Child Care Health Program
3020 Rucker Avenue, Suite 206
Everett, WA 98201-3900
425.252.5580 Fax: 425.339.5255
www.snohd.org
C
Child Care Health Consultation:
Evidence Based Effectiveness
Washington State Evidence-Based Data
Child care health consultation is a relatively new field of work. Nevertheless, longitudinal evidence is mounting to
demonstrate that child care health consultation is an effective means to improve early childhood environments and the
health of children in those settings. For many years, a highly competent network of child care health consultants has
effectively provided health and safety consultations for Washington State child care providers. Many of those
consultants, funded by Healthy Child Care Washington, gave input to the subjective results of their interventions into a
statewide database. Interventions include consultations, assessments, training, provider education, and investigations.
The following graph demonstrates longitudinal data reflecting significant changes in child care environments as a direct
result of child care health consultation work over a period of time ranging from October 2003 until March of 2007.
Table 1. Washington State Evidence of Improvement
Data from:
“Healthy Child
Care Washington
Evaluation
Report”, prepared
for the Washington
State Department of
Health by
Organizational
Research Services
and Geo Education
& Research, Seattle,
Washington.
The four areas of the greatest change in child care practices are listed in the Table 1 as provider knowledge,
behavior changes, policy changes and environmental changes. Examples of these changes include:
Provider knowledge –increased ability to recognize signs of abuse and neglect and when to report to CPS; safe food
handling practices are better understood and applied; child care providers recognize a child may have special needs
and makes recommended referrals to parent
Behavior change – improved handwashing and sanitizing practices used by children and staff; ill children are excluded
as needed; child care providers use car and booster seats when transporting children as required
Policy change – organized physical fitness program is incorporated into daily child care routines; an Individual Care
Plan for children with life-threatening allergies required
Environmental change – safety improvements are made on playground equipment to prevent injuries; children wear
helmets when using wheeled toys such as bikes
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Child Care Health Consultation is Population Based
Child care environments present incredible opportunities to improve health outcomes for large numbers of children at a
time, the primary goal for population based public health. The Snohomish Health District’s Child Care Health Program
(CCHP) uses the equivalent of 5.7 full time staff to affect positive health and safety behavior change to approximately
1,000 Snohomish County child care providers. These providers in turn apply their positive health and safety behaviors
daily as they care for about 21,000 of our county’s most vulnerable populations, children from 0-8 years of age.
Snohomish County Evidence-Based Data
CCHP evaluation demonstrates comparable results as those shown in the evidenced-based longitudinal studies of
Healthy Child Care Washington (of which the Child Care Health Program participated). From October 1999 until
March 2001, child cares in Snohomish County were enrolled in a demonstration project to determine the effectiveness
of health consultation activities. A comprehensive assessment tool was used at the beginning and again at the end of
the project, with monthly health consultations provided on various topics between the beginning and ending
assessments. Data from this project demonstrated that 94% of participating child cares showed improvement in health
and safety practices and in the child care environment following CCHP health consultation interactions. The greatest
improvement noted in child care provider practices as a result of working with CCHP staff occurred in sanitation,
followed by playground safety. Child care providers also improved markedly in the areas of health and illness,
medication management, and emergency preparedness.
Table 2. Snohomish County Evidence of Improvement
94% of participating
child cares showed
improvement in health
and safety practices
and the child care
environment following
health consultation
visits.
CCHP provides evidencebased public health
services to large groups of
children.
These services improve
the overall quality of
care, reduce illness, and
increase school readiness
for Snohomish County
children.
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National Evidence-Based Data
The following is a sample of national studies available that provide evidence that child care health consultation is
effective in creating positive health and safety change in child care environments:
(Longitudinal Data)
“Evaluation of the Child Care Health Consultation
Demonstration Program: Phase IV Final Report”,
Prepared for Oregon Department of Human Services Office
of Family Health, Portland, Oregon, prepared by Pacific
Research and Evaluation, LLC, November 2007.
Oregon Child Care Health Consultants provide on-site
consultations and assessments over a period of four
resulting in longitudinal data. Child care records and
policies were reviewed and assistance was provided.
Documented health and safety improvements ranged from
2% - 60% in the areas of health exclusions, handwashing,
emergency plans, and guidance and behavior.
27% ↑ of infant feeding safety practices
24% ↓ in infants with soft bedding
28% ↑ in safe chemical storage
40% ↑ in proper medication documentation
41% ↑ in care plans for children with special needs
38% ↑ in sanitizing food prep areas
30% ↑ in back-to-sleep SIDS prevention practices
Cole, PS. 2008, “Child Care Health Consultation
Improves Health and Safety Practices and Environments
in Early Education Settings”, Indiana Institute on
Disability and Community.
Moon R and Oden R. “Back to Sleep: Can We Influence
Child Care Providers.” PEDIATRICS, 2005, 112(4): 878882.
Carabin et al. 1999.“Effectiveness of a Training Program
in Reducing Infections in Toddlers Attending Day Care
Centers”. Epidemiology 10:3 219-227.
25% ↓ in upper respiratory tract infections
37% ↓ in diarrheal illnesses
17% ↓ in respiratory infections
Roberts, Smith, Jorm, Patel, Douglas, and McGilchrist,
“Effect of Infection Control Measures on the Frequency
of Upper Respiratory Infection in Child Care: A
Randomized, Controlled Study”, PEDIATRICS Vol. 105
No. 4 April 2000, pp. 738-742.
Roberts, Smith, Jorm, Patel, Douglas, and McGilchrist,
“Effect of Infection Control Measures on the Frequency
of Diarrheal Episodes in Child Care: A Randomized,
Controlled Study”, PEDIATRICS Vol. 105 No. 4 April
2000, pp. 743-746.
Alkon and Bernzweig 2008, “Child Care Health Linkages
Project Evaluation Summary” & “Child Care Health
Consultation Programs in California: Models, Services,
and Facilitators”, Public Health Nursing 25:2, 126-139.
66% ↓ in diarrheal episodes
15% ↑ in infants and toddlers with up-to-date
immunizations
6.4% ↑ in preschool aged children with up-to-date
immunizations
Conclusion
Due to the reporting efforts of Healthy Child Care Washington and the Oregon Department of Human Services
longitudinal data demonstrating the effectiveness of child care health consultation exists and is readily available.
CCHP has also demonstrated its effectiveness. National data also exists on the effectiveness of child care health
consultation in child care environments as noted above. Child care health consultation is a population and evidence
based public health service that is essential for healthy communities and families.
Child care environments serve as ideal settings to teach children about healthy behaviors that will help them lead
healthier lives. Examples include healthy eating behaviors, preventing obesity, physical activity, handwashing, and
how to prevent injuries. The positive impact of child care health consultation with children, child care providers, and
families is significant. Not only is child care health consultation evidence and population based, it is also a significant
avenue to promote a vast array of public health messages and behaviors.
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