Angela Moore, MPH Public Health Prevention Specialist

1. Impact of Healthy Child Care ETC on Public Health and Early Childhood Angela Moore, MPH Public Health Prevention Specialist

2. Overview • Child Care Health Consultation in the US • Child Care Health Consultation in GA • NWGA Healthy Child Care ETC Model • Preliminary Results • Next Steps

3. Why Do We Need Child Care Health Consultation? • Marked increase in working mothers with small children has increased the demand for out-of-home care • Out-of-home child care centers increases the likelihood of: • Exposure to communicable disease • Unsafe physical environments • Inadequate nutrition and physical activity practices

4. Collaborative Efforts • Healthy Child Care America • National Training Institute for Child Care Consultants • Early Childhood Comprehensive System

5. Mandated Health Consultant Requirements in State Licensing Regulations Consultation Program Regulations in the US

6. Mandated health consultant requirements – November 2005

7. Mandated health consultant requirements – November 2005

8. Mandated health consultant requirements – November 2005

9. Mandated health consultant requirements – November 2005

10. Mandated health consultant requirements – November 2005

11. NAEYC Standard 5.A.02 • The program has and implements a written agreement with a health consultant who is either a licensed pediatric health professional or a health professional with specific training in health consultation for early childhood programs.

12. NAEYC Standard 5.A.02 • The health consultant visits at least two times a year and as needed. Where infants and toddlers/twos are in care, the health consultant visits the program at least four times a year and as needed. • The health consultant observes program practices and reviews and makes recommendations about the program's practices and written health policies to ensure health promotion and prevention of infection and injury. The consultation addresses physical, social-emotional, nutritional, and oral health, including the care and exclusion of ill children. • Unless the program participates in the United States Department of Agriculture's Child and Adult Care Food Program, at least two times a year a registered dietitian or pediatric public health nutritionist evaluates the menus for nutritional content; portion sizes; nationally recommended limits on juice, sugar, sodium, and saturated fats; food service operations; special feeding needs to be met by the program; and procedures used for food brought from home. • The program documents compliance and implements corrections according to the recommendations of the consultant (or consultants).

13. Public Health in NWGA • Child Advantage Network-CAN • NWGA and CAN partnership • Training • Pilot test • Birth of Healthy Child Care ETC

14. Healthy Child Care ETC Model • Business Model Traits • Driven by regional office • Local infrastructure • Program development is driven by community needs • Sustained by revenue it generates: combination of grants and contracts • Evaluation is utilization focused and framework is developed by key stakeholders

15. Healthy Child Care ETC Model • Program Operations • Infrastructure • Service provisions • Workforce Development • Child Care Health Consultant Trainers • Child Care Health Consultants • Marketing • Social Marketing • Healthy Child Care ETC Marketing • Evaluation

16. Program Operations • District office provides technical assistance to counties • Marketing, contract negotiation, and consultation services are carried out by county health department

17. Organization Chart District Program Manager Nurse Managers Assistant Nursing Director Nursing Director Child Health Coordinator Child Care Health Consultants

18. Workforce Development • Nurse Managers select public health nurses to be trained and certified. • District staff provides training, technical assistance, and program guidance. • District reviews health consultant staff numbers, and plans additional training opportunities based on staff numbers.

19. Marketing • Two tier • Social marketing to child care providers and community stakeholders. • Business marketing to promote Healthy Child Care ETC. • Implementation plan • County oriented • District assists with marketing via regional conferences and program updates to the GA Division of Public Health and Bright From the Start.

20. Evaluation • Utilization focused • Developed during the initial stages of program planning • Goals • Did we do what we said we going to do? • Did we do it right? • What happened?

22. Program Implementation • Developed curricula • Developed marketing materials • Provided training • Partnership building • Kids Station • Quality Care for Children • Update provided to nurse managers • CCHCs actively seeking contracts

23. Healthy Child Care ETC Curricula • 6 Modules • Lions, Tigers, and ECERS-R Oh My! • Policy Development • Evaluation through Caring for Our Children and Stepping Stones • Aiding Center Staff- Health Risk Assessments • Community Resources • Progress Tracking • Marketing • Contract Negotiation • Documentation- Tracking and Reporting

24. Healthy Child Care ETC Curricula • Handbook • Quick Reference Guide • General Policies and Standards • Process Guide • Tracking and Reporting Guidelines • Data Collection Tools • Training Activities • Practicuum • Program Updates

25. Lending a Helping Hand • Social Marketing Campaign • Social marketing campaign booklet • Community awareness powerpoint • CD-ROM, posters, brochures, tent cards

26. Lending a Helping Hand • Child care centers are empowered through consultation to make changes in their programs. • Consultants will assist centers in a variety of ways that will help the center make the necessary modifications to become healthier and safer environments. • Consultants are available to help center directors to focus on issues and will work as an extra set of eyes when evaluating key program components.

27. Healthy Child Care ETC Marketing • Mass mail out to local centers • Web page • Presentations at task force meetings and community collaboratives • Participation in early childhood education conferences • Onsite visits

28. Development of Specialized Workforce • 2 CCHC NTI trainers • 80% of NWGA counties participating • Workforce • Newly certified CCHCs- 2 • Renewed certification- 11 • One active consultant in participating county with secured contracts

29. Partnership building efforts • Kids Station: The Inside Man • Established a MOU • Kids Station is a training center, help implement marketing strategies, and provides input • Healthy Child Care ETC provides Kids Station with consultation free of charge • Quality Care for Children • Work together to target child care centers who need resources • Market services

30. Program Challenges • Child care provider awareness • Fee for service • Dual roles of CCHCs • Strained partnership

31. Combating Challenges • Increase provider awareness • Better implementation of social marketing campaign • Kids Station becomes an advocate • Community outreach • Service affordability • Modification in negotiation strategies • Incentives are offered

32. Combating Challenges • Reduce workload • Increase workforce • CCHCs working in teams • Strengthening relationships • Steering committee • Open communication

33. Impact on Public Health • Relinquish power • Make new friends and keep the old • Adopt business practices • Customer driven services • Strong marketing • Entice instead of invite

34. How did we do? • Overall experience of having a CCHC available • CCHC relationship with center director • Usefulness of the service • Worth the time and effort • Recommend this service

35. Impact on Early Childhood • Increased compliance of common health and safety practices by child care providers • Gold standard care in contracting child care centers

36. Consultation at Kids Station • Initial ITERS/ECERS assessment • Overall scores were good (ITERS-5.71, ECERS- 5.50) • Unveiled some weaknesses • Cultural diversity • Lack of art, math, and science centers • Handwashing • Recommendations • Establish art, math, and science centers • Increase number of books • Educate staff on proper handwashing procedures • Build cultural diversity into curricula

37. Consultation at Kids Station • Staff health risk assessment • % of staff completed assessment • Health issues to be addressed: physical activity and nutrition • Health records review • Immunizations records were reviewed prior to state audit

38. Consultation at Kids Station • Policy review • Focus areas: admission and readmission after illness, health evaluation of child, management of communicable disease, surveillance of illness/injury, caregiver training, nutrition/oral health, CSN, emergency plans, playground safety, staff health, medication administration • Recommendations: revise illness policy to include guidelines for excluding unimmunized children in the event of an outbreak, revise surveillance of illness policy to include guidelines for notifying parents of outbreak and staff reporting of like symptoms in groups of children, and make revisions in safety policies

39. Results • Immunization state audit results: >90% compliance • Kids Station is modifying employee and parent handbooks based on policy recommendations • Action plan focused on handwashing and cultural diversity issues as outlined in ITERS/ECERS • Completed staff education on handwashing • Purchased culturally diverse items (books and music) • Teachers add cultural diversity into curricula

40. Results • Kids Stations underwent center of excellence audit without any technical assistance from Bright from the Start • Kids Station received Center of Recognition

41. Next Steps • Program update • Nurse managers • CCHCs • Strategic plan • Training for new class of CCHCs • Development of CHASE • Pandemic Flu curricula • Actively seeking contracts

42. Acknowledgements • Cathy Wiley, Child Health Coordinator • Gayle Brannon, Nursing Director • Margaret Bean, Program Manager

43. Thank you Any Questions