Overview of Child Care
Health Consultation
Name of Presenter
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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.
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
State Regulations
[If presenting in a particular state, provide
the state’s regulations here]
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
What Should a CCHC Know?
• Immunizations
• Injury prevention
• Oral health
• Nutrition and physical activity
• Inclusion of children with special needs
• Staff health
• Environmental health
www.healthychildcare.org
Overview of Child Care Health Consultation
Specialty Consultation
• Mental health
(Early Childhood Mental Health Consultant)
• Nutrition & physical activity
(Early Childhood Nutrition Consultant)
• Oral health
(Early Childhood Oral Health Consultant)
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
Effect of Child Care Health Consultation
on Health Issues and Policies in 5 States
NTI
Evaluation Summary
Means of Issues and Policies by Time Period
n=23
3
2.63
2.51
2.5
2.28
2.44
2.31
2.58
2.40
2.38
2.09
Response Value
2
1.87
1.51
1.5
1.02
1
0.5
0
Health Policies
Sanitation Issues
Safe/Active Play
Issues
www.healthychildcare.org
Em ergency
Preparedness
Issues
Nutrition Issues
SID Issues
Overview of Child Care Health Consultation
Effect of Child Care Health Consultation
on Health Issues and Policies in 5 States
www.healthychildcare.org
Overview of Child Care Health Consultation
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.
www.healthychildcare.org
Overview of Child Care Health Consultation
Impact of CCHCs
2006 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
www.healthychildcare.org
Overview of Child Care Health Consultation
Child Care Health Advocates
A child care health advocate (CCHA) can help
implement the advice of a CCHC.
For centers, the CCHA can be
licensed/certified/credentialed as a…
•
•
•
•
Director
Lead teacher
Associate teacher
Health care professional, health educator, or social
worker who works at the facility
www.healthychildcare.org
Overview of Child Care Health Consultation
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.
www.healthychildcare.org
Overview of Child Care Health Consultation
Finding a CCHC
Varies 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
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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)
www.healthychildcare.org
Overview of Child Care Health Consultation
Pediatricians as CCHCs
www.healthychildcare.org
Overview of Child Care Health Consultation
Pediatricians as CCHCs
What pediatricians have
to offer:
What programs can
offer:
• Expertise & knowledge in
child health issues
• Resources
• Exchange of advice
without regulation
• An opportunity for
community-pediatrics-inaction
• Medical referrals
• Children without medical
homes
• Families seeking advice &
assistance
www.healthychildcare.org
Overview of Child Care Health Consultation
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”
www.healthychildcare.org
Overview of Child Care Health Consultation
Tips for Working With Child Care Programs
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
www.healthychildcare.org
Overview of Child Care Health Consultation
Tips for Working With Child Care Programs
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
Resources
www.healthychildcare.org
Overview of Child Care Health Consultation
AAP Standards
Caring for Our Children: National Health and Safety Performance
Standards: Guidelines for Early Care and Education Programs, 3rd Ed
• 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
www.healthychildcare.org
Overview of Child Care Health Consultation
AAP Standards
Managing Infectious Diseases in Child Care and Schools:
A Quick Reference Guide, 2nd Ed
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
www.healthychildcare.org
Overview of Child Care Health Consultation
AAP Standards
Managing Chronic Health Needs in Child Care and
Schools: A Quick Reference Guide
Includes more than 35 quick-access fact sheets
that describes specific conditions, like:
– Allergies
– Asthma
– Autism
– Diabetes
– Heart conditions & defects
– Seizures
Also includes:
–
–
–
–
Care plans
Emergency planning recommendations
Ready-to-use sample letters & forms
Medication administration issues
http://tinyurl.aap.org/pub92742
www.healthychildcare.org
Overview of Child Care Health Consultation
Model Policies
Model Child Care Health Policies
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
• Available online at Healthy Child Care Pennsylvania
www.ecels-healthychildcarepa.org
• Available in print from NAEYC
www.healthychildcare.org
Overview of Child Care Health Consultation
Pediatrician’s Role
The Pediatrician’s Role in Promoting Health and Safety in
Child Care
• 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
http://tinyurl.aap.org/pub38947
www.healthychildcare.org
Overview of Child Care Health Consultation
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 info@nrckids.org to be added to the NRC
listserv
www.healthychildcare.org
Overview of Child Care Health Consultation
Training
National 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
www.healthychildcare.org
Overview of Child Care Health Consultation
NTI Flowchart
NTI Train-the-Trainer Program:
Develop expert-reviewed, rigorous curriculum
Evaluate curriculum materials and training methods
Present training through distance learning and on-site visit
NTI Trainers:
Graduates of NTI’s training program
Develop state/regional curriculum based on NTI curriculum
Train at least 10 CCHCs
Child Care Health Consultants:
Trained by NTI Trainers
Provide consultation and other services to child care providers
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
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: nti@unc.edu
Web site: http://nti.unc.edu
www.healthychildcare.org
Overview of Child Care Health Consultation
www.healthychildcare.org
For 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:
Web site:
Phone:
childcare@aap.org
www.healthychildcare.org
888/227-5409
www.healthychildcare.org
Overview of Child Care Health Consultation
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
www.healthychildcare.org
Overview of Child Care Health Consultation
Questions?
www.healthychildcare.org