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Child Health and Development Institute of Connecticut, Inc.
PRESS RELEASE
Unannounced Inspection Reports
December 1, 2009
Contact: Angela Crowley
203-737-2548
[email protected]
New Study Raises Health and Safety Concerns in
Connecticut Early Care and Education Programs
Out-of-home child care is a necessity for many families, and,
for most parents, the health and
safety of the facility are critical considerations when
entrusting their child into the care of others.A recently completed
study by Dr. Angela A. Crowley, Associate Professor at the Yale
University
School of Nursing, and Dr. Marjorie S. Rosenthal, Associate
Research Scientist, Division of
General Pediatrics, and Assistant Director, Robert Wood Johnson
Clinical Scholars Program at the
Yale University School of Medicine, analyzed the results of
1,422 routine, unannounced, randominspections of two major types of
child day care facilities, conducted by Connecticut Department
of Public Health (DPH) licensing specialists. This work
represents the first comprehensive
analysis of health and safety compliance ever undertaken in
Connecticut. This study was madepossible by funding from the
Childrens Fund of Connecticut through its subsidiary, the Child
Health and Development Institute (CHDI) and the full cooperation
of the Connecticut Department
of Public Health (DPH).
CHDI will publish findings from the study on December 1, 2009 as
part of its IMPACT series that
covers a wide variety of childrens health topics. CHDI is also
sponsoring a forum on Ensuring
Health and Safety in Connecticuts Early Care and Education
Programs on December 8, 2009 atthe Legislative Office Building in
Hartford. In addition to an in-depth review of the study
results
by the authors, the program will feature prominent national
speakers including Shannon
Rudisill, Associate Director of the Child Care Bureau, US
Department of Health and Human
Services Administration for Children and Families, and Linda
Smith, Executive Director,National Association for Child Care
Resource & Referral Agencies (NACCRRA).
Connecticut has an extensive network of approximately 4,350
licensed child day care facilities
with the capacity to serve approximately 116,000 infants,
toddlers, and preschool age children. In
this study, the researchers examined data from unannounced
inspections of 676 child day carecenters (approximately 41% of
1,650 centers) and 746 family day care homes (approximately 28%
of 2,700 homes.) All facilities are required to meet the states
minimum licensing requirements
and are subject to periodic, routine, unannounced inspections by
licensing specialists.
mailto:[email protected]:[email protected]
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Inspections Uncover Urgent Health and Safety Concerns
Despite meeting - and often exceeding - the legislatively
imposed inspection mandates, and high
levels of compliance with numerous documentation, supervision
and educational regulations aswell as some health and safety
requirements, Connecticut DPH inspections revealed urgent
health
and safety concerns.
The nature of the health and safety risks documented in the
inspection reports ranged from highincidences where health or
safety minimums were not met (e.g. 48% of centers had
playground
hazards, 41% of centers that administered medications did not
have written approved orders from
a health care prescriber, and 43% of family day care homes did
not have current health forms forchildren from pediatric primary
care providers) to situations where the incidence of non-
compliance was low in relative terms, but the consequences of
non-compliance could be severe
(e.g. 12% of child day care centers did not have CPR certified
staff and 16% of family day carehomes were rated below minimum with
regard to poisonous substances accessible to children).
The study found a strong association between increased
compliance with regulations in child carecenters and continuing
education for the staff.
Inspection Process Needs Improvement
In addition to raising immediate health and safety concerns, the
study suggests that there is a needto examine the licensing
inspection process itself. Findings indicate that Connecticut has
strong
regulations but weak oversight. Out of 50 states, Connecticut
ranks in the lower deciles in terms
of the frequency of unannounced inspections to both child day
care centers and family day carehomes. Also, while many minimum
licensing requirements are clear, many are not, and there
appears to be no usage of commonly understood benchmarks for
evaluating the states aggregate
level of compliance performance. Moreover, processes for
collecting, aggregating, analyzing andfollowing up on compliance
data (e.g. re-inspections or closing a non-compliant center)
vary
widely. Regarding data aggregation and analysis, the very fact
that an outside resource
(Childrens Fund of Connecticut) was needed to fund an analysis
of inspection data suggests astrong desire on the part of DPH to
fulfill this portion of its early child care mission but a lack
ofresources to do so.
Study Recommendations Address Initial Program and Process
Improvements
The Reports four recommendations are confined to the immediate
health and safety concerns and
the longer term inspection process issues:
1. Program improvement encompassing wider dissemination of
health/safety information
and resources through DPH and other reliable sources should be
more widely disseminated
via licensing specialists, health consultants, child care
resource and referral, professional
organizations, family provider networks, and state and
professional organization websites.Availability of a best practice
medication administration training program for child
care providers and resources to support dissemination.
2. Licensing requirements and training of licensing specialists
that support more frequentunannounced visits as well as more
consistent guidelines, training and measurement
designed to enhance inter-rater consistency.
3. Electronic data system to facilitate collection, storage,
access and analysis of findings
on an on-going basis as well as an annual report to the
Legislature.
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Study findings suggest that elements of a solution may already
exist in the current system. The
regulation requiring health consultants in child day care
centers is in place. However, it needsadequate budget support to
fulfill its original child day care center mandate, and there
appear to be
significant benefits to expanding this regulation further to
include family day care homes.
Findings Also Raise Childrens Health Policy Issues
Analysis of DPH inspection data also raises more fundamental
issues concerning the current state
of child care and child health in Connecticut. First, raw
inspection data indicated startling but
consistent utilization variances (aggregate actual attendance
ranged from 39% to 60% of capacitydepending on the facility type)
that beg the question regarding their cause. If out-of-home
child
care is a universal need and child care capacity is distributed
rationally across the state, is there
something about the system that is causing lack of attendance,
consistently high rates ofabsenteeism, or voluntary choice by
providers to enroll fewer children? Second, analysis of
positive (e.g. continuing education, trained health consultants)
and negative associations (e.g.
state-funded, facility located in area with low median income)
between compliance performanceand certain child care program
characteristics suggests that there may be systemic disparities in
the
compliance with regulations and therefore the quality of child
day care facilities across the state.
Finally, given that family day care homes disproportionately
serve lower income children, theinability of family day care homes
to access health consultants may be exacerbating disparities in
compliance and in low income families access to the larger
health care system. These and otherfindings take the report beyond
immediate program improvement and practice prescriptions into
the broader realm of childrens health and safety policy.
The IMPACT report will be available on the CHDI website at
www.chdi.org as of December 1.
For additional information and/or a copy of the full report of
the study results, please contact:
Angela A. Crowley, PhD. APRN, PNP, FAAN at
[email protected] or
Marjorie S. Rosenthal, MD, MPH, FAAP at
[email protected]
Details on the upcoming CHDI Forum may be obtained at
www.chdi.org.
The Child Health and Development Institute of Connecticut (CHDI)
is the operating arm of the Childrens Fund ofConnecticut (CFC) a
public, charitable foundation focused on developing comprehensive,
effective, community-based
health and mental health care systems for children and their
families. Based in Farmington, CHDI works to advance
policy, systems, program and practice changes that will result
in better health and developmental outcomes for the
children of Connecticut.
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