Infant and Toddler Care: Improving Quality Through Health and Safety Practices Danette Swanson Glassy, MD, FAAP CA Head Start Association 2015 Health Institute Los Angeles, CA April 29, 2015

Danette Swanson Glassy, MD, FAAP Mercer Island Pediatrics Advisory Committee, Head Start National Center on Health Co-Editor, Caring For Our Children, National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition

Agenda National Center on Health Best-Practice/Standards/Regulations Oh My! Infant/Toddler Care-a few highlights Medical Home Infection Control Immunizations: children and adults Safe Sleep Developmental Screening Feeding solids (anemia/allergy issues) Nutrition/Physical Activity Others? Resources Measure Your Quality

What is Health? “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  World Health Organization, 1948 The World Health Organization (WHO) adopted this definition of “health” in 1946 and has been used officially by all associated groups since 1948. WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The Definition has not been amended since 1948.

Office of Head Start National Centers NCPMFO Program Management and Fiscal Operations NCQTL Quality Teaching and Learning NCPFCE Parent, Family, and Community Engagement NCCLR Cultural and Linguistic Responsiveness EHSNRC Early Head Start NCH Health

Head Start National Center on Health Our Goal: Fostering a culture of health and wellness for children, families, staff, and communities Our Foundation: School readiness begins with health!

Sound Management Systems Staff, Parent, and Community Engagement Culturally & Linguistically Appropriate Positively Associated with Improvement in Learning Applicable to Home Visits & Child Care Settings Safety & Injury Prevention Oral Health Mental Health Nutrition & Physical Activity Health Literacy The NCH supports Head Start programs in a variety of health areas, including safety & injury prevention, oral health, mental health, and nutrition and physical activity. Health literacy is at the core of these issues, because the more we know about our health and our children’s health, the more we (staff, families, and children) can use preventive and appropriate strategies. We also incorporate the essential areas seen in the outer ring on this display: sound management systems to support health services and children’s safety Staff, parent, and community engagement, Cultural and linguistic responsiveness and appropriate approaches Understanding the link between a child’s health and his or her ability to learn And assuring our information is relevant to home visiting programs and center-based care, both in HS/EHS and child care programs.

National Center on Health Partners American Academy of Pediatrics Education Development Center, Inc. Center for Child and Human Development at Georgetown University National Maternal and Child Oral Health Resource Center at Georgetown University UCLA Health Care Institute at the UCLA Anderson School of Management AAP holds the cooperative agreement w/ OHS. AAP is the lead organization for the NCH and we work with the following partners… Working as a team, as one National Center on Health Each partner brings an area of expertise to the effort: EDC – the lead on Safety and Injury prevention Center for Child and Human Development at GT- lead on mental health National Maternal and Child OHRC at GT- (in partnership with you all at ASTDD) - lead on oral health UCLA – lead on health literacy University of North Carolina at Chapel Hill – lead on health consultation AAP – lead on Healthy Active Living and Asthma/Tobacco Exposure

NCH Resources Newsletters Online courses Webinars Fact sheets http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/center Newsletters Online courses Webinars Fact sheets T/TA tools

OHS Priority Health Issues Healthy active living Mental health Safety and injury prevention Health literacy Oral health and dental homes Asthma prevention with special emphasis on tobacco exposure prevention I mentioned these 6 priority areas earlier… One of the first products we’ve produced is a series of Fact Sheets on these 6 priorities (one targeting staff, the other set targeting families). The Fact Sheets provide basic info these topics… (a “10 Things you Need to Know” format). One packet was just sent to each of the 1600 Health Managers across the country, as a way to introduce the Center to them and provide info. The fact sheets will soon be available on ECLKC (early childhood Learning and Knowledge Center)

Emerging Issues Emergency preparedness and response Connecting children with medical and dental homes Health manager networks Health and home visiting Toxic stress and trauma in early childhood Orientation for new health managers Staff wellness After the initial directives from OHS to address the 6 priority areas – there are other areas/topics that the NCH is addressing. These came about as a result of the listening sessions, more collaboration with the other national centers, and networking with national partners/organizations….

Who’s Here Today? Health Managers? Family Services Managers? Other Area Managers? Classroom Staff, Home Visiting Staff, or Family Child Care Providers? Parents or Family Members? Directors or Administrators? Governing Boards/Tribal Council/Policy Council? Community Partners? TA Staff? Federal Staff? Other? From California or Other States? Use this opportunity in the beginning of the session to gauge the experience level of the audience and the relevance of your material and examples to their work.

Quality Evidence-based, expert informed * Head Start Program Performance Standards Accreditation Requirements State Child Care Regulations Evaluator Interpretation

Medical Home Overall better health with true Medical Home accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective

Medical Home Access-Use local outreach advocates: Communication Covered California Outreach and Education Grant Partners http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/OE/OutreachandEducntygrantees.pdf Promote www.WellVisitPlanner.org Communication Call, really, I mean it!

Infection Control Infants and Toddlers more vulnerable Infants with fever hospitalized if under 2-3 months With flu hospitalized at the same rate as senior citizens Diarrheal illness significantly reduced with proper hand hygiene, sanitizing/disinfecting

Infection Control Cleaning, Sanitizing, Disinfecting Written policy Which-for-What: CFOC Appendices J and K http://cfoc.nrckids.org Alameda County Green Child Care: http://acgov.org/ece/green_childcare.htm Coalition for Safety and Health in Early Learning: http://cshelwa.org/downloads/13_Disinfect_E15L.pdf

Infection Control Hand Hygiene http://www.cdc.gov/CDCTV/handstogether/ http://www.cdc.gov/CDCTV/WashYourHands/

Infection Control Diapering Use posters: http://www.ecels-healthychildcarepa.org/ http://here.doh.wa.gov/materials/how-to-change-a-diaper/12_DiaperCCsm_E12L.pdf Policy for parents using the diapering area Hand washing nowhere near food and bottle prep sink/area

Infection Control Inclusion/Exclusion Written policy shared with parents-Plan B Help from health professional- Child Care Health Consultant Health Services Advisory Member (Weaving Connections) Specific child’s Health Care Provider (call, really)

Immunizations Timing critical for Infants and Toddlers Trusted Advisor Parent Friendly resources Staff Immunizations a must Parent Immunizations http://www.cdph.ca.gov/programs/immunize/Pages/Schools-and-Childcare-Centers.aspx

Immunizations Resources CA DOH: http://www.cdph.ca.gov/programs/immunize/Pages/Schools-and-Childcare-Centers.aspx AAP: https://www2.aap.org/immunization/index.html Measles Simulation: http://fred.publichealth.pitt.edu/measles/results.php

Developmental Screening Critical Elements- Evidenced based tool Easy to understand and use Practice communicating results Know how to refer Always share results with health care provider

Developmental Screening EHS tip sheet No. 6 Learn the Signs, Act Early Home page- http://www.cdc.gov/ncbddd/actearly/index.html Free online training for Early Education and Child Care Providers- http://www.cdc.gov/ncbddd/watchmetraining/index.html

Safe Sleep More than SIDS, think SUIDS—Sudden Unexplained Infant Deaths Positioning AND Environment-cribs, blankets, temperature, cords, bumpers Resources and Free online training- http://www.healthychildcare.org/sids.html

Safe Sleep http://www.healthychildcare.org/sids.html A Parents' Guide to Safe Sleep ( Also available in Spanish) This brochure includes information for parents about infant sleep positioning and practices as well as describes how parents can work with child care providers to ensure that safe sleep practices are used in all child care settings as well as at home. (Updated April 2012) A Child Care Provider's Guide to Safe Sleep (Also available in Spanish) This easy-to-read brochure provides child care providers with information about ways to promote safe sleep practices and reduce the risk of SIDS. (Updated April 2012) Tummy Time This brochure provides information about the importance of supervised tummy time and how it promotes healthy development. (Revised 2011) It’s important to think about guidance for FCC homes. What are their sleep arrangements? Do they use cribs or playpens? Do they have access to the ground floor of a building in case of evacuation? For infants and toddlers, it’s important to plan to allow children to sleep on demand, not necessarily at a defined “nap time.” How will you plan for that?

Safe Sleep Online learning module: www.healthychildcare.org/sids More information about the new play yard standards. Links to keeping babies safe in their sleeping environments is at the Crib Information Center on CPSC’s website. Online learning module: Safe Sleep Practices and SIDS/Suffocation Risk Reduction This spinoff includes safe sleep practice standards from Caring for Our Children, 3rd Edition. www.healthychildcare.org/sids

Feeding Solids “Cue feed”, just like feeding bottles New recommendations: Promote iron-rich foods early on Introduce allergy-prone foods before 12 months

Nutrition/Physical Activity Remember NCH website: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/nutrition/nutrition.html http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/healthy-active-living/healthy-active-living.html

Little Voices for Healthy Choices Little Voices for Healthy Choices provides additional resources on nutrition and physical activity specific to infants and toddlers. Click the image to link to the page on ECLKC

Nutrition/Physical Activity Containers  Resources to keep infants and toddlers moving: Motion Moments-http://nrckids.org/index.cfm/products/videos/motion-moments1/ Bright Futures-http://www.brightfutures.org/physicalactivity/pdf/Infancy.pdf

Others

Resources Caring For Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education, 3rd Edition http://cfoc.nrckids.org Available in print or online

Resources CFOC Spinoffs: Caring for Infants and Toddlers in Early Care and Education Stepping Stones* Preventing Childhood Obesity in ECE Programs* Safe Sleep Practices and SIDS/Suffocation Risk Reduction Oral Health in Child Care and Early Education Environmental Health in ECE Coming Soon: Caring for Children with Special Health Care Needs in ECE

Resources Healthy Child Care America www.healthychildcare.org AAP Information, resources, trainings Sign up for newsletter

Resources National Resource Center for Health and Safety in Child Care and Early Education www.nrckids.org Houses CFOC and Spin Offs Search state child care regulations Child Care Health and Policy information Sign up for E-Resources Newsletters

Resources AAP books Managing Infectious Diseases in Child Care and Schools, 3rd Edition Easy to use guide with specific diseases and conditions Easy to copy information about inclusion and exclusion

Resources AAP Books Managing Chronic Health Conditions in Child Care and Schools Easy to use format, specific conditions addressed, easy to reproduce forms and handouts

Resources AAP Books Model Child Care Health Policies, 5th edition Also available online at http://www.ecels-healthychildcarepa.org/publications/manuals-pamphlets-policies/item/248-model-child-care-health-policies

Resources AAP Books PedFACTs-Pediatric First Aid for Caregivers and Teachers, 2nd edition Manual and a training program www.pedfactsonline.com

Resources Health Consultation Websites California Child Care Health: http://www.ucsfchildcarehealth.org/ Disinfecting/Sanitizing Worksheets Integrated Pest Management Toolkit Health and Safety Checklist

Resources Health Consultation Websites Early Childhood Education Linkage System http://www.ecels-healthychildcarepa.org/ Professional Development, Training, Tools Public Health Seattle King County Child Care Health Program http://www.kingcounty.gov/healthservices/health/child/childcare.aspx Trainings, Tools, Model Policy recently updated

Measure Your Quality Head Start Health and Safety Checklist Stepping Stones to Caring for Our Children, 3rd Edition Compliance/Comparison Checklist http://nrckids.org/index.cfm/products/stepping-stones-to-caring-for-our-children-3rd-edition-ss3/ CCCH Health and Safety Checklist http://www.ucsfchildcarehealth.org/pdfs/Checklists/HS_Checklist.pdf

National Center on Health Contact Information Toll-free: 888-227-5125 E-mail: nchinfo@aap.org Website: http://eclkc.ohs.acf.hhs.gov/hslc/tta- system/health/center