1. Karen Peifer PhD, MPH, RN Roopa Iyer PhD Ann Kaskel RN Does Place Matter For Healthy Early Child Care Environments?

2. Disclosure The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: We have no conflicts to report

3. State Board Statewide: Policy, Infrastructure, Programs, Coordination and Collaboration Regional Partnership Councils Local Decision making, Community Coordination and Collaboration, Targeted Programs Grantees and Partners Programs and Services to Children and Families First Things First Governance Model

4. What impacts quality and does place Matter? Quality First- QRIS Child Care Health Consultation Improve health and safety standards in child care settings –Standards based on Caring for Our Children, 3 rd Edition CCH Consultant : –National Training Institute (NTI) trained and certified professionals- post BA or BSN PROFESSIONAL DEVELOPMENT

5. Environmental Rating Scales: ECERS-R; ITERS and FCCERS Personal Care Routines Subscale CLASS: Classroom Assessment Scoring System Quality First Rating Scale FTF Quality First Point Scale Staff Qualifications Administrative Practices Curriculum

6. Personal Care Routines Scale Greeting and departing Meals and snacks Nap and rest Toileting and diapering Health practices Safety Practices

7. Child Care Health Consultation Tier 3 Tier 2 Tier 1  CCHC collaborate with QF Coaches  Telephonic technical assistance and resource  Expert mode consultation (short term)  + Tier 1 services  National Health and Safety Assessment  Collaborative model of consultation  Individualized instruction & training: Clinical pathway  Identify & train an on-site Health & Safety Specialist  + Tier 1 and 2 services

8. Hypothesis: Does Place Matter? Location of a child care center make a difference in quality of child care environments. H1: The scores on the Environmental Rating Scale (ERS) subscale for personal care routines (PCR) will vary in high poverty areas compared to non-poverty areas in the state. H2: The scores on the ERS and PCR will differ based on level of CCHC services. H2: The Center quality rating scores is illustrated by ERS and PCR scores

9. Methodology Child care centers enrolled in the Quality First Program (n = 670) Scores on ERS for Personal Care Routines sub-scale Calculated low poverty areas based on poverty of geographic region where the center is located (ACS 2008 - 2012). Comparing the tier levels of CCHC services – Tier 1 (less intensive) to tier 3 (more intensive services) Quality Rating scores by PCR and ERS scores

10. Limitations Administrative data Limited Data Sub-categories for poverty Dose of CCHC intervention - New data system ERS subscale scores in relation to length of program participation and assessment by different time points

11. Center-based Child Care Centers CentersNumber of Centers Cohort 1  CCHC Tier 2 & 3 (n = 299) Public : School based, Head Start and early childhood special education 57 (19%)15 Head Start, (7 are tribal Head Start) Private child care242 (81%) Cohort 2  CCHC Tier 1 (n = 371) Public : School based, Head Start and early childhood special education 119 (32%) Private child care252 (68%)

12. Results Cohort 1 Centers (299) n FPLAverage ERS by poverty level ERS PCR scores Exposed to CCHC Tiers 2 & 3 (On-site consultation) 171< 150% FPL3.232.06 128 >= 150% FPL3.232.08 Cohort 2 Centers (371) Exposed to CCHC Tier 1 (Phone consultation only) 262 < 150% FPL3.332.15 109 >= 150% FPL3.532.43

13. Results Cohort 1: Centers (299) CCHC Tiers 2 & 3 PCR scoresAverage ERS 210 (Star rating 1-2)1.922.97 89 (Star rating 3-5)2.514.02 Cohort 2:Centers (371) CCHC Tier 1 PCR scoresAverage ERS 215 (Star rating 1-2)2.053.22 156 (Star rating 3-5)2.453.95

14. Conclusion We expected that low poverty areas with limited CCHC services would have lower PCR scores than in higher poverty levels. Scores varied but not in the direction we assumed when more intensive CCHC services were delivered. Goals for CCHC interventions are similar but slightly different from the PCR rating scores. Importance in aligning goals between coaches, CCHC and other specialized technical assistants. Lessons learned.

15. Next Steps Quality First Implementation and Validation study Are the quality first improvement components implemented as intended (fidelity of implementation)? Which ones or what combination works best in moving programs to higher quality levels (star ratings)? Consulting Team: CCHC, Mental Health consultation in some regions Coaching consultation model Professional development Financial incentives

16. Questions/Comments

17. Thank you Karen Peifer PhD, MPH, RN Roopa Iyer PhD Ann Kaskel RN