AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
PAT COLE: Good morning. I'd like to start and share with you what was the purpose of this research project which was conducted in 2000. If you'd look in your packet of materials with the red cover, you'll find the second page will give you the reference to this information, which is available online and in multiple formats, should you desire this information.
First, we wanted to determine just how many of the National Health and Safety Standards that were included in Stepping Stones for Caring our Children. For those of you unfamiliar with that document, Stepping Stones is considered the minimum threshold of the National Health and Safety Standards that should be included in all types of child care to decrease the incidence of illness and injury and mortality. So that is a smaller document than the 800 standards, it's about 186. But we felt the first place we needed to look was at what degree of inclusion were those in our licensure and registration.
A point about the licensure and registration. In the state of Indiana we have many different degrees of regulation. We license homes that care for more than five unrelated children for more than five consecutive days for pay, which excludes a lot. We license centers, we register those programs that are sponsored by the 501(c)(3) status, whether or not they have religious designation or not at this time, and then we have 14 programs that have no regulations at all. So that's why we talk about the licensure and registration, I'll speak a little bit more to that being a shortcoming.
It was also an attempt to encourage an informed discussion about what it is we are regulating and why, and what is it we should be looking at, strictly from the health and safety aspect.
In my work at the Early Childhood Center at the AUCD in Indiana, we look across the board at the inclusion, successful inclusion of all children, and understand that in order to do that you have to have a healthy and safe place to begin with, and then you work with that. So in a way, it's a paradigm shift as we make everything great quality, and then the inclusion is natural. As opposed to changing settings or changing programs, so that those children can be included.
We had some challenges at our research model that I want to share with you, because I think they're important. The problem, one that you may face if you choose to do something of this sort, was actually the identification of all the regulation-related documents. While we have child care regulation, it cites in there that you need to go to building code here, the fire code here, and you need to refer to the State Department of Health code, and you need to go someplace else to get that information.
So depending on how your regulations and rules are written in your state, that may be a challenge for you. I would tell you that I spent approximately three months trying to gather all that information, and in turn decipher what it had to say. I think it's important that oftentimes child care regulation systems ask and demand that if you provide care, you understand the regulations, and I would say that would be a formidable task at best.
We also -- as I said, identifying those, and then there's always the "it's no longer in force, but yet it's in the regulation." So again, looking real carefully at where are those documents and how do you access them.
The other part that's important, many of you have regulations in your state, some of you have guidance for those regulations. We have what we call a regulation that -- where it says the fence will be seven feet tall or a standard that says the fence will be tall enough to keep children safe. Without guidance for tall enough to keep children safe, it's very hard to do an empirical comparison of the document with the Stepping Stones to Child Care. In our state at this time there is very little guidance, none for homes, and very little for centers, in terms of how we will interpret what that says. And it's left to individual consultants, which needless to say results in incredibly varied degrees of quality as related to health and safety.
And then we looked at the discrepancy in terms -- between the different types of licensure and registration, which further complicated the ability to compare the documents one to the other.
The study components was, as I say, the identification of all the documents, the compilation of all those documents in one place, which was hard, and then we attended orientation training in the state of Indiana. If you become regulated in any way, you must attend a regulation -- an orientation to understand what that means. We found that it was important as part of this to attend and listen to what was being said in these orientations in case there was information imparted that wasn't in documents.
What we found was when we attended orientation different months, which was provided by different consultants, we got different information. I'm pleased to say they now are standardizing that, and in terms of making sure people get all the same information with what I would consider death by PowerPoint, but at least it does assure them all that they get that information.
We did a Stepping Stones review. I spent hours understanding what Stepping Stones had to say. Those of you familiar -- how many in this room are familiar with the Stepping Stones to Caring for our Children? Stepping Stones in the National Health and Safety Standard tell what you type of care those standards apply to. Because there are some standards that apply to large group care that do not apply to smaller group care. So looking through and understanding all of that language, and where it's based and how it is interpreted, was another big part of the study.
And then the final comparison saying if the standard says this, where in the rules of regulations would you find that. And I would say to you if your rules and regulations do not have index referenced table of contents, it is a real treasure hunt for where would I find that, because it may not be at all where you would think it was in terms of the regulation.
And then of course issuing that findings report, which was not popular in many places, but I think has made a difference.
When I looked at the child care study, I looked at the degrees of significance. What we thought was really critical was that we needed to look at the intent of the regulation, in terms of how well it was addressed. And you can see that we had four different levels of significance. And what we determined early was that it had to be at a level three or above to be included in -- as being part of the rules and regulations that were addressed in the National Health and Safety Standards.
So you will find that we have -- the four had actually the whole criteria, there was almost a word-for-word interpretation in the regulation, and in some cases we found that it was actually lifted and put into the regulation. And then other times we found there was absolutely no mention. And that would be very true, and you'll see that when we look at the different types of care.
We created a number of different reports. One was in the first edition of Caring for our Children and Stepping Stones. There were five areas outlined in the National Health and Safety Standards. So we looked at those five areas, and how the different programs stacked up.
Then we looked at the nine topics, and I'll show you those, as well. Because we thought that was also important when you look at rules and regulations and you talk with state policymakers, about what they're willing and not willing to ask people to do, if you look into specific topic areas you could also then focus your efforts.
For instance, when we looked at one of the topic areas being, at that point, inclusion of children with special needs, it was a separate route, and in fact looking at the division that was responsible for those services was a way to focus the effort and bring attention and help with that information.
Then as I say, the other one was the percentage, which was critical for us to say are we going to do better when we redo our regs and revisions. The state of Indiana, we must do that every seven years according to a sunset law. So every seven years the rules and regulations are looked at, new ones promulgated, and then they have to go through what I call the 13 step process, which truly is with approvals all the way up to the governor, with the governor having the final say in how that will happen.
And then we looked at the types of three settings, the only ones we could look at in terms of any sort of regulation. And those being child care centers, licensed child care homes, and registered ministries.
If you look across the comparison of areas and settings, it's pretty hard to see here but I will share it with you.
UNKNOWN SPEAKER: Pat?
PAT COLE: Thank you. Looking at centers, and looking at the percentage of building and premises, equipment and safety was the one panel, you can see one said 68 percent of the standards of the Stepping Stones were included at a significant level. You can see the most regulated type of care across the board is center care, with the largest number of kids. Followed then by homes, and then looking at ministries. The number of percentages included by the area of the setting. We have the reportable communicable disease policies and practices.
For instance, we talk about the multiple documents. In this one we had to look at what was in the rules and regulations, but we also had to look at public health law, and what the public health laws say have to be reported. So in many cases -- I will share with you in ministries, these are things that are governed by things other than what they are regulated by in the state of Indiana. Thank you.
The degree of significance reported in our first study in 2000, using the first edition, was that 60 percent of the National Health and Safety Standards, including the Stepping Stones, were included in the center requirements. Only 32 for homes, and 20 percent for ministries. And I want to remind you, these are considered the minimum threshold to decrease morbidity and mortality in child care.
Some critical factors. One is that limited application, as I spoke about. One of the discrepancies here in fact is that Head Start programs or programs that serve only migrant children do not have to be licensed in the state of Indiana.
Also, that limited guidance for the application of standards, as I talked about. And when I -- what I did not do was do interviews with those who were responsible for enforcing those regulations, because it was at that point the regulators in the field for the state were private consultants who work for the state, and were not under control of the state at that time. That has changed since then.
And then the degree of enforcement. What we found, anecdotally, and because of being a licensed child care home provider at one point in the state of Indiana was it depended on what county you lived in and who was your regulator as to whether they put you on probation or didn't, depending on their interpretation. There was not a state standard for that. So that was an issue, as well.
My own experience, which I'd share with you, is that the person responsible for overseeing my child care was employed by the Office of Family and Children, which was previously known as welfare. She would come to me and ask me to explain to her all the rules and regulations, and then tell her whether or not I was meeting those, because there was not enough time in her day to understand this information. Since then, they have changed the way they handle that, but at that time it was handled that way, affecting the outcome.
We disseminated the study in many, many ways. What was most critical was the day that the press came to visit for a live interview. A child died in child care, in a child care home in the northern part of the state, due to child abuse by the provider. And as I was explaining my study, they threw that at me, because I had not heard it. And I chose to not speak to that study -- to that incident at that time, not having that information. But it was amazing how it did probably elevate in some respects the information that I shared.
Our mailing first was to those who were responsible for the regulation system. I thought it was really critical to let them know what I had found, that I was going to tell everybody else. So they weren't blind-sided by that information, and because I wanted to assure the cooperation as we went forward to make a change, here.
I did provide public testimony when there was rules and regulations being discussed. Sometime it was very unpopular, and I found that in reality it probably is not an effective way or place to do that. But it was done at that time.
We did the press release, as I say, across the state. The website. The PowerPoint, which is on that website that I gave you. The numerous conferences, the workshops. And then newsletters. Many different newsletters related to child care and early care and education picked up this information, and further disseminated it to raise the level of awareness.
The different responses. Always, anytime one gets involved in this you have to look at that sound bite, and that was a real critical piece. And I just focused on Indiana fails to provide standards that meet what's considered by national standards the minimum threshold for care for young children.
The results of the study is, one, we have an incredibly increased awareness of these standards, done a great job in cooperation with the Indiana State Department of Health in distributing copies of this Caring for our Children, the National Health and Safety Standards. And through the generosity of the American Academy of Pediatrics, have furthered that with a recent conference where we were able to disseminate it in a CD form. So there's an instant ability to go in and look at any one particular standard.
So now there's a lot of question, and people will call and say how does that relate, what are the numbers, what's happening there. And of course with the second edition we've seen many changes which we can bring to their attention.
It has included the discussion of the standards and the rules and regs. I have served on three different rules revision committees. The center one was very successful. The home one, we came up with incredibly great ideas, and the governor, with a change in governor last year, we note they did not go through. They were killed by the governor, if you will. And now we're back up for rewriting, and I will be a part of that group, and I've also been asked to be a part of the ministry group.
And then we do have an increased level. We now are up to a much higher level in center-based.
It's certainly also heightened the awareness of child care regulations, and I constantly have to say to people, no, I'm not the regulation person, when they want an interpretation. And so I can only say to them, here's what it says, but the final word on that belongs with this individual.
But we have created an awareness within the state of my position, and the number of calls from parents has been phenomenal. As well as licensing consultants, which I find is interesting.
An increased information about how rules are promulgated, so that people get involved in every step of the progress -- process, which they didn't used to. Where are these rules coming from, and who came up with them, and where are we going with them.
An increased number of requests from providers asking about those standards, who want to write their policies greater than the rules and regulations. Something I could encourage all of you to do. If you're stuck with the system, or challenged, I would say, by a system that doesn't respond, then working with individual providers has been a great boom for us in that respect.
And then we also have been successful in working with our partners. The Indiana Association for Education of Young Children, Indiana Association of Child Care Research and Referral. All of the quality partners in the state of Indiana now are familiar with this and will refer to it, because they know that health and safety is a cornerstone for all school readiness. That if we aren't safe and healthy in our child care, our ability to build cognitive skills are greatly diminished, and we have that in the research.
Here is our website address, information how to get a hold of this study, how to get a hold of me for further information. I will keep updating this study. I'm being encouraged to go and do actually a white paper on how this works, and what are the challenges related to that.
Are we taking questions now? Okay, I could answer questions now if there are some regarding this. Implementation, challenges, ideas. Yes.
UKNOWN SPEAKER: Pat, what do you think is the most important take-home message?
PAT COLE: I think the really critical message here is that if you don't know -- if you're wanting to increase the level of health and safety for children, and you don't know what your rules and regulations are asking those who provide care to do, it's important to look at that. Because we know that what happens for them, from the health and safety aspect in that child care, does affect their ability later in life, that was so pointed out this morning by the opening session.
So it's knowing what's going on in your state around quality as it relates to health and safety. Thanks. Other questions?
To get a copy of the National Health and Safety Standards you simply need to go to the National Child Care Information Center. You can search them by topic, you can do all sorts of things there online, which allows to you do that comparison. Thank you.