Advancing the health and safety of children in child care: national and state perspectives

1. Advancing the health and safety of children in child care: national and state perspectives National Smart Start conference Greensboro NC, May 2-5, 2011 Sandra Cianciolo RN BSN MPH Debra Garrett RN MPH CCHC Penn Gruehn PHRDH CCHC Patricia isbell PhD, MPH, MEd Jonathan Kotch MD MPH FAAP

2. Session Learning objectives • Participants will: • Understand national initiatives for healthy and safe child care supported by the US Maternal and Child Health Bureau. • Learn about North Carolina’s system of health consultation and its efforts to meet national goals to improve the quality of child care. • Recall the role of Child Care Health Consultants (CCHCs) in collaborating with others to prevent child maltreatment and reduce the risk of childhood obesity in child care. • List examples of the impact of CCHC in local communities.

3. national Perspective Sandra Cianciolo National Training Institute for Child Care Health Consultants

4. History • About 25 years ago, the US Department of Health and Human Services’ Maternal and Child Health Bureau noted an increase in the number of mothers of young children in the workforce. • Thus, enrollment of young children in early care and education settings steadily increased. • With increasing enrollment came increased exposure to respiratory and gastrointestinal illnesses and other risks. • State regulations of child care settings vary widely and do not ensure consistent minimum health and safety best practice. • In 1992, US DHHS supported efforts such as the creation of Caring For Our Children Health and Safety Performance Standards: Guidelines for Out-of Home Child Care Programs to promote health and safety.

5. History continued Since 1995, the US DHHS has supported efforts to disseminate CFOC and enhance early care and education through: 1. Healthy Child Care America Campaign (HCCA): • American Academy of Pediatrics’ Child Health Provider Partnership • The National Resource Center for Health and Safety in Child Care and Early Education • The National Training Institute for Child Care Health Consultants • Grants to states for building systems, creating partnerships and enhancing existing efforts • Grants to states for Early Childhood Comprehensive Systems building around 5 components: medical care/medical home, family support, parent education, early care and education, and social-emotional development of young children • Full or partial funding for technical assistance partners too numerous to name • Funds to create Early Childhood Advisory Councils with the goal of developing a strategic plan for early childhood in each state.

6. National Training Institute (NTI) • As one of 3 technical assistance partners of Healthy Child Care America, NTI has, since March 1999, • Created an evidenced based curriculum based on CFOC • Trained 462 instructors of CCHCs • Who have conducted over 250 State CCHC trainings and • In doing so, prepared over 4,800 CCHCs • Provides consultation to state CCHC leaders • Works with national partners to advance health and safety in early care and education settings

7. National Picture of CCHC training*

8. Reasons for not training CCHCs • Lack of funding and political support • ‘No demand’ • ‘Have enough CCHCs’ • Changes in program leadership • Shifting priorities • Reason not given

9. States with Future plans to train CCHCs • Alabama • Arkansas • Georgia • Idaho • Missouri • Nevada • New York • Ohio

10. States that currently train Cchcs

11. DEBBIE GARRETT • NORTH CAROLINA • STATE CHILD HEALTH • NURSE CONSULTANT

12. History of CCHC in North Carolina • 1980s: Registered Nurses hired by a few local health departments to work with “day care” programs. Focus on communicable disease and direct service to Child Care Programs. • Early 1990s: Additional RNs hired by local health departments. Focus on identification and treatment of disease. Direct service and education continue to be offered.

13. History of CCHC • 1995: Beginning of Healthy Child Care NC through NC DHHS, Division of Public Health • 1996: Pilot NC CCHC Training • NC Child Care Health & Safety Resource Center developed as a resource for CCHCs, other professionals working with child care, and parents. 1-800 CHOOSE 1 line operated through Resource Center. • Annual Healthy Child Care NC Educational Conference

14. History of CCHC Late 1990s-early 2000s • NC CCHC Training focused on consultation model. Most NC CCHC Programs offering consultation as opposed to direct service • UNC-CH School of Public Health takes responsibility for NC Health & Safety Resource Center and NC CCHC Training course • NC CCHC Training becomes combination of web based and face to face training

15. History of NC CCHC • Annual Healthy Child Care NC Educational Conference becomes Annual NC CCHC Educational Conference • Staff from NC Child Care Health & Safety Resource Center coordinate conference • NC CCHC training course offered as a Community Health Nursing course at two state universities.

16. HISTORY OF CCHC • NC CCHC Association developed. Membership is voluntary. • Sub-committees develop policies, mentor other CCHCs, recommend best practice, develop standardized care plans for chronic disease, promote CCHC as a profession. • NC CCHC Association takes responsibility for planning annual educational conference

17. Accomplishments of the North Carolina CCHC Association • Development of Professional Practice Statement and Code of Ethics. • Influence change at policy level by advocating for health and safety in ALL out-of-home care settings.

18. THANK YOU!!! • NC DHHS/NC Division of Public Health • Division of Child Development • North Carolina Partnership for Children/ Smart Start • And, all of our many community partners • … for supporting CCHC Programs throughout the state!

19. Questions?

20. Patricia IsbellA Child Maltreatment Prevention Project The University of North Carolina at Chapel Hill Gillings School of Global Public Health Department of Maternal and Child Health Funded by The Duke Endowment

21. Acknowledgements • Jonathan Kotch,Principal Investigator, Distinguished Professor, Department of Maternal and Child Health, Gillings School of Global Public HealthMary Piepenbring, Vice President, The Duke EndowmentBrenda Boberg, Executive Director, Family Support Network of Eastern North Carolina Lisa Woolard, Executive Director of the Beaufort/Hyde Partnership for Children Teresa LaRiche, Executive Director Family Support Network of the Crystal CoastTristan Bruner, Program Evaluator, Lenoir/Green Partnership for ChildrenBecki Brinson, Program Evaluator, Beaufort/Hyde Partnership for ChildrenAdib El Amin, Child Care Health Consultant, Lenoir/Greene Partnership for ChildrenHeather Carter, Child Care Health Consultant, Lenoir/Greene Partnership for ChildrenGlenda Pasko, Child Care Health Consultant, Beaufort Hyde Partnership for Children

22. Objectives • Participants will be able to: • list three components of an ecologic, community based model of child maltreatment prevention. • describe three characteristics of a child maltreatment prevention project that utilizes out-of-home child care settings for intervention. • describe the child maltreatment prevention role of a Child Care Health Consultant.

23. Guiding Principle • Change Requires: • Knowledge • Attitude • Behavior

24. background • Bronfenbrenner (1979) emphasized an approach that extends beyond interactions/involvement in immediate settings (microsystem) to larger contexts in which development occurs. • These contexts include: • the mesosystem, where microsystems such as home and school environments interact • the exosystem where social and community networks such as hospitals, neighborhood centers, churches interact • the macrosystem where larger social, cultural, and political norms exist

25. Model • The FFCC Project uses “prevention strategies involving a continuum of activities that address multiple levels of the model. These activities are developmentally appropriate and this approach is more likely to sustain prevention efforts over time than any single intervention” (CDC, 2007). 

26. Why out-of-home child care? • According to the US Census Bureau • 31% of America’s children under 5 years of age are cared for in organized child care settings including child care centers and family child care homes, preschools and Head Start Programs (Overturf Johnson, 2005). • Child care is uniquely suited as a venue for accessing a substantial minority of the community’s preschool children. • More parents and children consistently participate in child care centers than any other setting prior to school age.

27. Gutterman (1997) reported that “by screening participants and targeting services to only those in the highest-risk categories, interventions may screen out those who are most responsive to treatment”.

28. We didn’t…… • Go out and create new curricula • Go out and create new screening/assessment tools

29. We did…… • Put the concept of social ecology to work • Use a “new” professional, Child Care Health Consultant • Involve multiple local agencies and community individuals in the planning process • Utilize validated curricula

30. The Family Friendly Child Care Model Public Awareness Professional Papers Incredible Years Family Support Network CSEFEL Screenings, Intervention Local Advisory Board

31. 2005-2007 Child Maltreatment Numbers by County 1,168 Source: The Annie E. Casey Foundation, Kids Count 2010 Data 1,048 772 674 189 176 102 Beaufort CountyLenoir County

32. What are we measuring? • Child • Social Emotional Development • Challenging Behaviors • Family • Risk factors • Depression • Knowledge of Parenting • Child Care Center • Staff Depression • Staff Satisfaction • Classroom Environment

33. What are the Interventions? • Child • CSFEL trained staff • Referral to Medical Home with follow-up services as needed • Family • Parenting Pages • Incredible Years Classes • Family Support Network services • Out-of-Home Child Care Centers • Child Care Health Consultant services • CSEFEL trained programs • Monthly Feedback from the Event Sampling Form

34. Child informationtotal number of children in the study=484 56% male 44% female

35. What is CSEFEL? • The Center on the Social and Emotional Foundations of Early Learning-a national resource center funded by the Office of Head Start and the Child Care Bureau • Module 1-Promoting Children’s Success: Building Relationships and Creating Supportive Environments • Module 2-Social-Emotional Teaching Strategies • Module 3-Invividualized Intensive Interventions: Determining the Meaning of Challenging Behavior

36. What is the incredible years? • A Parent Education Package developed by Carolyn Webster-Stratton, • University of Washington • 14 weekly sessions with homework and trainer follow-up between sessions • Goals • To Reduce Conduct problems • To provide a cost-effective, community-based, universal prevention program designed to promote social competence and prevent maladapted behavior

37. Number of out-of-home child care programs child has ever participated in

38. Total Number of families who signed consent forms and filled out paperwork=484

39. Yearly family income

40. Caregiver level of education

41. Out-of-home child care staff • 100% of the staff in 28 Center-based facilities participated in the study. • 248 Staff completed study forms and participated in CSEFEL training. • 99% (245) are Female. • 1% (3) are Male. • Mean age of 36 with a range of 19-72 years.

42. Highest level of education

43. Staff satisfaction

44. Enough time to do the job

45. Linking it all together • Child Care Health Consultant • “a health professional who has an interest in and experiences with children, has knowledge of resources and regulations and is comfortable linking health resources with facilities that provide primarily education and social services” • Caring For Our Children, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, 2002, p32.

46. Early Childhood Dental Health Program Guildford County Department of Public Health PENN GRUEHN Guilford County Department of Public Health

47. NAP SACC Intervention: Changes in Nutrition and Physical Activity in Child Care Jonathan Kotch1, Abbey Alkon2, Angela Crowley3, Sara Benjamin Neelon4 1 University of North Carolina at Chapel Hill 2 University of California San Francisco 3 Yale University 4 Duke University

48. Acknowledgements • Impossible without Sarah Hartmann, Sherika Hill, Michelle Masson, Viet Nguyen, Roberta Rose, Eric Savage, Linda Shipman, Cynthia Wallace, Suzanne Weber, Pan Yi, and Lori Yu • Supported in part by Maternal and Child Health Bureau grant #R40MC08727 NAPSACC Intervention

49. Background • 31% of America’s children under 5 years of age are cared for in organized preschool settings (Johnson, 2002). • In the 2003-2004 NHANES, 26.2% of 2 to 5 year olds were either overweight or at risk for overweight (Ogden et al., 2006). • The Nutrition And Physical activity Self-Assessment in Child Care (NAPSACC) pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings (Benjamin et al., 2007). NAPSACC Intervention

50. Study Aim To evaluate the Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC) intervention conducted by nurse child care health consultants in child care centers in California (CA), Connecticut (CT), and North Carolina (NC) NAPSACC intervention