AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
SHARON DOUGLAS WARE: Thank you very much. Can you all hear me? Well, I'm the last, hopefully not the least, and I'm excited to be here. And as I begin, I want to just talk about how -- Dr. Phillips mentioned before about Healthy Child Care America. Even though Child Care America -- Healthy Child Care America, Healthy Child Care is no longer a funded division, the philosophy is continuing on.
And I want to give you just a little sample of what my history is, although she read my bio beautifully, but I was working actually as an early childhood teacher, and I went into teaching not because I wanted to make more money, obviously, but I was working as a nurse, and I would see the end part of children coming into the hospital or coming into the clinic with illnesses that seemed like if I could do something early on, I could change that. And so I went into teaching thinking that I could improve that. And as a result, realizing that many of the issues that I was seeing at the late end were the result of maybe nutrition, environment, all those things that I felt like I could control. And that was about 1995, and Peggy Byers remembers in Oklahoma, we were talking about how do we get this -- you know, thing going in Oklahoma.
And the federal government was talking about, you know, health and safety inputs into child care, bridging Maternal Child and Child Care Rural, bringing them together, Blueprint For action was being developed, and Step Nine, Blueprint for Action was the health consultant.
So while I was working as a kindergarten teacher I was offered a job as an outreach trainer in Oklahoma. And later they said we need a nurse that can do this outreach. And I thought, I'm a nurse, I'm a real nurse. RN. So I kind of fell into the job, it really wasn't an intentional type thing.
But one thing I want to bring up is that even though we had that in Oklahoma and I was the first one, and we got it going, many states have done that. How many of you have done child care consultation through Healthy Child Care America grants. Anyone? You get it going, you start it, and it's exciting, but what happens?
UNKNOWN SPEAKER: No funding.
SHARON DOUGLAS WARE: No funding. So state roll funding is a key course. And I feel very, very fortunate -- of course my supervisor is in the room, Carol Cass. And I think that's important that the Division of Public Health in North Carolina recognized that no matter how much you did in this arena, and how many grants you have, if you don't have stable funding, then it just goes away. And so they created a Title V position. And the bureau administrator and the state, right now you have some Title V money -- talk to Carol afterward how she did it, put it under five.
But it's so true, to have stable funding -- how many would agree with that? That you have to have it. And we'll talk about why that's important.
Also, you have to have people in the state with a vision. We happen to have Smart Start. I hear all kinds of other terms in other states, but basically, Smart Start had a vision connected to the early -- the school readiness program, that every child in North Carolina will arrive at school healthy and prepared for success. And you can't do that unless you have, at the top, a vision for that, and also the people to institutionalize that.
So what Smart Start does, they fund several health-related projects, and the purpose is to improve health outcomes for children without supplanting existing funding. So it's not just another program, and then that goes away, you know, we've seen that. But we want to really look -- Smart Start really wants to look at where there's a gap. We talked about earlier this morning -- how many were in the earlier session this morning at 8:00? Talking about the investment in children and talking about those venture programs, and private and public funding.
But we want to make sure all those gaps are filled in, those health-relate gaps. And also early childhood gaps. Of just funding, you know, quality child care. So to resolve funding the majority of child health consultants.
So then lack of funding results in a disconnect. And every state that I've been in or worked with that had granted child care health consultants that had only a temporary grant, once that grant is gone, a lot of times the program was gone. So you have to have stable funding. You get that through Title 5.
And this is my first time at AMCHP, and I'm really excited to believe here because I really think clearly understanding the significance -- I mean, I was very glad for my position to have stable funding, but I realize without that stable funding you can't really move forward to build infrastructure.
So what is a child health care consultant, anybody know? Oh, come on, I know you. I'm going to point you out. For a child care health consultant. But essentially it's a health professional. It's a health professional that's working in child care. And many times a child care health consultant is an early childhood person, but we really strongly push that that health professional, primarily nurses, sometimes like in Pennsylvania it's maybe a pediatrician, I think in West Virginia -- yeah, and nurses. So it's a health professional that's working to link back that child care person with all those resources.
Obviously, there's lots and lots of stuff going on in child care that we're expected -- early child care professionals to get on board with, and maybe they don't have the background, education, or the time. So that health professional is helping to link that role.
And then important for caring for children, although the child care health consultant may have a dual rule, such as providing direct care to some of the children, like in North Carolina, they may be a child service coordinator, they may be a clinic nurse, they may be a lot of different things, but they're not a regulated inspector, they're in a consultation role. They're there to provide consultation.
And it's kind of like the old adage of if you fish for a person, they eat for a day. But if you teach them how to fish, they eat for a life. I'm not saying it right, but you get the gist. We go in to really try to give them the tools so that they can really do this. Through a consultation method or technical assistant method.
So after you get your child care health consultant on, you get the stable funding, what are the components of statewide network? So infrastructure that supports mentoring and encouraging longevity. Now that we've been in this business about 10 years, a little over 10 years, many of them, some states have health consultants that have been around longer, but roughly 10 years, what we're finding out is that we can hire them in, but if they leave in a year then we have to start all over again. So building a system that supports longevity, putting things in place.
If people know that their funding is going to leave in a year, how likely are they going to stay? They’re going to look for something else. Or if they're paid at a lower rate, maybe not at a rate that an RN is paid, maybe a rate that's lower, then maybe they'll say I really like this job, but I have to go. And you've probably heard all of those stories. So you need to have a system that supports mentoring and longevity.
You need to have a state-wide system of collecting data and reporting. We have to know what are our numbers like, what -- you know, are we doing what we need to do. And I'll talk more about these in just a moment.
You need to have professionalism. A scope of practice and code of ethics. Every new profession has standards, and this is how we do the work that we do. If everybody is doing their own thing, then you go back to that data collecting system that, you know, our data doesn't look right because we're all kind of doing our own thing. In the early days we all did, we didn't know. We just though if I could do this thing over here with injury, that's where my focus was because that's what I like. Whereas, you know, maybe Peggy over here, she really likes nutrition, and that's what she's doing. And then maybe Karen over here, she's doing abuse and neglect. So it looks like we're not doing much, so we have to kind of pull everything together and say what do we really want to accomplish.
And then we have to have a state-wide volunteer association, and that I'll talk to you about in just a moment.
And then of course state roll funding. So infrastructure. The permanent position at the state level, that Title 5 position. That position that's going to be institutionalized. And it may not be Title 5, but Title 5 appears to be the best person for that.
So in our state, this is what we have. We have a state system, and then we have a regional system. And right now we're working out the bugs, like all new systems, but what happens is you get a state level position that's stable, that can kind of guide practice, and then you get those regional people who can provide some of that mentoring and some of that local work.
You know, when a new child care health consultant comes on board, regardless of their background, they could have 20 years in the health profession, it's kind of -- it's kind of daunting to have this field, and all of a sudden you have to know everything about everything. And that's what they say. You know, it's like we have to know all this stuff, and be a resource for everything for everybody. And it's pretty overwhelming.
But then if you think about they may be the only health consultant in that county, or even in that state. How many are from states with only one or two health consultants? So that's very overwhelming. So if you have a system in place, once that person is hired, to go out, to work with them, to get them connected to the right people, to kind of help them. Sometimes I get calls from people saying, you know, what do you think I should do? It's just too much. And then we kind of get the focus in on what they need to do, they -- oh, okay, yeah, that's what I'm going to concentrate on.
So trying to help them to retain, retention. And overturn -- turnover, sorry, is real big in this field, so -- like all health care professionals.
So the state health consultant, which is myself in North Carolina, establishes direction for health consultation in the state.
Assistant trainee. And many of you know about the NCI, many of your state people should go to NCI and be trained. And when I first went into child care health consulting in about '95 -- oh, I guess about '99, there was about 300 child care health consultants in the nation. Now there's about 3,000, closer to 4,000. So we're growing. So the training is constantly there. But because of turnover, we constantly need to be training new people. So we have in North Carolina an ongoing training program, it's web based, we have some face-to-face time. We have two cohorts every year, and recently we've been doing training with our university system, where we take community health nurses in the nursing program, train them, so once they get their B.S.N. that spring and graduate, they also have a qualified child care health consultant certificate. Which makes it a nice pool of new people coming up who are B.S.N., but they may have had nursing experience in the past. Because many of the B.S.N. programs, you know, they come in as nurses. So that's a really nice thing in North Carolina.
The state health consultant assists in professional development and continuing education. Once you get them trained, you don't just leave them go, it's constantly overall professional development. What do we need to do as a profession. What are new in the field, what's -- you know, what's the current trend. We always are thinking about how can we improve their practice. And they need to be a resource for people in the field, as I said, just going out and helping them through.
You know, a lot of times the child care health consultant is starting, the first thing they are afraid to do -- because if they are nurses they're used to an environment like the hospital that you go in, and you have sick people, and they're kind of captured in this ring or hall, and you take care of them. But a child care center, the kids are running all around and they're not sick and, you know, what do you do first? So it seems overwhelming, so having someone to be able to go out with them in the field.
And then promote the role itself, and encourage sustainability.
So when I talk about public awareness and promoting the role, what I'm talking about is just let people know what a CCAC is. And I have my little button here, CCAC, but how many times have I been somewhere and people say to me, well, what do you do for a living? And I say, well, I'm a child care health consultant. And they say -- okay.
And I know by that response that they have no clue what I do. And so we've developed this little elevator speech that we talk about what we do, that we are health professionals that work in child care, to help improve the health and safety of children in child care.
And, oh, okay, we get it now.
So we have this campaign in North Carolina that we're just trying to get people aware. Because how do you ask for extra funding if they don't know what you are or what you do? So we're just pushing that. And you'll see people at the conference with a T-shirt or a button that says CCAC, and hopefully you'll say, I know what you do. Or you'll go up and say, what do you do? And they'll have the right answer.
So. Mentorship. I talked about the regional system. The regional system is designed to work with the local child care health consultants, help them through their process of being on the job. And that first six months is crucial, they will probably have that turnover within that first six months to a year. Which you don't want.
So what they do is they help train new health consultants, support health consultants in isolated areas, assist in training and professional development. And it's a clearinghouse of knowledge and information. Statewide database collection.
How many of you have heard of Dr. Jonathan Cox, UNC, you probably have. The data and times project, some of you may be using a paper form of that. We have it electronic so we can collect the data and know what we're doing out there in the field, and make recommendations accordingly.
And that's a sample there of our child care evaluation form, looking at our centers, looking at our files, trying to figure out what's going on with our children, so we can have appropriate outcomes.
Professionalism is another as expect. Scope of practice, I talked about that earlier. You have to have standards, you have to know where you're going. And in our scope of practice we also have a health outcomes, so we're all working on the same group of outcomes. So that not only are we doing great things for kids, but we can measure them.
And we looked at our database form to develop our health outcomes, we looked at our service indicators from our early childhood systems grant, their indicators. We looked at some of the guidelines for Title 5. We -- what do you call them, the needs assessment, and we looked at that, to make sure we were right on track in terms of what we expected to happen in a child care center.
So it gives you guidelines for practice, shared health outcomes, and differentiated practice. Because not all health consultants are R.N., and we work many times with a team approach. We have an R.N. and we have a health educator, or R.N. and a dental hygienist or a social worker. It's a team approach. And health consultation works best when it is a team approach.
Our association, and I think we're unique in North Carolina, that other states don't have an association. We have a volunteer association, and what it is it's kind of an operation network of child care health consultants throughout the state. It's a volunteer organization.
This year we recently became more of a professional organization, we've got our own bank account, we've got our own federal ID number, we've got our own post office box, and we're charging dues now. So we've come a long way. But what we're doing is trying to make this more -- those isolated health consultants in areas, make sure that they can get the information, even though it may or may not have contact with their regional person.
So the association also promotes healthy development of children, and we do study illness in child care settings. It's a vehicle for discussion to act on local, state and national child care issues. I can't advocate at the state level in terms of the legislature on issues, but the health consultants, because they're a volunteer association, can.
And they are an avenue for members to share ideas, resources, and assist in problem-solving concerns and offer collaboration and support. So we have this collaborative funding in North Carolina. Smart Start funds Alliance of Health Consultants, about 70, which is pretty amazing. In our state, 70 full-time positions.
Division of Child Development funds a significant amount. They make sure that some of those regional positions are funded.
Of course, my home, DPH, funds Title V . Real excited about.
And of course the vision of Healthy Child Care America, which was originally housed in public health, is still going throughout, and ambition is continuing on. So that's my presentation. And I stayed on time.
So do you have any questions? Yes, ma'am.
UNKNOWN SPEAKER: Hi. Thank you so much for presenting this. I am actually from a state in which we have -- we have started to train public health nurses to be child care health facilitants, and we started out with 60, but over the last two years we're now down to about 40. And the thing is, it's only within our region, so we have 10 counties that we oversee, and we have like that 40 within those counties.
And so what advice would you give to us, to actually -- you know, put this out throughout the state, or get the word out, or gain buy-in from the state so that we can have consultants in at least all of the counties?
SHARON DOUGLAS WARE: That's a whole presentation. Wow, that's a lot to say on that. But let me ask the question, are your public health nurses full-time health consultants or part-time, or is this volunteer?
UNKNOWN SPEAKER: They're part-time, they're actually working in the county health department, so this is something added for them. And so --
SHARON DOUGLAS WARE: And that's hard.
UNKNOWN SPEAKER: That's very hard.
SHARON DOUGLAS WARE: That's one of the problems, because, you know, if you're a public health nurse you may have a passion for adult diabetes, and then to be given child health care consultation -- you know. So that's an issue, and of course the whole public awareness in terms of the people who are funders to be backing this.
I could talk to you later probably in more detail, because I know I don't have a lot of time, but one thing that I was real appreciative when I was in North Carolina, people got involved. And it wasn't just one agency, it has to be many agencies. And I hope this is a take-home message that it's a collaborative approach, and somebody has to lead. Lead the -- you know. You can't just train people and hopefully they'll do what they need to do. Somebody has to lead it. And that may be an issue, too, so. But I'll talk to you afterwards. Yes, sir.
UNKNOWN SPEAKER: Could you compare and contrast your profession to the Title 5 care coordinators as well as the school nurse.
SHARON DOUGLAS WARE: I can't compare and contrast the care coordinators, but the school nurse, in a real simple format, we're like, with school nurse, we're for the little people. We're kind of like school nurses for the little people. We don't do as much of the direct service, and many school nurses have gotten away from that because they just can't because of the numbers. So we do -- we do a little bit more of the -- trying to make that overall environment safe for children, and healthy for children. Because the numbers, we can't just serve every individual child, where the school nurse may attempt to do that. And I'm not -- you know, I'm not an expert in either of those areas, but I think that kind of gives you a little overview.
UNKNOWN SPEAKER: There's one thing I would also add to that, perhaps a lot on to that, but the one thing I think, child care consultants and early childhood, these are individuals who recognize the value of early intervention services, and in many communities service as that link in terms assessment, recognition of need, and funneling children and families to the services that they need. At an early point, way before school entry.
SUSAN ARONSON: I think the other thing about child care health consultation is that because there are no other health professionals nor other professionals, really, other than educators in the early childhood environment, except in the military where they can draw on environmental specialists and others, in fact the health consultant is jack of all health and safety related trades and is a link to other community services when it goes beyond that person's skill level.
So they may be dealing with food safety, and menu planning, as well as, you know, ensuring preventive health services and helping to get through the gatekeepers of the health care system for the children who have perhaps some special needs that are not getting attention. Or helping to implement medication recommendations which are being thrown out on a parent, and the parent supposedly being the health educator for the staff who take care of their children. You know, with the whisper down the lane approach. It's really a broad scope, whereas school nurses tend to have a superintendent-defined function.