Caring for Our Children: Chapter 1 - Staffing Chapter 1: Staffing 1.1 CHILD:STAFF RATIO AND GROUP SIZE STANDARD 1.001 RATIOs for SMALL FAMILY CHILD CARE Homes The small family child care home provider child:staff ratios shall conform to the following table: If the small family child care home provider has no children under two years of age in care, then the small family child care home provider may have 1-6 children over two years of age in care If the small family child care home provider has 1 child under two years of age in care, then the small family child care home provider may have 1-3 children over two years of age in care If the small family child care home provider has 2 children under two years of age in care, then the small family child care home provider may have no children over two years of age in care The small family child care home provider's own children shall be included in the child:staff ratio. RATIONALE: Although child:staff ratios alone do not predict the quality of care, direct warm social interaction between adults and children is more common and more likely with lower child:staff ratios. Care - givers must be recognized as performing a job for groups of children that parents of twins, triplets, or quadruplets would rarely be left to handle alone. In child care, these children do not come from the same family and must learn a set of common rules that may differ from expectations in their own homes. Low child:staff ratios are most critical for infants and young toddlers (0 to 24 months) (1). Infant development and caregiving quality improves when group size and child:staff ratios are smaller (2). Improved verbal interactions are correlated with lower child:staff ratios (3). For 3- and 4-year old children, the size of the group is even more important than ratios. The recommended group size and child:staff ratio allow 3- to 5- year old children to have continuing adult support and guidance while encouraging independent, self-initiated play and other activities (4). The National Fire Protection Association (NFPA) requires in the NFPA-101 Life Safety Code that small family child care homes serve no more than 2 clients incapable of self-preservation (6). COMMENTS: Some states are setting limits on the number of school-age children that are allowed to be cared for in small family child care homes, e.g., two school-age children in addition to the maximum number allowed for infants/preschool children. No data are available to support using a different ratio where school-age children are in family child care homes. Since school-age children require focused caregiver time and attention for supervision and adult-child interaction, this standard applies the same ratio to all children over two years of age. The family child care provider must be able to have a positive relationship and provide guidance for each child in care. Unscheduled inspections encourage compliance with this standard. For more information regarding brain development in children in child care, see STANDARD 1.010. TYPE OF FACILITY: Small Family Child Care Home STANDARD 1.002 RATIOS FOR LARGE FAMILY CHILD CARE HOMES AND CENTERS Child:staff ratios in centers and large family child care homes shall be maintained as follows during all hours of operation, including transport and nap times: Age Maximum Child:Staff Ratio Maximum Group Size Birth - 12 mos. 3:1 6 13 - 30 mos. 4:1 8 31 - 35 mos. 5:1 10 3-year-olds 7:1 14 4-year-olds 8:1 16 5-year-olds 8:1 16 6 - 8-year-olds 10:1 20 9 - 12-year-olds 12:1 24 During nap time, at least one adult shall be physically present in the same space as the children. Other adults who are included in the child:staff ratio need not be in the same space with the children when all the children are napping. However, in case of emergency, these adults shall be on the same floor and shall have no barrier to their coming to help immediately. The caregiver who is in the same space with the children shall be able to summon these adults without leaving the children. When there are mixed age groups in the same room, the child:staff ratio and group size shall be consistent with the age of most of the children when no infants or toddlers are in the mixed age group. When infants or toddlers are in the mixed age group, the child:staff ratio and group size for infants and toddlers shall be maintained. In large family child care homes with two or more care-givers caring for no more than 12 children, no more than three children younger than 2 years of age shall be in care. RATIONALE: These child:staff ratios are within the range of recommendations for each age group that the National Association for the Education of Young Children (NAEYC) uses in its accreditation program (5). The NAEYC recommends a range that assumes the director and staff are highly trained and, by virtue of the accreditation process, has determined a staffing pattern that enables effective staff function. The standard for child:staff ratios in this document uses a single desired ratio, rather than a range, for each age group. In some cases, these child:staff ratios and group sizes are the more stringent ratios and group sizes recommended in the National Research Council's report, Who Cares for America's Children? Child Care Policy for the 1990s (1). According to the National Research Council, child:staff ratios and group size are two of the four most important areas to be addressed in national standards. Children with special health care needs may require additional staff on-site, depending on their special need and extent of disability (1). Low child:staff ratios for non-ambulatory children are essential for fire safety. The National Fire Protection Association, in its NFPA-101 Life Safety Code , recommends that no more than three children younger than 2 years of age be cared for in large family child care homes where two staff members are caring for up to 12 children (6). Children benefit from social interactions with peers. However, larger groups are generally associated with less positive interactions and developmental outcomes. Group size and ratio of children to adults are limited to allow for one to one interaction, intimate knowledge of individual children, and consistent caregiving (7). Although child:staff ratios alone do not predict the quality of care, direct warm social interaction between adults and children is more common and more likely with lower child:staff ratios. Caregivers must be recognized as performing a job for groups of children that parents of twins, triplets, or quadruplets would rarely be left to handle alone. In child care, these children do not come from the same family and must learn a set of common rules that may differ from expectations in their own homes. Low child:staff ratios are most critical for infants and young toddlers (0 to 24 months) (1). Infant development and caregiving quality improves when group size and child:staff ratios are smaller (2). Improved verbal interactions are correlated with lower ratios (3). For 3- and 4-year old children, the size of the group is even more important than ratios. The recommended group size and child:staff ratio allow 3- to 5- year old children to have continuing adult support and guidance while encouraging independent, self-initiated play and other activities (4). In addition, the children's physical safety and sanitation routines require a staff that is not fragmented by excessive demands. Child:staff ratios in child care settings should be sufficiently low to keep staff stress below levels that might result in anger with children. Caring for too many young children, in particular, increases the possibility of stress to the caregiver, and may result in loss of self-control. Although observation of sleeping children does not require the physical presence of more than one caregiver, the staff needed for an emergency response or evacuation of the children must remain available for this purpose. Nap time may be the best option for regular staff conferences and staff training, but these activities should take place in an area next to the room where the children are sleeping so no barrier will prevent the staff from assisting if emergency evacuation becomes necessary. COMMENTS: The child:staff ratio indicates the maximum number of children permitted per caregiver (8). These ratios assume that caregivers do not have time-consuming bookkeeping and housekeeping duties, so they are free to provide direct care for children. The ratios do not include other personnel (such as bus drivers) necessary for specialized functions (such as driving a vehicle). Group size is the number of children assigned to a caregiver or team of caregivers occupying an individual classroom or well-defined space within a larger room (8).The "group" in child care represents the "homeroom" for school-age children. It is the psychological base with which the child identifies and from which the child gains continual guidance and support in various activities. This standard does not prohibit larger numbers of children from joining in collective activities as long as child:staff ratios and the concept of "home room" are maintained. Unscheduled inspections encourage compliance with this standard. These standards are based on what children need for quality nurturing care. Those who question whether these ratios are affordable must consider that our efforts to limit costs have resulted in overlooking the basic needs of children and creating a highly stressful work environment for caregivers. Community resources other than parent fees and a greater public investment in child care are critical to achieving the child:staff ratios and group sizes specified in this standard. For more information regarding brain development in children in child care, see STANDARD 1.010. TYPE OF FACILITY: Center; Large Family Child Care Home STANDARD 1.003 RATIOS FOR FACILITIES SERVING CHILDREN WITH SPECIAL HEALTH NEEDS Facilities enrolling children with special needs shall determine, by an individual assessment of each child's needs, whether the facility requires a lower child:staff ratio. RATIONALE: The child:staff ratio must allow the needs of the children enrolled to be met. The facility should have sufficient direct care professional staff to provide the required programs and services. Integrated facilities with fewer resources may be able to serve children who need fewer services, and the staffing levels may vary accordingly. Adjustment of the ratio allows for the flexibility needed to meet the child's type and degree of special need. The facility should seek consultation with parents and other professionals regarding the appropriate child:staff ratio and may wish to increase the number of staff members if the child requires significant special assistance. COMMENTS: These ratios do not include personnel who have other duties that might preclude their involvement in needed supervision while they are performing those duties, such as cooks, maintenance workers, or bus drivers. TYPE OF FACILITY: Center; Large Family Child Care Home: Small Family Child Care Home STANDARD 1.004 RATIOS DURING TRANSPORTATION Child:staff ratios established for out-of-home child care shall be maintained on all transportation the facility provides or arranges. The driver shall not be included in the ratio. No child of any age shall be left unattended in a vehicle. RATIONALE: Children must continue to receive adequate supervision during transport. Placement of a child in a vehicle does not eliminate the need for supervision. Drivers must not be distracted from safe driving practices by being simultaneously responsible for the supervision of children. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 1.005 RATIOS FOR WADING AND SWIMMING The following child:staff ratios shall apply while children are wading or swimming: Developmental Levels Child:Staff Ratio Infants 1:1 Toddlers 1:1 Preschoolers 4:1 School-age Children 6:1 During any swimming/wading activity involving mixed developmental levels where either an infant or a toddler is present, the ratio shall always be 1 adult to 1 infant/toddler. The required ratio of adults to older children shall be met without including the adults who are required for supervision of infants and/or toddlers. An adult shall remain in direct physical contact with infants at all times during swimming or wading. RATIONALE: The circumstances surrounding drownings and water-related injuries of young children suggest that requirements and environmental modifications will reduce the risk for this type of injury. Essential elements are close continuous supervision (9), fences and self-locking gates around all swimming/wading pools, hot tubs, and spas, and special safety covers on pools when they are not in use (10). Infant swimming programs have led to water intoxication and seizures because infants may swallow excessive water when they are engaged in any submersion activities. COMMENTS: These ratios do not include personnel who have other duties that might preclude their involvement in supervision during swimming/wading activities while they are performing those duties. Thus, this ratio excludes cooks, maintenance workers, or lifeguards from being counted in the child:staff ratio if they are involved in these specialized duties at the same time. A lifeguard is not counted in the child:staff ratio unless he/she is assigned only to the children in that group. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 1.2 LICENSURE/CERTIFICATION OF QUALIFIED INDIVIDUALS STANDARD 1.006 CHILD CARE CREDENTIAL Any individual who will be primarily responsible for children in a separate classroom, a group of children, or a small family child care home shall hold an official child care credential as granted by the authorized state agency. RATIONALE: The supervision of children must be overseen by a person who has experience and education to properly care for them. The qualification of anyone who will be alone with children must be actively assured and not assumed. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home 1.3 PRESERVICE QUALIFICATIONS AND SPECIAL TRAINING GENERAL QUALIFICATIONS FOR ALL CAREGIVERS, INCLUDING DIRECTORS, OF ALL TYPES OF FACILITIES STANDARD 1.007 STAFF RECRUITMENT Staff recruitment shall be based on a policy of non-discrimination with regard to gender, race, ethnicity, disability, or religion, as required by the Equal Employment Opportunity Act. The policy of non-discrimination shall extend also to sexual orientation. Staff recruitment policies shall adhere to requirements of the Americans with Disabilities Act as it applies to employment. The tasks required for each position shall be defined in writing and the suitability of an applicant shall be measured with regard to the applicant's qualifications and abilities with the tasks required in the role. RATIONALE: Child care providers must adhere to federal law. In addition, child care providers should model diversity and non-discrimination in their employment practices to enhance the quality of the program and to teach children and parents about diversity and tolerance for individuals on the staff who are competent caregivers with different background and orientation in their private lives. The goal of the Americans with Disabilities Act (ADA) in employment is to reasonably accommodate applicants and employees with disabilities to provide them equal employment opportunity and to integrate them into the program's staff to the extent feasible, given the individual's limitations. Under the ADA, employers are expected to make reasonable accommodations for persons with disabilities. Some disabilities may be accommodated, whereas others may not allow the person to do essential tasks. The fairest way to address this evaluation is to define the tasks and measure the abilities of applicants to perform them. COMMENTS: Reasons to deny employment include the following: The applicant or employee is not qualified or is unable to perform the essential functions of the job with or without reasonable accommodations; Accommodation is unreasonable or will result in undue hardship to the program; The applicant's or employee's condition will pose a significant threat to the health or safety of that individual or of other staff members or children. Accommodations and undue hardship are defined and based on each individual situation. Caregivers can obtain copies of the Equal Employment Opportunity Act and the American with Disabilities Act from their local public library (11, 12). Facilities should consult with ADA experts through the U.S. Department of Education funded Disability and Business Technical Assistance Centers throughout the country. These centers can be reached by calling 1-800-949-4232 and callers will be routed to the appropriate region. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 1.008 REFERENCES AND BACKGROUND CHECKS Directors of centers and caregivers in large and small family child care homes shall check references and examine employment history and criminal and other appropriate court records (including fingerprinting and checks with state child abuse registries) before employing any staff member (including substitutes), even in states where licensing has not been instituted. Background checks shall be required for all child care providers. When checking references, prospective employers shall specifically ask about previous convictions with child abuse or child sexual abuse. Failure of the prospective employee to disclose previous convictions of child abuse or child sexual abuse is grounds for dismissal. Persons who acknowledge being sexually attracted to children or who acknowledge having physically or sexually abused children, or who are known to have committed such acts shall not be hired or allowed to work in the child care facility. RATIONALE: To ensure their safety and physical and mental health, children must be protected from any risk of abuse. Although few persons will acknowledge past child abuse to another person, the obvious attention directed to the question by the licensing agency or caregiver may discourage some potentially abusive individuals from seeking employment in child care. In addition, the measure is very inexpensive. COMMENTS: Records of substantiated child abuse are usually kept in state social services departments. In the State of California, a state supported service for facilitating background checks has been successful in identifying people applying for child care jobs who have a history of previous offenses against children. Child care centers with multiple caregivers are more likely to protect children from abuse than child care sites where there is only one caregiver. Therefore, this standard must be applied to caregivers who work in isolation. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 1.009 PRESERVICE AND ONGOING STAFF TRAINING In addition to the credentials listed in STANDARD 1.014, prior to employment, a director of a center or a small family child care home network enrolling 30 or more children shall provide documentation of at least 26 clock hours of training in health, psychosocial, and safety issues for out-of-home child care facilities. Small family child care home providers shall provide documentation of at least 12 hours of training in child development and health management for out-of-home child care facilities prior to initiating operation. All directors and caregivers shall document receipt of training that revisits the following topics every 3 years: a) Child development knowledge and best practice, including knowledge about the developmental stages of each child in care; b) Child care as a support to parents; c) Parent relations; d) Ways that communicable diseases are spread; e) Procedures for preventing the spread of communicable disease, including handwashing, sanitation, diaper changing, food handling, health department notification of reportable diseases, equipment, toy selection and proper washing, sanitizing to reduce the risk for disease and injury, and health issues related to having pets in the facility; f) Immunization requirements for children and staff, as defined in STANDARD 1.045; g) Common childhood illnesses and their management, including child care exclusion policies; h) Organization of the facility to reduce the risks for illness and injury; i) Teaching child care staff and children about infection control and injury prevention; j) Staff occupational health and safety practices, such as proper procedures, in accordance with Occupational Safety and Health Administration (OSHA) bloodborne pathogens regulations; k) Emergency procedures, as defined in STANDARD 3.048 through STANDARD 3.052; l) Promotion of health in the child care setting, through compliance with STANDARD 3.001 through STANDARD 3.089; m) Management of a blocked airway, rescue breathing, and other first aid procedures, as required in SSTANDARD 1.026; n) Recognition and reporting of child abuse in compliance with state laws; o) Nutrition; p) Knowledge of medication administration policies and practices; q) Caring for children with special needs in compliance with the Americans with Disabilities Act (ADA); r) Behavior management. RATIONALE: The director of a center or large family child care home or the small family child care home provider is the person accountable for all policies. Basic entry-level knowledge of health and safety is essential to administer the facility. Caregivers must be knowledgeable about infectious disease because properly implemented health policies can reduce the spread of disease, not only among the children but also among staff members, family members, and in the greater community. Knowledge of injury prevention measures in child care is essential to control known risks. Pediatric first aid training is important because the director or small family child care home provider is fully responsible for all aspects of the health of the children in care. COMMENTS: The American Academy of Pediatrics (AAP) and the National Association for the Education of Young Children (NAEYC) published a set of videos, based on the first edition of Caring for Our Children, that illustrates how to meet the standards in centers and family child care homes. This six-part video series is accompanied by a set of reproducible handouts for training. Other training materials, including videos, workshop curricula, and print materials suitable for training of caregivers, are also available from the AAP and NAEYC. Contact information for the AAP and the NAEYC is located in Appendix BB. Training in infectious disease control and injury prevention is strongly recommended. This type of training may be obtained from qualified personnel of children's and community hospitals, managed care companies, health agencies, public health departments, pediatric emergency room physicians, or other health professionals in the community. For more information about training opportunities, contact the AAP, Healthy Child Care America Project, the National Resource Center for Health and Safety in Child Care, or the National Training Institute for Child Care Health Consultants (at the University of North Carolina). Contact information is located in Appendix BB. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 1.010 ADDITIONAL QUALIFICATIONS FOR CAREGIVERS SERVING CHILDREN BIRTH TO 35 MONTHS OF AGE Caregivers shall be prepared to work with infants and toddlers and, when asked, shall be knowledgeable and demonstrate competency in tasks associated with caring for infants and toddlers: a) Diapering; b) Bathing; c) Feeding; d) Holding; e) Comforting; f) Putting babies down to sleep positioned on their backs and on a firm surface to reduce the risk of Sudden Infant Death Syndrome (SIDS); g) Providing responsive and continuous interpersonal relationships and opportunities for child-initiated activities. To help manage atypical or disruptive behaviors of children, caregivers, in collaboration with parents, shall seek professional consultation from the child's source of routine health care or a mental health professional. RATIONALE: The brain development of infants is particularly sensitive to the quality and consistency of interpersonal relationships. Much of the stimulation for brain development comes from the responsive interactions of caregivers and children during daily routines. Children need to be allowed to pursue their interests and encouraged to reach for new skills (13). COMMENTS: For additional qualifications and responsibilities of teachers for centers and homes serving children from birth to 35 months, see also General Qualifications for All Caregivers, STANDARD 1.007 through STANDARD 1.010; and Training, STANDARD 1.023 through STANDARD 1.036. TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home STANDARD 1.011 ADDITIONAL QUALIFICATIONS FOR CAREGIVERS SERVING CHILDREN 3 TO 5 YEARS OF AGE Caregivers shall demonstrate the ability to apply their knowledge and understanding of the following, to children within the program setting: a) Typical and atypical development of 3- to 5-year-old children; b) Social and emotional development of children, including children's development of independence and their ability to adapt to their environment and cope with stress; c) Cognitive, language, early literacy, and mathematics development of children through activities in the classroom; d) Cultural backgrounds of the children in the facility's care by demonstrating cultural competence through interactions with children and families and through program activities. To help manage atypical or disruptive behaviors of children, caregivers, in collaboration with parents, shall seek professional consultation from the child's source of routine health care or a mental health professional. RATIONALE: Three- and 4-year-old children continue to depend on the affection, phys