Child Care Health Education Broome County Health Department

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Child Care Health EducationBroome County Health
Department
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Who are we?

• Susan Blythe RN, Kathy Cerny SPHN, Jean Hardik
  PHN, and Marie Shafer PHN
• Trained as Child Care Health Consultants by the
  NYSDOH
• Certified Medication Administration Training
  Trainers
• Work closely with Sue Verity, Dental Hygienist

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Who do we serve?

• Infants and Toddlers 6 weeks to 3 years.
• Caregivers
• 25 Centers
• 16 Family based
• 3 Group family based
• 1 Drop-in Center
• Parents

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Infants and Toddlers Served
Total 419
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Caregivers Served
Total 241
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Families Served
Total 678
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What do we do?

• Utilize the nursing process as it applies to
  child care sites
• Assessment
• Nursing diagnosis
• Goals
• Interventions
• Outcomes
• Revision of care

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Assessment
Needs Assessment Survey of Training Topic
Interests Health and Safety Checklist ITERS/FDCRS
Record Review Direct Observation/ Conversation
with Staff
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NEEDS ASSESSMENT

• ISSUES/CONCERNS
• Staff
• Safety
• Infection control/communicable disease  
• Nutrition
• Immunization/lead testing
• Children
• Parents
• Other

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Survey of Training Topic Interests Results

• First
• Communicable Diseases/Exclusion Criteria
• Diapering/Toileting
• Second
• Infant Mental Health
• Developmental Concerns
• Hand Washing
• Third
• Children with Special Needs
• Emergencies in Child Care

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Nursing Diagnosis
Knowledge deficit related toas evidenced by
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Other Category Includes

• Diapering and toilet learning
• Health Insurance
• Abuse and Neglect
• Mental Health  
• Children with special needs (medical)
• Health Care Plan
• Oral Health  
• Behavior/Discipline 

• Emergencies in childcare
• Communication with parents/ Physicians  
• Fire Safety  
• Smoking cessation  
• Staff health  
• SIDS
• And more 

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Goals

• To introduce best practice health, safety and
  nutrition standards to child care programs in
  Broome County.

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Goals
Caregivers verbalize increase in knowledge of
health, safety and nutrition. Increase
in immunizations and lead tests
documented adequately documented
medication-related information number of current
well-child physicals documented emergency contact
information number of children with special needs
with special care plans Decrease in incidents
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Interventions
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Record Review, Notices to Parents, Immunization
Posters ? Lead Testing Notification and
Signature Forms and handouts ? Tickler System ?
Sample Health Care Plan ? Sample emergency
plan? Free copy of Model Child Care Health
Policies and Preparing for Illness? Free choke
tubes
Interventions (Services Offered)
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Ages and Stages Questionnaires ? Special Care
Plans ? Health, Safety and Infection Control
Posters ? Infant Menu Template and nutrition
information ?Wide range of informational
handouts on health, safety, infection control and
nutrition topics? Referral to Community Agencies
 ? Questions for the Nurse posters ? Assist
with program improvement plans and ITERS/FDCRS.
Interventions (Services Offered)
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Available Trainings

• 1. Asthma
• 2. Caring for the Health and Safety of Child Care
  Staff
• 3. Childhood Illnesses and Immunizations (for
  parents)
• 4. Communicable Diseases
• 5. Daily Health Checks
• 6. Developmental Assessment of Infants and
  Toddlers
• 7. Diapering and Toilet Learning
• 8. Early Childhood Mental Health
• 9. Effects of Loud Noise on Infants and Children
  (done with parents)

• 10. Germs (for kids)
• 11.Hand Washing and How Diseases Spread
• 12. Head Lice
• 13. Immunizations
• 14. Infant Nutrition
• 15. Lead
• 16. MAT
• 17. Nutrition, Birth to Three Years
• 18. Playground Safety
• 19. Shaken Baby Syndrome

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Total 591
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Communicable Disease Training

• Number of child care providers trained to date

63
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Communicable Diseases

• contagious
• can be spread from one person to another

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Caused By

• Viruses
• Bacteria
• Parasites
• Infants and toddlers are highly susceptible
  because...

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Infants and toddlers are highly susceptible
because...

• They have not been exposed to most common germs
• Poor health habits
• Some lack adequate immunizations

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Method of Transmission

• Different diseases are spread in different ways
• Direct contact
• Respiratory Transmission
• Fecal-Oral Transmission
• Blood Transmission

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Ringworm
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Exclusion

• Child care providers need policies for preventing
  and handling illness
• Exclusion may be necessary to prevent the spread
  of contagious disease
• Children who have fever and are behaving normally
  do not need to be excluded
• Children with colds who are behaving normally do
  not need to be excluded

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Exclusion Criteria

• Children have often already exposed others before
  becoming obviously ill - or are not contagious
  after beginning treatment

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Exclusion Criteria

• Child not well enough to participate in the usual
  activities of the program
• Staff not able to care for the sick child without
  interfering with the care of other children
• Child has any indication of contagious disease or
  immediate need for medical evaluation

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Medication Administration Training

• Number of Child Care Providers Trained to Date

101
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• Competency based training course
• Certifies day care providers to administer
  medications in a child care setting for seven
  routes oral, topical, inhaled, medicated
  patches, eye, ear, and emergency injection using
  an auto-injector device.

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Health Information Update Request Child Care
Provider Name _________________________________ C
hilds Name ______________________________________
______ Dear Parent(s), In order to foster the
best health possible for all children in our
care, our records must be kept current. We need
your assistance in doing this, and appreciate
your cooperation. The following need to be
updated as soon as possible ? No child health
assessment form in record ? No child health
assessment form within the last year ? Emergency
card not updated within past 6 months ?
Immunization record not up to date ? Hepatitis B
(1st, 2nd, 3rd dose) ? Diptheria, Tetanus and
Pertussis (1st, 2nd, 3rd, 4th, 5th dose) ?
Haemophilus Influenzae Type b (1st, 2nd, 3rd, 4th
dose) ? Inactivated Polio (1st, 2nd, 3rd, 4th
dose) ? Measles, Mumps and Rubella (1st, 2nd
dose) ? Varicella ? Pneumococcal (1st, 2nd,
3rd, 4th dose) ? No record of lead
test at age 1 and/or 2 years of age All
children, regardless of lead exposure risk,
should be screened with a blood lead test at one
and two years of age as part of routine primary
care Physicians Handbook on Childhood Lead
Poisoning Prevention, NYS Department of Health
and American Academy of Pediatrics, 2002 Thank
you for your cooperation! Record reviewed by
______________________________________ Date
______________
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• Lead Testing Notification and Signature Form
• Child Care Provider Name ________________________
  _________
• Childs Name _____________________________________
  _______
• Dear parent(s),
• In order to foster the best health possible for
  all children in our care, our records must be
  kept current. We need your assistance in doing
  this, and appreciate your cooperation.
• ? No record of lead test at age 1 and/or 2 years
  of age
• All children, regardless of lead exposure risk,
  should be screened with a blood lead test at one
  and two years of age as part of routine primary
  care Physicians Handbook on Childhood Lead
  Poisoning Prevention, NYS Department of Health
  and American Academy of Pediatrics, 2002
• I understand that lead testing at age 1 and 2 is
  public health law and is advised by the American
  Academy of Pediatrics. I also understand that my
  child can be lead tested at his or her
  pediatricians office or at the local health
  department (778-2839). Children older than age 2
  and younger than age 6 should be screened for
  lead poisoning risk factors and tested if at high
  risk.
• Parent signature _________________________________
  _______
• Date _______________

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Tickler System

• Childs Name_____________________________DOB
  _____________
• Child Health Assessment Form (yearly)
• Dates______ _____ _____ ______ ______ _____ _____
  _____ _____
• Emergency Card Updated (every 6 months)
• Dates______ _____ _____ _______ _____ ______ ____
  _____ _____
• 2 mos 4 mos 6 mos 12 mos 15 mos 4-6 yrs
• DtaP 1_____ 2_____ 3_____ 4_____ 5_____
• EIPV 1_____ 2_____ 3_____ 4_____
• Hib 1_____ 2_____ 3_____ 4_____
• Hep B 1_____ 2_____ 3_____
• MMR 1_____ 2_____
• Varicella 1_____
• PC7 1_____ 2_____ 3_____ 4_____
• Lead Screening 1 year old_____ 2 years old_____

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Tickler System
Notes DtaP 4 15-18 months ?EIPV 3 6-18
months Hib 4 12-15 months. If child gets Comvax
(Hep B/Hib combo) only needs 3 Hibs in this
case, Hib 3 must be after 12 months of age. Hep
B if not Comvax Hep B 1 Birth - 2 mos (Birth
dose of Hep B Hep B 2 1-4 mos is counted in
series) Hep B 3 6-18 mos Hep B if Comvax Hep B
1 2 mos (Birth dose of Hep B Hep B 2 4
mos not counted in series) Hep B 3 12-18
mos MMR 1 12-15 months ?Varicella 1 12-18
months Pneumococcal 4 12-15 months -
Pneumococcal not required for daycare recommended
for health. Pediarix (DtaP/Hep B/IPV combo) 2,4
6 months. Still need DtaP 4, DtaP 5 EIPV
4. Birth dose of Hep B not counted in series.
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Outcomes
Record Review Results Per site Cumulative
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Revision of Care
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Revision of Care (for ELO II)

• Develop and offer trainings related to safety and
  emergency preparedness
• Introduce revised child health assessment form
  that includes height and weight to identify
  growth concerns i.e. obesity
• Include informational handout with each lead
  testing notification form

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Revision of Care (for ELO II)

• Provide on-site assessment and recommendations
  regarding
• Emergency preparedness (1st aid kits, disaster
  kits, emergency numbers, staff trained in CPR and
  first aid)
• Cleaning and disinfecting (procedures, schedules
  and staff assignments)
• Medication documentation and handling, special
  health care plans and daily health checks

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Revision of Care (for ELO II)

• Provide on-site assessment and recommendations
  regarding
• Safety (incident study, and health and safety
  mock inspection)
• Food Safety
• Use of Ages and Stages Questionnaires (ASQ) and
  ASQ Social Emotional

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The ultimate goal is to create an environment
that will cultivate warm, responsive,
health-conscious caregivers. We do this by
supporting the caregiver.