BACKGROUND
The Child Care Health Consultation Program provides consultation services in Oregon through projects in 6 demographically and geographically diverse counties in East Multnomah, Lincoln, Jackson Baker/Union, and Clackamas Counties. The vision of the Program is to develop “beacons of excellence” for the future development of child care health consultation services in the state. The Program has been providing consultation services to child care providers since March 2003, seeking to improve the physical, social and emotional health of young children through the following activities and services:
- Child care health consultation
Trained Child Care Health Consultants (CCHC) provide direct support to child care providers through training, telephone, and on-site consultation regarding child health, safety, and, the promotion of healthy social and emotional development to improve child health. Services are intended to show improved health outcomes for children documented through improved immunization status, access to health care, reductions of childhood illness and injuries through health policy development, and increased provider skill and self-efficacy.
- Development of child health services
Local child care health teams provide support to the CCHCs, and provide referrals to community health resources, including mental or behavioral health specialists, pediatric nurses and physicians, oral health care providers, special education services, early intervention programs, and local health department resources.
- Increased access to health care
Access to primary health care and oral health care by children, families, and providers is increased through enrollment in the Oregon Health Plan. CCHCs also connect children and providers with specialized health services and resources in the community.
- Demonstrate promising practices and effective service delivery
An evaluation of the program and process outcomes and service delivery approaches at the five project sites by an independent evaluation consultant provides information about the effectiveness of consultation services and different approaches to delivering services at each site to improve child health outcomes. The data provides critical information for program administration, quality control, and program development.
- Collaborate in developing early childhood system
Program services are coordinated with other local early childhood systems development efforts at the local level. They are developed in response to needs identified at the community level through local planning sponsored by the Oregon Commission on Children and Families. Projects develop specific services though focus groups and needs assessment processes established through the Program to articulate specific training, consultation and resource development needs identified by child care providers and parents.
LOCAL PROJECTS
The projects were designed to serve children and families from populations that are known to have barriers to health care, such as low-income families, children with special needs, and Hispanic families; and, include child care providers who serve infants and toddlers. All types of child care providers receive consultation services; however, specialized outreach has been designed to serve family child care providers due to the fact that most families use this type of care to meet some part of their child care needs.
Each project forms a “Core Team” made up of staff that provide consultation services to child care providers through this program. It includes the CCHC, a Child Care Resource & Referral child care specialist, and a mental health specialist and/or early childhood educator. When the child care health consultant is not a public health nurse a public health expert participates with members on the core team. The purpose of the Core Team is to support comprehensive services for child care providers and build the knowledge, skills, and capacity of the “Core Team” members.
Each child care health consultation project must address statewide goals, such as access to primary care, increased immunization, and the promotion of social and emotional development. In addition, projects identify local needs and design services to maximize the use of community resources. Projects must employ professionally qualified health consultants who are trained as specialists in child health within a holistic context. Training is provided for all project staff, including a program orientation. Consultants complete a statewide health consultation training based on the National Training Institute Child Health Consultation curriculum and the Promoting First Relationships curriculum. Trainings required by the program include:
Core Team Members
- Module 1: Building Your Consultation Skills
- Module 2: Building Your Skills As A Trainer
- Promoting First Relationships
Child Care Health Consultants (in addition to above training)
- Module 3: Consulting To Prevent Injury & Promote Safety
- Module 4: Consulting For Programs Caring For Children With Special Needs
- Module 5: Caring For The Health Of Program Staff
- Module 6: Consulting To Promote Health and Prevent/Manage Illness
- Module 7: Nurses In The Nursery
An important key to delivery of services has been to develop close relationships with child care providers and early childhood and health care professionals by building on local early childhood system planning efforts, and by addressing needs and priorities identified by child care providers. Each project develops a community “Health Team” to support and advise the project and assist with referrals to health and other community resources. The “Health Team” includes members from the community specializing in health, mental and dental health, early childhood care and education.
SERVICES FOR CHILD CARE PROVIDERS
Local projects provide health consultation services for the individual child care provider. These range from presenting health information through group trainings and events to phone and on-site consultations. When child care providers work with CCHCs on-site, they begin by participating in an assessment of their interests and needs in the area of health and safety in child care. Providers rate their own level of confidence in areas of heath and safety through a provider self-assessment. The consultants conduct reviews of child care records for documentation of up-to-date immunizations and medical and dental homes, as well as examine health and safety policies. The result of the review is discussed with the child care provider and together they plan consultation activities. All providers are offered assistance to up-date immunization records and document medical/dental homes, and to distribute information about local medical and dental services to parents.
EVALUATION SUMMARY
An independent evaluation, conducted by Pacific Research and Evaluation, began during the first year of the Program. A report completed in October 2006 showed that during the 2005-2006 program year the program had a significant impact in the child care community:
- 1593 contacts with 1,177 providers were made, and 263 group events and trainings were held. 181 child care providers received intensive on-site consultation.
- Registered and Certified Family home care providers received 62% of the contacts, Certified Centers 7%, Preschools 5%, new providers 5%, and hard to reach exempt home and center care providers 21%.
- There was a 15% jump in the number of providers who became licensed during the year. (N=79)
- The pre/post assessment data showed the percent of providers who used enrollment forms, kept children’s immunization records, had a medical and dental health care provider listed for each child and a signed medical authorization from parents all increased significantly over the year (N=27 limited data).
- There were significant positive changes in the number of policies that were developed, posted and reviewed with parents (N=27 limited data).
- Provider confidence increased most in the areas childhood illnesses and immunizations; personal well-being, guidance, discipline, and behavior, communication with parents, child development, and emergencies. (N=79)
- 79% of the providers who received consultation on social and emotional development and behavior reported they felt “Concerned but in control” when behavior problems occurred, and that problem behavior decreased “somewhat” or “quite a bit”. (N-77)
- Parents responses to the parent survey about their child care arrangements compared favorably with those of Emlen’s scale entitled Quality Child Care from the Parents’ Point of View. 89% answered “Yes” when asked if the child care they have in place is “just what (their) child needs.” (N=267)
- And, once again, the satisfaction levels of child care providers with the program were extremely high. Almost all providers expressed overall satisfaction with the program in both years. (N=79)
- Pacific Research and Evaluation, Phase III Final Report, October 2006.
PROMOTING HEALTHY SOCIAL AND EMOTIONAL DEVELOPMENT
Introduction
In October 2003, the Office of Family Health, together with other state, local, federal, and regional early childhood partners, sponsored a Summit in Oregon to focus attention on the emerging crisis among young children and to identify promising approaches. The summit was organized in response to reports about the large number of children under age 5 who have serious emotional health issues, and recognition that early childhood professionals need assistance in caring for these children. At the same time, it was clear that while there is a lack of treatment resources for children with diagnosed mental illness, young children need flexible services. Resources or strategies that seek to prevent problems hold the promise of reducing the incidence of diagnosable problems. In fact, a majority of children do not have serious diagnosable mental health problems, but do need additional support for the promotion of healthy social and emotional development.
A key strategy to prevent mental health problems identified by Summit participants is to provide consultation services that focus on the promotion of healthy social and emotional development within the child care setting. In addition to working on improving providers’ skills, confidence and capacity to care for children with challenging behavior, the health consultant will link children and families with treatment services when appropriate. The health consultant, in collaboration with the early childhood mental health professional on the health team, will assess children who appear to need individual specialized services, and make referrals to community services.
Program Goals
The statewide goals for this component are as follows:
- Create positive child care environments that are nurturing and support healthy social emotional development
- Identify children who have atypical social and emotional development and can benefit from referral for professional assessment
- Assist child care providers to build skills in working with children who have challenging behavior to reduce exclusions,
- Increase child care providers’ confidence and self-efficacy in caring for children who have special social/emotional or behavioral care needs
- Provide education and support in promoting healthy social and emotional development to families as the primary caregivers.
Activities: 2005-2006 Program Year
The program carried out each of the following activities at the five project sites:
- Provided training for CCHCs and early childhood partners on social and emotional development consultation methods and strategies.
- Conducted focus groups at project sites by consultants and early childhood mental health professionals to assess local needs and priorities. The focus groups included local stakeholders, child care providers and parents.
- Developed local service delivery plans based on local focus group results. Service delivery plan include protocols for assessment, screening, and treatment.
- Conducted trainings for providers and parents on topics of interest identified through focus group sessions (On-going).
- Provided program-focused consultation services to individual child care facilities. The CCHC focuses on the program level consultation (On-going).
- Provided early identification of children with behavioral issues or unmet social and emotional needs through assessments and referrals (On-going).
- Developed resources and strategies to make further evaluation and treatment available to individual children and families when needed. Depending on the community, those resources may be provided by early childhood mental health services on site or through other community agencies and organizations (On-going).
- Developed a parent education and services component (On-going).
- Expanded the core early childhood health team to include (at a minimum) a child health consultant, a child care specialist, an early intervention specialist, a pediatric health professional, and an early childhood mental health specialist. These members are in addition to the other members of the local child care health team (on-going).
Useful References and Websites
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