Winter 2016 Health Link Online

HealthLink Online

Uniting Children, Parents, Caregivers, and Health Professionals

Infant-Toddler Quality Improvement Project – Preliminary Report

Infant-Toddler Quality Improvement Project – Preliminary Report

In August of 2013, ECELS received a 3-year federal quality improvement grant. The purpose of the grant is to show how to improve the care of infants and toddlers in child care centers.  ECELS staff and expert consultants developed an observation tool. The tool measures 13 selected standards in Caring for Our Children: National Health and Safety Performance Standards, 3rd edition (CFOC3).

CFOC3 defines best practices for early care and education programs. Many national quality improvement activities use CFOC3. ECELS staff recruited 32 Pennsylvania STAR 2 and STAR 3 centers to participate in the grant-funded program.

The ECELS staff randomly assigned the 32 centers to one of two groups. Independent observers assessed both groups. They visited the centers to use the observation tool when the center entered the project and one year later. ECELS linked half of the centers with a child care health consultant (CCHC) right after completing the assessment. The other half of the centers, the contrast group, had a one-year delay before ECELS linked them with a CCHC.

ECELS selected 9 topic areas from the 13 CFOC3 standards as targets for quality improvement. The 9 topics areas are: 1. Prevention of Child Abuse, 2. Personal Relationships, 3. Opportunities for Physical Activity, 4. Safe Sleep Practices and SIDS Risk Reduction, 5. Training of Caregivers to Administer Medication, 6. Procedure for Changing Diapers/Soiled Underwear/Training Pants, 7. Hand Hygiene, 8. Care Plans for Children with Special Needs, and 9. Immunization Documentation. In each center the center director and the CCHC chose 3 of the 9 topic areas to work on. Their plans focused on improving staff knowledge, child care practices and facility policies in the center.

What is clear so far is that staff need ongoing education and well-written policies about appropriate health and safety practices. The concerns highlighted by the initial assessments of the 32 centers are: 
  • Staff do not take infants and toddlers outside as recommended in the CFOC3 standards. State reg-ulations, Environment Rating Scale criteria and the Pennsylvania Position Statements each have different requirements. These differences are confusing. None of them is entirely consistent with the standards in CFOC3
  • Many staff and families do not receive education about safe sleep practices. Centers lack policies about safe sleep practices. 
  • No formal training requirement exists in Pennsylvania child care regulations for staff who administer medication. 
  • Infants, who rely on their teachers/caregivers to wash their hands, did not have their hands washed at times designated in CFOC3
  • Only one of 66 infants and toddlers that the center staff identified as having a special need had all the necessary information on a Care Plan signed by a health care professional. 
  • An audit of the infants’ and toddlers’ immunization records showed that, on average, only 23% of the infants and 42% of toddlers had up to date immunization records on file at the centers. 

The study is continuing. The follow-up assessments will measure specific performance changes in both the immediate-linked and delayed-linked centers. Meanwhile, directors and lead teachers in centers that are not involved with the study should consider which of the topic areas need to be targets for improvement in their centers. Pay special attention to the concerns high-lighted by the initial assessments of the centers. Stay tuned for more findings from this project.

Contributed by Rosemary Johnston, RN, BSN, MSN, T/TA Coordinator and Beth DelConte, MD, FAAP, ECELS Pediatric Advisor