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									                                              Child Care Nurse Consultant
                                                           Role Guidance
                                                                              to Achieve the
                                                                Performance Measures and
                                                             Annual Performance Standards
                                                                     State Fiscal Year 2010




                                                 Thomas Newton, MPP, REHS Department Director
                                                          M. Jane Borst, RN, MA, Title V Director
                                                                Iowa Department of Public Health
                                                                             th
Chester J. Culver, Governor                                                15 Edition July 2009
Patti Judge, Lt. Governor

H:\hcci\CCNC\FY2010 CCNC role guidcance.doc                                              SFY 2010
Welcome to                                                          Healthy Child Care Iowa adopted the five goals outlined in the
                                                                    Blueprint for Action from the Healthy Child Care America cam-
                     Healthy Child Care Iowa
                                                                    paign.1 The goals are below.
       The Iowa Department of Public Health, Title V Maternal
                                                                    1. Safe, healthy child care environments for all children, including those
and Child Health program, with assistance from the Iowa De-            with special health needs

partment of Human Services supports the Healthy Child Care          2. Up-to-date and easily accessible immunizations for children in child care

Iowa campaign to improve the quality of health and safety in        3. Access to quality health, dental, and developmental screening and com-
                                                                       prehensive follow-up for children in child care
child care businesses. The Child Care Nurse Consultant Role
Guidance to Achieve the Performance Measures and Annual             4. Physical and oral health and mental health consultation, support, and
                                                                       education for all families, children, and child care businesses
Performance Standards document is a tool used to define child
                                                                    5. Health including oral hygiene, nutrition, and safety education for children
care nurse consultation and strategies to quantify the activities      in child care, their families, and child care businesses.

performed.
                                                                    The Blueprint for Action contains 10 action steps that communi-
   Healthy Child Care Iowa was initiated in 1997 as part of the
                                                                    ties may take to promote safe and healthy out-of-home child
national Healthy Child Care America campaign supported by the
                                                                    care.
federal Department of Health and Human Services, Health Re-
                                                                        The Bureau of Family Health, Iowa Department of Public
sources and Services Administration, Maternal and Child Health
                                                                    Health (Tel.1-800-383-3826) is available to respond to ques-
Bureau. Writing of the original document, Child Care Nurse
                                                                    tions about Healthy Child Care Iowa and the role of the Child
Consultant Performance Measures and Annual Performance
                                                                    Care Nurse Consultant or visit the Healthy Child Care Iowa
Standards was supported by Maternal and Child Health Bureau
                                                                    website at: http://www.idph.state.ia.us/hcci.
federal grant funds MCJ-19T029 (State Systems Development
Initiative) and MCJ-19KCC7 (Community Integrated Service
System-Health System Development in Child Care). The role
guidance document for child care nurse consultants (CCNC)
was completed in 1999.
                                                                    1
                                                                     US Department of Health and Human Services, Child Care Bureau and Maternal
                                                                    and Child Health Bureau, 1996.
                                                                                                                                                  2
                                                                                                                                     SFY 2010
Child Care Nurse Consultant                                                                   Environmental health and safety
                                                                                              Structured observation and assessment methods
Background                                                                                    Communicable disease prevention and control
         The title, Child Care Nurse Consultant, is a nursing subspe-                         Consultation and communication skills
cialty, in pediatric community health nursing practice. Registered                            Cultural diversity and meeting the needs of children and
nurses (RNs) practicing in community health have long been called                             Children with special health or developmental needs.4
upon by child care businesses to assist in responding to issues of
childhood communicable disease, child development, safety and in-                    Upon completion of the ITPCCNC a CCNC may be employed or con-
jury prevention, nutrition, and family health. Community health nurses               tracted with a local Maternal and Child Health agency (authorized by
with pediatric expertise have gradually built the subspecialty.                      the Iowa Department of Public Health). The CCNC then participates in
                                                                                     the following CCNC professional development activities.
Because families are meeting the challenge of home, work, education,
and recreation, more children between the ages of birth to 12 years                           Annual CCNC continuing education seminar
are spending considerable time in out-of-home care arrangements.
                                                                                              Coaching/mentoring sessions with the regional CCNC
Families may use several child care arrangements during a week to
                                                                                              Program fidelity monitoring and visits with the regional CCNC
meet their needs. Iowa has an estimated 585,000 children between
the ages of birth through 14 years spread across metro, urban, and                            Quarterly ICN continuing education courses
rural communities.2 Iowa ranks third in the nation in the                                     Quarterly regional meetings convened by the regional CCNC
percent of children under 6 years of age with all parents in the labor
force (70 percent).3                                                                 In 2005 the Iowa Department of Human Services accepted the Iowa
                                                                                     Department of Public Health definition for Child Care Nurse Consul-
        Families depend upon child care businesses to meet their
children's needs, anticipate problems and concerns, and to direct or                 tants and placed the definition in the Iowa Administrative Code.5
refer families to needed resources. The CCNC is one of the resources
available to support child care businesses in meeting the health and                        “Child care nurse consultant” means a registered nurse licensed
safety needs of the children in out-of-home child care.                                  in the state of Iowa who has completed training using a nationally
                                                                                         approved curriculum for health and safety in child care and early
Professional Qualifications and Training                                                 education. The child care nurse consultant provides on–site consul-
                                                                                         tation, technical assistance, and training to child care and early
     Iowa CCNCs are registered nurses (preferably with a bachelor                        education businesses regarding health and safety. The child care
degree). The RNs have expertise in community health and maternal                         nurse consultant is employed by or has a written agreement with
and child health. The RNs complete the Iowa Training Project for                         the local Title V maternal and child health (MCH) agency or con-
Child Care Nurse Consultants (ITPCCNC) to build their expertise in                       tracts for service delivery directly through the state–level Title V ma-
serving the child care business community. The ITPCCNC covers the                        ternal and child health program administered by the Iowa depart-
following topics.                                                                        ment of public health, bureau of family health.
        Community resources and partnership building
        Core public health functions and essential services
                                                                                     4
                                                                                        The Iowa Training Project for Child Care Nurse Consultants is affiliated with the
2
  National Child Care Information Center, state profiles. Retrieved 10-10-.08 from   National Training Institute for Child Care Health Consultation, University of North
www.nccic.org .                                                                      Carolina, Chapel Hill, NC.
3                                                                                    5
  U.S. Census Bureau, 2005 American Community Survey, Table R2302.                     Iowa Administrative Code 441-118 passed Iowa General Assembly 2005.
H:\hcci\CCNC\FY2010 CCNC role guidcance.doc                                                                                                                       SFY 2010
Child Care Nurse Consultant Job Description                               7. Reports all encounters and activities conducted with children, fam-
                                                                              ilies, and child care businesses to the regional CCNC using the
Qualifications, Education, and Experience:                                    electronic CCNC Activity Log reporting system. (HCCA Steps 9,
  Registered Nurse with current Iowa licensure, a Bachelor of                 10).
  Science in Nursing or related degree is preferred                       8. Maintains communication capability for receiving email and at-
  Minimum of three years experience as a Registered Nurse in                  tachments and disseminating child care health and safety informa-
  community health or pediatric practice                                      tion with the regional CCNC, Child Care Resource and Referral of-
  Completion of the Iowa Training Project for Child Care Nurse                fices, Iowa Department of Public Health, and other community
  Consultants (ITPCCNC)                                                       partners. (HCCA Step 1)
  Employed or contracted by an Iowa Maternal and Child Health             * Specific activities are outlined in the Output section of the Perfor-
  (MCH) agency                                                            mance Measures.

Job Duties for the Child Care Nurse Consultant (CCNC): *                  Typical Schedule:
1. Provides guidance, training, coordination, and support to commu-       The CCNC needs flexible scheduling to accommodate the needs of
   nity-based child care businesses to promote safe and healthy           child care businesses. The CCNC may need to schedule evening and
   child care environments for all children including children with       weekend hours for training or consultation activities.
   special health or developmental needs. (HCCA Steps 1, 8)
2. Uses Healthy Child Care Iowa materials and nursing assessment          Travel:
   tools when completing the nursing process in consultation, train-      The CCNC will have in-state travel usually confined to the geographic
   ing, and technical assistance. (HCCA Steps 1, 4, 5, 7, 8)              service region of the employing organization. The CCNC travels to
3. Provides guidance, support, referrals, and access to care coordi-      quarterly regional CCNC meetings, the annual CCNC continuing edu-
   nation for families and child care businesses to access up-to-date     cation seminar (convened by the Iowa Department of Public Health),
   immunizations for children in child care (including children with      child care related continuing education sessions, and to child care
   special health or developmental needs). (HCCA Step 2)                  businesses.
4. Provides guidance, support, referrals, and access to care coordi-
   nation for families and child care businesses to access quality        Salary:
   health, oral health, and developmental screening and comprehen-        State wage data updated for 2004 using the Employment Cost
   sive follow-up for children in child care (including children with     Index shows an RN hourly wage range from $15 to $27 per
   special health or developmental needs). (HCCA Step 3)                  hour. 6
5. Provides guidance, support, referrals, and care coordination for
   families and child care businesses to access mental health con-
   sultation and educational services for the family, children (includ-
   ing children with special health or developmental needs), or child
   care businesses. (HCCA Steps 4, 9, 10)
6. Provides guidance, support, referrals, and access to care coordi-
   nation for families and child care businesses to access health (in-
   cluding oral hygiene), nutrition, and safety education and services
   for children (including children with special health or developmen-
   tal needs). (HCCA Steps 5, 6, 7, 9, 10)
                                                                          6
                                                                           Iowa Department of Public Health, Issue Brief: Status of the Nurse Workforce in
                                                                          Iowa, February 2006.
                                                                                                                                                             4
                                                                                                                                              SFY 2010
Child Care Nurse Consultant Program Fidelity

1. The Child Care Nurse Consultant (CCNC) follows all nursing                       Maternal and Child Health contract with the Iowa Department
practice laws, rules, and regulations                                                of Public Health, Division of Health Promotion and Chronic
     Nursing Practice for Registered Nurses -- Iowa Administrative                  Disease Prevention
       Code 655-6.                                                                  Maternal and Child Health contract agency written agreements
                                                                                     with Child Care Resource and Referral lead agencies (written
2. The CCNC uses the nursing process7                                                annually)
     Assessment and Diagnosis
     Planning                                                                5. The CCNC uses Iowa child care law, regulation, and rules in
     Nursing Intervention                                                    consultation, technical assistance and training contacts with
     Evaluation of Nursing Outcomes                                          consumers.
                                                                                   Child Care Facilities -- Iowa Code 237A
3. The CCNC participates in nursing professional development                       Child Care Centers – Iowa Administrative Code 441-109
program                                                                            Child Development Home – Iowa Administrative Code 441-110
     Iowa Training Project for CCNCs using the National Training                  Iowa Quality Preschool Program Standards, Iowa Department
       Institute for Child Care Health Consultation model, materials,                of Education
       and methods                                                                 Iowa Quality Rating System –Iowa Administrative Code 441-
     HCCI sponsored education conferences via ICN                                   118
     Annual CCNC seminar and meeting                                              IMMUNIZATION and immunization education: PERSONS
     Quarterly meetings with the regional CCNC                                      ATTENDING ELEMENTARY OR SECONDARY SCHOOLS,
     Consultation and annual assessment of reliability and fidelity                 LICENSED CHILD CARE CENTERS or institutions of higher
       monitoring with the regional CCNC                                             education – Iowa Administrative Code 641-7
                                                                                   Communicable Disease reporting and exclusion
4. The CCNC uses national and state performance measures and
                                                                                   Occupational Safety and Health Administration regulations
standards in consultation, technical assistance and training con-
tacts with consumers.                                                         6. The CCNC uses the Healthy Child Care Iowa nursing assess-
     Caring for Our Children, National Health and Safety Perfor-             ment process and tools in consultation, technical assistance and
       mance Standards: Guidelines to Out-of-Home Child Care Pro-             training contacts with consumers.
       grams, American Academy of Pediatrics, Second Edition.                      Business Partnership Agreement
       2002.                                                                       Child Care Center Director/Owner Survey
     Maternal and Child Health, Title V, block grant, State Perfor-               Home Child Care Owner/Director Survey
       mance Measure #2                                                            Injury Prevention Checklist tool and reports
     Child Care Nurse Consultant Role Guidance to achieve the                     Child Record Review tool and reports
       Performance Measures and Annual Performance Standards,                      Health and Safety Assessment tool and reports
       (reviewed annually)                                                         Health and Safety Quality Improvement Plan
                                                                                   Notice of Urgent Need form

7
 Nursing Diagnoses, Outcomes, and Interventions, NANDA, NOC, and NIC
Linkages, Center for Nursing Classification, University of Iowa, College of
Nursing, Iowa City. Mosby Press, 2001.
                                                                                                                                                5
                                                                                                                                     SFY 2010
                                                                             Child Care Nurse Consultation Process Map
                                                                              Child Care Business and CCNC Connect


                                                           Provider requests assistance                                              Provider requests information


                                                                                                                                                           Information supplied
                                                                                     CCNC partnership for services offered
                                                                                           to child care business


                                                     CCNC services
                                                    verbally accepted                                                                                   CCNC services
                                                                                                                                                       verbally declined

         Business Partnership Agreement com-
         pleted (Informed Consent for Service


                                                     Child Care Center or Child Development Home
                                                                                                                                                        Telephone TA continued1
                                                                   survey completed
                                                                                                                                                      General health and safety training
                                                                                                                                                          offered through CCRR1

                 Injury Prevention                      Child Record                   Health and Safety As-
                     Checklist                            Review                             sessment
                                                                                                                                                    Health and safety information via
                                                                                                                                                     CCRR statewide newsletter 1
                                                      Child referrals
                                                       completed                                                                                  Disease outbreak intervention1


                                                                                                                                                  Immunization status assessment

                         Customized                    Customized                    Customized
                         Consultation                   Training                 Technical Assistance                                              Short term intervention, consultation, or
                                                                                                                                                       technical assistance provided 1

        1. Grey shaded boxes indicate CCNC services available to early care and education providers without having a written agreement on file.



H:\hcci\CCNC\FY2010 CCNC role guidcance.doc                                                                                                                                                    SFY 2010
Child Care in Iowa

     Iowa licensed and registered child care businesses are regu-             Data about Iowa child care is available through the National
lated by the Iowa Department of Human Services authorized in              Child Care Information Center: http://www.nccic.org .
Code of Iowa chapter 237A. Child care is an early childhood care,             Iowa has over 1,500 licensed child care centers. And, over
health, and education business. There are a variety of types of           5000 child development home businesses. Frequently children are
child care. Child care may be classified as ―for profit‖ or as ―not for   in several types of child care each week. For example: A child
profit‖ for tax purposes. Iowa recognizes out-of-home child care as       may be in a Head Start preschool four mornings a week. One
center-based or home-based. Licensed child care centers are re-           morning a week the child is with the grandparents but the child
gulated by the Iowa Administrative Code Chapter 441-109. Regis-           spends afternoons at the local child care center. This child is mov-
tered child development homes are regulated by the Iowa Admin-            ing between 3 child care arrangements each week. Two of the
istrative Code chapter 441-110. School-based child care may be            child care businesses (Head Start and the local child care center)
licensed by the Iowa Department of Human Services or may fol-             are regulated according to state law.
low the Iowa Quality Preschool Program Standards of the Iowa
Department of Education.                                                      The Iowa Department of Human Services and Iowa Depart-
                                                                          ment of Public Health have a written interagency agreement defin-
    The Iowa Department of Human Services contracts with com-             ing the partnership to improve child care health and safety. The in-
munity-based Child Care Resource and Referral (CCRR) agen-                teragency agreement supports Healthy Child Care Iowa activities
cies to support child care businesses by offering introductory or         and resources. There are five full-time Regional Child Care Nurse
continuing education courses; on-site consultation or technical as-       Consultants (RCCNC) each affiliated with a Child Care Resource
sistance; facilitating and processing referrals from parents; main-       and Referral lead agency. Local CCNC are supported through a
taining child care business database; and operating financial as-         combination of Title V Maternal and Child Health, Community Em-
sistance grant programs. Iowa has five Child Care Resource and            powerment, Head Start/Early Head Start, or school funds.
Referral lead agencies. The CCRR map is available at:
www.iowaccrr.org.                                                             All CCNC in Iowa are required to complete the Iowa Training
                                                                          Project for Child Care Nurse Consultants. Iowa uses the model
    Personnel available through the CCRR lead agency include              and materials from the National Training Institute for Child Care
the executive director, parent referral counselors, data specialist,      Health Consultation sponsored by the US Department of Health
regional child care nurse consultant (RCCNC), home consultants,           and Human Services, Maternal and Child Health Bureau. The
training coordinator, infant/toddler specialist and a quality rating      Iowa CCNC training course includes several days of training over
system specialist.                                                        a several month period. The Iowa Board of Nursing has historical-
                                                                          ly approved the course for nursing continuing education credit.




                                                                                                                                             7
                                                                                                                                  SFY 2010
Child Care Resource and Referral Map – Regional Child Care Nurse Consultants


                                                             1. CCRR Northwest Iowa - Mid-Sioux Opportunity, Inc.
                                                             Kim Schroeder, RN, RCCNC
                                                             418 Marion Street
                                                             PO Box 390
                                                             Remsen, IA 51050
                                                             Tel: (712) 786-3493 or (800) 859-2025
                                                             Fax: (712) 786-3240

                                                             2. CCRR Northeast Iowa - Exceptional Persons, Inc.
                                                             Marsha Platt, RN, BSN, RCCNC
                                                             3675 University Avenue
                                                             Waterloo, IA 50704
                                                             Tel: (319) 233-0804 or (800) 475-0804
                                                             Fax: (319) 274-8841

                                                             3. CCRR Southwest & So. Central Iowa - West Central De-
                                                             velopment Corporation
                                                             Cathy Renz, RN, MEd, RCCNC
                                                                    th
                                                             701 10 St.
                                                             Harlan, IA 51537
                                                             Tel: (712) 755-7381 or (800) 945-9778
                                                             Fax: (712) 755-7827

                                                             4. CCRR of Central Iowa - Orchard Place-Child Guidance
                                                             Center
                                                             Karen Doughan, RN, BS, RCCNC
                                                             808 5th Avenue
                                                             Des Moines, IA 50309
                                                             Tel: (515) 246-3567 or (800) 722-7619
                                                             Fax: (515) 246-3570

                                                             5. CCRR of Community Action of Eastern Iowa
                                                             Candace Chihak, RN, BSN
                                                             PO Box 490
                                                             Hiawatha, IA 52233
                                                             Tel: (800) 383-3826
                                                             Fax: (319) 739-0106




                                                                                                                    8
                                                                                                      SFY 2010
Healthy Child Care Iowa
Acronym List
ADA - Americans with Disabilities Act federal law.                                   ISU - Iowa State University. www.iastate.edu
http://www.usdoj.gov/crt/ada/adahom1.htm                                             LBOH - Local Board of Health
AEA - Area Education Agency.                                                         MCH - Maternal and Child Health program, Title V, of the Social Security
NEW: http://www.iowa.gov/educate/content/view/527/550/                               Act. http://www.idph.state.ia.us/hpcdp/family_health.asp
CACFP - Child and Adult Care Food Program from the United States Depart-             NAA - National After-School Association. http://www.naaweb.org
ment of Agriculture.                                                                 NAEYC - National Association for the Education of Young Children.
NEW: http://www.iowa.gov/educate/content/view/365/432/                               http://www.naeyc.org
CCNC - Child Care Nurse Consultant                                                   NAFCC - National Association for Family Child Care.
CCRR - Child Care Resource and Referral agency.                                      http://www.nafcc.org/include/default.asp
http://www.dhs.state.ia.us/dhs2005/dhs_homepage/reports_pubs/results_based/          NPPS - National Program for Playground Safety.
childcare.html                                                                       http://www.uni.edu/playground
CDC – Centers for Disease Control and Prevention. www.cdc.gov                        NPSI – National Playground Safety Institute
CFOC - Caring for Our Children, National Health and Safety Performance Stan-         NTI – National Training Institute for Child Care Health Consultation, Uni-
                                                            nd
dards, Guidelines for Out-of-Home Child Care Programs, 2         Ed. 2002.           versity of North Carolina, School of Public Health.
http://nrc.uchsc.edu/CFOC/index.html                                                 OSHA - Occupational Health and Safety Administration.
CHSC - Child Health Specialty Clinics at the University of Iowa Hospital and Clin-   http://www.osha.gov
ics. http://www.uihealthcare.com/depts/state/chsc/index.html                         QRS - Quality Rating System, Iowa Administrative Code 441-118 (passed
CPSC - Consumer Product Safety Commission. www.cpsc.gov                              2005)
CSHCN - Children with Special Health Care Needs                                      RCCNC - Regional Child Care Nurse Consultant
DHS - Iowa Department of Human Services. www.dhs.state.ia.us                         RN - Registered Nurse
EPI – Epidemiology. http://www.idph.state.ia.us/adper/surveillance_manual.asp        SCCAC - State Child Care Advisory Council, authorized by Code of Iowa
EPSDT – Early Periodic Screening Diagnosis and Treatment program Medicaid            Chapter 237A
hawk-i - Healthy and Well Kids in Iowa, Title XXI, of the Social Security Act,       SDA - Service Delivery Area
Iowa’s child health insurance program. http://www.hawk-i.org                         TA - Technical Assistance
HCCI - Healthy Child Care Iowa. www.idph.state.ia.us/hcci                            WIC - Special Supplemental Nutrition Program for Women, Infants, and
IAC - Iowa Administrative Code. www.legis.state.ia.us                                Children from the US Department of Agriculture.
ICN - Iowa Communications Network fiber optic distance learning system               http://www.idph.state.ia.us/wic/default.asp
IDPH - Iowa Department of Public Health. www.idph.state.ia.us

                                                                                                                                                                  9
                                                                                                                                                    SFY 2010
                                    Child Care Nurse Consultant Performance Measures and Annual Performance Standards
Performance Measure 1: The Child Care Nurse Consultant (CCNC) promotes safe and healthy child care environments for all children including children
with special health or developmental needs. (HCCA Steps 1, 8)
                 Outputs                                  Annual Performance Standards                                              Comments
1.1 Use and disseminate the reference:           Promote the use of CFOC national standards in 100% Caring for Our Children the National Health and Safety
Caring for our Children (CFOC), National         of consultation, TA, and training visits.                Performance Standards Guidelines for Out-of-Home Child
                                                                                                                            8
Health and Safety Performance Stan-              Disseminate pertinent portions of the national perfor-   Care Programs, the entire text of CFOC is available on
dards Guidelines for Out-of-Home Child           mance standards during visits with child care busi-      the internet: http://nrc.uchsc.edu/CFOC/index.html
Care Programs as the basis for resolving         nesses.                                                  Other national standards are published by child care or-
problems, responding to requests, and in         Stepping Stones to Using Caring for our Children may ganizations like the National Association for the Education
training.                                        also be used.                                            of Young Children (NAEYC), National After-School Asso-
                                                                                                          ciation standards and the National Association for Family
                                                                                                                                            9
                                                                                                          Child Care (NAFCC) standards.
1.2 Conduct consultation, technical as-      Upon request or based upon identified need, the CCNC         The CCNC may be asked to review health/safety related
sistance, and training with child care       shall                                                        policies and practices within the child care facility. Health
businesses to promote safe and healthy           conduct on-site consultation to address and resolve      promotion and protection activities are appropriate activi-
personnel practices.                             health and safety concerns related to policy, practice   ties for the CCNC to provide. Resources for the CCNC
                                                 or a specific child/family concern.                      include the Iowa Department Public Health, Centers for
                                                 work with child care businesses about their personnel    Disease Control and Prevention, American Academy of
                                                 health policy and practice that impact the health, safe- Pediatrics, OSHA, American Red Cross, American Heart
                                                 ty and well-being of children and co-workers.            Assoc., American Lung Association and others.
                                                 reinforce adult immunization and preventive health
                                                 practices.                                               HCCI business forms are available through the HCCI
                                                 offer health education and guidance to child care        webpage: http://www.idph.state.ia.us/hcci/products.asp
                                                 businesses.                                                   Infant, Toddler, Preschool Age – Child Health Exam
                                                 coordinates all education and training of child care          Form
                                                 businesses with the CCRR training coordinator.                Iowa School-age Care - Health Status - Parent State-
                                                 use the child care business forms available at the            ment
                                                                                                                                                                  10
                                                 HCCI website.                                                 Iowa Child Care Provider Physical Exam Report (for
                                                                                                               employees, volunteers, and substitute personnel)
                                                                                                               Infant Daily Report form
                                                                                                               Injury/Incident Report form
                                                                                                               Monthly Medicine Record

1.3 Conduct health and safety assess-                      The CCNC shall                                                                    Child care assessment is taught in the Iowa Training
ments and develop a health/safety plan                        use the HCCI Child Care Nurse Consultant Consulta-                             Project for Child Care Nurse Consultants. The CCNC

8
  Caring for Our Children, American Public Health Association and the American Academy of Pediatrics, National Center for Education in Maternal and Child Health, Arlington,
VA, 2002. Available on the Internet: http://nrc.uchsc.edu/CFOC/index.html .
9
  The national associations have websites. GO to http://www.idph.state.ia.us/hcci/websites.asp page.
10
  This form meets the Iowa Administrative Code 441-109 Child Care Centers and IAC 441-110 Child Development Homes.
Child care center employees are required to have a physician-signed statement concerning health status. Child care center volunteers and substitutes are required to sign a statement of health status.
Child Development Home providers, substitute providers, and all provider household members that may be present when children are in the home are required to have a physician-signed statement of health status.
                                                                                                                                                                                                                    10
                                                                                                                                                                                                         SFY 2010
Performance Measure 1: The Child Care Nurse Consultant (CCNC) promotes safe and healthy child care environments for all children including children
with special health or developmental needs. (HCCA Steps 1, 8)
                 Outputs                               Annual Performance Standards                                             Comments
with the child care businesses.             tion Process Map when developing a relationship with receives small group and one-to-one training on assessing
                                            child care businesses. See page 6 of this document         health and safety in child care from the RCCNC at region-
Comment: Nursing assessments are            participate in program reliability and fidelity monitoring al meetings and joint RCCNC/CCNC on-site visits.
completed to guide needed quality im-       with the regional child care nurse consultant
provement. The CCNC may identify ha-        (RCCNC). There is a minimum of 1 face to face pro-         Assessment tools are only available from the RCCNC.
zards and concerns that require more        gram fidelity visit for each HCCI assessment instru-       The Healthy Child Care Iowa health and safety assess-
extensive assessment prior to planning      ment                                                       ment tools include:
and intervention.                           conduct assessments using Healthy Child Care Iowa              Business Partnership Agreement,
Child Care Businesses may be enrolled       assessment tools adopted from the Quality Enhance-             Home Child Care Director/Owner Survey OR the Child
                                                                                     11
in the Iowa Quality Rating System           ment Project for Infants and Toddlers.                         Care Center Director /Owner Survey,
(QRS), accreditation through a national     conduct assessments and develop a plan for 100% of             Injury Prevention Checklist,
child care or education organization (ex-   calls from DHS personnel who have health and safety            Child Record Review, and the
ample NAEYC), or individual business        questions or problems concerning a specific child care         Health and Safety Assessment.
quality improvement process.                facility.
                                            use Addendum 1 for specific CCNC process in com-           There are additional documents available for CCNC use
                                            pleting nursing assessment process.                            Notice of Urgent Need—used when a CCNC finds a
                                            prioritize visits for the purpose of conducting a              situation that requires an immediate response/action
                                            health/safety assessment. Consult with the RCCNC               on the part of the child care business owner/director.
                                            for assistance in prioritizing assessment visits.              Child Care Business Health and Safety Quality Im-
                                            send a copy of all assessments and action plans to             provement Plan—used by the CCNC to document
                                            the RCCNC for review and input.                                plan of action and to document dialog between the
                                            send a copy of assessment report and plan to DHS               child care business and the CCNC.
                                            licensing consultant or to the CCRR home consultant
                                            for each DHS or home consultant referral.
1.4 Use standardized tools and checklist    Use a standardized tool or checklist when conducting           Checklists are available from the Consumer Product
from a credible resource for playground     review of playground safety.                                   Safety Commission (CPSC) http://www.cpsc.gov/cgi-
or play space safety.                       Conduct a playground review of policy, practice or             bin/pub.aspx
                                            facility for 100% of questions or concerns from child          CPSC public playground safety handbook:
                                            care businesses or DHS licensing consultants regard-           http://www.cpsc.gov/cpscpub/pubs/325.pdf
                                            ing play spaces.                                               CPSC home child care playground handbook:
                                            The CCNC may refer requests or questions to a play-            http://www.cpsc.gov/cpscpub/pubs/324.pdf
                                            ground safety specialist at the National Program for           National Program for Playground Safety—Child
                                            Playground Safety. Documentation of such referrals             Care Assessment Manual for Outdoor Play Environ-
                                            shall be maintained by the CCNC for liability purpos-          ments available from 1-800-554-PLAY or
                                            es.                                                            http://www.uni.edu/playground/
                                                                                                           Accessible play ground final rule: http://www.access-
                                                                                                           board.gov/play/finalrule.pdf
1.5 Customize health and safety consul-     The CCNC shall use CFOC in all consultations re-           The Americans with Disabilities Act sections pertaining to
11
 Quality Enhancement Project for Infants and Toddlers, (Jonathan Kotch, MD, MPH) North Carolina Division of Child Development ant The University of North Carolina At
Chapel Hill, School of Public Health, CB # 7400, Chapel Hill, NC 27599-7400. 2000.
                                                                                                                                                                        11
                                                                                                                                                           SFY 2010
Performance Measure 1: The Child Care Nurse Consultant (CCNC) promotes safe and healthy child care environments for all children including children
with special health or developmental needs. (HCCA Steps 1, 8)
                  Outputs                            Annual Performance Standards                                           Comments
tation, TA, and training to include how     garding children with special needs.                   child care are available on the Internet.
children with special needs are affected    The CCNC shall identify barriers prohibiting children  http://www.usdoj.gov/crt/ada/adahom1.htm The CCNC
by health and safety policy and practice.   with special health or developmental needs from        may contact the Area Education Agency where the child
                                            enrolling and participating in the child care program  care program is located. Iowa Child Health Specialty Clin-
                                            and activities, including playground facilities.       ics have health care personnel specializing in the care of
                                            The CCNC shall inform the director or proprietor of    children with special health or developmental needs. The
                                            such barriers.                                         HCCI talkline has contact information for AEAs and Child
                                            The CCNC shall inform child care businesses about      Health Specialty Clinics 1-800-369-2229.
                                            the American’s with Disabilities Act and the sections
                                            pertaining to child care.                              Accessible play ground final rule: http://www.access-
                                                                                                   board.gov/play/finalrule.pdf
1.6 Use the Americans with Disabilities     Maintain access to ADA information and materials       Internet for the ADA:
Act (ADA) materials pertaining to child     using the Internet, Area Education Agencies or Iowa    http://www.usdoj.gov/crt/ada/childq%26a.htm
care to increase access to child care for   Child Health Specialty Clinics.
children with special needs.                Share copies of the ADA with child care businesses or Accessible play ground final rule: http://www.access-
                                            inform businesses where they can secure their own      board.gov/play/finalrule.pdf
                                            copy.
1.7 Assist child care businesses to de-     Encourage and facilitate communication between the     Use contacts already involved with the family like Area
velop inclusive child care practices for    family, child care business, and agen-                 Education Agencies, Head Start/Early Head Start, or Iowa
children with special health or develop-    cies/professionals already serving the child and fami- Child Health Specialty Clinics. The HCCI talkline has con-
mental needs.                               ly. Support a team approach to assisting children with tacts for Area Education Agencies and Iowa Child Health
                                            prescribed treatments and goals.                       Specialty Clinics at 800-369-2229.
                                            Refer family and child care businesses to appropriate
                                            services to support best practice for the individual   The CCNC should work with the parent counselors from
                                            needs of each child.                                   CCRR when helping families find inclusive child care.
                                            Provide guidance, education, and support for inter-
                                            agency collaboration among professionals to increase
                                            inclusive practices.
1.8 Use the CCRR database                   Review and become familiar with the CCRR database NACCRRAware is the national database for Child Care
NACCRRAware, to identify child care         (NACCRRAware) within 4 months of starting position     Resource and Referral agencies available on the Internet:
businesses that may be caring for child-    as a CCNC.                                             http://two.naccrraware.net (restricted access website-
ren with special needs.                     Complete a written agreement between the CCNC          security clearance, password and signed agreement re-
                                            and the CCRR for access to and use of NACCRRA-         quired).
                                            ware within 4 months of starting position as a CCNC.
                                            Use the CCRR database to build caseload of busi-
                                            nesses caring for children with special needs.
                                            The CCNC shall report 100% of new child care busi-
                                            nesses to the CCRR so the new businesses can be
                                            added to the NACCRRAware database.
1.9 Report ―communicable disease‖           Report 100% of incidents (IAC 641-1 Notification and   CCNC may not initially be involved or knowledgeable of
events to local public health officials.    Surveillance of Reportable Diseases) when the CCNC incidents of communicable disease. CCNC shall report
                                                                                                                                                            12
                                                                                                                                                SFY 2010
Performance Measure 1: The Child Care Nurse Consultant (CCNC) promotes safe and healthy child care environments for all children including children
with special health or developmental needs. (HCCA Steps 1, 8)
                 Outputs                              Annual Performance Standards                                         Comments
                                            is directly involved.                                  only those incidents where the consultant is directly in-
Report all involvement in reportable        Report 100% of involvement with communicable dis-      volved in providing consultation or technical assistance.
communicable disease in child care to       ease to the RCCNC.                                     The CCNC shall work with the Local Board of Health’s
the RCCNC.                                  Follow all instructions given by the Iowa Department   designee for reporting communicable disease. The EPI
                                            of Public Health or local public health authority per- Manual & reporting procedures are on the Internet:
                                            taining to communicable disease.                       http://www.idph.state.ia.us/adper/surveillance_manual.asp
                                            Maintain record of all reporting documents completed. Child care centers are required to publicly post a notice
                                            Report 100% of communicable diseases to DHS li-        about communicable diseases-the CCNC shall work with
                                            censing consultant for child care centers.             the RCCNC and DHS licensing consultant on appropriate
                                            The Disease Reporting hotline # 1-800-362-2736.        information to be posted.

Performance Measure 2: The CCNC assures or secures access to up-to-date immunizations for children and child care businesses in child care. (HCCA
Step 2)
                  Outputs                                 Annual Performance Standards                                            Comments
2.1 Conduct reviews of child care immu-          CCNC will review immunization records of children       Local boards of health (LBOH) are responsible for auditing
nization records of all children enrolled in     enrolled at child care facilities. This activity may be childhood immunization status in each county.
child care programs, through on-site vis-        negotiated with the local board of health and is not to CCNC shall work with and take direction from the LBOH to
its.                                             duplicate the required state immunization audit con-    complete this activity.
                                                 ducted by a local board of health                       The CCNC may use the IDPH immunization reporting tool
                                                 The results of the immunization review of child care    which is available from Iowa Department of Public Health
                                                 centers shall be reported to IDPH and to the DHS        Immunization office telephone: 1-800-831-6293.
                                                 child care licensing consultant when immunization re-   Immunization schedule and information is available on the
                                                 view is conducted in child care centers.                Iowa Department of Public Health website:
                                                 The CCNC shall use the IDPH schedules for child-        http://www.idph.state.ia.us/adper/immunization.asp
                                                 hood and adult immunizations.
                                                 The CCNC shall work with local public health, child
                                                 care businesses and families to obtain needed immu-
                                                 nizations.
2.2 Refer children and families to local     CCNC will refer 100% of children who are not up-to-date     The Iowa Department of Public Health, Bureau of Immuni-
health resources for immunizations.          on immunizations using the IDPH schedule of immuniza-       zation has local immunization clinic providers in each
                                             tions.                                                      county. Contact your local public health agency or health
                                                                                                         department. Call the HCCI talkline to obtain the phone
                                                                                                         number of immunization providers: 1-800-369-2229.
2.3 Assist child care businesses in secur-       Refer 100% of child care employees, owners, and         Adults need to maintain up-to-date immunizations such as
ing immunizations for adults (child care         directors who need immunizations to the local public    tetanus, influenza, pneumonia, hepatitis, shingles vaccine
personnel or family members of children          health or county public health department regarding     etc.
enrolled).                                       adult immunizations. The CCNC may need to work          There are not public funds to support adult immunization.
                                                 with community partners to secure funds for a special   Adults should expect to pay a fee for adult immunization.
                                                 immunization project for adults.                        Adult immunization schedule is available at:
                                                 Share the adult immunization schedule with child care http://www.idph.state.ia.us/adper/immunization.asp

                                                                                                                                                                13
                                                                                                                                                     SFY 2010
                                                  businesses.
2.4 CCNC shall provide health education      The CCNC shall offer health education upon request using       Printed materials are available through the public health
to child care businesses and families        immunization information from the Immunization Bureau at       clearinghouse at the Cedar Rapids public library 1-800-
                                                                                              nd
regarding the importance of obtaining        the Iowa Department of Public Health and CFOC, 2 Ed.,          398-9696
immunizations to prevent disease.            2002.

Performance Measure 3: The CCNC assures access to quality health, oral health, nutrition, and developmental screening and comprehensive follow up
for children including children with special health or developmental needs in child care. (HCCA Step 3)
                 Outputs                                 Annual Performance Standards                                              Comments
3.1 Review the health status of children      Conduct a review with 100% of a child care business’s   Use of the Child Record Review tool is taught in the Iowa
and the status of medical and dental          child health and safety related records upon request    Training Project for Child Care Nurse Consultants, through
homes for children enrolled in child care.    from DHS, RCCNC, or the child care business.            regional CCNC meetings and one-to-one visits between
Develop a plan with the child care busi-      Use the Child Record Review tool and process when       the RCCNC and CCNC.
ness for obtaining needed health servic-      reviewing records (an instrument adapted from the       The tool and all supportive documents are available from
es for children.                              Quality Enhancement Project for Infants and Tod-        the RCCNC.
                                                      12
                                              dlers).                                                 The assessment consists auditing child enrollment and
                                              Report aggregate findings to DHS child care licensing   health records for 18 child health indicators.
                                              consultants when review is conducted in a licensed
                                              child care center. Report results to RCCNC.             The Child Record Review is also part of the Iowa QRS.
3.2 Refer children and families to needed     CCNC will refer 100% of children identified as needing The CCNC shall assure children and families have access
primary health care or specialty health       health care services including dental, nutritional, and to appropriate health care services including specialty
care services. (medical, dental home)         mental health services.                                 health services. The CCNC shall be knowledgeable about
                                              The CCNC will coordinate referrals of children to local availability and eligibility for health services such as family
                                              Title V child health program for care coordination ser- planning, community health centers, rural health cen-
                                              vices.                                                  ters/clinics, Title V child health services, Child Health Spe-
                                              The CCNC will coordinate with the MCH agency I-         cialty Clinics, and WIC clinics.
                                              Smile coordinator to access oral health services for    The CCNC shall work with local Title V child health agen-
                                              children.                                               cies to assure health care access.
                                              The CCNC will work with other community-based              Location of child health services:
                                              health care providers to assure access to preventive       http://www.idph.state.ia.us/webmap/default.asp?map=epsdt
                                              health services (example: family planning, community       Location of Child Health Specialty Clinics:
                                                                                                         http://www.uihealthcare.com/depts/state/chsc
                                              health centers, and maternal health agencies)
                                                                                                         The I-Smile Coordinator map:
                                              The CCNC shall make referrals to Iowa Child Health         http://www.idph.state.ia.us/hpcdp/oral_health_ismile.asp
                                              Specialty Clinics for children with special health care    Culturally appropriate information may be obtained
                                              needs.                                                     from the Office of Minority Health at the Iowa Depart-
                                              Use culturally appropriate, relevant and current re-       ment of Public Health 1-800-383-3826.
                                              source materials for adult or child audiences.             The HCCI talkline 1-800-369-2229 has name, address,
                                                                                                               and telephone number of Title V child health agencies,
                                                                                                               I-Smile Coordinators or the Child Health Specialty Clin-
                                                                                                               ics.

12
 Quality Enhancement Project for Infants and Toddlers, (Jonathan Kotch, MD, MPH) North Carolina Division of Child Development ant The University of North Carolina At
Chapel Hill, School of Public Health, CB # 7400, Chapel Hill, NC 27599-7400. 2000.
                                                                                                                                                                        14
                                                                                                                                                           SFY 2010
3.3 Assist child care businesses in locat-      Upon identification of a child or family health care need,   Child care businesses may have families with low incomes
ing special community based health ser-         the CCNC shall refer the family to appropriate health ser-   and the families may be eligible for specific health servic-
vices for children in child care, their fami-   vices.                                                       es such as maternal health, WIC, TB medication, etc.
ly members and child care business per-         The CCNC shall be knowledgeable about health care pro-       Iowa has several low cost/no cost health clinics. The HCCI
sonnel.                                         grams and services for low income families.                  talkline (1-800-369-2229) is available to assist the CCNC
                                                                                                             in locating community-based health services. A list of free
                                                                                                             medical clinics is maintained by the Center for Local Pub-
                                                                                                             lic Health (Judy Naber) at the Iowa Department of Public
                                                                                                             Health 1-800-383-3826.
3.4 Conduct or coordinate noninvasive               The CCNC may conduct or coordinate actual health         The CCNC should work with local MCH agency when
health screenings like child growth and             screenings with children while they attend child care.   planning to conduct a screening or treatment program in
development, oral/dental health, or vision          National standards and approved screening protocols      the child care setting. CCNC are not encouraged to con-
screenings in the child care environment.           shall be followed.                                       duct screenings that require a needle stick (blood lead
                                                    CCNC shall coordinate and cooperate in the I-Smile       screening) when the parent is not with the child.
                                                    program coordinators for preventive oral health of       I-Smile program materials are available by contacting the
                                                    children.                                                Oral Health Bureau at the Iowa Department of Public
                                                                                                             Health http://www.idph.state.ia.us/hpcdp/oral_health.asp
                                                                                                             or call: (515) 281-3733.
3.5 Inform child care businesses and                CCNC shall attend the every 2 years update about              The CCNC shall inform and assist families in enrolling
families about health care coverage,                public programs for children’s health insurance.              in Medicaid or hawk-i. CCNC may use materials from
payment programs (Medicaid-EPSDT                    The CCNC shall carry an updated file of enrollment            the Covering Kids program found:
and the state children’s health insurance           forms and materials in English and Spanish.                   http://www.idph.state.ia.us/coveringkids/
program, hawk-i) and other low cost or              100% of child care businesses shall be informed               Locations of free health clinics:
free health care clinic service providers.          about hawk-i toll-free telephone number 1-800-257-           http://www.idph.state.ia.us/webmap/default.asp?map=vhcpp
                                                    8563.                                                        Location of Community Health Centers:
                                                                                                                 http://www.ianepca.com/our_members/our_members.php

Performance Measure 4: The CCNC provides mental health consultation support, and education for families, children including children with special
health or developmental needs and child care businesses. (HCCA Steps 4, 9, 10)
                  Outputs                           Annual Performance Standards                                          Comments
4.1 Respond to requests for materials,     Make initial response to 80% of requests within 2       Customize response to the needs of child care business,
consultation, or training regarding child  working days.                                           family, and community.
mental health, behavior, and child devel-  When follow-up action is indicated, a follow up plan is Information about the First Five, Healthy Mental Develop-
opment.                                    developed with the child care business or family for    ment program is available from the program coordinator at
                                           100% of requests.                                       800-383-3826.
                                           CCNC makes available information about health care
                                           payment public programs (Medicaid, hawk-i, and
                                           MCH services). The CCNC may refer families directly
                                           to MCH agencies for the care coordinators to work
                                           with those families in securing health care source and
                                           payment.
                                           The CCNC shall work with the First Five Healthy Men-
                                           tal Development program when that program is avail-
                                           able within a community.
                                                                                                                                                                            15
                                                                                                                                                                SFY 2010
4.2 Assist child care businesses in locat-    Refer 100% of children with behavioral or mental        The RCCNC maintain a list of community-based mental
ing community-based mental health ser-        health needs to appropriate mental health services.     health services for children.
vices and training.                           The CCNC refers 100% of children without medical        Area Education Agency services
                                              home or health care payment resource to the local       (http://www.state.ia.us/educate/aea/map.html),
                                              Title V care coordinator to secure services and pay-    Child Health Specialty Clinics
                                              ment.                                                   (http://www.uihealthcare.com/depts/state/chsc/), community
                                                                                                      mental health centers, child psychiatrist or psychologist or
                                                                                                      social workers specializing in therapy with child-
                                                                                                      ren/families.
                                                                                                      The HCCI talkline 1-800-369-2229 is available to assist
                                                                                                      the CCNC in locating community-based services.

Performance Measure 5: The CCNC provides health, nutrition, and safety education for children including children with special health or developmental
needs, families, and child care businesses. (HCCA Steps 5, 6, 7, 9, 10)
                  Outputs                             Annual Performance Standards                                            Comments
5.1 Respond to requests for health, nutri-   Make initial response to 80% of requests within 2       Customize response to the needs of child care business,
tion, and safety materials and training.     working days.                                           family, or community.
(including mental and oral/dental health)    Schedule on-site consultations, TA sessions, or train-  Use culturally current, relevant and appropriate resource
                                             ing with child care business, children, and families as materials for adult or child audiences.
                                             requested.                                              Use community resources like licensed or registered dieti-
                                             Use health specialist when possible to introduce ex-    cians, playground safety specialists, and child passenger
                                             perts to children, child care businesses and families.  safety technicians.
                                             The CCNC coordinates with the RCCNC to locate re-
                                             sources.
5.2 Provide developmentally and cultural-    Schedule on-site child health education with the child  Culturally appropriate information may be obtained from
ly appropriate health education to child-    care business as requested.                             the Office of Minority Health at the Iowa Department of
ren in child care.                           Consult with RCCNC on 100% of request when de-          Public Health (515) 281-4904.
                                             veloping new health education materials for children,
                                             families or child care businesses.

Performance Measure 6: The CCNC is accountable for activities conducted with children, families, and child care businesses. (HCCA Steps 9, 10)
                 Outputs                                 Annual Performance Standards                                      Comments
6.1 Document and maintain record of all       Use the electronic CCNC Activity Log to document all  The CCNC shall use the activity log format available from
encounters with child care businesses,        encounters with child care businesses.                the Iowa Department of Public Health, Healthy Child Care
families, and other professionals. Report     Maintain the CCNC Activity Log on a month to month    Iowa office.
encounter data to the RCCNC.                  basis.                                                The CCNC shall file the CCNC Activity Log electronically.
                                              Keep record a minimum period of 2 years from the      No hard copy reports can be accepted.
                                              end of the contract year.
                                              Send monthly CCNC Activity Log to the RCCNC by
                                                      th
                                              the 15 of the month following the month in which ac-
                                              tivity was recorded.
6.2 Use data from CCNC activity log       Collaborate with community partners to identify resources Resources: CCRR personnel, licensing consultants, Child
when working with community partners to or services to respond to 100% of requests from child care and Adult Care Food Program (CACFP) personnel, Head

                                                                                                                                                               16
                                                                                                                                                    SFY 2010
identify and respond to child care busi-      businesses or families who have children in out-of-home         Start, Iowa Child Health Specialty Clinic (CHSC), Iowa
ness or family needs for resources, TA,       child care.                                                     State University (ISU) extension, public health nursing,
and trainings.                                                                                                community action agencies and others.
6.3 Contact new licensed and registered           Provide materials and offer services to 100 % of child      HCCI materials may be added to CCRR promotion pack-
                      13
child care businesses to inform them              care businesses within 3 months of the time they ob-        ets for new child care businesses. The CCNC and home
about CCNC services and resources.                tain new license or registration.                           consultants shall work together informing registered child
                                                  The local CCNC coordinates with the RCCNC on                care businesses about HCCI and other health or safety
                                                  marketing of CCNC services.                                 related resources. Example: Medicaid and hawk-i, Con-
                                                                                                              sumer Product Safety Commission and others.
6.4 Contact non-registered child care             Send an introductory letter/brochure with CCNC con-         CCNC materials may be added to CCRR promotion pack-
businesses added to the CCRR data                 tact information to 100 % of child care businesses          ets for new child care businesses. The CCNC and home
base to inform the child care businesses          within three months of the time they are added to           consultants shall work together informing non-registered
about CCNC and resources.                         CCRR database.                                              child care businesses about HCCI and other health or
                                                  Provide materials about the CCNC and HCCI and               safety related resources. Example: Medicaid and hawk-i,
                                                  other health and safety related resources as indicated.     Consumer Product Safety Commission and others. Non-
                                                                                                              registered child care businesses shall be recruited to be-
                                                                                                              come a registered child care business.
                                                                                                                                                     14
Performance Measure 7: The CCNC develops and maintains the linkage with child care regulatory personnel and child care partners.
                 Outputs                                 Annual Performance Standards                                           Comments
Partner - Iowa Department of Human
Services Child Care Licensing Consul-
      15
tants
7.1 Give and receive information and       Respond to 100% of request from DHS child care licens-     Licensing consultants are the legal authority for the regu-
referrals on ongoing basis.                ing consultants within 2 working days.                     lation of child care centers. To improve the health and
                                                                                                      safety of child in out-of-home child care a good relation-
                                                                                                      ship with the licensing consultant is critical.
7.2 Job-shadow licensing consultant        Within the first year of employment as a CCNC, request to When a child care center adds a new service like infant
through entire process of licensing a cen- job-shadow 1 new center licensing visit with the DHS li-   and toddler care a new child care license is required.
ter.                                       censing consultant. The CCNC will coordinate this activity Achievement of this standard is dependent on the availa-
                                           through the RCCNC.                                         bility of the licensing consultant time.
Partner: DHS child care registration
personnel
7.3 The CCNC shall know DHS child              In the first year of employment as a CCNC, participate DHS registration personnel may refer new businesses or
care registration personnel for their          in 1 face-to-face meeting with DHS child development person considering child care career to the CCNC for pre-
CCNC service area.                             home registration personnel. Then schedule meetings business consultation services like policy development,
                                               or communicate as needed in response to a specified    health and safety procedures, storage for medication, first
                                               request.                                               aid supplies, etc.
                                               100% of DHS registration personnel shall have con-

13
   Iowa Code 237A, Iowa Administrative Code 441-109 & 110, define licensed child care centers and registered child care family or group homes.
14
   HCCI has several partners where a contract or memorandum of agreement has been negotiated. The Performance Measures address these partners. HCCI recognizes that the
CCNC will interact with multiple community partners in fulfilling the Performance Measures.
15
   The Iowa Department of Human Services is the regulatory authority for child care in Iowa.
                                                                                                                                                                          17
                                                                                                                                                            SFY 2010
                                                                                                                                                       14
Performance Measure 7: The CCNC develops and maintains the linkage with child care regulatory personnel and child care partners.
                  Outputs                                 Annual Performance Standards                                           Comments
                                                tact information for the CCNC. The RCCNC can assist
                                                the CCNC make connections with DHS registration
                                                personnel.
7.4 Give and receive information and       Respond to 90% of referrals or request for information      The CCNC will prioritize responses. It is imperative to
referrals on ongoing basis.                from DHS registration personnel within 2 working days.      maintain the communication links with DHS.
Partner: DHS
                                        16
Child Care Assistance personnel
7.5 Give and receive information and       The CCNC shall promote informing families eligible for      One of the roles of the CCNC is to help families access
referrals on ongoing basis with child care child care assistance about the program based on compa- permanent medical home and stable health payment op-
assistance (DHS child care subsidy Pro-    rable income eligibility criteria. Example: Medicaid, hawk- tions.
gram) personnel.                           i, WIC, Title V Maternal and Child Health services, food
                                           stamps low income housing and other programs. Com-
                                           plete as requested.
Partner: CCRR
7.6 Attend and participate in quarterly    The CCNC shall participate in 100% of the RCCNC quar-       The CCNC shall meet with colleagues and RCCNC to
meetings with the RCCNC and other          terly meetings.                                             promote health and safety in child care and to maintain
CCNC in the CCRR lead agency service       When a CCNC covers a geographic region that spans           continuity among CCNC practice.
area.                                      across 2 CCRR regions, the CCNC may choose which
                                           CCRR lead agency and RCCNC to most closely align and
                                           communicate with.
7.7 Share information with the RCCNC            Report 100% of child care business encounters using    The CCNC uses the Activity Log developed by the Iowa
about encounters with child care busi-          the CCNC Activity Log to the RCCNC.                    Department of Public Health.
nesses.                                         Send 100 % of monthly reports to RCCNC.
                                                Send 100% of monthly reports to the CCNC employer.
                                                Disseminate monthly reports to other community part-
                                                ners as requested and feasible.
7.8 The CCNC shall have written docu-           100% of CCNC shall have a written agreement with       The Iowa Department of Public Health requires registered
mentation defining the partnership be-          the CCRR lead agency or be included in the local       nurses who participate in the Iowa Training Project for
tween the CCNC, RCCNC, and the                  MCH interagency agreement with CCRR lead agen-         Child Care Nurse Consultants to partner with CCRR lead
CCRR lead agency.                               cies.                                                  agencies to improve the quality of health and safety ser-
                                                The agreement shall follow template and checklists     vices in child care. The CCRR lead agency is the ―hub‖
                                                available from the Iowa Department of Public Health,   for child care businesses accessing resources. The
                                                Bureau of Family Health.                               CCRR lead agency has responsibility for coordinating
                                                                                                       consultation, training, technical assistance, resources and
                                                                                                       referrals to/from child care businesses and to families
                                                                                                       seeking child care. More information about such contracts
                                                                                                       is available from the HCCI office at 1-800-383-3826.
7.9 Work with RCCNC and CCRR parent Attend a minimum of one face-to-face meeting per year
referral specialist to identify child care with the CCRR parent referral specialist.

16
 Child care subsidy is a family support program to help low income families pay for child care. Funds for the subsidy are from the federal Child Care Development Fund. Local
DHS offices have information and enrollment materials.
                                                                                                                                                                           18
                                                                                                                                                               SFY 2010
                                                                                                                                           14
Performance Measure 7: The CCNC develops and maintains the linkage with child care regulatory personnel and child care partners.
                 Outputs                                Annual Performance Standards                                          Comments
business needs for health and safety
information or resources.
Partner: Child Care Businesses and
Community Partners:
7.10 Receive and respond to invitations   Coordinate with RCCNC conducting a minimum of 1 HCCI Example: Empowerment groups, DHS Decategorization.
from community groups to conduct group promotion or training session per year promoting public         Child Abuse Prevention group, Local Board of Health.
training regarding health and safety in   health practice in child care.
child care.
Partner: hawk-i & Medicaid, Title V
MCH, WIC programs
7.11 Promote and refer families to the         CCNC will attend one training every 2 years to update Enrolling Iowa children in health insurance programs, Title
resources hawk-i, Medicaid, WIC, and           knowledge about hawk-i, and how to enroll children.     V program, or WIC is a critical component of the Healthy
the Title V MCH program                        CCNC will carry and disseminate hawk-i, applications Child Care Iowa program.
                                               and marketing materials to 100% of on-site consulta-
                                               tion or TA visits. 100% of children without health in-
                                               surance will be referred to the hawk-i, program.
                                               CCNC will carry and disseminate applications and
                                               marketing materials at 100% of training sessions with
                                               child care businesses.
                                               CCNC will carry contact information for referral to the
                                               WIC and the MCH program.
                                               The CCNC will make referrals to MCH care coordina-
                                               tion services for 100% of children needing health ser-
                                               vices.
7.12 Participate in the public health Ma- 100% of CCNC will be included in a local Maternal and        The CCNC employer may work with the RCCNC when
ternal and Child Health system. Including Child Health agency contract either through direct em-       writing a MOU with the MCH agency.
the system for care coordination.         ployment or through a written agreement. If an agreement The list of MCH agencies and directors is available from
                                          is used, the Child Care Nurse Consultant Role Guidance       the Healthy Child Care Iowa talkline at 800-369-2229.
                                          document shall be contained in the agreement.

Performance Measure 8: The CCNC maintains communication capability for receiving and disseminating child care health and safety information.
                 Outputs                               Annual Performance Standards                                         Comments
8.1 The CCNC shall use the HCCI logo      Develop a mechanism to affix the logo to printed items or Using the HCCI logo helps market the national Healthy
when disseminating information or         to envelopes to identify the CCNC to the HCCI campaign.   Child Care America campaign and associates the actions
printed materials to child care business-                                                           of the CCNC to the campaign.
es, families, and health care profession-
als.
8.2 Use electronic communication me-          Each CCNC shall have a personal business related      Examples of Internet sites:
chanisms to send and receive informa-         email address to receive and send communication       National Resource Center for Health and Safety in Child
tion and data.                                with the state HCCI coordinator, the RCCNC, and re-   Care, http://nrc.uchsc.edu/;
                                              quired list-serves. The email services should accept  Consumer Product Safety Commission: www.cpsc.gov;
                                              email attachments from the HCCI office.
                                                                                                                                                           19
                                                                                                                                                  SFY 2010
                                                            The CCNC shall use electronic data reporting for all                 Centers for Disease Control and Prevention www.cdc.gov
                                                            CCNC encounters using the CCNC activity log.                         Children's Defense Fund
                                                            The CCNC shall subscribe to the following website/list               http://www.childrensdefense.org/;
                                                            serves:                                                              Other useful websites:
                                                                     o National Resource Center for Health and                   National Network for Child Care www.nncc.org;
                                                                          Safety in Child Care listserve and the                 National Child Care Information Center, www.nccic.org;
                                                                     o Consumer Product Safety Commission                        National Safe Kids Coalition www.safekids.org
                                                            The CCNC shall disseminate consumer product in-
                                                            formation to child care businesses.
8.3 Participate in responding to inquiries                  Respond to calls referred to the CCNC from the HCCI                  HCCI talkline: 1-800-369-2229 OR 1-800-735-2942 for
from child care businesses to the HCCI                      talkline or the RCCNC within 2 working days of re-                   (TT/TTY)
talkline or inquiries to the RCCNC. Dis-                    ceipt.
seminate HCCI talkline contact informa-                     Promote the use of the talkline when communicating                   HCCI website: www.idph.state.ia.us/hcci
tion to child care businesses.                              with child care businesses.

Addendum 1: Nursing Assessment Process and Instruments


         Healthy Child Care Iowa developed the chart below to aid child care nurse consultants (CCNC) in understanding the health and safety
nursing assessment process and components. The chart below identifies and describes each nursing assessment instrument and the actions of
the CCNC. The nursing assessment process for health and safety begins with the child care business completing a Business Partnership Agree-
ment (BPA) and a health and safety Survey specific to the type of child care business (home or center). The BPA and Survey serve as a founda-
tion for the nursing process.17 The suggested order for assessment for quality in child care is as follows: 1st Injury Prevention Checklist, 2nd Child
Record Review and 3rd Health and Safety Assessment. There may be extenuating circumstances that cause a child care business to request an
assessment be conducted in an order different than the suggested. However, child care businesses should be counseled regarding the rational for
the recommended nursing assessment order and process.


            Health and Safety Nursing Assessment Instrument                                                                       CCNC Actions
Step 1: This is a conversation with child care provider at the introductory                       No CCNC actions specified. The CCNC may begin relationship-building inte-
level. No specified CCNC instruments or actions                                                   ractions with child care businesses. The CCNC may introduce child care
                                                                                                  businesses to the nursing assessment process.
Step 2: Business Partnership Agreement (BPA)                                                      CCNC Process:
Purpose: To structure the business relationship between the child care busi-                      1. The BPA may be sent to the child care business by the CCNC via mail
ness and the CCNC. The BPA informs the child care business of the scope                                or given as a handout in training sessions. The CCNC may arrange for
of services available to the business from the CCNC. The BPA lists the                                 the Child Care Resource and Referral personnel to give the BPA to child
names of the local CCNC and the RCCNC. The RCCNC is listed to inform                                   care businesses during trainings or informational meetings.
the business that a backup person exists to respond to questions or con-                          2. The CCNC has the obligation to fully inform the child care business re-
                                                                                                                                                               19
cerns when the CCNC is not available. The BPA serves as the written in-                                garding the CCNC services available and the conditions in which the
formed consent for services. The CCNC is strongly encouraged to complete                               services are delivered. Because the document is the informed consent

17
     Nursing Diagnoses, Outcomes, and Interventions, NANDA, NOC, and NIC Linkages, Center for Nursing Classification, University of Iowa, College of Nursing, Iowa City. Mosby Press, 2001.
19
     Conditions of CCNC services may include timelines, fees, and availability of service delivery.
                                                                                                                                                                                                  20
                                                                                                                                                                                       SFY 2010
a BPA with all child care businesses requesting or receiving CCNC services.                         the conversation between the CCNC and the child care business owner
                                                                                                    is critical to development of the business partnership.
The BPA is part of the Iowa QRS and may be completed at any Level of the                         3. The BPA requires the child care business director/owner to sign the
                                                  18
QRS for which the child care business is applying. The BPA document                                 agreement then return the entire agreement to the CCNC.
should be used with all child care business. The BPA is not solely a QRS                         4. The CCNC signs the agreement and returns the top copy of the form to
document.                                                                                           the child care business. The CCNC keeps the document for the CCNC
                                                                                                    records for that specific business.
CCNC On-Site Visit: Strongly recommend a face-to-face, on-site, or specific                      5. The CCNC advises the child care business to always keep a copy the
communication where the details are explained.                                                      BPA in the director/owner’s files.

Description of form:
  1-page form, printed on 8 x 11 inch, 2-part self-carbon paper, printed in
black/white/yellow color print. The form requires the signatures of CCNC and
the child care business director/owner to be considered a valid agreement.
Step 3: Child Care Center Director/Owner Survey OR Home Child Care                               CCNC Process:
Owner/Director Survey                                                                            1. The Survey may be sent to the child care business by the CCNC via
Purpose: These documents are referred to as Surveys. The Surveys begin                              mail or given as a handout in training sessions. The CCNC may arrange
the assessment of health and safety in child care businesses. The Survey is                         for another child care consultant to give the Survey to child care busi-
a self-report assessment of the characteristics of children and families                            nesses during training or other child care meetings.
served; the child care personnel, and the facilities where child care services                   2. The child care business director/owner completes the Survey while on-
are delivered. The Survey begins the CCNC process for data collection,                              site at their child care business. Note: The Survey should be completed
analysis, and reporting regarding the quality of health and safety in a child                       when the business director/owner is at their business site. Completion of
care business. The Survey assists the CCNC in identifying hazards early in                          the Survey requires the child care business director/owner to review in-
the CCNC-child care business relationship. The Survey gives the CCNC in-                            formation and begin to evaluate equipment used at the child care facility.
formation about the business, and the health/safety needs for employees,                            The child care business director/owner must be on-site at their business
children and families served. The CCNC is required to review and analyze                            to accurately complete the Survey.
the data and begin the nursing consultation process.                                             3. The CCNC may also complete the Survey in a question/answer inter-
                                                                                                    view format during an on-site visit.
CCNC On-Site Visit: Recommended, but not required. The child care busi-                          4. The child care business completes and signs the Survey and returns the
ness owner must complete the Survey while on-site at the child care busi-                           completed Survey to the CCNC.
ness. There are questions that require the child care business to check items                    5. The CCNC reviews the responses given by the child care business and
on-site at the business.                                                                            begins to identify and document needs and health/safety recommenda-
                                                                                                    tions for the child care business. The CCNC may use the Child Care
Relationship to the Iowa QRS: The Survey documents may be used with any                             Business Health and Safety Quality Improvement Plan to begin do-
child care business and is not solely a QRS document. The Iowa Depart-                              cumenting needs and recommendations for improvement.
ment of Human Services is the authority and awarding entity for all QRS re-                      6. The CCNC may make a telephone contact or on-site visit to respond and
lated activities. Each CCRR has a QRS Specialist that can assist child care                         give recommendation of findings to the child care business direc-
businesses with QRS questions. There are no QRS points associated with                              tor/owner.
completion of the Survey. The Survey forms require signature of CCNC and                         7. The CCNC and child care business director/owner begin development of
                                                                                                                                                                        20
the child care business owner or director for use in the Iowa QRS.                                  a child care business health and safety Quality Improvement Plan as

18
  Relationship to the Iowa QRS: The Iowa Department of Human Services is the authority and awarding entity for all QRS related activities. Each CCRR has a QRS Specialist that can assist child care
businesses with QRS questions. There are no QRS points associated with completion of the BPA.
20
  The child care business health and safety Quality Improvement Plan is an optional document that may be used by the CCNC with a child care business to document identification of need
solve.
                                                                                                                                                                          21
                                                                                                                                                                                       SFY 2010
                                                                                       indicated by the dialog that occurs between the CCNC and the child care
                                                                                                                                                     21
Description of forms:                                                                  business. The CCNC may also use a Notice of Urgent Need form to
  The forms are referred to as ―Surveys‖                                               identify issues that pose immediate danger of death or disability to child-
  The Survey forms are printed on 1-page of paper, size is 11 x 17 inch with           ren enrolled in child care.
a center-fold to make a 4 page document, form is printed front/back in              8. Upon reporting and discussing the results of the Survey with the child
black/white print. The document may also be printed on 8 ½ x 12 inch paper             care business, the CCNC signs the Survey, makes a photocopy, and re-
and prints on 4 pages (or prints 2 pages if printed front to back).                    turns the Survey to the child care business. The CCNC shall keep a pho-
  There is a Survey form for registered Child Development Homes and a                  tocopy of the document in the CCNC records.
Survey form for licensed Child Care Centers.                                        9. The child care business should always keep the Survey in the own-
                                                                                       er/director files.
Optional documents that may be used by the CCNC throughout the consul-
tation process:
                                                                            20
     Child Care Business Health and Safety Quality Improvement Plan is
     a 1-page front/back document that may be used to document the child
     care businesses’ plan to make corrections or complete recommenda-
     tions. The Quality Improvement Plan contains descriptive statement of
     needed improvement, actions needed to improve, timeline and budget
     considerations.
                             21
     Notice of Urgent Need document is a 1-page document printed on 2-
     part self-carbon paper. The document is used when an issue of imme-
     diate importance is identified that impacts child morbidity or mortality.
     The Notice of Urgent Need may be shared with DHS regulatory person-
     nel.
Step 4: Iowa Child Care Nurse Consultant Injury Prevention Checklist                CCNC Process:
(IPC)                                                                               1. The child care business asks the CCNC or the CCNC suggests to the
Purpose: To identify potential hazardous or recalled equipment and to identi-          child care business director/owner that an injury prevention checklist as-
                                                                                                                 23
fy unsafe practices in use within child care businesses. The leading cause of          sessment be conducted.
death for children over age one-year is unintended injury. Preventing injuries      2. The CCNC schedules appointment for on-site visit.
in early childhood equates to saving children from death and disability. Pro-       3. The CCNC informs the child care business about the activities that will
tecting children by conducting injury prevention assessment is the primary             be conducted during the on-site visit. The CCNC specifically informs the
rationale for conducting this assessment before conducting the child record            child care business of the need to inspect equipment, even equipment
review or health and safety assessments.                                               that may be held in storage by the business. The CCNC will inform the
                                                                                       child care business that information from the Consumer Product Safety
CCNC On-Site Visit: Required. Multiple visits are usually needed to complete           Commission (CPSC) will be used during the visit.
the hazard identification and remediation planning process.                         4. The CCNC should instruct the child care business to develop a file listing
                                                                                       all equipment, tools, toys etc. used in the business, collect all warrantee
Relationship to the Iowa QRS: The Iowa Department of Human Services                    and product information obtained at time of purchase, to record brand
                                    22
regulates and awards all QRS points.                                                   names, model numbers, and to record date/place of purchase. The


21
   The Notice of Urgent Need document is an optional use form that a CCNC may use to document issues requiring immediate response by the child care business. The Notice of Urgent nee
issue has high potential for child morbidity or mortality.
22
   The total of 3 points may be awarded for the Injury Prevention Checklist. All QRS points are awarded by the Iowa Department of Human Services NOT the CCNC. All ques-
tions from child care businesses regarding the Iowa QRS should be referred to the Child Care Resource and Referral QRS Specialist.
                                                                                                                                                                          22
                                                                                                                                                              SFY 2010
Iowa Administrative Code for QRS IAC 441-118.3(3) Health and safety. A                       business director/owner may also take photographs of equipment to
child care center or preschool may earn a maximum of eight points in the                     properly identify all items used in the child care business. This may be
health and safety category. Points are awarded as follows:                                   done by the child care business prior to the CCNC visit. The child care
Injury prevention. A facility may earn a maximum of three points for injury                  business director/owner may need technical assistance to develop such
prevention. Points are awarded as follows:                                                   an equipment warranty file.
a) One point is awarded if the facility completes the Iowa department of               5.    The site visit is conducted by the CCNC using the IPC. The site visit
     public health’s Form HCCI–IP2006, Injury Prevention Summary Report,                     usually takes several hours to complete, depending upon the amount of
     during a visit with a child care nurse consultant.                                      equipment to be checked. This assessment may require more than one
b) Two points are awarded if the child care nurse consultant verifies that                   visit to the business.
     the facility has started the process of making recommended corrections.           6.    The CCNC requests that all CPSC recalled items be immediately re-
c) Three points are awarded if the child care nurse consultant verifies that                 moved from use. If immediate removal is not possible the CCNC and the
     the facility has completed all corrections.                                             child care business shall develop a written plan for equipment removal
                                                                                             (the Child Care Business Health and Safety Quality Improvement Plan
                                                                                             should be used). CPSC recalled equipment that remains in use will be
Description of forms:                                                                        reported on a Notice of Urgent Need form (this is a form for use by
  The IPC assessment form is printed on 1-page of paper, paper size is 11 x                  CCNC). The child care business is required at a minimum to develop a
17 inches with fold in center to make a 4 page document the document is                      written plan for removal from use of all CPSC recalled equipment.
printed front/back in multicolor print. The form may be printed on 8 ½ x 12            7.    The CCNC and child care business shall develop a written plan to ad-
inch paper and will print on 4 pages (or will print on 2 pages if printed front to           dress other hazards found during the injury prevention assessment. The
back).                                                                                       plan shall contain a timeline and budget for addressing every hazard
  The IPC contains evaluation of 41 potential indoor and outdoor safety ha-                  found.
zards.                                                                                 8.    The CCNC shall complete and sign the CCNC signature page for initial
                                                                                             assessment completed on the Injury Prevention Summary Report.
  The Injury Prevention Summary Report is a 4-page document printed on                 9.    The CCNC shall ask the child care director/owner to sign the report as
front side only, printed in black/white. The document is available electronical-             the method of verifying the child care business was informed of hazards
ly for ease of data entry.                                                                   found using the IPC.
  The form requires the signature of the CCNC and the child care business              10.    Note: If the child care business is enrolled in the Iowa QRS program,
director/owner.                                                                              the QRS required form is the Injury Prevention Summary Report form
                                                                                             number HCCI-IPC2006. You will find the form number located in the foo-
                                                                                             ter of the page in the lower right corner on the Injury Prevention Sum-
                                                                                             mary Report form. The CCNC shall keep a copy of all forms and docu-
                                                                                             mentation pertaining to the injury prevention assessment.
                                                                                       11.   The CCNC and child care business shall schedule appointment for fol-
                                                                                             low-up visit(s) to determine progress in completing the recommendations
                                                                                             to remove all identified hazards.
                                                                                       12.   The CCNC and child care business may now be using photocopied ver-
                                                                                             sion of the IPC that has both the CCNC and the director/owner signature
                                                                                             (if the child care business submitted original forms to Iowa QRS).
                                                                                       13.   The child care business shall continue to correct hazards that are within
                                                                                             the authority and control of the business. Those items not within the au-

23
  The suggested order for assessments for quality in child care is as follows: 1 st Injury Prevention Checklist, 2nd Child Record Review and 3rd Health and Safety Assessment. There
may be extenuating circumstances that cause a child care business to request an assessment be conducted in a different order. However, the child care business should be counseled
regarding the rational for the specified order in which the various assessments are recommended.
                                                                                                                                                                                  23
                                                                                                                                                                     SFY 2010
                                                                                        thority and control of the business or those items that require a large fi-
                                                                                        nancial investment shall be identified by the child care business and the
                                                                                        CCNC. The CCNC and the child care business shall develop a Quality
                                                                                        Improvement Plan outlining each remaining hazard and the plan for res-
                                                                                        ponding to the safety hazard.
                                                                                    14. The CCNC and child care business shall maintain copies of correspon-
                                                                                        dence, assessments and reports from the injury prevention assessment.
Step 5: Child Record Review (CRR)                                                   CCNC Process:
Purpose: To identify if children are receiving preventive health services and       1. The child care business asks the CCNC to conduct or the CCNC re-
screenings; to identify special health or development needs; and to assist              commends the conducting of the CRR.
families in securing needed services through referral and care coordination         2. The CCNC schedules appointment for on-site visit. The CCNC informs
process.                                                                                the child care business about the activities that will be conducted during
                                                                                        the on-site visit. The length of the site visit depends upon the number of
The Child Record Review is recommended at Level 4 of the QRS.                           children enrolled and number of child records to be reviewed.
                                                                                    3. The child care business informs parents of the review, giving parents the
CCNC On-Site Visit: Required, more than 1 visit is likely to be needed                  opportunity to ask specific questions or relate concerns to the CCNC.
                                                                                        Parents also have the authority to refuse to have the CCNC review a
Relationship to the Iowa QRS: The Iowa Department of Human Services                     child’s record. Parents should be encouraged to be present or to call the
                                        24
regulates and awards all QRS points.                                                    CCNC when their child’s record is being reviewed by the CCNC.
Iowa Administrative Code for QRS IAC 441-118.3(3) Health and safety. A              4. The CCNC randomly selects records for review. A minimum of 25
child care center or preschool may earn a maximum of eight points in the                records should be reviewed. If fewer than 25 children are enrolled, the
health and safety category. Points are awarded as follows:                              CCNC reviews the records of all enrolled children. The CCNC should
   b. Child record review. A facility may earn a maximum of two points for              prioritize infant records for review. If no infants are enrolled, then the
child record review. Points are awarded as follows:                                     CCNC should review records of toddlers and so forth; moving from the
   (1) One point is awarded if the facility completes the Iowa Department of            youngest children enrolled to the oldest. Note: The child care business
Public Health’s Form HCCI–CRR2006, Child Record Review, during a visit                  may request records of specific children be reviewed by the CCNC. Ex-
with a child care nurse consultant.                                                     ample: child with frequent illness, child with special needs, and child with
   (2) Two points are awarded if the child care nurse consultant verifies that          development concerns etc. Parents have the right to refuse the CCNC
the facility has worked with the child care nurse consultant to refer families to       review of a child or children’s records. Records from each age group
health care providers.                                                                  enrolled should be reviewed.
                                                                                    5. The CCNC reviews records for all items contained on the CRR Child
                                                                                        Health Status Worksheet. The CCNC notes what preventive health ser-
Description of forms:                                                                   vices or documents are missing from the child’s record.
  The Child Record Review Child Health Status Worksheet is a 1-page                 6. The CCNC develops an aggregate data list of missing health documen-
form, printed on 8 x 11 size paper, 2-part self-carbon paper, printed in                tation.
black/white/yellow print.                                                           7. The CCNC develops a list of health services needed by specific children.
  The Child Record Review Child Health Status Worksheet addresses 17                    The CCNC develops health related referrals as indicated.
child health indicators.                                                            8. The CCNC completes and signs the CRR Initial Report of Findings.
                                                                                    9. The CCNC shall photocopy and keep a file the CRR Initial Report of
The CCNC should use the CRR Initial Report of Findings and the CRR                      Findings.
Report of Progress to document results of the assessment. Both of these             10. The child care business and CCNC jointly develop the plan for correcting
documents are one-page 8 ½ x 12 inch paper.                                             missing health information. The CCNC may use the Child Care Business

24
     Child Record Review is associated with the Iowa QRS. The Iowa Department of Human Services may award 2 QRS points for completion of the CRR.
                                                                                                                                                                        24
                                                                                                                                                             SFY 2010
                                                                                      Health and Safety Quality Improvement Plan to document the child
                                                                                      care business’s plan for correction.
                                                                                  11. The CCNC and child care business determine date for follow up visit Or
                                                                                      to conduct telephone conference call to review the progress made by the
                                                                                      child care business in developing a method to secure and actually secur-
                                                                                      ing missing information for child files and to determine response to refer-
                                                                                      rals.
                                                                                  12. The CCNC conducts the follow up visit or conference call with the child
                                                                                      care business. The CCNC has the option to review records of children
                                                                                      whose records were reviewed during the initial visit or to select different
                                                                                      records to assure that items missing from the records during the first re-
                                                                                      view have now been added to all children’s records.
                                                                                  13. The CCNC shall review follow up on referrals made for health or deve-
                                                                                      lopmental services for children.
                                                                                  14. The CCNC shall use form CRR – Report of Progress to document the
                                                                                      follow up visit. The CCNC will specifically evaluate the development of
                                                                                      method to obtain needed child health information and the use of forms to
                                                                                      obtain the child health information. Note: The child care business is not
                                                                                      penalized for a family’s refusal to act upon a health referral or referrals
                                                                                      that are not yet complete. The CCNC will collaborate with the Maternal
                                                                                      and Child Health care coordinator to complete child health referrals.
Step 6: Health and Safety Assessment (HAS)                                        CCNC Process:
Purpose: to identify written child care policy and personnel practices that       1. The child care business asks or the CCNC recommends a health and
may jeopardize the health and safety of children enrolled in child care.              safety assessment be conducted.
                                                                                  2. The CCNC schedules appointment for on-site visit. The CCNC informs
CCNC On-Site Visit: Required, more than 1 visit is likely to be needed.               the child care business about the activities that will be conducted during
                                                                                      the assessment. The CCNC specifically informs the child care business
Relationship to the Iowa QRS: The Iowa Department of Human Services                   of the health and safety categories of policy and practice that will be
                                        25
regulates and awards all QRS points.                                                  covered. The CCNC shall inform the business that some HAS items re-
Iowa Administrative Code IAC 441-118.3(3)Health and safety. A child care              quire the CCNC to visit with the director/owner, staff members, and pos-
center or preschool may earn a maximum of eight points in the health and              sibly families.
safety category. Points are awarded as follows:                                   3. Child care policies may be reviewed off-site from the child care busi-
   c. Health and safety assessment. A facility may earn a maximum of three            ness.
points for health and safety assessment. Points are awarded as follows:           4. The assessment is conducted by the CCNC using the HAS. The as-
   (1) One point is awarded if the facility completes the Iowa department of          sessment takes several hours to complete.
public health’s Form HCCI–HAS2006, Health and Safety Assessment, dur-             5. At the completion of the assessment, the CCNC shall complete the
ing a visit with the child care nurse consultant.                                     Health and Safety Assessment Report of Findings document (this is the
   (2) Two points are awarded if the child care nurse consultant verifies that        QRS required form HCCI-HAS2006) sections for item findings, areas of
the facility has developed a plan of action to correct deficiencies.                  concern, and recommendations. Each of the categories of HAS has a

25
  The Health and Safety Assessment is associated with the Iowa QRS. The Iowa Department of Human Services may award 3 QRS points for completion of the HAS. The Health
and Safety Assessment Report of Findings is the QRS required form HCCI-HAS2006. The form number is located in the footer in the lower right corner of the page. The form
requires the signatures of the CCNC and the child care business to apply for the second and third point in the QRS.

                                                                                                                                                                      25
                                                                                                                                                           SFY 2010
  (3) Three points are awarded if the child care nurse consultant verifies that    specific section on the Health and Safety Assessment Report of Find-
the facility has completed all corrections.                                        ings document. The report of findings shall detail all of the hazards and
                                                                                   concerns found during the assessment visit.
                                                                               6. The initial report on the Health and Safety Assessment Report of Find-
Description of forms:                                                              ings document shall be signed by the CCNC and the child care business
  The Health and Safety Assessment form is a seven-page document                   owner/director. The CCNC shall photocopy and keep a file copy of doc-
printed in multi-colors, front/back in booklet format on 11 x 17 inch paper        ument.
with a center-fold.                                                            7. The CCNC and the child care business director/owner will develop a
  The assessment covers eight categories of health and safety policy and           Quality Improvement Plan to identify and correct hazards and con-
practice.                                                                          cerns. The plan shall include timelines and budget considerations.
  The Health and Safety Assessment Report of Findings is a 6-page              8. The CCNC and child care business shall schedule appointments for fol-
form printed in multi-color on 8 x 11 inch size paper. This document is avail-     low up visit(s) to determine progress in completing the recommenda-
able electronically to ease data entry.                                            tions.
                                                                               9. The CCNC and child care business shall schedule appointments for fol-
Note: The Health and Safety Assessment form has an optional numerical              low up visit(s) to determine progress in completing the recommenda-
scoring format. The scoring format may be used as an indicator of making           tions.
progress in correcting hazards or concerns. The score is not required for the 10. The CCNC and child care business shall keep copies of all the Health
QRS process.                                                                       and Safety Assessment Report of Findings, correspondence, and docu-
                                                                                   ments.
     The CCNC nursing assessment instruments are used by CCNC when consulting with child care businesses. Some child care businesses participate in
     quality improvement initiatives sponsored by Child Care Resource and Referral agencies or local Community Empowerment Boards.
     A child care business may request a CCNC to use one of the instruments to assess the business even if the business is not a participant in the Iowa
     QRS.
     The CCNC shall keep a file of all documents, notes, and correspondence pertaining to assessment of child care business policy, practices, and facilities.
     The child care business may decide to enroll in the Iowa QRS program and use CCNC nursing assessments at a later date.
     Additional guidance is available to the CCNC from the regional CCNC or the Healthy Child Care Iowa office at the Iowa Department of Public Health.
     Tel: 800-383-3826.




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                                                                                                                                                       SFY 2010

								
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