This chapter contains recommendations for the responsibilities of agencies, organizations, and society, not for the individual caregiver or child care facility. These recommendations provide the support systems for implementation of the standards in the preceding chapters. Although many of these recommendations are directed to state administrative activity, they define necessary actions to assure the health and safety of children in out-of-home settings
9.1 THE REGULATORY AGENCY
REGULATION OF ALL OUT-OF-HOME CHILD CARE
Every state should have a statute that identifies the regulatory agency and mandates the licensing and regulation of all full-time and part-time out-of-home care of children, regardless of setting, except care provided by parents or legal guardians, grandparents, siblings, aunts, or uncles or when a family engages an individual to care solely for their children (
1).
DISCUSSION: A state statute gives government the authority to protect children as vulnerable and dependent citizens and to protect families as consumers of child care service. Licensing must have a statutory basis, because it is unknown to the common law. The statute must address the administration and location of the responsibility. Fifty states have child care regulatory statutes. The laws of some states exempt part day centers, school-age child care, care provided by religious organizations, lessons, summer camps or care provided in small or large family child care homes. These exclusions and gaps in coverage expose children to unacceptable risks.
The licensing agency should issue permits of operation to all facilities that comply with standards.
DISCUSSION: Every child has a right to protective care that meets the standards, regardless of the child care setting in which the child is enrolled. Public and private schools, nurseries, preschools, centers, child development programs, babysitting centers, early childhood observation centers, small and large family child care homes, and all other settings where young children receive care by individuals who are not close relatives should be regulated. Facilities have been able to circumvent rules and regulations in some states by claiming to be specialized facilities. Nothing in the educational philosophy, religious orientation, or setting of an early childhood program inherently protects children from health and safety risks or provides assurance of quality of child care.
Any exemptions for care provided outside the family may place children at risk. In addition to the basic protection afforded by stipulating requirements and inspecting for licensing, facilities should be required to be authorized for operation. Authorization for operation gives states a mechanism to identify facilities and individuals that are providing child care and authority to monitor compliance. These facilities and individuals may be identified as potential targets for training, technical assistance, and consultation services. Currently, many church run nurseries, nursery schools, group play centers, and home based programs operate incognito in the community because they are not required to notify any centralized agency that they care for children.
The lead agency for licensing of child care in most states is the human services agency. However, the state public health agency can be an appropriate licensing authority for safeguarding children in some states. The education system is increasingly involved in providing services to children in early childhood. The standards should be equally stringent no matter what agency assumes the responsibility for regulating child care.
Home care, which is the care of a child in his/her own home by someone whom the parent has employed, is not care within the family. This type of care should not be licensed as a facility. The relationship between the parent and caregiver is that of employer and employee rather than that of purchaser and provider of care, thus licensing or certification of the individual who provides such care, rather than of the service itself, is desirable and recommended.
A good resource on licensing, regulatory, and enforcement issues is the National Association for Regulatory Administration (NARA), an international professional organization for licensors, dedicated to promoting excellence in human care regulation and licensing through leadership, education, collaboration, and services. Contact information for NARA is located in Appendix BB. In addition, the Position Statement on Licensing and Public Regulation of Early Childhood Programs published by the National Association for the Education of Young Children (NAEYC) includes rationale for policy decisions related to licensing and regulation (
1). See Appendix AA, for the NAEYC position statement on licensing.
CRIMINAL RECORD AND CHILD ABUSE CHECKS
Every state should have a statute which mandates the licensing agency or other authority to obtain a criminal records check and a child abuse registry check on every prospective child care staff person, volunteer, or on a family child care home provider's family member who is over 10 years of age and who comes in contact with children. The expense of criminal records check and child abuse registry checks should be a public responsibility. No staff should be unsupervised with the children until a negative report has been received by the agency. Volunteers should not be unsupervised with the children at any time.
DISCUSSION: The cost of criminal records checks, where they have been implemented, has become an additional financial burden on programs, which are forced to pass on the expense to parents or staff. Placing the burden on potential new staff, volunteers, and substitute caregivers themselves proves to be another disincentive to enter this field of work. In many cases juvenile records are sealed and can not be used for the purposes of background checks. Juvenile offender records begin at age 10.
Some states have established definitions for regular volunteers (for whom criminal record and child abuse registry checks should be required) and for short-term visitors, such as entertainers and others, who will not be unsupervised with the children.
uniform categories AND definitions
Each state should adopt uniform categories and definitions for its own licensing requirements. While states may use different terms, every state should have individual standards that are applied to the following types of facilities:
a)
Small family child care home: A facility providing care and education of one to six children, including preschool children of the caregiver, in the home of the caregiver;
b)
Large family child care home: A facility providing care and education of 7 to 12 children, including preschool children of the caregiver, in the home of the caregiver, with one or more qualified adult assistants to meet child:staff ratio requirements;
c)
Center: A facility providing care and education of any number of children in a nonresidential setting, or 13 or more children in any setting if the facility is open on a regular basis (for instance, if it is not a drop-in facility);
d)
Drop-in facility: A facility providing care that occurs for fewer than 30 days per year per child, either on a consecutive or intermittent basis, or on a regular basis but for a series of different children;
e)
School-age child care facility: A facility offering activities to school-age children before and after school, during vacations, and non-school days set aside for such activities as teachers' in-service programs;
f)
Facility for children with special needs: A facility providing specialized care and education in a setting of one or more children who cannot be accommodated in a setting with typically developing children (
2). See Children Who are Eligible for Services Under the Individuals with Disabilities Education Act (IDEA),
STANDARD 7.001 through
STANDARD 7.016;
g)
Facility for ill children: A facility providing care of one or more ill children who are temporarily excluded from care in their regular child care setting. See Caring for Ill Children,
STANDARD 3.070 through
STANDARD 3.080;
1)
Integrated or small group care for ill children: A facility that has been approved by the licensing agency to care for well children and to include up to six ill children;
2)
Special facility for ill children: A facility that cares only for ill children, or a facility that cares for more than six ill children at a time;
DISCUSSION: Lack of standard terminology hampers the ability of citizens and professionals to compare rules from state to state or to apply national guidance material to upgrade the quality of care (
1). For example, child care for 7 to 12 children in the residence of the caregiver may be referred to as family day care, a group day care home, or a mini-center in different states. While it is not essential that each state use the same terms and some variability in definitions of types of care may occur, terminology should be consistent within the state and as consistent as possible from state to state in the way different types of settings are classified. Child care facilities should be differentiated from community facilities that primarily care for the mentally retarded, the elderly, and other adults and teenagers who need supervised care.
care of ill children not requiring exclusion
Any facility should be encouraged to care for ill children who do not need to be excluded, as defined in
STANDARD 3.068, provided that the licensing authority has approved the facility's written plan describing the symptoms or conditions that the facility is prepared to accommodate and procedures for daily care for such children. Facility types should be specific to the child's developmental level.
DISCUSSION: Children enrolled in child care are of an age that places them at increased risk for acquiring infectious diseases. Many children with illness (particularly mild respiratory tract illness without fever) can continue to attend and participate in activities in their usual facility. This perspective is reflected in the standards for excluding children from child care attendance. See Inclusion/Exclusion/Dismissal of Ill Children,
STANDARD 3.065 through
Clearly, when children with possible communicable diseases are present in the alternative care arrangements, emphasis on preventing further spread of disease is as important as in the usual facilities. Prevention of additional cases of communicable disease should be a key objective in these alternative care arrangements for children with minor illness and temporary disability.
Current state regulations concerning exclusion of children from facilities because of illness may be more restrictive than these standards. Some states currently require isolation of a child who becomes ill during the day while attending the facility, and for an ill child who is not expected to return to the facility the following day (
5). The most common alternative care arrangement is for a parent of the ill child to stay home from work and care for the child. Some states have established regulations governing child care for sick children (
5).
Data are inadequate by which to judge the impact of group care of ill children on their subsequent health and on the health of their families and community. The principles and standards proposed in this manual represent the most current views of pediatric and infectious disease experts on providing this special form of child care. These standards will require revision as new information on disease transmission in these facilities becomes available. The National Association for Sick Child Daycare (NASCD) conducts and sponsors original research on issues related to sick child care and helps establish sick care facilities across the nation. Contact information for the NASCD is located in Appendix BB.
INDIVIDUAL CREDENTIALING/CERTIFICATION
credentialling of INDIVIDUAL child care providers
All persons who provide child care or who may be responsible for children or alone with children in a facility should be individually credentialed by a state licensing agency or credentialing body recognized by the state child care regulatory agency. The credential should be granted to individuals who meet age, education, and experience qualifications, whose health status facilitates providing safe and nurturing care, and who have no record of conviction for criminal offenses against persons, especially children, or confirmed act of child abuse. The state should establish qualifications for differentiated roles in child care and a procedure for verifying that the individual who is authorized to perform a specified role meets the qualifications for that role.
DISCUSSION: Individual credentialing will enhance child health and development and protect children by ensuring that the staff who care for children are healthy and are qualified for their roles. The current system, in which the details of staff qualifications and ongoing training are checked as part of facility inspection, is cumbersome for child care administrators and licensing inspectors alike. If staff qualifications were established as part of a separate, more central process, the licensing agency staff could check center records of character references and whether staff members have licenses for the roles for which they are employed.
In a centralized individual credentialing system, successful completion of education should be verified by requiring the individual to submit evidence of completion of credit-bearing courses that have been previously approved as meeting the state's requirements to a central verification office where this transcript should be continually updated. Criminal records and child abuse registries should be checked by state licensing agency staff for evidence of behavior that would disqualify an individual for work in specified child care roles. Evidence of a recent health examination indicating ability to care for children can be submitted at the same time. The center director then knows whether job applicants who have been working in the field previously are qualified at the time they apply for the job, without lengthy waiting for background checks of a prospective employee and without having to hire before background checks have been completed. By this means, children are not exposed to health and safety risks from understaffing, or to care by unqualified or even dangerous individuals employed provisionally because the results of a check are not yet available to the director.
Centralizing individual credentialing, qualifying, or licensing (whichever term is consistent with the state's approach to authorizing legal professional activity) will improve control over quality, encourage a career ladder with increasing qualifications, and reduce the risk of abuse. It will help consumers know that individuals who are caring for their children have met basic requirements for consumer protection. Such a process is analogous to that provided for other education professionals (teachers), and even those service providers with less potential for harm than is involved in caring for children (such as beauticians, barbers, taxi drivers).
The cost of individual certification, credentialing, or licensure will be offset by the benefits to consumers of reliable and consistent qualifications of child care personnel. Program administrators, licensors, and child care personnel, who do not have to undertake the tedious process of verification of each portion of an individual's credentials during all site visits, when sites are licensed, or when individuals change jobs, will experience cost savings and assurance of compliance. Public and private policymakers should use financial and other incentives to help caregivers meet credentialing requirements. They should encourage community colleges to offer courses appropriate for provider training at times convenient for child care workers to attend.
Periodic renewal of the credential should be required, and should be related to requirements for continuing education and the absence of founded claims of child abuse or criminal convictions. The requirement for renewable certification is likely to deter people from applying for work in child care as a way of gaining access to children for sexual purposes since the process would include a check of the child abuse registry (
3).
While there is value in checking criminal records, not all criminal records represent hazards for children so serious as to prohibit the individual from working in a child care setting. States should specify which crimes defined in the state's criminal code will prohibit certification and whether any other crimes should limit the ability of the individual to be certified for certain roles. Individuals who have been convicted of violent and/or sexual crimes should not work in child care settings. States should be careful not to rely entirely on criminal record checks to prevent abuse. This method is expensive and does not result in a high number of "hits" as records are checked, because many abusers have not yet been convicted of a crime. In addition, states should rely on other, less costly measures to protect children. The Federal Bureau of Investigation (FBI) maintains a central criminal file. Contact information for the FBI is located in Appendix BB. If all caregivers are certified, and are required to present or post their certificates where they work, their identity, background, and competence can be documented. Checking compliance requires simple inspection of the certificate and verification by contacting the state agency that maintains the computerized registry of qualified individuals. Precautions against forgery should be built into the system.
For information on individual staff qualifications,
see Preservice Qualification and Special Training,
STANDARD 1.007 through
STANDARD 1.022.
licensing agency PRE-LICENSING Procedures
Before granting a license to a facility, the licensing agency should check as specified below for a record of a physical examination and for educational qualifications, and should check criminal records, juvenile records and the child abuse registry for all adults who are permitted to be alone with children in a facility. The licensing agency should also check the criminal record files and child abuse registry, as specified below, for all persons over 10 years of age who live in a small or large family child care home where child care is provided.
a) Staff health appraisals, as specified in Pre-employment Staff Health Appraisal,
STANDARD 1.045;
c) Criminal record files, for crimes of violence against persons, especially children, within the state of residence, and for personnel who have moved into the state within the past 5 years, federal or out of state criminal records of the other state(s) where the individual has resided in the past 5 years;
d) The child abuse registry, for a known history of child abuse or neglect in the state of residence and for personnel who have moved into the state within the past 5 years, the other state(s) where the individual has resided in the past 5 years.
DISCUSSION: In many cases juvenile records are sealed and cannot be used for the purposes of background checks. Ten years is the minimum age to be adjudicated a juvenile offender.
ALTERNATIVE MEANS OF COMPLIANCE
alternative means of compliance
Alternative means of compliance should be granted from state licensing requirements when the intent of the requirement is being met by equivalent means and does not compromise the health, safety or protection of children.
DISCUSSION: The ability to grant alternative means of compliance recognizes the variety of settings and services that can effectively and safely meet children's needs. Flexibility in applying licensing regulations should be permitted to the extent that children's need for protection is met.
THE REGULATION SETTING PROCESS
RATIONAL BASIS OF REGULATIONS
The state child care regulatory agency should formulate, implement, and enforce regulations that reduce risks to children in out-of-home child care.
DISCUSSION: Regulations describe the minimum performance required of a facility. Regulations must be:
· Understandable to any reasonable citizen;
· Specific enough that any person knows what is to be done and what is not to be done;
· Enforceable, in that they are capable of measurement;
· Consistent with new technical knowledge and changes in public views to offer necessary protection.
community participation in development of licensing rules
State licensing rules should be developed with active community participation by all interested parties including parents, service providers, advocates, professionals in medical and child development fields, funding and training sources.
Regulations formulated through a representative citizen process should come before the public at well-publicized public hearings held at convenient times and places in different parts of the state. The licensing rules should be re-examined and revised at least every 5 years. The regulatory development process should include many opportunities for public debate and discussion as well as the ability to provide written input.
DISCUSSION: The legal principle of broad interest representation has long been applied to the formulation of regulations for child care. Changes in regulation can be implemented only with broad support from the different interests affected. State administrative laws and constitutional principles require public review. The interests of the child must take precedence over all other interests.
collaborative development of child care requirements and guidelines
Local and state health departments, child care licensing agencies, health professionals, attorneys, caregivers, parents, and representatives of the business community, including employers, should work together to develop child care licensing requirements and guidelines for ill children.
DISCUSSION: Local and state health departments have the legal responsibility to control communicable diseases in their jurisdictions (
4). To meet this responsibility, health departments generally have the expertise to provide leadership and technical assistance to licensing authorities, caregivers, parents, and health professionals in the development of licensing requirements and guidelines for the management of ill children. The heavy reliance on the expertise of local and state health departments in the establishment of faci-lities to care for ill children has fostered a partnership in many states among health departments, licensing authorities, caregivers, and parents for the adequate care of ill children in child care settings. In addition, the business community has a vested interest in assuring that parents have facilities that provide quality care for ill children so parents can be productive in the workplace. This vested interest is likely to produce meaningful contributions from the business community to creative solutions and innovative ideas about how to approach the regulation of facilities for ill children. All stakeholders in the care of ill children should be involved for the solutions that are developed in regulations to be most successful.
ADMINISTRATION OF THE LICENSING AGENCY
adequacy of staff and funding for regulatory enforcement
All phases of regulatory administration should have authorization, funding, and enough qualified staff to monitor and enforce the law and regulations of the state.
DISCUSSION: For regulations to be effective, the regulatory body must formulate, implement, and enforce licensing requirements and assure that licensing inspectors are both sufficient in numbers and capable of fairly and effectively developing and applying the regulations. Funds for all phases of the licensing process should be provided or faulty administrative operations may result, such as inadequate protection of children, formulation of irresponsible standards, inadequate investigations, and insufficient and unfair enforcement.
training and PERFORMANCE MONITORING of licensing inspectors
Licensing inspectors should receive initial and periodic competency-based training to monitor compliance with licensing standards. Competency should be initially and periodically assessed by simultaneous, independent monitoring by a skilled licensing inspector until the trainee attains the necessary skills.
DISCUSSION: Objective assessment of compliance is a learned skill that can be fostered by classroom and self teaching methods but should be mastered through direct practice and apprenticeship. To ensure consistent protection of children, licensing inspectors should undergo periodic retraining and reevaluation to assess their ability to recognize sound and unsound practices. In addition, all staff involved in licensing such as agency directors, attorneys, policy staff, managers, clerical/support personnel and information system staff need periodic training updates. Training for licensors should include best practice and programming, child development theory, and law enforcement.
frequenCY OF INSPECTIONS OF Facilities
Sufficient numbers of licensing inspectors should be hired to provide sufficient time visiting and inspecting facilities to insure compliance with regulations.
DISCUSSION: Licensing centers and large family child care homes should require at least one pre-licensing visit, and at least one more visit after granting of the provisional license, and after children are in attendance, to determine that all requirements are being met and that a full license can be granted. In addition, licensing inspectors should follow up promptly, based on priority of severity and on complaints of noncompliance made by parents and the general public. They should make routine unannounced inspections at least annually to determine continued compliance, and they should study compliance at length at the time of re-licensing. The most effective way of ensuring compliance with standards is through the licensors' presence in facilities, identifying deficiencies and giving technical assistance/consultation to bring about compliance. Workloads should be designed so that the licensing inspectors' time is not consumed by in-office tasks.
education and experience of licensing inspectors
Licensing inspectors, and others in licensing positions, should be pre-qualified by education and experience to be knowledgeable about the form of child care they are assigned to inspect. They should receive no less than 40 clock hours of orientation training upon employment. In addition, they should receive no less than 24 clock hours of continuing education each year, covering the following topics and other such topics as necessary based on competency needs:
a) The licensing statutes and rules for child care;
b) Other applicable state and federal statutes and regulations;
c) The historical, conceptual and theoretical basis for licensing, investigation, and enforcement;
d) Technical skills related to the person's duties and responsibilities, such as investigative techniques, interviewing, rule-writing, due process, and data management;
e) Child development, early childhood education principles, child care programming, scheduling, and design of space;
f) Law enforcement and the rights of licensees;
g) Center and large or small family child care home management;
h) Child and staff health in child care;
i) Detection, prevention, and management of child abuse;
j) Practical techniques for inclusion of children with special needs;
k) Exclusion/inclusion of ill children;
l) Health, safety, and nutrition;
m) Recognition of hazards.
DISCUSSION: Licensing inspectors are a point of contact and linkage for caregivers and sources of technical information needed to improve the quality of child care. This is particularly true for areas not usually within the network of early childhood professionals, such as health and safety expertise. Unless the licensing inspector is competent and able to recognize areas where facilities need to improve their health and safety provisions, the opportunity for such linkages will be lost.
training of licensing agency personnel about child abuse
Staff and administrators in licensing agencies and state supported resource and referral agencies should receive 16 hours of training about child abuse with an emphasis on how child abuse occurs in child care.
DISCUSSION: Licensing and resource and referral persons should be as well informed about child abuse issues as caregivers, or better. States should establish inspection procedures to ensure compliance of their agency personnel.
statutory authorization of on-site inspections
The state statute should authorize the state regulatory agency to conduct on-site inspections.
DISCUSSION: The National Association for the Education of Young Children (NAEYC) Position Statement says, "Effective enforcement requires periodic on-site inspections on both an announced and unannounced basis with meaningful sanctions for noncompliance" (
1). When unannounced inspections are used, they should be conducted at any hour the facility is in operation, i.e., evenings and nights included if the facility operates at those times. NAEYC recommends that all centers and large and small family child care homes receive at least one site visit per year. Unannounced inspections have been shown to be especially effective when targeted to providers with a history of low compliance. (
1)
initial inspection and at least one annual inspection
The licensing inspector should make an initial inspection upon receipt of the application for license (either announced or unannounced within a specified time frame), and at least one annual inspection to each center and large and small family child care home thereafter. These inspections may be announced or unannounced.
The schedule of inspections depends upon the quality of the facility as measured by:
a) The results of an annual inspection by a regulatory inspector;
b) Concerns raised about compliance with rules by visitors who provide technical assistance and training for the child care providers;
c) Inspections initiated because of complaints.
The number of inspections should not include those inspections conducted for the purpose of investigating complaints. Parents should be given a summary list of rules and a telephone number for reporting violations and should be encouraged to observe the facility for compliance.
DISCUSSION: The initial inspection and consultation often lead to full compliance with health, safety, and program standards, but over time, compliance may slip. Supervision and monitoring of child care facilities are critical to facilitate compliance with the rules in order to prevent or correct problems before they become serious. Technical assistance and consultation on an on-going basis can be very successful in helping programs to achieve compliance with the rules and even to go beyond the basic level of quality. These positive strategies are most effective when they are coupled with the non-regulatory methods used by other parts of the early care and education community to promote quality (such as accreditation, training/education, peer support, and consumer education). All of these methods are most effective when they work together within a coordinated child care system.
Family child care home providers need the same level of support as do larger child care programs. When the licensing agency is not able to make annual inspections, additional contact and support can be provided by other sources, such as the Child and Adult Food Program, a mentor caregiver, or a designated child care health consultant. In these situations, the on-site monitors are encouraged to inspect the facility for basic health and safety hazards and to report to the licensing agency observations of any substantial non-compliance with rules. State statutes and policy differ on the frequency of on-site inspections. Since the average duration of a small family child care home is often less than two years, more frequent visits of licensing inspectors or consultants to these facilities might help keep them in the system and improve the quality of care.
Recent changes in welfare policies have, in some states, supported the growth of "informal" family child care, which is "legally exempt" from regulation. As a consequence, some children who may benefit most from a high quality child care program are in programs that are never visited by a regulator of
The licensing agency should adopt monitoring strategies that ensure compliance with licensing requirements. When these strategies do not include a total annual review of all licensing requirements, the agency should review selected policies and performance indicators and/or conduct a random sampling of licensing requirements at least annually. The licensing agency should have procedures and staffing in place to increase the level of compliance monitoring for any facility found in significant noncompliance.
DISCUSSION: Due to an insufficient number of inspectors in licensing agencies across the country, it is important to use various methods in the licensing process to insure quality
.
PROCEDURES FOR COMPLAINTS AND REPORTING
procedure for receiving complaints
Each licensing agency should have a procedure for receiving complaints regarding violation of the regulations. Such complaints should be recorded, investigated, and appropriate action, if indicated, should be taken.
DISCUSSION: The telephone number for filing complaints should be listed on material about licensing that is given to parents by the state licensing agency or the resource and referral agency. At a minimum, the licensing agency has responsibility for consumer protection. Complaints serve as an early warning before more serious adverse events occur. A fair and equitable process for handling complaints is essential to protect both the person complaining and the target of the complaint from harassment.
whistle-blower protection under state law
State law should ensure that caregivers and child care staff who report violation of licensing requirements in the settings where they work are immune from discharge, retaliation, or other disciplinary action for that reason alone, unless it is proven that the report was malicious.
DISCUSSION: Staff in child care facilities are in an excellent position to note areas of noncompliance with licensing requirements in the setting where they work. However, so that they feel safe about reporting these deficiencies, they must be assured immunity from retaliation by the child care facility unless the report is malicious. This immunity is best provided when a state statute mandates it. Individuals who report problems in their own workplace may be known as "whistle-blowers".
States should recognize and develop a system to deal with complaints against a provider that are retaliatory by disgruntled staff or parents. At times these nuisance complaints serve only to harass the provider and expend valuable licensing resources or unnecessary work.
publicity about reporting suspected child abuse
Licensing agencies should publicize the requirements for reporting and methods of reporting suspected child abuse.
DISCUSSION: Child care staff and parents should be aware of the reporting requirements and the procedures for handling reports of child abuse. State requirements may differ, but those for whom reporting suspected abuse is mandatory usually include child care personnel. Information on how to call and how to report should be posted so it is readily available to parents and staff. Emotional abuse can be extremely harmful to children, but unlike physical or sexual abuse, it is not adequately defined in most state child abuse reporting laws. States need to develop procedures for handling allegations of all types of abuse.
Procedures for evaluating allegations of physical and emotional abuse may or may not be the purview of the licensing agency. This responsibility may fall to another agency to which the licensing agency refers child abuse allegations.
state statute support of regulatory enforcement
The state statute should authorize the suppression of illegal operations and enforcement of child care regulations and statutory provisions.
DISCUSSION: Without proper enforcement, especially the suppression of illegal operations, licensing could become a ritual and lose its safeguarding intent. Some state laws lack adequate provisions for enforcement.
States should have an official broad-based child care advisory body to deal with a wide scope of both regulatory and policy child care related issues. This advisory body should be composed of public and private agency personnel, child development and health professionals, child care providers including caregivers, parents, and citizens.
DISCUSSION: A child care advisory board is
· Review overall rules and regulations for the operation and maintenance of facilities and the granting, suspending, and revoking of both provisional and regular licenses;
· Recommend administrative policy;
· Recommend changes in legislation.
The advisory group may include representatives from the following agencies and groups:
c) State agencies with regulatory responsibility or an interest in child care (human services, public health, fire marshal, emergency medical services, education, human resources, attorney general, safety council);
d) Private organizations with a child care emphasis;
e) Child care providers including caregivers;
f) Professionals with expertise in pediatrics, nutrition, mental health, oral health, injury prevention, or early childhood education;
g) Parents who represent ethnic and cultural diversity;
The advisory group should actively seek citizen participation in the development of child care policy, including parents and child care providers at the level of administration and one-to-one care to children. One method for encouraging citizen participation is through public hearings. In response to specific issues, it is often effective to constitute an ad hoc group to study the questions and provide input to the regulatory agency.
9.2 HEALTH DEPARTMENT RESPONSIBILITY
HEALTH DEPARTMENT ROLE AND PLAN
state and local health department role
State and local health departments should play an important role in the identification, prevention and control of injuries, injury risk, and infectious disease in child care settings as well as in using the child care setting to promote health. This role includes the following activities to be conducted in collaboration with the child care licensing agency:
1. Assisting in the planning of a comprehensive health and safety program for children and child care providers.
2. Monitoring the occurrence of serious injury events and outbreaks involving children or providers.
3. Alerting the responsible child care administrators about identified or potential injury hazards and infectious disease risks in the child care setting.
4. Controlling outbreaks, identifying and reporting communicable diseases in child care settings including:
a) Methods for notifying parents, caregivers, and health care providers of the problem.
b) Providing appropriate actions for the child care provider to take;
c) Providing policies for exclusion or isolation of infected children;
d) Arranging a source and method for the administration of needed medication.
e) Providing a list of reportable diseases, including descriptions of these diseases. The list should specify where diseases are to be reported and what information is to be provided by the child care provider to the health department and to parents;
f) Requiring that all facilities, regardless of licensure status, and all health care provi-ders report certain communicable diseases to the responsible local or state public health authority. The child care licensing authority should require such reporting under its regulatory jurisdiction and should collaborate fully with the health department when the latter is engaged in an enforcement action with a licensed facility;
g) Determining whether a disease represents a potential health risk to children in out-of-home child care;
h) Conducting the epidemiological investigation necessary to initiate public health interventions;
i) Recommending a disease prevention or control strategy that is based on sound public health and clinical practices (such as the use of vaccine, immunoglobulin, or antibiotics taken to prevent an infection).
