Health and safety needs in early care and education programs: what do directors, child health records, and national standards tell us?

OBJECTIVE: To identify the overlapping and unique health and safety needs and concerns identified by early care and education (ECE) directors, health records, and observed compliance with national health and safety (NHS) standards. DESIGN AND SAMPLE: Cross-sectional study. 127 ECE programs from 5 California counties participated in the study, including 118 directors and 2,498 children's health records. MEASURES: Qualitative data were collected using standardized ECE directors' interviews to identify their health and safety concerns; and objective, quantitative data were collected using child health record reviews to assess regular health care, immunizations, health insurance, special health care needs, and screening tests and an observation Checklist of 66 key NHS standards collected by research assistants. RESULTS: The overlapping health and safety needs and concerns identified by the directors and through observations were hygiene and handwashing, sanitation and disinfection, supervision, and the safety of indoor and outdoor equipment. Some of the health and safety needs identified by only one assessment method were health and safety staff training, medical plans for children with special health care needs and follow-up on positive screening tests. CONCLUSIONS: Comprehensive, multimethod assessments are useful to identify health and safety needs and develop public health nursing interventions for ECE programs.

Child care health consultation improves health and safety policies and practices.

OBJECTIVE: To evaluate the effects of county-level child care health consultation intervention programs on child care centers' health and safety policies and practices. METHODS: A 3-year experimental study was conducted in 5 California counties and 111 licensed child care centers (73 intervention, 38 comparison) participated at the baseline and postintervention times. Trained research assistants conducted objective observations with a Policies Checklist and Health and Safety Checklist, which were composed of key national health and safety standards. RESULTS: At baseline, both groups were not significantly different on the Policies Checklist and the Health and Safety Checklist. At the post-intervention time, intervention centers had significantly more and higher-quality written health and safety policies on 9 of the 10 policies rated (medication administration, care of mildly ill children, exclusion of ill children, cleaning and sanitizing, handwashing, daily health checks, inclusion of children with special needs, emergency preparedness, staff health) than comparison centers. At the postintervention time, intervention centers improved their health and safety practices in the areas of emergency preparedness and handwashing, controlling for consultation model, time in study, and director turnover. Both groups improved their indoor and outdoor facilities and overall Health and Safety Checklist means. CONCLUSIONS: Child care health consultation programs can improve the written health and safety policies and may improve practices in child care centers.

Assessing health and safety in early care and education programs: development of the CCHP health and safety checklist.

INTRODUCTION: To assess health and safety in early care and education (ECE) programs, an objective, standardized instrument was developed based on the recommended national health and safety standards. METHOD: The California Childcare Health Program Health and Safety Checklist was developed by conducting a literature review, identifying a gold standard, revising and updating the original Checklist, consulting with an advisory group, and pilot testing the Checklist. The Checklist included 66 items grouped into 10 subscales, and each item was rated on a three-point scale: meeting, partially meeting, or not meeting national standards. Face, content, and construct validity along with measures of reliability, inter-rater reliability, and internal consistency were established. RESULTS: The Checklist was completed in 127 ECE centers. The highest subscale score was for emergency preparedness and the lowest was for handwashing routines and equipment maintenance. Cronbach's alpha subscale scores ranged from moderate to strong (0.27 to 0.70). DISCUSSION: The Checklist provides valid and reliable information to assess adherence to key national health and safety standards and objective data to develop intervention programs to improve health and safety in ECE programs.

Child care health consultation programs in California: models, services, and facilitators.

OBJECTIVE: To summarize findings from a descriptive evaluation study of 20 county-level child care health consultation programs, services provided, and factors that facilitated the development of the programs. DESIGN: A 3-year intervention study of 20 county-level child care health consultation programs, selected through a competitive review process, was conducted in California. SAMPLE: Study participants were the child care health consultation program staff, lead agency administrators and health consultants, and early care and education (ECE) staff, including health advocates and directors. MEASUREMENT AND INTERVENTION: Data collection included focus groups, interviews, consultant activity logs, and surveys. Health consultation intervention services included health and safety assessments, on-site consultation, and workshops for ECE providers and parents. RESULTS: 4 child care health consultation models were established based on the type of administrative agency. Health consultants and advocates primarily provided on-site consultation and education and training on child health promotion issues. Consultation programs were facilitated by the linkages formed among agencies, community characteristics, personal relationships, lead agency support, and consultant training and knowledge. CONCLUSIONS: Child care health consultation programs can address the health and safety needs for ECE programs, but they need administrative support, trained staff, and sustainable relationships with local ECE programs.