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Overview of Child Care Health Consultation. Name of Presenter. 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

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  • 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 & Safety in Child Care
  • Healthy 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
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
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
State Regulations
  • [If presenting in a particular state, provide the state’s regulations here]
what should a cchc know
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 know8
What Should a CCHC Know?


Injury prevention

Oral health

Nutrition and physical activity

Inclusion of children with special needs

Staff health

Environmental health

specialty consultation
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
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 cchcs11
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 cchcs
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
child care health advocates
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
child care health advocates17
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 cchc
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
state cchc initiatives
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
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

  • 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 cchcs23
What pediatricians have

to offer:

Expertise & knowledge in child health issues


Exchange of advice without regulation

What programs can


An opportunity for community-pediatrics-in-action

Medical referrals

Children without medical homes

Families seeking advice & assistance

Pediatricians as CCHCs
tips for working with child care programs
Tips for Working With Child Care Programs
  • Establish practical guidelines
    • How should the program contact you?
  • Be familiar with licensing rules & regulations
  • Visit the program to meet staff. Remember that you are engaging with a “different culture”
  • Demonstrate an appreciation for the program’s challenges & strengths
  • Avoid becoming the “child care police”
tips for working with child care programs25
Tips for Working With Child Care Programs
  • Create a trusting relationship
  • Listen carefully, ask questions, clarify
  • Recognize & respect each other’s knowledge, experience, and feelings
  • Show empathy and understanding of a program’s constraints
  • Understand that illnesses in child care may be treated differently than in the child’s home
tips for working with child care programs26
Tips for Working With Child Care Programs
  • Make recommendations that…
    • Build on positive things already being done
    • Are cost-effective
    • Are easily implemented
  • Prioritize your concerns; avoid overwhelming
  • Promote, don’t interfere, with existing relationships between families & their medical homes
  • Give clear & simple advice
  • Pursue a long-term consulting relationship
other issues to remember
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
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
aap standards
AAP Standards

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Ed

  • Primary reference for health & safety in child care!
  • 707 standards & recommendations
  • Developed by AAP/APHA
  • Includes rationale for why standards are important; based on evidence when possible
  • Full text is available at: http://nrckids.org/CFOC/index.html
  • Print copies from AAP, APHA, NAEYC:
  • http://tinyurl.aap.org/pub38873
aap standards31
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
aap standards32
AAP Standards

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

  • 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
  • http://tinyurl.aap.org/pub92742
model policies
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
pediatrician s role
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
licensing and regulations
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
  • 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
building better child care through 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
become an nti cchc trainer
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
  • 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: childcare@aap.org
  • Web site: www.healthychildcare.org
  • Phone: 888/227-5409
  • 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, 2nd 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