2006 AMCHP Conference

1. Workshop D-5 2006 AMCHP Conference Healthy Child Care America: Linking Health and Child Care Systems Workshop D5 AMCHP Conference 2006

2. Workshop D-5 Healthy Child Care America:Linking Health and Child Care Systems Phyllis Stubbs-Wynn, MD, MPH, Moderator Pat Cole, MPH Susan S. Aronson, MD, FAAP Sharon D. Ware, RN, EdD

3. Workshop D-5 Session Objectives: • Describe How Standards Improve the Quality of Child Care • Identify Ways to Link Children in Child Care to Medical Homes • Identify Components of a Statewide Consultant Network

4. Workshop D-5 Healthy Child Care America Campaign Shared Vision Child Care Bureau Maternal and Child Health Bureau

5. Workshop D-5 History of HCCA • Launched in 1995 (Child Care Health Forum and Blueprint for Action) • National Standards: Caring for Our Children (AAP/APHA) • National Resource Center • American Academy of Pediatrics • National Training Institute

6. Workshop D-5 Healthy Child Care America (HCCA) is… A collaborative program of health professionals, child care providers, and families working to improve the health and safety of children in child care. HCCA seeks to maximize the health, safety, well-being, and developmental potential of all children so that each child experiences quality child care within a nurturing environment and has a medical home.

7. Workshop D-5 Quality Assurance Through Standards Indiana’s State-of-Child Care Analysis Pat Cole, MPH Indiana Child Care Health Consultant Program Indiana Institute on Disability and Community Indiana University - Bloomington

8. Workshop D-5 Purpose of Research • Determine degree of inclusion of standards in Indiana’s licensure and registration requirements • Encourage discussion and action to increase the level of quality of child care in Indiana through use of the Standards

9. Workshop D-5 Challenges in Research Model • Identification of all regulation-related documents • Identification of all documents and State Statutes cited in the regulations, • Interpretation of language contained in regulations, • Discrepancy in terms

10. Workshop D-5 Empirical Study Components • Identification of all documents • Compilation of license documents • Orientation training attendance • Stepping Stones Review • Comparison • Findings Reports

11. Workshop D-5 Degrees of Significance • Scores reflect degree of agreement between National Standard and language of licensure/registration requirement. • 4 – Includes all criteria • 3 – Includes intent, plus elaboration • 2 - Includes intent, plus mention • 1 - Some mention, no elaboration • 0 – No Mention

12. Workshop D-5 Types of Reports Generated • 5 Areas outlined in National Health & Safety Performance Standards • 9 Topics outlined in National Health & Safety Performance Standards • Percentage of National Standards addressed by Indiana’s licensure or registration requirements (a rating of 3 or greater) • Findings across 3 types of settings

13. Workshop D-5 Comparison of Areas/Settings

14. Workshop D-5 Degree of Significance Reported • 60% - center requirements • 32% - child care home requirements • 20% - registered ministries requirements

15. Workshop D-5 Critical Factors Affecting Quality of Child Care Not Addressed • Limited scope of application of child care licensure and registration system • Extremely limited guidance for application of standards • Degree of enforcement of licensure/registration requirements

16. Workshop D-5 Dissemination of study • Mailing • Testimony • Press release • Website • PowerPoint • Conferences, workshops • Newsletters

17. Workshop D-5 Media response to study release • Television interviews • Radio interviews • Newspaper coverage

18. Workshop D-5 Results of study to date • Increased awareness of existence of National Health and Safety Standards • Inclusion of discussion of Standards in rules revision • Increase in number of Standards included at significant level in new regulations

19. Workshop D-5 Results (continued) • Heightened public awareness of Indiana’s child care regulations • Increased awareness of how regulations are promulgated • Increased number of provider requests for information about standards • Increased utilization of Standards by State Agencies organizations involved in Child Care Quality Initiatives

20. Workshop D-5 Website Address for Complete Study http://www.iidc.indiana.edu/ecc/ material/projects/comparison.pdf

21. Workshop D-5 Linking Children in Child Care with their Medical Homes Using An Online Tracking Tool Pennsylvania’s Early Childhood Education Linkage System Susan S. Aronson, MD, FAAP American Academy of Pediatrics

22. Workshop D-5 What is a Medical Home? An approach to providing health care Care that is: • Accessible (personally, geographically, $$) • Family-centered • Comprehensive (prevention and treatment) • Continuous (24-7; through all transitions) • Coordinated • Compassionate • Culturally-competent

23. Preventive Care - Today

24. Goals Shared by Educators and Health Professionals • Promote well-being • Prevent harm • Collaborate with • Families • Other sources of support for the child and family • Policy makers and advocates

25. Primary Reference Caring for Our Children, National Health and Safety Performance Standards for Out-of-Home Child Care, 2002

27. http://nrc.uchsc.edu

28. Pennsylvania Chapter - American Academy of Pediatrics

29. A program of the PA Chapter of the AAP

30. Health Measures in Child Care Programs

31. Ensure Preventive Health Care • Early education programs can be a safety net to ensure immunizations & screenings • Check documentation • Give families reminders

32. Educator’s Challenges • Complex Health Screening Schedule • Complex Immunization Schedule • New Vaccines/Combinations • Need Reminder – Recall Tools • Parent Resistance • Health Professional Performance Varies • State Requirements for Reporting

33. AAP Schedule for Preventive Care

34. 2006 Immunization Schedule

35. Healthy People 2010 • Achieve and maintain immunization • 90% 4:3:1:3:3:1 (19-35 mo.) • 95% 4:3:1:3:3:1 (19-35 mo.) Child care • Blood Lead – children age 1-6 yrs. • 0 % DTaP, IPV, MMR, Hib, HepB, Varicella

36. Individual Children in PA Child Care Centers 2002-03 • Immunizations – 72.5% received all recommended vaccines for age • Immunizations and Screenings – 25% up-to-date for preventive care

37. Go to Medical Home When educators inform families about gaps in preventive health care, more children receive recommended services

38. Child Care Tools to Ensure Preventive Care • Child Health Assessment (parent obtains from health provider) • Immunization Dose Counter • Internet-based software: www.WellCareTracker.org

39. WellCareTracker™ www.WellCareTracker.org

40. WellCareTracker™ • 8 years of statewide data trends • Web-based application at www.WellCareTracker.org • Accessible with any PC connected to the Internet • Password protected/private

41. Home Page • Demo • Letters • News • Links

45. Preventive Care - Tomorrow Well Care Community-based Outreach Child Care/Schools (e.g. WellCareTracker ™, Vaccine Registry) Medical Home Insurance QA incentives, VFC, case mgmt support

46. Summary • Strengthen links between early education/child care and medical homes • Improve the preventive care status of children • Achieve Healthy People 2010 objectives for children enrolled in early care and education programs

47. Infrastructure Building Through Health Consultation North Carolina’s Statewide Network Sharon D. Ware, RN, EdD

48. Strong linkages are built between health & early childhood/child care through a stable funding source

49. North Carolina’sSmart StartPartnership for Children Vision Every child in North Carolina will arrive at school healthy and prepared for success

50. Smart Start funds the majority of Health Related Activities in NC in Child Care Purpose: To improve health outcomes for children without supplanting existing funding Results: Funding the majority of Child Care Health Consultants