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Article Excerpt
Approximately 12 million children under 6 years of age are n non-parental child care arrangements for some part of the day (Federal Interagency Forum on Children and Family Statistics, 2007). For more than two decades (Gomby, Lamer, Stevenson, Lewit, & Behrman, 1995; Peisner-Feinberg et al., 1999), studies indicate that participation in child care poses both risks and benefits to children's health and development. Injuries (Waibel & Misra, 2003) and communicable diseases, specifically gastroenteritis, upper respiratory infections, and otitis media (Bradley & the National Institute of Child Health and Human Development [NICHD] Early Child Care Research Network, 2003), are common among children attending child care. Conversely, child care programs with a strong health component have demonstrated positive outcomes for children, including decreased rates of respiratory infections (Roberts et al., 2000) and injuries (Ulione, 1997), and up-to-date health visits and immunizations (Williams & Sadler, 2001).
Recognizing the importance of decreasing risk and promoting health in these settings, the U.S. Department of Health and Human Services (DHHS) Maternal Child Health Bureau developed a number of initiatives in collaboration with the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) to support healthy and safe child care, including national health and safety standards, Caring for Our Children (CFOC): National Health and Safety Performance Standards: Guidelines for Out-of-home Child Care Programs (AAP, APHA, & the National Resource Center for Health and Safety in Child Care, 2002; APHA & AAP, 1992).
A priority standard for improving health and safety is the use of child care health consultation services. Evidence suggests that health consultation improves health knowledge and compliance of child care providers, children's immunization status and access to health care, and health screenings and early detection of health problems (Ramler, Nakatsukasa-Ono, Loe, & Harris, 2006). Furthermore, the Maternal Child Health Bureau funded the National Training Institute for Child Care Health Consultants at the University of North Carolina, Chapel Hill, School of Public Health to develop a curriculum and provided grants to states to develop a system of child care health consultants.
Currently, child care regulations in 20 states recommend or require the services of a health professional or health consultant to promote healthy and safe practices and address children's health needs (P. Fahey, personal communication, July 17, 2007). However, some states, specifically Colorado, Connecticut, Illinois, Minnesota, Rhode Island, and Washington, have required health consultation to child care programs for decades, and nurses have served as health coordinators to Head Start programs for years (Crowley, 2000). Promising reports of the impact of health consultation on children's health and safety influenced the current national initiative to build state systems of child care health consultants (Ramler et al., 2006). The number of nurses engaged in health consultation to child care and Head Start programs is not available. However, the majority of the 385 graduates of the National Training Institute for Child Care Health Consultants trainer program are nurses or advanced practice nurses, and 4,118 nurses and other professionals have been prepared by National Training Institute for Child Care Health Consultants graduates to practice as child care health consultants (S. Cianciolo, personal communication, December 4, 2007). Although no consensus exists on the role of the health consultant, national standards (AAP, APHA, & the National Resource Center for Health and Safety in Child Care, 2002) and models of practice are emerging (Ramler et al., 2006).
The State of Connecticut child care regulations require that all child care centers enrolling 13 or more children and group day care homes caring for 7 to 12 children must have consultants, including health, social service, education, dental, and nutrition (if food is served) (State of Connecticut, Department of Public Health, Community-Based Regulation Section, Child Day Care Licensing Program, 2005). The consultants should be available by telecommunication or onsite as needed in addition to providing an annual review of policies and in-service education programs. Further more, programs that enroll children under 3 years of age on a full-time basis must arrange, at minimum, weekly visits by a health consultant. For programs that enroll children 2 to 3 years of age on a part-day basis, monthly visits are mandated. The health consultant must be a registered nurse (RN), advanced practice registered nurse (APRN), physician, or physician assistant. No other specialization or preparation is required for this role. Additional regulatory responsibilities and activities of health consultants, who visit programs enrolling infants and toddlers, include maintaining health records and first aid kits, monitoring health and safety practices and health screenings for children, and identifying abuse and neglect.
Although no data are available regarding the percentages of health consultants by profession, Crowley (2000) reported that in a randomly selected sample of 100 child care health consultants who visited programs enrolling infants and toddlers in Connecticut, all were nurses or advanced practice nurses. This article reports on an evaluation of a pilot training of nurse child care health consultants, child care directors, and community teams in Connecticut, and the effect of the training on (a) nurses' and directors' perceptions of the health consultant role, (b) nurses' knowledge and activities as health consultants, and (c) child care health and safety policies and practices.
Description of Training and Evaluation
The pilot training. Consultants and staff of Healthy Child Care Connecticut, a DHHS Maternal Child Health Bureau grant-funded project, developed and conducted a pilot training program for nurse child care health consultants, child care center directors, and community teams. The training included 12 modules specific to health consultation (see Table 1) created by the National Training Institute for Child Care Health Consultants at the University of North Carolina at Chapel Hill. The Healthy Child Care Connecticut trainers adapted the national training curriculum in several ways. The Ecological Model of Child Care Health Consultation (Crowley, 2001) served as the theoretical framework for the training and preparation for the health consultant role. The model emphasizes a family-centered approach to child care health consultation and includes two objectives: (a) to support a healthy and safe environment for children, families, and staff, and (b) to promote child and family health and development. In addition, state-specific information, such as Connecticut health resources, was included in the curriculum as well as an...
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