Overview of Child Care Health Consultation Name of Presenter

Overview of Child Care Health Consultation

Name of Presenter

Overview of Child Care Health ConsultationOverview of Child Care Health Consultation

www.healthychildcare.orgwww.healthychildcare.org

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



Health & Safety in Child Care• Health 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.



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



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



State Regulations

[If presenting in a particular state, provide the state’s regulations here]



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



What Should a CCHC Know?• Immunizations

• Injury prevention

• Oral health

• Nutrition and physical activity

• Inclusion of children with special needs

• Staff health

• Environmental health



Specialty Consultation

• Mental health (Early Childhood Mental Health Consultant)

• Nutrition & physical activity(Early Childhood Nutrition Consultant)

• Oral health(Early Childhood Oral Health Consultant)



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



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



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.




Impact of CCHCs2006 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



Child Care Health AdvocatesA child care health advocate (CCHA) can help implement the advice of a CCHC.

For centers, the CCHA can belicensed/certified/credentialed as a…• Director• Lead teacher• Associate teacher• Health care professional, health educator, or social

worker who works at the facility



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.



Finding a CCHCVaries 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



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



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



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)



Pediatricians as CCHCs



Pediatricians as CCHCsWhat pediatricians haveto offer:

• Expertise & knowledge in child health issues

• Resources• Exchange of advice

without regulation

What programs canoffer:

• An opportunity for community-pediatrics-in-action

• Medical referrals• Children without medical

homes• Families seeking advice &

assistance



Tips for Working With Child Care Programs

1. Establish practical guidelines• How should the program contact you?

2. Be familiar with licensing rules & regulations

3. Visit the program to meet staff. Remember that you are engaging with a “different culture”

4. Demonstrate an appreciation for the program’s challenges & strengths

5. Avoid becoming the “child care police”




6. Create a trusting relationship

7. Listen carefully, ask questions, clarify

8. Recognize & respect each other’s knowledge, experience, and feelings

9. Show empathy and understanding of a program’s constraints

10. Understand that illnesses in child care may be treated differently than in the child’s home




11. Make recommendations that…• Build on positive things already being done• Are cost-effective• Are easily implemented

12. Prioritize your concerns; avoid overwhelming

13. Promote, don’t interfere, with existing relationships between families & their medical homes

14. Give clear & simple advice

15. Pursue a long-term consulting relationship



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



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



Resources



• Primary reference for health & safety in child care!

• Developed by AAP/APHA/NRC

• Includes rationale for why standards are important; based on evidence when possible

• Full text is available at: http://www.nrckids.org/CFOC3/index.html

• Print copies from AAP, APHA, NAEYC: http://tinyurl.aap.org/pub38873

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs, 3rd Ed

AAP Standards



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

Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Ed

AAP Standards



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


Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide

AAP Standards

– Allergies

– Asthma

– Autism

– Diabetes

– Heart conditions & defects

– Seizures



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

Model Child Care Health Policies

Model Policies

• Available online at Healthy Child Care Pennsylvaniawww.ecels-healthychildcarepa.org

• Available in print from NAEYC



• 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


The Pediatrician’s Role in Promoting Health and Safety in Child Care

Pediatrician’s Role



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 [email protected] to be added to the NRC

listserv



TrainingNational 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



NTI Flowchart

NTI Train-the-Trainer Program:Develop expert-reviewed, rigorous curriculum

Evaluate curriculum materials and training methodsPresent training through distance learning and on-site visit

NTI Trainers:Graduates of NTI’s training program

Develop state/regional curriculum based on NTI curriculumTrain at least 10 CCHCs

Child Care Health Consultants:Trained by NTI Trainers

Provide consultation and other services to child care providers



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



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: [email protected]

Web site: http://nti.unc.edu



www.healthychildcare.orgFor 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: [email protected] site: www.healthychildcare.org Phone: 888/227-5409



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, 3rd 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



Questions?

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Overview of Child Care Health Consultation Name of Presenter