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How to Start Day Care Business in Ct

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					Update on Infant and Toddler
Policy Issues

            Keynote Speakers:
          Joan Lombardi, Ph.D.
      Founder, Better Baby Care Campaign
                  &
       Susan Aronson, MD, FAAP
          Clinical Professor of Pediatrics
      The Children’s Hospital of Philadelphia

            November 8th, 2005
Towards
   Better Care
       for Babies……..


Joan Lombardi, Ph.D.
Founder, Better Baby Care Campaign
Babies and toddlers today…
    4 million babies born each year
    12 million infants and toddlers in the
     United States
    More than 2 million infants and toddlers live in
    poverty
    Almost 40 percent of the babies and toddlers in
    the U.S live in or near poverty
    Infants are the fastest growing group in foster
    care
             Increasing number of infants and toddlers are
             in non parental care on a regular basis
             90
                                                         82.3
             80
             70                          69.2
                                 57.8
Percentage




             60
                          52.3
             50
                  42.7
             40
             30
             20
             10
              0
                   0       1      2        3              4
                                 Age     Source:NIEER: based on National
                                         Center for Education Statistics,
                                         (2001)National Household Education
                                         Survey of 1999 Data Files.
                Primary Child Care Arrangements of
               Children Younger than 3 with Working
                    Mothers by Income^ (2002)
                 L o w-Inc ome                                                                   38% *
                 H ighe r -Inc ome                                                                      32%
                                                                           32% *

                                                                                  26%

                  21%
        16% *                           1 5%
                               11 % *
                                                             7%
                                                     3% *


       C en te r-b ased      F a m ily C h ild    N an n y/B aby-          R e lative        P are n t/O th e r
            C are                 C are               sitte r
^Low-income is defined as below 200 percent of the poverty threshold and higher-income as 200 percent or above.
*Estimate for low-income children is significantly different from estimate for higher-income children.
Source: Urban Institute calculations from the National Survey of America’s Families.
                   Ready to Succeed:
            Early Childhood Development 0-3

    Goals
                                                         Children of
Healthy children                                Early




                                         ds
                                                         Families in Poverty
Strong families




                                    nee
Early Learning                                Head Start (Working or Home)



                                   ial
                                  pec
                                hs
                           wit
                                                                 Children of
                                              Quality
                           en

                                                                 Working Families
                        ldr



                                          Child Care
                    chi
                   or
                    f
               orts
            pp




                                 Health Care and Family
           Su




                                                                           All Children
                                        Support
                             Ready to Succeed:
                            Prenatal to Age Three
Level I- Universal Access to:
  Prenatal care
  Health insurance
  Medical home
  Developmental screening and follow-up
  Paid family leave for up to one year
  Parenting resources and support

Level II- Working Family Access to Quality Child Care
  Trained and credentialed providers
  Infant Toddler Specialists in Every Community
  Family Child Care Networks
  Outreach to Family, Friends and Neighbor Providers
  Linkages to health, mental health and early intervention

Level III- Families in Poverty Access to Early Head Start
  Comprehensive services (health, education, family support, special needs services)
   through center based, home based or combination programs
                    Infants and
                  Toddlers Need…
   A strong nurturing family
   A clearly identified medical home with up-to-date
    primary care
   Health insurance and access to information on health
    resources, including services special needs children
   Access to paid family and medical leave for the first
    year of a baby’s life
   Access to parent education and family support
   Access to early intervention services
   Access to quality, affordable care
   A stable and permanent home and access to
    specialized services where needed
Health and Safety in Early
Education and Child Care
What You Need to Know and
Do

  Susan S. Aronson, MD, FAAP
  Clinical Professor of Pediatrics
  The Children’s Hospital of Philadelphia
  Audio conference - November 8, 2005
Objectives
List/Describe/Use
 Health & Safety Issues for Infant/Toddler
  Early Education & Child Care
 Three-way Communication of Families,
  Educators and Health Professionals
 Role of Health Consultants

 Helpful References and Tools
All Children are in Child Care
“All children are in some form of child care,
  including those who remain at home with a
  parent. Even at home, there may be
  questions about safe environments,
  developmental instruction, and desires and
  interest of the at home parent to care for a
  young child”

 Peter Michael Miller, MD, MPH, and Ed Schor, MD
 US News and World Report (12/3/00)
Vocabulary – The Facilities
   Center-based (full day/part day)
       Head Start
       Nursery Schools
       Child Care, Child Development Centers

   Family Child Care Homes
       Large (also called Group Homes)
       Small single provider business
       Relative’s home with family only

   Child’s Own Home
Goals Shared by Educators
and Health Professionals
    Promote well-being
    Prevent harm
    Collaborate with
        Families
        Other sources of support for the child and
         family
        Policy makers and advocates
Ensure Preventive Health Care
    Early education programs as a safety net
     to ensure immunizations and screenings
    Check documentation, give families
     reminders
    Tools: Secure Internet link to use software




     http://www.wellcaretracker.org
             Prevent Injury

            Rates for infants and toddlers:
                Centers < FCCH < Own Home
            Peak Hours = 10 am and 4 PM
            Most common/most severe (all ages) =
             falls to surface
            SIDS in child care

Briss & Sacks, 1990 (U.S. centers); Kopjar & Wickizer, 1992 (Norwegian town);
Cummings & Rivara, 1996 (King County WA); Kotch, 1997 (3 NC counties);
Gershon & Moon, 1997 (DC area BTS positioning)
    Safe Child Care Project
       33% of observed centers did not practice
        back-to-sleep positioning
       No special care plan for children with
        special health needs
            59% - seizures
            61% - asthma
            68% - allergy
            76% - development


134 volunteering PA-licensed centers – ECELS pretest data 2001-’02
     Illness Frequency
     Early Education & Child Care
        Sick more often in first 2 years of life
        More ear infections, tympanostomy tubes
        More antibiotic-resistant bacterial
         infections
        Increased illness rates bears little relation
         to other aspects of development



Wald, J Pediatr, 1991; Holmes, Epi Rev, 1996; NICH&HD Early Child
Care Research Network, 2001
      URI By Type of Care
2.5
                                                      Relative hm
 2                                                    FCCH
                                                      Center
1.5                                                   Own hm

                                                  Odds of illness
 1                                                in each type of
                                                  care compared
0.5                                               with odds of
                                                  illness if only in
                                                  own home
 0
       12 mo     24 mo       36 mo

NICHD. Arch Pedatr Adolesc Med.2001;155:481-488
      Ear Infection By Type of Care
2.5
                                                   Relative hm
 2                                                 FCCH
                                                   Center
1.5                                                Own hm


 1                                                Odds of illness
                                                  in each type of
                                                  care compared
0.5                                               with odds of
                                                  illness if only in
                                                  own home
 0
       12 mo      24 mo      36 mo

NICHD. Arch Pedatr Adolesc Med.2001;155:481-488
      GI Illness By Type of Care
2.5
                                                     Relative hm
 2                                                   FCCH
                                                     Center
1.5                                                  Own hm

                                                  Odds of illness
 1                                                in each type of
                                                  care compared
0.5                                               with odds of
                                                  illness if only in
                                                  own home
 0
       12 mo      24 mo      36 mo

NICHD. Arch Pedatr Adolesc Med.2001;155:481-488
Health Consultant Activities
   Give Technical Advice (phone/email, on-
    site, written policies/procedures)
   Educate Staff & Parents
   Plan Care (child with special health needs)
   Ensure Preventive Care & Referrals
   Address Staff Health
   Do Research
Requirements for CCHC
   29 states require some use of health
    consultants
   22 states require CCHC visits for
    infant/toddler care
   NAEYC Accreditation criterion: 4
    visits/year for infant/toddler programs
 Efficacy of
 Health Consultants
   Reduction of hazards and risky practices –
    safe active play, emergency preparedness,
    sanitation, nutrition & food safety, SIDS
    (PA, NC, CA)
   Improved access to care and more
    complete preventive health services
    (PA, NC, CA)
   Reduction of outbreaks, absence from care,
    acute/emergency medical care, medical
    care costs, work time lost by parents (NC)

Aronson & Fiene 1992; Crowley 1990 & 1997; Alkon 2002; Kotch 2004
           Efficacy of
           Health Consultants
              Improved written health policies
               (PA, NC, CA)

              CT providers perceive CCHC as
               valuable:
                  85% of CT directors
                  73% CT directors prefer at least weekly visits
              NJ directors & FCCH providers rated:
                  Satisfaction with CCHC, mean score = 2.85/4
                  Changes due to CCHC, mean score = 2.33/4


Aronson & Fiene 1992; Crowley 1990 & 1997; Alkon 2002; Kotch 2004; Dellert 2004
Resources
   Caring for Our Children: National
    Performance Standards, 2002 –
    AAP/APHA/NRC
   Stepping Stones (to CFOC) - NRC
   Health in Child Care Manual for Health
    Professionals – AAP
   Healthy Young Children – NAEYC
Resources
   Model Child Care Health Policies – hard
    copy from NAEYC; electronic copy at
    www.ecels-healthychildcarepa.org
   Managing Infectious Diseases in Child
    Care and Schools - AAP
   Posters www.global-healthychildcare.org
Resources
   Resource and Referral
       National Association of Child Care Resource and Referral
        Agencies www.naccrra.org

   National Child Care Information Center
    www.nccic.org
   Accreditation
       National Association for the Education of Young Children
        www.naeyc.org
       National Association For Family Child Care www.nafcc.org

   Environmental Rating Scales
       Frank Porter Graham Child Development Institute (ITERS-R,
        ECERS-R, FDCRS, SACERS) www.fpg.unc.edu/
Support and
Professional Development
   National Resource Center for Health and
    Safety in Child Care http://nrc.uchsc.edu
    (University of Colorado Health Sciences Center)
   National Training Institute for Child Care
    Health Consultants
    www.sph.unc.edu/courses/childcare/
    (School of Public Health, University of North
    Carolina)
   Health and Child Care Partnership Program
    –Healthy Child Care America
    www.healthychildcare.org
    (American Academy of Pediatrics)
Summary
   Focus on shared goals of educators and
    health professionals
   Promote health care in a “medical home”
   Use effective communication to foster on-
    going relationships among educators,
    health professionals and families
   Use resources to foster healthful care

				
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