Model Child Care Health Policies 5 th Edition 2014

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1 Model Child Care Health Policies 5 th Edition 2014 Audio conference Feb 12, 2014 Noon to 1:30 PM EST Using Model Child Care Health Policies to Improve Quality Moderator: Danette Glassy, MD, FAAP Presenters: Susan Aronson, MD, FAAP Timothy Shope, MD, FAAP

2 Using Model Child Care Health Policies to Improve Quality Moderator: Danette Glassy, MD, FAAP Danette Glassy, MD, FAAP

3 Caring for Our Children (CFOC) 3 rd Ed. Basis: Caring for Our Children, 3 rd Ed. National Health and Safety Performance Standards for Early Care and Education Programs 3 rd edition Revision completed and published in June Technical Panels - 85 total panel members - Content Experts from AAP, APHA, and subject specialists Updates at KIDS (5437) University of Colorado College of Nursing 2012 National Resource Center for Health and Safety in Child Care and Early Education

4 Stepping Stones 3 rd Edition Compilation of selected CFOC3 standards, which when followed or implemented, are most likely to prevent adverse outcomes for children/staff in child care and early education settings. (Adverse outcomes may be physical, developmental, or social/emotional.) KIDS (5437) University of Colorado College of Nursing 2012 National Resource Center for Health and Safety in Child Care and Early Education

5 American Academy of Pediatrics Healthy Child Care America Available online at Hard copy for sale at Or 1-888/

6 American Academy of Pediatrics Healthy Child Care America Funding for this audio conference was provided by: PA Department of Public Welfare, OCDEL Maternal & Child Health Bureau, HRSA, HHS

7 Continuing Education, Prof. Development Credit University of Pittsburgh 1.5 CME, 0.15 CEU Act 48 and PA Keystone STARS Send the completed evaluation form to ECELS by February 26 for credit. (See instructions on the form)

8 For handouts and recorded audio conference For problems accessing materials, ECELS at

9 Susan S. Aronson, MD, FAAP Timothy Shope, MD, FAAP

10 American Academy of Pediatrics Healthy Child Care America

11 Nearly 1,000 people registered 72 responded to the preconference survey by 2/9/2014

13 Q20 Have you ever used any edition of Model Child Care Health Policies? Q21 Have you already looked at the 5 th edition of Model Child Care Health Policies ONLINE on the ECELS website?

14 Use Data (as of 2/9/2014) Q20 Ever used any edition of MCCHP? (71 responses) 66% Q21 Have viewed the online 5th edition of MCCHP on the ECELS website? (72 responses) 21% Number of MCCHP5 hits on the ECELS website to date 4,379

16 Sections rated as Essential or Very High =or > 75% Respondents 2. Supervision & provision of social-emotional care (Section 2 of MCCHP) 3. Planned program, teaching & guidance (permissible teaching methods, behavior management, developmentally appropriate care, required clothing, transitions) 10. Health Plan (assessments, correct hazards, CSN, Medication, CCHC) 11. Care of children and staff members who are acutely ill or injured 13. Emergencies and Disasters 77%** 75%* 81%**** 97%***** 77%**

Stepping Stones to Caring for Our Children, 3rd Edition (SS3) NRC released SS3 in 2013 138* essential standards

17 Stepping Stones to Caring for Our Children, 3rd Edition (SS3) NRC released SS3 in * essential standards intended to reduce the rate of morbidity and mortality in child care and early education settings *of 686 in CFOC3

18 Crosswalk of SS3 and MCCHP-5

19 Health and Safety in ERS

20 In making or updating policies seek input from all involved: Affected by the policy Have authority to implement it Have expertise in the topic Be sure to give feedback to all involved about how their input was used or why it was not used.

21 Integration and Collaboration Early Care and Education Professionals Community Experts CHILD Health, Safety and Nutrition Professionals Family

22 Videos on the ECELS website help explain policy-making process and demonstrate some of the content. Examples: Child Care Health Consultant Role a 4.5 minute video Child Care Health Consultants as Members of the Support Team 2 minute video Collaboration among Families, Health Professionals & Educators a 4 minute video Health Consultants & Relationships with Child Care Providers - a 4 minute video that explains how to use observations, strategic planning, involving other sources of expertise and interpersonal relationships to improve child care health practices. Discusses written policies.

24 Health Consultant Involvement Improves Quality Reduction of hazards and risky practices safe active play, emergency preparedness, sanitation, nutrition & food safety, SIDS (PA, NC, CA, WA) Improved access to care and more complete preventive health services (PA, NC, CA) Reduction of infectious disease outbreaks, absence from care, acute/emergency medical care utilization, medical care costs, work time lost by parents (NC) Written health and safety policies that are consistent with national standards in Caring for Our Children (NC, PA, CA, OR)

25 Section 10. Health Plan A. Child and Staff Health Services (child and adult health assessments, tracking and updating immunizations and checkup records information, updating/verifying information) B. Oral Health (food choices, pacifiers & teething rings, bottles & no-spill cups, oral hygiene, fluoride in drinking water, dentist for each child, tooth decay & dental emergencies, oral health education) C. Hazard/Safety Checks and Corrective Actions refers to Section 8. Environmental Health, B. (total facility hazard/safety checks, outdoor & indoor large-muscle play areas, toys, documentation of inspections, incidents and corrections)

26 Section 10. Health Plan (continued) D. Obesity Prevention (refers to Section 4 Nutrition, Food Handling and Feeding and Section 5. Physical Activity and Screen Time) E. Children with Special Needs and Disabilities (care plan, orientation & training of staff members, specific conditions, and related parts of other Sections: 1.A. Admission, 2.A. Ratios, Group Size & Staff Qualifications, 4.F. Feeding children with special nutritional needs) F. Medication Administration (acceptable requests, symptomtriggered medication, authorized staff members, storage, expired medications, documentation, errors, reactions and incidents) G. Health Education (topics, methods, calendar-focused health education, notification of families about sensitive topics)

27 Professional Development Credit for using MCCHP ECELS SLM requires use of at least 3 sections Fostering Use of Model Child Care H Professional Development Credit

28 Model Child Care Health Policies 5 th edition, Section 11 Timothy R. Shope, MD, MPH Associate Professor of Pediatrics Children s Hospital of Pittsburgh of UPMC

Suzy At the daily health check the teacher/caregiver notices that 3 year old Suzy is sneezing and has greenish discharge from her nose. Suzy is smiling and interactive.

29 Suzy At the daily health check the teacher/caregiver notices that 3 year old Suzy is sneezing and has greenish discharge from her nose. Suzy is smiling and interactive. The teacher/caregiver thinks Suzy s green runny nose means she is contagious and should be excluded. She checks with the director to be sure. The situation is a little tense because Suzy s mom has a high-powered job and was upset before when the program excluded Suzy for illness

30 Section 11 of MCCHP5 A. Admission and Exclusion Family and staff should share info about symptoms. Have a backup plan for care. Situations that require a health care provider note Who has the authority to make exclusion/return decisions Exclusion criteria for children who are acutely ill or injured

31 A child should be excluded if: Ability to Participate: The child s condition prevents the child from participating comfortably in activities Need for More Care: The condition requires more care than teachers/caregivers can provide with compromising the needs of other children in the group. Risk to Others: Keeping the child in care poses an increased risk to the child or other children or adults with whom the child has contact see Managing Infectious Diseases in Child Care and Schools

32 MCCHP5 Staff Members Who are Ill or Injured Specific criteria available in MIDCCS3 or CFOC3 Important for several reasons Don t want to leave (pay, pulling own weight) Leave too often (undue burden on others or creates unsafe ratios)

33 Permitted Attendance Common colds Cough not associated with fever Discharge from eye Pinkeye Fever without signs of illness Rash without fever or behavioral change Lice or nits Ringworm Molluscum contagiosum Thrush Fifth disease MRSA CMV, Hepatitis B, HIV Diarrhea as long as contained in diapers or toilet

34 State Regulations That Apply to Exclusion MCCHP5 encourages you to list the conditions for which exclusion is required in your state

35 PA Child Care Regulations Example of Need to Advocate for Updating Title 55 PA Code Ch 3270 states, An operator who observes an enrolled child with symptoms of a communicable disease or infection that can be transmitted directly or indirectly and which may threaten the health of children in care shall exclude the child from attendance until the operator receives notification from a physician or a CRNP that the child is no longer considered a threat to the health of others. The notification shall be retained in the child s file. Diseases and conditions which require exclusion are specified in 28 Pa. Code Chapter 27 (relating to communicable and noncommunicable diseases). The Department of Health will provide, upon request, a list of communicable diseases.

36 27.72: Exclusion Requirement for specific symptoms A person in charge of a public, private, parochial, Sunday or other school or college shall, following consultation with a physician or school nurse, exclude immediately a child, or staff person, including a volunteer, having contact with children, showing any of the following symptoms, unless that person is determined by the school nurse, or a physician, to be noncommunicable.

37 27.73: Readmission of excluded children A child or staff excluded from school may not be readmitted until the school nurse or a physician, is satisfied that the condition for which the person was excluded is not communicable or until the person presents a statement from a physician that the person has recovered or is noninfectious A child excluded for the following reasons shall be readmitted only when a physician has determined the illness to be either resolved, noncommunicable or in a noncommunicable stage: Rash with fever or behavioral change Productive cough with fever

38 Some Regulatory Language Problems Leads to over-exclusion due to confusion about communicable, contagious, infectious, transmissible concepts Leads to under-exclusion and confusion about who decides because does not contain two primary reasons for exclusion Too ill to participate Requires too much care Specific required exclusion out of synch with MIDCCS5 Conjunctivitis Fever above 102 (unrelated to cause or behavior) Persistent diarrhea (?persistent vs. normal looser stools) Tends to increase unnecessary health care visits because suggests that everyone excluded needs to see a health care provider prior to return even if seems well

39 B. Procedure for Management of Short- Term Illnesses If a child is mildly ill but staying for the day, document to support good care: - Admission Symptom Record - Care Plan - Symptom Record - Contingency Plan for if Symptoms Worsen

40 C. Reporting Requirements Have and use a list of communicable diseases that require reporting to the health department. Designate one person to keep an updated list and do the reporting. Parents and staff should be aware of the list and to whom to report any instance of a disease on the list Parents and staff should know what must be reported

41 D. Obtaining Immediate Medical Help See MCCHP5 Section 13. Emergency and Evacuation Plan, Drills, and Closings.

42 E. Outbreaks of Diseases Designated person at the program reports to the health department when a threshold of cases of disease is crossed (2 or more) Flu outbreaks are expected each year but facilities should have a plan and implement it in September each year. This plan should also incorporate procedures for possible pandemic.

43 Summary MCCHP5 contains a nice outline and plan for development of policies about handling illnesses and injuries at your program It can be supplemented with other resources If you implement this, you will far exceed state requirements It will make life easier, especially with exclusion and return to care issues

The Indiana Parent Information Network, Inc. and Indiana Institute on Disability and Community Indiana University-Bloomington

Comparison of Indiana s Child Care Licensing and Registration Requirements to the National Health and Safety Performance Standards: Guidelines for Out-of Home Child Care Programs The Indiana Parent Information