Failing Grades: States' Standards for Child Care Centers

The Early Ed Watch blog (thanks, New America Foundation) brings news of a report by the National Association of Child Care Resource and Referral Agencies on state efforts to monitor child care. Link to report.

The news is not good.

Who's watching who's watching the children? The federal government
leaves this task to the states. But states are failing to ensure that childcare
centers are safe, according to a report released today by the National Association
of Child Care Resource & Referral Agencies.

Parents assume that if a child care center has obtained a state license, it must meet some basic standards of child safety and personnel training. But in many places, the license means very little, said Linda K. Smith, NACCRRA's executive director.

"A license on a wall does not mean that a center has ever been inspected," Smith said. "This is inexcusable."

NACCRRA examined state regulations and oversight in 50 states plus the District of Columbia and the Department of Defense, which runs its own network of child-care centers. Each state was judged using a scorecard created by the association that gave states points for policies that address health, safety, and quality of childcare providers -- such as how frequently the facilities are inspected, whether caregivers must go through background checks, and whether directors have any training in child development.

The average score was an F. No state earned an A or B, and only one -- Washington, D.C. -- earned a C. The Department of Defense got the top score, with 131 of 150 possible points or a B grade. Unlike states, the military must comply with standards under the Military Child Care Act of 1989.

NACCRRA's breakdown of the states with the strongest and weakest standards in child care licensure (the Defense Department and District of Columbia were included):

Top 10: DoD, DC, OK, TN, MD, RI, NY, IL, FL, WA
Bottom 10: NM, AK, IA, MO, KS, CA, GA, NE, LA, ID

Good news - three of the largest birthplace states are in the top 10.

Bad news - California is in the bottom 10....

And here's a stat from NCCRRA's webpage that caught my eye...

Over 11 million children under age 5 spend an average of 36 hours a week in
non-parental care settings. Almost two-thirds of these children are in
center-based care.

Good News (Sorta): Educating Iowa

The Des Moines Register has an article about two initiatives proposed by child advocates.

One would create a statewide education program:

PROPOSAL: State public health officials would create a statewide prevention program for shaken-baby syndrome to educate parents and others caring for a child. The state would reach out through parent education and support programs, child care referrals, schools, health care providers and birthing facilities. Participation in the program would be voluntary.

STATUS: Senate File 101 passed unanimously out of the Senate Human Resources Committee and is now eligible for debate by the full Iowa Senate.

The article notes that shaken-baby syndrome is the leading cause of young-child homicide in Iowa, with 49 deaths between 1995 and 2007, according to a report by the Iowa Child Death Review Team.

The other would license all home-based child care providers. Apparently, Iowa only regulates centers. Incorporating SBS education for these providers could have a significant impact on the potential for injury: research has found much higher injury rates in home based care than centers, especially for infants.

Link to a Powerpoint presentation by Dr. Julia Wrigley that describes her research.
www.namb.net/atf/cf/%7BCDA250E8-8866-4236-9A0C-C646DE153446%7D/childcare.ppt

It's interesting - in an unsettling sort of way - to read the comments on the merits of educating child care providers. One more venue in which the arguments for personal responsibility vs. social responsibility are being played out.

Regardless of what view of personal responsibility prevails, it is (or should be) obvious that keeping children safer in child care reduces social costs for everyone: it allows greater opportunity for parents to participate in the work force, reduces medical costs and avoid the costs of investigation, prosecution and incarceration.

Resource: Trustline.Org and Child Care

California has a good tool for parents who want to screen child care providers - Trustline.org

What is TrustLine?

TrustLine is California's registry of in-home child care providers, tutors and in-home counselors who have passed a background screening. It was created by the California Legislature in 1987 and is a powerful resource for parents hiring a nanny or baby-sitter. All caregivers listed with TrustLine have been cleared through a fingerprint check of records at the California Department of Justice. This means they have no disqualifying criminal convictions or substantiated child abuse reports in California. TrustLine is administered by the California Department of Social Services and the non-profit Child Care Resource and Referral Network. It is endorsed by the California Academy of Pediatrics.

However, you still need to ensure that anyone who cares for your child is aware of the vulnerability of young children to shaking and inflicted head injuries, and has a coping plan for those inevitable moments of frustration and anger.

Ask them to make that commitment and let them know it's OK to call you.

Forgive me for being a bit cranky, but today brought a news story from WPTZ in Vermont that once again highlights how clueless (and I mean that in a literal, not unkind way - they may be clueless, but at least they're trying) about prevention some media folks can be.

A 13 month old boy is injured as a result of being shaken by a "babysitter."

Following a shot of the hospital, Reporter interviews "experts": Nurse, who teaches a babysitting course. Reporter then interviews director of the local child care resources center. Well-meaning people all...

If you watched it, the "lessons" you learned were:

- First, hire a licensed child care provider who knows CPR (um, CPR is good, but irrelevant: does Vermont require child care providers to be trained about the causes and consequences of shaking young children? I couldn't find anything about SBS prevention on the VT DCF site for child care providers, which isn't that unusual - most states don't require it. I did find some good SBS training, but it's for child welfare specialists: unfortunately, that's cart-before-the-horse training on how to deal with the consequences, instead of prevention...).

- Second, check references and do a criminal background check (um, "has she ever shaken your child?" - while this perpetrator is the exception to the rule, having a domestic violence "charge" driving with a suspended license, and having parole violations, most SBS cases don't involve someone with a criminal background). Oh, and given that most children are shaken by a parent or relative, just how helpful is advice to "hire someone you know personally"?

Not one mention that it might be a good idea to ask someone taking care of your child whether she has learned about shaken baby syndrome (or, for that matter, if your child is not a year old yet, SIDS), and whether she has a coping plan for those inevitable moments of frustration that do come when caring for a young child.

Given the absence of that critical info, it's particularly unfortunate and misleading that the televised report is "How You Can Protect Your Children..."

More on the story from the Burlington Press

Diane at Foster Family Talk has a post about a shaken baby case in Florida. She reminds parents of the importance of checking references of child care providers.

This was my response:

A parent should certainly research all available references and history.

However, while that's necessary, it's not sufficient to ensure that you've done everything you can to protect your child.

You must talk with your child care provider about the danger of shaking young children, that frustration and anger is a normal response to caring for young children, and they need to agree to follow a simple coping plan: recognize that frustration, leave the baby in a safe place and call someone, either as a safety vent or to acknowledge the frustration. They need to know that it's OK with you to have feelings of frustration.

It can be done in a manner that doesn't accuse, but instead talks about sharing knowledge and opportunity to protect your child from injury. If your child is an infant, it can be especially effective coupled with SIDS information.

In New York and several other states, licensed providers must have training on the causes, consequences and prevention of shaken baby. That obligation doesn't extend to "exempt" providers, and it's not complete assurance - providers have attended training and still shaken children.

But this education model is based on a program for new parents in Buffalo that reduced the incidence of shaken babies and inflicted injuries by 50%.

Not perfect, but for a simple 15 minute intervention, pretty effective insurance!...

So, if a parent just checks references, they will have a false sense of security.

Sharing information with all other caregivers of your child about the causes and consequences of SBS and the need for a simple coping plan - and ensuring they share your commitment to using it - is the key.

And not only will that help protect your child, it will help protect others.

For more info, visit the resources page on www.skippervigil.com

A book review in the New York Times points out some reasons why thinking we're safe can be unsafe....

Some of those "thinks" to keep in mind, whether designing community prevention initiatives or an individual, personalized prevention program for your child:

- we think we're more skilled than experience suggests;
- when routines allow us to think less about safety, we are distracted from anticipating stress events and less prepared to cope; and
- we think we - and other caregivers, like babysitters and child care providers - know what we need to know about the skills required to raise a child.

Assuming you're safe can be fatal. Assuming you "know" what any individual taking care of your child will or won't do can also have tragic consequences.

Nowadays, the cause of collisions, or one of them, is people believing they’re better drivers than they are. We base our judgment on the number of crashes we’ve been in, rather than on the number of accidents we narrowly avoid, which, if we’re being honest (or we’re being me), happen just about every time we drive.

Compounding this vehicular hubris is the fact that most of the driving we do appears to be safer than it is. Driving rarely commands 100 percent of our attention, and so we feel comfortable multitasking: talking on the phone, unfolding a map, taking in the Barca-Lounger on the road’s shoulder. Vanderbilt cites a statistic that nearly 80 percent of crashes involve drivers not paying attention for up to three seconds. Thus the places that seem the most dangerous — narrow roads, hairpin turns — are rarely where people mess up. “Most crashes,” Vanderbilt writes, “happen on dry roads, on clear, sunny days, to sober drivers.” For this reason, roads that could be straight are often constructed with curves — simply to keep drivers on the ball.

This basic truth — feeling safe kills — lies beneath many of the book’s insights. Americans think roundabouts are more dangerous than intersections with traffic lights. Roundabouts require you to adjust your speed, to merge, in short, to pay attention. At an intersection, we simply watch the light. And so we may not notice the red-light runner coming at us or the pedestrian stepping off the curb. A study that followed 24 intersections that had been converted from signals or stop signs to roundabouts showed an almost 90 percent drop in fatal crashes after the change.

For similar reasons, S.U.V.’s are more dangerous than cars. Not just because they’re slower to stop and harder to maneuver, but because — by conferring a sense of safety — they invite careless behavior. “The safer cars get,” Vanderbilt says, “the more risks drivers choose to take.” (S.U.V. drivers are more likely to not bother with their seat belts, to talk on cellphones, and to not wear seat belts while talking on cellphones.) So it goes for much of the driving universe. More people are killed while crossing in crosswalks than while jaywalking. Drivers pass bicyclists more closely on a road with bike lanes than on one without.

An interesting study by way of ScienceDaily.com

The researchers [Juhee Kim, a University of Illinois community health professor, and Karen Peterson, a professor of nutrition and society at Harvard University’s School of Public Health] classified a large sample of 9 month old infants by whether they were in child care, care by relatives or parental care.

They found those infants who routinely receive non-parental care – provided by relatives, licensed day-care centers or informal child-care providers – were likely to experience higher rates of unfavorable feeding practices and weigh more than those infants whose parents (OK, we know they really meant mothers, don't we?) were primary caregivers.

Of special note:

First, this study confirms how important it is that a prevention strategy reach child care providers with awareness and education information.

The study looked at a nationally representative sample of 8,150 9-month-old infants and found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care.

Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months [thus, around 40% of the sample had another caregiver during the peak period for colic - and SBS], and 21 percent at 6 months or older.

Second, the researchers point out the importance of proactive communication between providers and parents. Another area where modeling those behaviors can help caregivers engage parents in communication. Once that conversation begins, it can extend to other ways to keep children safe.

Third, it suggests that non-parental caregivers might be feeding just to calm infants. Not the worst outcome, but worth considering...

Non-parental Care Of Infants Tied To Unfavorable Feeding
Practices
ScienceDaily (July 13, 2008) — With more new mothers in the workplace than ever before, there has been a corresponding increase in the number of child-care facilities in the United States.
At the same time, data from a variety of sources point to a growing prevalence of overweight infants and toddlers.
Is there a connection?
According to a new study co-written by University of Illinois community health professor Juhee Kim and Karen Peterson, a professor of nutrition and society at Harvard University’s School of
Public Health, child-care factors and feeding practices may indeed play a role.
“Our study is the first to report, to our knowledge ... the potential importance of infant child care on infant nutrition and growth,” the researchers said in an article published in the July issue of the Archives of Pediatrics & Adolescent Medicine, a publication affiliated with the Journal of the
American Medical Association. “The results of this study indicate that structural characteristics of child care, such as age at initiation, type and intensity, were all related to infant feeding practices and weight gain among a representative sample of U.S. infants.”
Specifically, Kim and Peterson found that 9-month-old infants who routinely receive non-parental care – provided by relatives, licensed day-care centers or more informal child-care providers – may experience higher rates of unfavorable feeding practices. The babies also weigh
more than those whose primary caregivers are their parents.
The researchers’ findings could have significant public-health ramifications, as weight gain in
infancy can ultimately be a predictor of obesity later in life.
Obesity, in turn, is linked to a number of chronic illnesses, such as diabetes and
hypertension, as well as adulthood morbidity and mortality.
In their study, Kim and Peterson analyzed baseline data from a nationally representative sample
of 8,150 9-month-old infants to determine whether infant-feeding practices and non-parental care might be a factor in the rise in weight of the infants. They used data collected for children enrolled in the Early Childhood Longitudinal Study, Birth Cohort, conducted by the U.S. Department of Education’s National Center for Education Statistics.
Kim and Peterson found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care. Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months,
and 21 percent at 6 months or older.
“Weight gain and the prevalence of overweight were lowest among infants who received care by parents,” the researchers noted in the published article.
The researchers also examined data regarding breastfeeding initation for babies receiving parental and non-parental care, along with the stage at which solid foods were introduced to
the infants. Only starting solid foods before 4 months of age was associated with increased overweight among infants.
“Infants who initiated child care before 3 months of age had lower rates of ever having been breastfed and higher rates of early introduction of solid foods,” they wrote. “Infants in parental
care were more likely to have breastfeeding initiated and solid foods introduced after 4 months of age compared with those in child-care settings.”
Further, infants in part-time child care gained more weight – 175 grams – by 9 months of
age, compared with those receiving only parental care. Those being cared for by relatives also showed a weight gain – 162 grams.
“A strength of our findings,” the researchers noted, “is that the observed effects of child-care
factors remained significant after controlling for maternal pre-pregnancy BMI (body mass index) and a child’s birth weight.”
“Although both factors are known to be strong predictors of childhood overweight status, in our study, only birth weight was a significant factor in weight gain.”
Kim said there are a couple of important take-home messages from their research results for parents and child-care providers.
“Parents may (may?) want to have enough communication with child-care providers about when, what and how to feed their babies during their stay in day care, which is important to avoid potential risk of overfeeding or underfeeding at home,” she said.
“Child-care professionals can encourage parents’ active involvement in the decision process of what, when and how to feed infants. Child-care providers also need to participate in nutrition-education/training programs to understand the importance of starting solid foods, transition from breast milk or formula to foods, and how to implement recommended practices to ensure a healthy eating environment.”
Kim hopes to be able investigate relationships among child care, feeding practices and weight gain in children in other parts of the world.
“It would be interesting to conduct a cross-cultural study,” she said. “Considering eating is
a socio-economical and cultural event, the impact of child care on infant feeding practices – food consumption – might be different among different countries.”
The current research was supported in part by the Berkowitz Fellowship of the department of nutrition, Harvard School of Public Health; an Early Childhood Longitudinal Study, Birth Cohort training grant from the National Center for Education Statistics; and training grants on statistical
analysis for education policy from the American Educational Research Association.
Adapted from materials provided by University of Illinois at Urbana-Champaign.

APA MLA University of Illinois at Urbana-Champaign (2008, July 13). Non-parental Care Of Infants Tied To Unfavorable Feeding Practices. ScienceDaily. Retrieved July 13, 2008, from
http://www.sciencedaily.com­ /releases/2008/07/080711125729.htm