A GLIMPSE OF HEALTH CONSULTATION ACTIVITIES IN WYOMING’S CHILD CARE SETTINGS
 
 
 

Prepared by

Gena Sandberg, Asst. Project Coordinator
Karen Williams, Project Director

HEALTHY CHILD CARE WYOMING
Department of Family & Consumer Sciences
University of Wyoming
Funded by the Maternal & Child Health Bureau

SUMMER, 2001


Background

Healthy Child Care Wyoming (HCCWY) is a project funded by the Federal Child Care Bureau and the Maternal & Child Health Bureau and is in its fifth year of activities. Housed in the University of Wyoming, Department of Family & Consumer Sciences, HCCWY has the expertise of early childhood development and family life professionals. Partnership between the Department of Family & Consumer Sciences and organizations and agencies throughout the state, including the UW School of Nursing, Wyoming Departments of Health, Family Services, & Education, Nutrition and Children’s Services/Child Care Finder, the Head Start-State Collaboration Project and The Learning Center, enables the completion of activities contributing to improved health & safety of children in child care settings and their families. Nationally, the Healthy Child Care America Campaign is guided by the Blueprint for Action, which includes ten steps that communities can take in their efforts to improve health & safety in child care.

Past accomplishments of HCCWY include the establishment of a web site, trainings on health & safety topics in early childhood, a brochure on inclusive playgrounds, a brochure on outdoor play in Wyoming, a curriculum guide on health & safety for young children, a Director’s Certificate, and an Infant & Toddler Credential. The current year’s activities include creating TV spots on health & safety topics, inclusion of health & safety regulations in Wyoming’s Revised Licensing Rules, newsletter articles on health & safety in child care, training of child care health consultants and continued planning for a system of child care health consultation in Wyoming.

Introduction

Action Step Nine of the National Blueprint for Action is to use child care health consultants to help develop and maintain health and safety for children in child care. As a step in planning for a system of health consultants in our state, Healthy Child Care Wyoming assessed the activities that are taking place in child care settings, what needs providers have for health consultation, and the current state of interest in utilizing health consultant services. The current report contains data collected from Wyoming child care providers, including family child care providers, child care centers, Head Start Programs, and Developmental Preschool Programs. All types of child care providers were included because it is hoped that health consultation will be used in all types of settings where children are being cared for.

Methods

The survey was developed to obtain an overview of current use and future need for health consultation in child care settings. To encourage participation, survey length was limited to one page, front and back. Permission was granted to use Colorado’s Assessment of Need for Nursing Consultation in Child Care Centers as a guide. Input was sought from the statewide partners of HCCWY and the final survey included nine questions for child care providers and eight for public health nurses.

Using the most currently available list of child care providers in the state, a total of 779 surveys were mailed and 43% were returned. [Data was not entered for four of the returned surveys for the following reasons: 1) Provider was new and children were not yet attending, 2) Provider was sent more than one survey (two cases), and 3) Provider was no longer in business.]

A second survey was completed with Public Health Nurses (PHN’s) in every county. A total of 29 surveys were mailed and 19 (or 66%) were returned.

Each survey was number-coded to mach the list of providers and public health nurses in order to track their location within the state. Each licensed child care provider, Head Start program, and Developmental Program was color-coded separately to observe trends within program type. Some child care providers are included on more than one list (i.e., a program could be a Head Start, Developmental program, and be licensed simultaneously), and the effort was made to avoid duplicative listing in the survey pool. However, contact names and program names are sometimes different on various lists, so some programs received more than one copy.
 

RESPONSES TO PROVIDERS SURVEY

1. Please tell us what type of child care you provide and average number in each category. Mark all that apply.

Each age group, given as a percent of the total number of children reported by providers, is as follows:

Infants                                         7.2%
Toddlers                                     12.8%
Preschool                                    51.5%
School Age                                  16.6%
Children with Special Needs        11.8%

It is important to note that children may be included in more than one category or only one category. For example, a child with special needs may be counted in their age category and in the special needs category, or they may only be included in the special needs category but not their age category.

2. Have you ever asked for advice from a health care professional in your community for assistance in a health or safety related topic concerning children in your care?

  • 211 said they have contacted a health care professional for assistance in a health or safety related topic concerning children in their care.
  • 117 providers indicated they have not sought advice

Please note: those who answered "No" to this question were asked to skip to question #8 and complete the survey from there. Those who answered "Yes" completed the entire survey.

3. What type of health professional have you been in contact with? Mark all that apply.

Providers indicated they have contacted the following types of health care professionals in their community:

Public Health Nurse             184        55.4%
School Nurse                        74          22.3%
Local Hospital                      45          13.6%
Local Physician                     139        41.9%
Local Dentist                        60          18.1%
Local Optometrist                 43         13%
Other                                    288       86.7%

Responses in the "other" category included the following:

Other Health Professional, Various (including sanitation, dietician, geneticist, audiologist, orthopedist, etc.) (12)
Nurse, various (10)
Developmental Center (8)
Mental Health Professional (6)
Parent who is a nurse (4)
Phone information line (3)
Department of Family Services (1)
One provider shared that a local physician "refused" [contact].

4. Do you have any formal contracts (in writing) with health care professionals to provide health and safety consultation to your program?

37 providers indicated they do have a formal contract with one or more health care professional to provide consultation in their program.

Additional comments given include:

  • Two said that the nursing office spoke at day care meetings or did "Super Tots" training for providers.
  • One has a nurse on staff.
  • One has a verbal but not a written agreement for consultation.
  • One contacts a physician with questions on specific children.

5. About how often are you in contact with a health care professional regarding children in your care?

Providers indicated about how often they are in contact with a health professional regarding children in their care, as follows:

Frequency         #         Percent
Daily                3          0.9%
Weekly             24        7.2%
Monthly           51        15.4%
Quarterly          64        19.3%
Yearly               63        19.0%

Comments show that providers usually only contact a nurse if specific questions arise. This tended to be seldom, although one person said that they were in contact twice per week, and the other said they hadn’t used one in three years!

6. Do you provide care for sick children at your facility?

While 177 said they do not provide care for sick children, 47 indicated they do provide sick child care. Two providers expressed that while they do not currently provide sick child care, they see it as a need. Other comments include:

  • Only for cold, allergy, end of illness, ear infections, mildly ill, low fever, or on medicine (24)
  • Only until parents can pick the child up (6)
  • Depends on the illness and the health of the other children (6)
  • Sometimes parents bring them sick (can’t miss work, etc.) (4)
  • Care for children with special health care needs (3)
  • Never (2)
  • Only after they’ve been seen by a physician (2)
  • Other: "We have a nurse." "Check state rules & contact those who do with questions of state law?"

7. What type of contact do you have with health care providers in your community concerning children in your care? Check all that apply.

Types of contact providers reported include the following:

  • Phone contact only, not regularly     39.2%
  • Phone contact only, on a regular basis     3.0%
  • Health professional visits at your site upon request only     7.8%
  • Health professional visits at your site on a regular basis     7.5%
  • Combination of phone and on-site contact, not regularly     11.7%
  • Combination of phone and on-site contact, on a regular basis     6.0%
  • Written documents from health professional to follow up after contact     12.3%
  • Training sessions on health & safety topics offered to child care staff     31.0%
  • Training sessions on health and safety topics offered to parents of children in care     10.5%

Comments in the "other contact" line include many (6) indicating they use health professional services for First Aid and/or CPR training. Many providers (8) shared that they contact a health professional by phone or in the office as needed. Three mentioned discussing specific issues, such as infants & newborns eating and sleeping, young mothers who have questions, hand washing, etc. Two had health advisory committee. Two mentioned access to nursing expertise through themselves or a parent nurse. The remainder of comments are varied and include: "collaboration for interagency resources," "daily visits by BSN," "none. If a child is sick I don’t have them," "written information, faxed," "yearly report," "The doctor will not consult without an appointment," and "For special-needs child."

8. What topics do (or would) you discuss with health professionals available to you? Mark all that apply.

Providers shared topics they do or would seek advice on, including the following:

1. "Other"........................................(308)… 92.8%
2. Immunizations.............................(202)… 60.8%
3. First Aid & CPR..........................(190)… 57.2%
4. Child Development......................(168)… 50.6%
5. Nutrition......................................(160)… 48.2%
6. Illness/Disease Prevention..............(160)… 48.2%
7. Hearing and/or Vision...................(122)… 36.7%
8. Treatment of Injuries.....................(122)… 36.7%
9. State Licensing Regulations...........(116)… 34.9%
10. Accident & Injury Prevention.....(114)… 34.3%
11. Health Records...........................(109)… 33.1%
12. Children w/ Special Needs..........(107)… 32.2%
13. Sick Child Care............................(98)… 29.5%
14. Medication Administration...........(91)… 27.4%
15. Transportation Safety...................(83)… 25.0%
16. Referrals to Primary Care...............(70)… 21.1%
17. Outdoor Safety.............................(75)… 22.6%
18. Dental..........................................(69)… 20.8%
19. Staff Health..................................(57)… 17.2%

The "Other" category for topics included receiving assistance for children with special health needs (7), discipline (2), specific illnesses (4), mental health (3), and topics already being addressed (2). Other comments were: "all topics are covered at monthly meetings," "dental," "I would feel comfortable discussing any of these," and "specific children". In addition, two other responses include, "We do all this," and "All topics are reviewed at monthly meetings."

9. Please describe ways a child care health consultant would be most useful to your program and the children and families you serve.

Common themes on how child care providers feel health consultants could be beneficial include:

  • Information and help with sick child care.
  • Training and information on disease prevention.
  • Immunizations (tracking, helping parents understand the need for them).
  • Trainings for providers (medication administration, CPR, First Aid, "required trainings for DFS). Also coming in and doing short lessons with the children on topics like brushing teeth, handwashing, and nutrition.
  • Referrals and for questions about possible developmental problems seen with a child.
  • Safety information: transportation safety, general safety.
  • Well child and general health screenings for the children and throat cultures.
  • General help in working with parents and providing parent education
  • Information on biting, tantrums, discipline, working with infants.
  • To answer questions as needed (often by phone consultation).
  • Written information (like pamphlets) as resources for them and parents.

RESPONSES TO PUBLIC HEALTH NURSES SURVEY

1. Have you ever provided consultation to a licensed child care provider on a health or safety related issue regarding children in their care?

  • 16 Public Health Nurses (PHN’s) in Wyoming said they have provided consultation to a licensed child care provider.
  • 3 said they have not.

Please note: Those who answered "yes" to this question were asked to complete the entire survey. Those who answered "no" were asked to skip to question 6, 7 & 8.

2. What type of child care provider have you been in contact with? Mark all that apply.

The PHN’s who have provided consultation have worked with the following types of child care programs:

  • Child Care Center                 (16)     84.2%
  • Home Child Care Provider    (12)     63.2%
  • Corporate Child Care            (2)       10.5%

3. Do you have any formal contracts (in writing) with any child care providers to provide health and safety consultation?

  • 3 said they do have a formal contract.
  • 13 PHN’s indicated they do not have a formal contract with a child care provider

4. About how often are you in contact with child are providers regarding children in their care?

PHN’s said they are in contact with child care providers during the following intervals:

  • Quarterly     (9)     47.4%
  • Monthly      (7)     36.8%
  • Weekly        (1)     5.3%

5. What type of contact do you have with child care providers in y our community concerning children in their care? Check all that apply.

Public Health Nurses in Wyoming work with child care providers in the following ways:

  • Phone contact only, not regularly     31.6%
  • Phone contact only, on a regular basis     100%
  • Visits at child care site upon request only     78.9%
  • Visits at child care site on a regular basis     89.5%
  • Combination of phone and on-site contact, not regularly     68.4%
  • Combination of phone and on-site contact, on a regular basis     78.9%
  • Written documents to follow up after contact     84.2%
  • Training sessions on health & safety topics offered to child care staff     31.6%
  • Training sessions on health & safety topics offered to parents of children in care     84.2%
  • Other comment, "Training to children."

6. What topics do (or would) you discuss with child care providers? Mark all that apply.

Public Health Nurses indicated they provide (or would provide) consultation on the following topics:

1. Immunizations  (19)  100%
2. "Other"  (17)  89.5%
3. Illness/Disease Prevention  (16)  84.2%
4. Children w/ Special Needs  (12)  63.2%
5. Nutrition  (11)  57.9%
6. Accident/Injury Prevention  (9)  47.4%
7. Child Health Records  (9)  47.4%
8. Referrals to Primary Care  (9)  47.4%
9. Transportation Safety  (8)  42.1%
10. First Aid/CPR  (7)  36.8%
11. Sick Child Care  (7)  36.8%
12. Staff Health  (6)  31.6%
13. Child Development  (6)  31.6%
14. State Licensing Regulations  (5)  26.3%
15. Outdoor Safety  (5)  26.3%
16. Dental  (4)  21.1%
17. Hearing and/or Vision  (4)  21.1%
18. Medication Administration  (3)  15.8%
19. Treatment of Injuries  (3)  15.8%

7. Please describe any potential barriers to providing health & safety consultation to child care providers regarding children in their care.

A major barrier expressed by public health nurses was with time, inadequate staffing & resources (6). While one commented that "our service is very much wanted by the centers" (1), there was also concern of child care providers accepting consultation services (2), for example, "Directors defensive re: [about] health consultation.  Why do you need to come? I know re: [about] child development." Other comments were:

  • "child care providers inability to get away from site sometimes a problem."
  • "Consultation is primarily with after school enrichment program"
  • "None"

8. If you do not currently provide child care health consultation, would you be interested in doing so in the future? Why or why not?

While interest in doing health consultation was shown, PHN’s expressed concerns about the barriers mentioned previously.

  • 3 said yes, they would be interested.
  • 2 said possibly, depends on barriers listed.
  • 2 said no, they would not be interested.