I find a child care health consultant? • Pediatricians as child care health consultants • What can pediatricians offer child care programs? • What can child care programs offer pediatricians? • How can pediatricians build a relationship with child care programs? • Resources • Publications • Licensing & Regulations • Training

3. Health & Safety in Child Care • Healthy and safety topics can have a broad range of issues from simple to complex • Minor injuries • Infectious diseases • Health & safety policies • Care plans for children with chronic health conditions • Child care health consultants can help ensure provision of safe and healthy environments for children.

4. What is a Child Care Health Consultant? • A child care health consultant (CCHC) is a health care professional who… • has interest in & experience with children, • has knowledge of resources & regulations, and • is comfortable linking health resources with facilities that provide primarily education & social services

5. Who Can Be a CCHC? • Nurses, nurse practitioners, physician assistants, physicians, health educators, nutritionists, dental hygienists, sanitarians, & medical social workers • Must have: • Knowledge & experience in health & safety practices in child care • Specialized training

6. State Regulations • [If presenting in a particular state, provide the state’s regulations here]

7. What Should a CCHC Know? • National health & safety standards • Licensing requirements • Child care day-to-day operations • Disease reporting requirements • Reporting requirements for child abuse & neglect • Community and mental health resources

8. What Should a CCHC Know? Immunizations Injury prevention Oral health Nutrition and physical activity Inclusion of children with special needs Staff health Environmental health

9. Specialty Consultation • Mental health (Early Childhood Mental Health Consultant) • Nutrition & physical activity(Early Childhood Nutrition Consultant) • Oral health(Early Childhood Oral Health Consultant)

10. Benefits of CCHCs • CCHCs can help improve health & safety by: • Consulting and teaching child care providers & parents • Assessing needs • Providing on-site, phone, & e-mail TA • Providing referrals to community services • Developing/updating policies

11. Benefits of CCHCs • Reviewing health records • Helping to manage care of children with special health needs • Consulting with a child’s health care professional • Assisting with developmental screening • Interpreting standards/regulations

12. Effect of Child Care Health Consultation on Health Issues and Policies in 5 States 12

13. Effect of Child Care Health Consultation on Health Issues and Policies in 5 States 13

14. Effect of Child Care Health Consultation on Health Issues and Policies in 5 States • CCHCs have a positive impact on child care facility health policies and observable health issues. • CCHCs have a positive impact on children’s access to care. • Through training, monitoring and follow-up, CCHCs can improve child care providers’ diapering and food handling behaviors. 14

15. Impact of CCHCs • 2006 literature review found these positive outcomes: • Policy: Positive impact on standard-based health & safety policies • Practice: Effective in promoting specific health practices in child care programs • Regular Source of Care: Contributes to increased # of children with up-to-date immunizations & regular source of medical care • Specialty Consultation: Contributes in specialty areas including mental health, nutrition & physical activity, & oral health • Process of Consultation: Collaborative relationship between director and CCHC facilitates effective consultation

16. Child Care Health Advocates • A child care health advocate (CCHA) can help • implement the advice of a CCHC. • For centers, the CCHA can be • licensed/certified/credentialed as a… • Director • Lead teacher • Associate teacher • Health care professional, health educator, or social worker who works at the facility

17. Child Care Health Advocates • Responsibilities: • Policies • Day-to-day issues related to health • Does not need to perform health & safety tasks, • but should be the person to raise health & • safety concerns.

18. Finding a CCHC • Varies state-to-state: CCHCs may be… • Employed by public or non-profit agencies • State & local health department eg, Public health nursing department • Available at CCR&R • Available through referral at other health institutions eg, local AAP chapters; National Training Institute for Child Care Health Consultants • Independent • Parent of a child enrolled in child care program who is a health care professional capable of performing as a CCHC • Local pediatrician, nurse, or other health care professional

19. State CCHC Initiatives • 2006 report of 54 states & territories found: • 27 have established, ongoing initiatives • 10 are re-building former initiatives or beginning new ones • 12 are no longer active or reduced in capacity • 5 had no state-level initiative

20. Facilitators to Implementing CCHC Programs Linkages between community agencies and child care programs Strong commitment to the CCHC program by the lead agency Ample community health resources Good communication and personal relationships

21. Barriers • Lack of funding • Lack of available community health & safety resources • Lack of systems • Child care providers unfamiliar with CCHC or unable/unwilling to participate • Geographic barriers (access to resources for rural programs)

22. Pediatricians as CCHCs

23. What pediatricians have to offer: Expertise & knowledge in child health issues Resources Exchange of advice without regulation What programs can offer: An opportunity for community-pediatrics-in-action Medical referrals Children without medical homes Families seeking advice & assistance Pediatricians as CCHCs

24. Tips for Working With Child Care Programs • Establish practical guidelines • How should the program contact you? • Be familiar with licensing rules & regulations • Visit the program to meet staff. Remember that you are engaging with a “different culture” • Demonstrate an appreciation for the program’s challenges & strengths • Avoid becoming the “child care police”

25. Tips for Working With Child Care Programs • Create a trusting relationship • Listen carefully, ask questions, clarify • Recognize & respect each other’s knowledge, experience, and feelings • Show empathy and understanding of a program’s constraints • Understand that illnesses in child care may be treated differently than in the child’s home

26. Tips for Working With Child Care Programs • Make recommendations that… • Build on positive things already being done • Are cost-effective • Are easily implemented • Prioritize your concerns; avoid overwhelming • Promote, don’t interfere, with existing relationships between families & their medical homes • Give clear & simple advice • Pursue a long-term consulting relationship

27. Other Issues to Remember: • Consent and confidentiality • Liability • To limit liability, follow the most current AAP recommendations • Refer to your state licensing regulations for consultation guidelines

28. Don’t Have Time to Be a CCHC? • Pediatricians can still help advocate for CCHCs • Promote the use of CCHCs • Educate other pediatricians and health care professionals about CCHCs • CCHCs can be the liaison between the pediatrician and child care program • Help connect CCHCs with local professional chapters • eg, AAP, NAPNAP • Assist with training CCHCs • Provide resources to CCHCs

29. Resources

30. AAP Standards Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Ed • Primary reference for health & safety in child care! • 707 standards & recommendations • Developed by AAP/APHA • Includes rationale for why standards are important; based on evidence when possible • Full text is available at: http://nrckids.org/CFOC/index.html • Print copies from AAP, APHA, NAEYC: • http://tinyurl.aap.org/pub38873

31. AAP Standards Managing Infectious Diseases in Child Care and Schools:A Quick Reference Guide, 2nd Ed • Includes more than 50 quick reference fact sheets on common diseases and symptoms featuring: • Easy-to-understand explanations • Strategies for limiting spread of infection • Exclusion and readmission criteria • Guidance on which situations require immediate medical attention • http://tinyurl.aap.org/pub52359

32. AAP Standards Managing Chronic Health Needs in Child Care and Schools: Quick Reference Guide • Includes more than 35 quick-access fact sheets that describes specific conditions, like: • Also includes: • Care plans • Emergency planning recommendations • Ready-to-use sample letters & forms • Medication administration issues • http://tinyurl.aap.org/pub92742

33. Model Policies Model Child Care Health Policies • Over 60 Sample policies – examples: • Admissions policy • Evacuation procedure • Daily transportation to & from program • Pet policy • Food brought from home • Also: • Health & safety checklist • Injury report form • Available online at Healthy Child Care Pennsylvania • www.ecels-healthychildcarepa.org • Available in print from NAEYC

34. Pediatrician’s Role The Pediatrician’s Role in Promoting Health and Safety in Child Care • Resource guide designed to help pediatricians become more involved in child care issues • Provides suggestions on how to be involved at 3 different levels: • Level 1: Providing Guidance to Families on Child Care Issues • Level 2: Providing Health Consultation to Child Care Programs • Level 3: Advocating for Quality Child Care • http://tinyurl.aap.org/pub38947

35. Licensing and Regulations • Individual states’ child care licensure regulations: http://nrckids.org/STATES/states.htm • Sign up for the National Resource Center for the Health and Safety in Child Care and Early Education (NRC) listserv • Encourages health care professionals & other key leaders to share ideas/resources with each other • E-mail info@nrckids.org to be added to the NRC listserv

36. Training • National Training Institute for Child Care • Health Consultants (NTI) • Goal: To enhance the quality of out-of-home child care through CCHC • Trains trainers of CCHCs • 15 modules on child care related topics • Format: pre-training work, 4 days on-site followed by 13 weeks of distance learning

37. NTI Flowchart

38. Building Better Child Care Through Health Consultation • Video produced by NTI • Introduces the role of the CCHC • Hear the experiences of child care center directors, health consultants, and consultant trainers • http://nti.unc.edu/video

39. Become an NTI CCHC Trainer • For more information on how to become a CCHC trainer, or how to find a CCHC trainer in your area, contact NTI at: • Phone: 919/966-3780 • E-mail: nti@unc.edu • Web site: http://nti.unc.edu

40. www.healthychildcare.org • For additional resources, visit the Healthy Child Care America Web • site (a program of the American Academy of Pediatrics), which • includes: • Tips for engaging in a health consultation relationship • Reducing the Risk of SIDS in Child Care speaker’s kit • Medication administration curriculum for use by CCHCs • E-News • Searchable Resource Library • AAP Chapter Child Care Contacts • E-Mail: childcare@aap.org • Web site: www.healthychildcare.org • Phone: 888/227-5409

41. References • American Academy Of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd edition. Elk Grove Village, IL: American Academy of Pediatrics and Washington, DC: American Public Health Association; 2002 • Farrer J, Alkon A, To K. Child care health consultation programs: barriers and opportunities. Maternal and Child Health Journal. 2007;11(2):111-8 • Kotch, J. Infectious disease in out of home child care: the impact of child care health consultation. Chapel Hill, NC: National Training Institute for Child Care Health Consultants; 2008 • National Training Institute for Child Care Health Consultants. How to Choose and Use a Child Care Health Consultant. Available at: www.healthychildcare.org/pdf/HowtoChooseCCHC.pdf • Ramler M, Nakatsukasa-Ono W, Loe C, Harris K. The influence of child care health consultants in promoting children’s health and well-being: A report on selected resources. Newton, MA and Oakland, CA: Healthy Child Care Consultant Network Support Center. 2006 • United States. Maternal and Child Health Bureau. Child care health consultation initiatives: A status report. Newton, MA: Education Development Center, Healthy Child Care Consultant Network Support Center. 2006

42. Questions?