Angela A. Crowley

Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index

BackgroundTo address the public health crisis of overweight and obese preschool-age children, the Nutrition And Physical Activity Self Assessment for Child Care (NAP SACC) intervention was delivered by nurse child care health consultants with the objective of improving child care provider and parent nutrition and physical activity knowledge, center-level nutrition and physical activity policies and practices, and children’s body mass index (BMI).MethodsA seven-month randomized control trial was conducted in 17 licensed child care centers serving predominantly low income families in California, Connecticut, and North Carolina, including 137 child care providers and 552 families with racially and ethnically diverse children three to five years old. The NAP SACC intervention included educational workshops for child care providers and parents on nutrition and physical activity and consultation visits provided by trained nurse child care health consultants. Demographic characteristics and pre - and post-workshop knowledge surveys were completed by providers and parents. Blinded research assistants reviewed each center’s written health and safety policies, observed nutrition and physical activity practices, and measured randomly selected children’s nutritional intake, physical activity, and height and weight pre- and post-intervention.ResultsHierarchical linear models and multiple regression models assessed individual- and center-level changes in knowledge, policies, practices and age- and sex-specific standardized body mass index (zBMI), controlling for state, parent education, and poverty level. Results showed significant increases in providers’ and parents’ knowledge of nutrition and physical activity, center-level improvements in policies, and child-level changes in children’s zBMI based on 209 children in the intervention and control centers at both pre- and post-intervention time points.ConclusionsThe NAP SACC intervention, as delivered by trained child health professionals such as child care health consultants, increases provider knowledge, improves center policies, and lowers BMI for children in child care centers. More health professionals specifically trained in a nutrition and physical activity intervention in child care are needed to help reverse the obesity epidemic.Trial registrationNational Clinical Trials Number NCT01921842

Child care health consultation: the Connecticut experience.

Objectives: The quality of child care is of increasing national concern. Federal initiatives are recommending child care health consultation to promote healthy, safe, and developmentally appropriate care. However, few studies have investigated the implementation of this recommendation. The purpose of this study was to explore the experience of Connecticut child care center directors and their health consultants who were engaged in mandated, weekly, on-site health consultation. Methods: One hundred Connecticut child care center directors and their health consultants participated in a mailed, self-administered survey. The centers were stratified by region and selected by random probability sampling. Descriptive analyses of the data examined the perspectives of both groups. Results: Eighty-four percent of the child care center directors reported that health consultation visits were important or very important for the management of their programs. Eighty-one percent of the health consultants believed that their directors considered the visits important or very important. The reported tasks of the health consultants were consistent with regulatory requirements. Cost was cited as a factor that negatively influenced access to services by at least 37% of the director sample. Demographics of the sample, description of the role, and recommendations by directors and health consultants are included. Conclusions: Health consultation visits were highly valued among this sample as an effective means of promoting childrens health and development in child care centers. Future initiatives should promote child care health consultation through training, infrastructure development, and funding of health consultation services.

Strengthening PNP Curricula in Mental/Behavioral Health and Evidence-based Practice

INTRODUCTION The incidence of mental health/behavioral and developmental problems in children and teens is escalating. However, many primary care providers report inadequate skills to accurately screen, identify, and manage these problems using an evidence-based approach to care. Additionally, educational programs that prepare pediatric nurse practitioners (PNPs) have been slow to incorporate this content into their curriculums. METHODS The purpose of this project was to implement and evaluate a strengthened curriculum in 20 PNP programs from across the United States that focused on: (a) health promotion strategies for optimal mental/behavioral health and developmental outcomes in children, and (b) screening and evidence-based interventions for these problems. An outcomes evaluation was conducted with faculty and graduating students from the participating programs along with faculty and students from 13 PNP programs who did not participate in the project. RESULTS Participating schools varied in the speed at which components of the strengthened curriculum were incorporated into their programs. Over the course of the project, faculty from participating programs increased their own knowledge in the targeted areas and reported that their students were better prepared to assess and manage these problems using an evidence-based approach. Although reports of screening for certain problems were higher in the graduating students from the participating schools than the non-participating schools, the overall use of screening tools by students in clinical practice was low. DISCUSSION There is a need for educational programs to strengthen their curricula and clinical experiences to prepare students to screen for, accurately identify, prevent, and provide early evidence-based interventions for children and teens with mental health/behavioral and developmental problems. This project can serve as a national model for curriculum change.

Promoting child development and behavioral health: family child care providers' perspectives.

INTRODUCTION Given the significant proportion of children in nonparental child care and the importance of early life experiences on development, interventions to improve a child care providers ability to enhance a young childs development and behavior are essential. Such interventions require understanding of and responsiveness to the providers self-perceived roles, responsibilities, and willingness to engage in such interventions, yet prior research is limited. The purpose of the study was to characterize licensed family child care provider perspectives as a first step toward designing effective provider-based interventions to improve childrens development and behavior. METHOD We conducted a qualitative study using in-depth interviews with licensed family child care providers serving economically disadvantaged children. Interviews were audiotaped, transcribed, and synthesized into common themes using the constant comparative method of qualitative data analysis. RESULTS The family child care providers described five domains related to their role in child development and behavior: (a) promotion, (b) assessment, (c) advising parents, (d) acknowledging barriers, and (e) their own skill development. DISCUSSION The family child care providers we interviewed describe how the developmental and behavioral health of children is an important aspect of their role and identify innovative and feasible ways to enhance their skills. Understanding the self-perceived role, responsibility, and willingness of child care providers is an important foundation to designing effective interventions to achieve high-quality child care.

Collaborative childcare health consultation: a conceptual model.

PURPOSE This study explored the nature of consultation between childcare providers and nurse childcare health consultants and identified factors that promote a collaborative relationship. DESIGN AND METHODS A qualitative study using semistructured, individual interviews of five collaborative and five conflicted pairs of nurse childcare health consultants and childcare center directors. Data were analyzed following principles of grounded theory and applying the constant comparative method of analysis. RESULTS Establishing a collaborative relationship was influenced by previous experiences and four themes in the relationship: open and active communication, commitment, respect, and congruent philosophies. PRACTICE IMPLICATIONS Preparation in developing collaborative relationships should be incorporated into the education of nurse consultants and childcare directors and providers.

Health services in child day-care centers: A survey

This descriptive study examined the types of health services provided by 49 child day-care centers. A questionnaire was used to collect data from the day-care center directors. The study explored the existing health services and education and training for children, parents, and staff. The study also explored services that the centers would like to offer. Fewer than 50% of the day-care centers offered more than three primary care health services for children. The provision of health education and training for children, parents, and staff varied widely, but these services were offered more frequently than primary care health services. Directors were very interested in offering more comprehensive primary care services, options for sick-child care, and education and training in the areas of safety, disease prevention and management, child development, and availability of community resources. Directors cited infectious disease prevention and management, sick-child care options, and staff training as their most pressing health issues. Recommendations are made for improving the delivery of health services to day-care centers.

The child care dilemma: expanding nurse practitioner involvement.

Abstract As a result of various economic and social factors, a significant increase in the number of women with young children in the labor force has occurred. This trend has resulted in an unprecedented demand for both public and private child care. Consequently, most parents today are grappling with a host of child care issues. This article discusses the child care needs of working parents and effective interventions by nurse practitioners within their practices and communities.

Family child care providers' experience in health promotion.

Family child care providers may be well-suited to provide health promotion to young children and their families. The investigators conducted a qualitative study using in-depth interviews with family child care providers serving low-income children. Child care providers perceive that they have an important role in health promotion, including (1) the childs physical health, (2) the childs development, and (3) supporting and educating parents, and are willing to assume this role in the context of collaborative relationships with parents. Providing education and ongoing support to child care providers in developing collaborative partnerships may enhance opportunities for health promotion in this setting.

Health and Safety of Child Care Centers: An Analysis of Licensing Specialists’ Reports of Routine, Unannounced Inspections

OBJECTIVES We assessed the prevalence of regulatory noncompliance of licensed child care centers and identified factors associated with improved compliance. METHODS We analyzed 676 routine, unannounced reports of child care centers collected by the Connecticut Department of Public Health licensing specialists over a 2-year time period, included characteristics of centers, and created categories of regulations. RESULTS The sample included 41% of licensed child care centers. Of the 13 categories of regulations in the analyses, 7 categories (outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, infant-toddler indoor health, and infant-toddler indoor safety) had regulations with center noncompliance greater than 10%. Playground hazard-free was the regulation with the highest frequency (48.4%) of noncompliance. Compliance with the regulation for 20 hours of continuing education per year for child care providers was the characteristic most frequently associated with regulations compliance. CONCLUSIONS Efforts to support continuing education of child care providers are essential to improve and sustain healthy and safe early-care and education programs. Analyses of state child care licensing inspection reports provide valuable data and findings for strategic planning efforts.

Sick child care: A developmental perspective

Sick child care programs provide an alternative when mildly ill children are excluded from their regular child care program. Although infectious disease implications have been addressed, little attention has been directed to the potentially negative consequences of care by unfamiliar providers in unfamiliar settings. Appropriate options for care during illness must be based not only on the physical but the emotional and developmental needs of young children.