Licensed Child Care Facilities Research Articles

A Statewide Program to Test and Reduce Lead in Drinking Water at Schools and Child Cares.

A lead testing act was passed in Colorado mandating that all licensed child care facilities and public schools serving fifth grade and lower test all drinking water locations for lead by May 31, 2023. Colorado's Water Quality Control Division created the Test & Fix Water for Kids program to implement this act. Aspects of the program included establishing a database, outreach and education, technical assistance, lead analyses at the Colorado State Laboratory, remediation, and reimbursement. Of a total of 6000 licensed child care providers and public elementary schools, 4500 entities enrolled and tested 53 000 water samples for lead at drinking water fixtures. Testing results showed that 93% (46 000 total) of the fixtures tested were below the 5 parts per billion (ppb) action level. As a result, 7% (3700) of the fixtures tested were above the action level. Of the fixtures that tested above 5 ppb, 47% were classroom faucets. Many of these faucets had not been used since COVID-19 when several schools switched to using bottle fillers. The program identified all fixtures associated with low usage as well as older fixtures to be replaced with lead-free options to reduce lead levels below 5 ppb. Almost 600 000 children have been protected from potential exposure to lead in drinking water through this program. This article outlines the methods of launching a statewide lead testing program and the importance of testing fixtures for lead in drinking water in early childhood education buildings.

Standardizing Diabetes Care in Colorado Schools: Nearly Two Decades of Success.

Since 2005, a group of stakeholders in Colorado has collaborated to improve diabetes management in schools and childcare centers by standardizing care and embedding local expertise to support school personnel in this task. This effort has included the development of toolkits for parents, school nurses, and other health care providers; the establishment of a diabetes resource nurses program; and annually updated guidelines titled Standards of Care for Diabetes Management in the School Setting & Licensed Child Care Facilities. This collaboration has fundamentally changed how school nurses and staff in Colorado care for students with diabetes.

Parents, Are You Getting Your Money’s Worth at Your Childcare Center?

Historically, mothers were the primary caregiver and were expected to stay at home to care for their child. In today’s society, there is an increasing trend of dual-earner families where both individuals contribute to the household income. This created a demand for childcare services such as preschools, childcare centers, and family daycare homes. Due to the high demand, a majority of parents had difficulty obtaining childcare services and it brought into question whether parents are still able to fully assess each available childcare centers’ quality and cost, or if they are forced to select any center with available space. Additionally, considering its high demand, it’s uncertain whether centers are still providing high quality care at their price points. This study investigated if the cost of childcare at licensed childcare facilities in cities and districts under the jurisdiction of Vancouver Coastal Health (VCH) align with their structural qualities of care.

Early Childcare and Education in a Post-Industrial Landscape: Inequalities in Proximity to Active and Relic Manufacturing in Metropolitan Providence, Rhode Island.

Children are uniquely vulnerable to environmental health risks associated with industrial contamination, and early childcare and education (ECE) facilities are important sites for potential exposure to environmental contaminants. Emerging research on historic urban industry has additionally demonstrated that urban environmental risk accumulates historically and spatially across urban landscapes. Accordingly, this study pairs cross-sectional data on licensed childcare facilities with longitudinal manufacturing site data in Providence, Rhode Island. We use these data to investigate the proximity of ECE facilities to active and relic manufacturing sites, controlling for a range of organizational- and tract-level characteristics. Results show that type of childcare facility (center-based vs. in-home) and language of instruction (Spanish vs. English) are important predictors of children's proximity to industrial lands, past and present. These findings indicate that Spanish-speaking children in Providence may experience a "double jeopardy" in the form of disproportionate legacy environmental hazards at ECE as well as at home-suggesting that the historical nature of urban industrial land use is an important mechanism of environmental inequality for young children.

Does an active play standard change childcare physical activity and healthy eating policies? A natural policy experiment

BackgroundIn 2017, the provincial government of British Columbia (BC) implemented a mandatory policy outlining Active Play Standards (AP Standards) to increase physical activity (PA) levels, sedentary and motor skills among children attending licensed childcare centers. Concurrently, a capacity-building initiative was launched to help implement policies and practices supporting both PA and healthy eating (HE) in the early years. This study evaluated differences in center-level PA and HE policies and practices before and after the enforcement of the new provincial AP Standards.MethodsUsing a repeat cross-sectional design, surveys were distributed to managers and staff of licensed childcare facilities serving children aged 2–5 years before (2016–2017 or ‘time 1’) and after (2018–2019 or ‘time 2’) implementation of the AP Standards across BC. The total sample included 1,459 respondents (910 and 549 respondents at time 1 and time 2, respectively). Hierarchical mixed effects models were used to examine differences in 9 and 7 PA/sedentary policies and practices, respectively, as well as 11 HE policies between time 1 and time 2. Models controlled for childcare size and area-level population size, education, and income.ResultsCompared to centers surveyed at time 1, centers at time 2 were more likely to report written policies related to: fundamental movement skills, total amount of Active Play (AP) time, staff-led AP, unfacilitated play/free play, total amount of outdoor AP time, limiting screen time, breaking up prolonged sitting, staff role modeling of PA, and training staff about PA (P < 0.01 for all 9 policies examined). Compared to time 1, centers at time 2 reported more frequent practices related to ensuring children engaged in at least 120 min of AP, 60 min of outdoor AP daily, and limiting screen time (P < 0.01 for 3 out of 7 practices examined). Despite no additional policy intervention related to HE, centers were more likely to report having written policies related to: HE education for children, encouraging new foods, having family-style meals, offering only milk or water, limiting the amount of juice served, staff role modeling of HE, limiting the types of foods at parties/celebrations and foods brought from home (P < 0.05 for 9 out of 11 HE policies).ConclusionApproximately a year after the implementation of a governmental policy targeting PA supported by a capacity-building initiative, childcare centers reported positive changes in all 9 PA/sedentary policies examined, all 3 out of 7 PA/sedentary practices and 9 out of 11 HE policies evaluated at the center-level.

Reaching Target Communities in a Community Preschool Vision Screening Program

To develop a method to identify preschools with the greatest need for vision screening, correlations between socioeconomic status, preschool capacity, and rates of pediatric vision screenings performed by a community vision screening program were investigated. Geoinformatics mapping software was used to visually display the areas of greatest need. Vision screening data from a community vision screening program, child care facility data from California Department of Social Services, and income data from the U.S. Census Bureau through ArcGIS software (Esri) were collected. When possible, data were consolidated at the ZIP code level. Kolmogorov-Smirnov analysis was used to determine correlations between data elements. Licensed child care facilities were scored on a scale (from 1 to 5) based on the socioeconomic status of the ZIP code and the facility capacity. The scoring system prioritized larger facilities in lower income communities to most efficiently use vision screening program resources. There was a positive correlation between the capacity of the child care facility and the median household income (P = .005). Second, we found a positive correlation between child care capacity and the median household income (P = .005). Licensed child care facilities were mapped and colored using GIS software according to their cumulative score. Challenges to vision screening in under-served communities include the lack of child care facilities and smaller facility size. The use of a scoring system and mapping software can direct vision screening programs to reach a greater number of children with the most efficient use of resources. [J Pediatr Ophthalmol Strabismus. 2022;59(6):375-379.].

Implementation of a new childcare Workforce Background Check system

PurposeAs child abuse and neglect in childcare settings continue to occur, a quality childcare workforce is imperative. This paper aims to describe how an efficient and effective childcare Workforce Background Check system was developed and implemented to protect both children and childcare staff in the state of Michigan.Design/methodology/approachThe user-centered design (UCD) approach was used in the creation and statewide implementation of a new acceptable and usable system, the Michigan childcare background check (CCBC) system. The authors conducted focus groups to obtain user feedback and performed several usability evaluations. This approach was used as guidance for the development process and to evaluate the concept designs for the web application that was created.FindingsThis paper discusses the overall process of implementing the CCBC program, focusing on successes, barriers and lessons learned in the planning, designing and execution phases. By May 2019, more than 92,069 background checks were conducted on personnel in 8,740 licensed childcare facilities across Michigan. Collaboration across stakeholders in different sectors facilitated the implementation of the new system, while structural barriers and stigma provided barriers to implementation.Practical implicationsHaving individuals with various roles, abilities and technical expertise assist with the development and implementation of the system ensured the usability and acceptability of the new system by all types of users.Social implicationsThe general public expects childcare providers to ensure that their employees meet the highest professional standards. Developing effective, easy-to-use fingerprint-based criminal history background check systems to identify ineligible applicants and monitor current employees is one component of an overall strategy to promote child safety and minimize child abuse and neglect in the childcare environments.Originality/valueThis paper provides a practical example of how a CCBC system can be developed, implemented and scaled to be used statewide. This approach can be used by other states or other disciplines with a similar context.Plain language summaryAs child abuse and neglect in childcare settings continue to occur, a quality childcare workforce is imperative. This paper shows how this study uses the UCD approach to create an acceptable and usable system and complete statewide implementation of a new Michigan CCBC program. This resulted in an efficient and effective Workforce Background Check system that is essential to protect both children and childcare staff.

Characteristics of COVID-19 Cases and Outbreaks at Child Care Facilities - District of Columbia, July-December 2020.

The occurrence of cases of COVID-19 reported by child care facilities among children, teachers, and staff members is correlated with the level of community spread (1,2). To describe characteristics of COVID-19 cases at child care facilities and facility adherence to guidance and recommendations, the District of Columbia (DC) Department of Health (DC Health) and CDC reviewed COVID-19 case reports associated with child care facilities submitted to DC Health and publicly available data from the DC Office of the State Superintendent of Education (OSSE) during July 1-December 31, 2020. Among 469 licensed child care facilities, 112 (23.9%) submitted 269 reports documenting 316 laboratory-confirmed cases and three additional cases identified through DC Health's contact tracers. Outbreaks associated with child care facilities,† defined as two or more laboratory-confirmed and epidemiologically linked cases at a facility within a 14-day period (3), occurred in 27 (5.8%) facilities and accounted for nearly one half (156; 48.9%) of total cases. Among the 319 total cases, 180 (56.4%) were among teachers or staff members. The majority (56.4%) of facilities reported cases to DC Health on the same day that they were notified of a positive test result for SARS-CoV-2, the virus that causes COVID-19, by staff members or parents.§ Facilities were at increased risk for an outbreak if they had been operating for <3 years, if symptomatic persons sought testing ≥3 days after symptom onset, or if persons with asymptomatic COVID-19 were at the facility. The number of outbreaks associated with child care facilities was limited. Continued implementation and maintenance of multiple prevention strategies, including vaccination, masking, physical distancing, cohorting, screening, and reporting, are important to reduce transmission of SARS-CoV-2 in child care facilities and to facilitate a timely public health response to prevent outbreaks.¶.

Breastfeeding History, Preschool Children’s Sleep, and Obesity

ABSTRACT Breastfeeding and sleep are both considered medically and physiologically protective factors for child health. Most existing research studied their impact on child health outcomes, respectively. Few studies examined the two factors collectively to explore any potential associations among a history of breastfeeding and quantity of sleep in children and child health. This study sought to uncover the association among breastfeeding history, the amount of sleep, and obesity in preschool-aged children to provide additional insights into their protective physical and psychological effects on health outcomes. As part of a larger study examining obesity in preschool children, the current investigation explored the association among obesity, a history of breastfeeding, and the total number of hours of preschool children’s sleep, as reported by parents. Actual heights and weights were collected on a total of 1,693 children 3–5 years of age enrolled in licensed child care facilities in Mississippi. Descriptive analyses of the demographic and parent survey variables were conducted to explore the status related to breastfeeding in Mississippi. To understand the relationships between breastfeeding and covariates, bivariate analyses such as chi-square independent tests, Cochran-Mantel-Haenszel chi-square tests, and Fisher’s exact tests were performed. Obesity was negatively correlated to breastfeeding, and Caucasian mothers were significantly more likely to breastfeed than African American mothers. Obesity was also negatively correlated to the amount of sleep, and African American children reportedly slept significantly less than Caucasian children. The average amount of time of sleep reported for children with a history of being breastfed was significantly higher than for those who were not breastfed, suggesting that breastfeeding could have a significant positive association with preschool children’s sleep, serving as an additional protective factor obesity. The interaction between breastfeeding and subsequent sleep as children mature is an important area for future research to fully explore their foundational impact in family health practices that combat obesity in children and promote other subsequent health outcomes.

P17 Participation in the Child and Adult Care Food Program (CACFP) Influences Nutrition-Related Practices of Child Care Settings in Nebraska

Background Federal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children. Objective Determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. Study Design, Settings, Participants Cross-sectional surveys were distributed to 3,014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2-5 years. Measureable Outcome/Analysis Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). Results The sample included 1,345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P Conclusion While participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommending mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding USDA.

Does Public Pre-K Have Unintended Consequences on the Child Care Market for Infants and Toddlers?

I estimate the impact of public pre-kindergarten for 4-year-olds on the provision of private child care for younger children by considering New York City's 2014 Universal Pre-K expansion. Private child care facilities often care for children from infancy or toddlerhood through pre-K. A public option for older children could therefore affect availability, prices, or quality of care for younger children. This effect could be positive or negative depending on the structure of the child care market, the design of the public pre-K program, and parent preferences. I use a panel dataset covering all licensed child care facilities in New York City and a difference-in-differences strategy that compares changes over time for neighborhoods with more versus fewer new public pre-K sites. I estimate that the public pre-K program reduced the capacity for children younger than 2 years old at private child care centers by 2,700 seats. The entire decrease in capacity occurs in areas with high poverty, and this decline was not offset by an increase in provision in the home day care market. In complementary analysis, I find a within-center increase in public complaints and inspection violations for day care centers that are closer to new public pre-K sites, suggesting a decrease in quality due to the increased competition from public pre-K. A back-of-the-envelope calculation indicates that for every seven 4-year-olds who shifted from day care centers to public pre-K, there was a reduction of one day care center seat for children under the age of 2.

Implementation of Best Practices in Obesity Prevention in Child Care Facilities: The Arizona Empower Program, 2013-2015.

IntroductionObesity is a major health concern in every US age group. Approximately one in 4 children in Arizona’s Special Supplemental Nutrition Program for Women, Infants, and Children is overweight or obese. The Arizona Department of Health Services developed the Empower program to promote healthy environments in licensed child care facilities. The program consists of 10 standards, including one standard for each of these 5 areas: physical activity and screen time, breastfeeding, fruit juice and water, family-style meals, and staff training. The objective of this evaluation was to determine the level of implementation of these 5 Empower standards.MethodsA self-assessment survey was completed from July 2013 through June 2015 by 1,850 facilities to evaluate the level of implementation of 5 Empower standards. We calculated the percentage of facilities that reported the degree to which they implemented each standard and identified common themes in comments recorded in the survey.ResultsAll facilities reported either full or partial implementation of the 5 standards. Of 1,678 facilities, 21.7% (n = 364) reported full implementation of all standards, and 78.3% (n = 1,314) reported at least partial implementation. Staff training, which has only one component, had the highest level of implementation: 77.4% (n = 1,299) reported full implementation. Only 44.0% (n = 738) reported full implementation of the standard on a breastfeeding-friendly environment.ConclusionArizona child care facilities have begun to implement the Empower program, but facilities will need more education, technical assistance, and support in some areas to fully implement the program.

Proximity of Licensed Child Care Facilities to Near-Roadway Vehicle Pollution

We assessed child care facilities' proximity to heavily traveled roadways in an attempt to estimate the extent of potential exposure of young children to vehicle-related pollution in this understudied microenvironment. We examined approximately 24,000 licensed child care facilities in California located within 200 m of heavily traveled roadways. Approximately 57000 of the available slots in California child care centers (7% of the overall capacity) are in facilities located within 200 m (650 ft) of roadways averaging 50000 or more vehicles per day, and another 172000 (21%) are in facilities located within 200 m of roadways averaging 25,000 to 49,000 vehicles per day. Facilities providing care to infants or preschool-aged children and facilities located in disadvantaged areas were more often situated in medium-or high-traffic areas. Additional research is needed to further clarify the significance of the child care microenvironment in terms of potential childhood exposures to vehicle-related pollutants. Design strategies, notification standards, and distance-based siting restrictions should be considered in the facility licensing process and in land use and transportation planning.

Implications for the development of children in over 11 hours of centre-based care.

With increasing numbers of women joining the evening/night-time and extended-hour workforce, there is a need for quality childcare during these hours. This project, conducted in Japan, sought to compare the effects of expanded childcare on the development and adaptation of 648 young children after 2 years in care. All parents in 41 governmentally licensed child care facilities in Japan completed a survey on the child-rearing environment at home, their feelings of self-efficacy, and the presence of support for childcare to provide a baseline of information. Two years later, 648 of these parents were surveyed again. Childcare professionals evaluated the development of children at both times. The results of multiple regression analysis indicate that factors in the home environment, not length of centre-based care, explained developmental risks 2 years later.

Evaluation Informs Coalition Programming for Environmental Tobacco Smoke Reduction

The objective for this formative evaluation was to establish baseline data for informing a community coalition's strategic planning in environmental tobacco smoke (ETS) risk reduction. The coalition had chosen 3 targeted settings for ETS risk reduction: restaurants, childcare facilities, and government buildings. The evaluation methodology involved telephone interviews (restaurants, n = 805; governmental buildings, n = 258) and mailed surveys (childcare facilities, n = 1,142). Data on county residents and businesses were used for comparison purposes and were analyzed from the Nebraska Social Climate Survey (2001; n = 558). Evaluation baseline findings showed that licensed childcare facilities were more ETS knowledgeable, less ETS tolerant, and more smoke-free than restaurants. Residents were more bothered by ETS than what restaurant proprietors perceived. The majority of governmental buildings were not smoke-free. Conclusions were that community health nurse evaluators can provide coalitions with formative evaluative data to inform strategic planning and increase the likelihood of effective program interventions for community impact on ETS.¹

From the Centers for Disease Control and Prevention. Vaccination coverage among children enrolled in Head Start programs, licensed child care facilities, and entering school--United States, 2000-01 school year.

The implementation of state and local requirements for vaccination before entry to Head Start programs, licensed child care facilities, and school has resulted in high vaccination levels among preschool and school children. One of the national health objectives for 2010 is to maintain > or = 95% vaccination coverage among children attending licensed child care centers and kindergarten through postsecondary school (objective 12-23). National estimates of vaccination coverage among children in Head Start programs, licensed child care facilities, and those entering school have been published each year since 1997 on the basis of reports from federally funded immunization programs (IPs) in the 50 states, five cities, eight territories, and the District of Columbia. This report summarizes data reported by states, cities, and the District of Columbia for the 2000-01 school year. Although vaccination coverage for 2000-01 appears similar to that for previous years, the number of programs reporting and the completeness of the reports are lower than in previous years and do not permit precise estimation of coverage at the national level. IPs use school data to identify undervaccinated children enrolled in Head Start programs, licensed child care facilities, and those entering school; evaluate the success of prevention programs targeting these children; and document the proportion of children whose parents claim exemptions from one or more vaccines. Plans are ongoing to assist IPs in applying successful strategies for collecting, reporting, and increasing the precision of coverage estimates for these populations.

Compliance of Licensed Child Care Centers With the American Academy of Pediatrics' Recommendations for Infant Sleep Positions

Sudden Infant Death Syndrome is an elusive and tragic cause of infant mortality. In 1992, the American Academy of Pediatrics (AAP) recommended that healthy term infants be placed in the supine or lateral positions for sleep, based on research conducted in Europe, Australia, and New Zealand. The AAP modified its recommendation in 1994, indicating a preference for the supine position. Since the initial AAP proposal, national educational programs have worked to encourage parents and health care providers to utilize AAP guidelines. Studies have been done on parental use of the supine position. However, very little information exists about the procedures utilized in licensed child care facilities. A survey of child care providers was conducted to determine the risk for Sudden Infant Death Syndrome, as indicated by rates of compliance with AAP guidelines. Results show that although the majority of the child care providers knew the AAPrecommendations, only 14.3% were in complete compliance. We make recommendations for the role of the public health nurse in facilitating compliance in child care centers along with suggestions for future research.

Compliance of Licensed Child Care Centers With the American Academy of Pediatrics' Recommendations for Infant Sleep Positions

Sudden Infant Death Syndrome is an elusive and tragic cause of infant mortality. In 1992, the American Academy of Pediatrics (AAP) recommended that healthy term infants be placed in the supine or lateral positions for sleep, based on research conducted in Europe, Australia, and New Zealand. The AAP modified its recommendation in 1994, indicating a preference for the supine position. Since the initial AAP proposal, national educational programs have worked to encourage parents and health care providers to utilize AAP guidelines. Studies have been done on parental use of the supine position. However, very little information exists about the procedures utilized in licensed child care facilities. A survey of child care providers was conducted to determine the risk for Sudden Infant Death Syndrome, as indicated by rates of compliance with AAP guidelines. Results show that although the majority of the child care providers knew the AAPrecommendations, only 14.3% were in complete compliance. We make recommendations for the role of the public health nurse in facilitating compliance in child care centers along with suggestions for future research.

Teachers' comfort and importance ratings for interventions for preschoolers with AD/HD

AbstractThe main purpose of this study was to explore preschool teachers' ratings of both the perceived importance of and their comfort levels implementing interventions for children with AD/HD. Participants included 138 teachers from licensed child care facilities. Teachers completed a questionnaire that required them to rate, on a 7‐point Likert‐type scale, the importance of 43 interventions and how comfortable they would be executing the strategy if asked to do so in the classroom. Overall, teachers concluded that the majority of the interventions were mostly important and believed they would be comfortable using the strategies. In addition, findings indicated that preschool teachers' importance and comfort ratings were highly correlated. Teacher variables (i.e., years of teaching experience, educational level, and having a student with AD/HD) were not correlated with, or discriminative of, comfort and importance ratings. The implications of these findings are discussed. © 2001 John Wiley &amp; Sons, Inc.

Zinc Adequacy of Preschool Menus: The Implication of Phytate/Zinc Molar Ratios

Trends towards a more plant-based diet may alter zinc status of groups with marginal zinc intakes, such as children. Careful menu planning by registered dietitians is critical. The objectives of this study were 1) to determine if the planned menus of licensed child care facilities that participated in Child Care Food Program provided adequate amounts of zinc, and 2)to assess the menus for their phytate content, the known modifier of zinc bioavailability. We contacted 180 child care facilities and randomly selected one week planned menus from 18 facilities (10%) for analysis. The menus were analyzed using a subset of the foods from the Nutrient Database for Nationwide Food Surveys, Release 9. The 5-day average intakes of zinc and other selected nutrients were compared against 1/2 and 2/3 of the Recommended Dietary Allowances (RDAs) established for children 4-6 years of age (there are no RDAs available for ages 3-5). Mean Zinc intakes fell below 1/2 and 2/3 of the RDA. To assess zinc bioavailability as affected by phytate, we calculated phytate to zinc molar ratios for all 18 facilities. Our results showed that phytate to zinc molar ratios were below the critical ratio of 10 for all facilities. In conclusion, the zinc content of the meals that were provided to children participating in the selected childcare facilities did not meet the RDA but that the phytate content of the menus did not inhibit the bioavailability of zinc.