Showing posts with label children's health. Show all posts
Showing posts with label children's health. Show all posts

Thursday, February 16, 2017

Update on Licensing, Health, and Safety at DEL

(SoomaaliEspaƱol)

To the Early Learning Community,

The Department of Early Learning, which I have the honor to direct, regulates thousands of small businesses that provide childcare to 180,000 children in Washington every year. You hear a lot about “regulations crushing small businesses” and “regulations being critical to ensure safety.” Finding a balance between adequate safety and supporting childcare providers is important to getting the best outcomes for kids. 
  • We do fingerprint-based background checks on anyone who has unsupervised access to children, about 50,000 of these a year. This ensures that sex predators and people with a history of abusing or neglecting their own children don’t get to work in the industry. 
  • We make sure childcare facilities have fire safety checks, have safe playgrounds, have enough square footage to provide enough room for kids to move around, don’t have dangerous cords hanging down from window blinds, don’t have cleaning products or weapons accessible to children, etc. 
  • We make sure there are enough adults in the classroom to ensure safety. There are national standards for this kind of thing and we work hard to follow them. 
  • We ensure that facilities follow practices like safe sleep, food prep safety, good diapering practice to avoid fecal coliform infections, etc. 
  • We ensure minimum provider education levels because outcomes are much better for kids when they have a provider with a stronger educational background. 
  • We follow federally-required annual inspection schedules and incident follow-up deadlines.

Our goal is to prevent injuries and fatalities. Despite our best efforts some will occur, but many fewer than if we didn’t have rules providers have to follow.

In addition, we have a voluntary system (“Early Achievers”) that measures the quality of childcare. For taxpayer-subsidized kids we require at least a level 3 on our 5 point scale because it’s better for kids and we think taxpayers have a right to insist that they only pay for high-quality care. We pay more for higher quality care and instruction because it costs more. It’s worth it because we get better outcomes. Read more about Early Achievers here.

Like any regulator, we get complaints from the businesses that we regulate. They complain that our regulations cost too much to comply with, that our enforcement is biased against them because they are X, Y, or Z, or that we are inconsistent in our enforcement. Providers that have more than one location served by different licensors often have evidence that this is so, with different problems treated differently by different licensors. 

I try to approach problems like this analytically, so I asked for a systematic review of discipline practices across the state in my first few months. It turns out the businesses are right – we have different practices in different places, and often between different licensors inside the same office.  This isn’t OK, but it is a challenge to fix.  We have to have the regulation, but we also have to enforce it the right way. To improve the consistency and appropriateness of our licensing effort we’re doing the following: 
  1. Clarify the rules. Our rules should be readable by providers who have a high school education, our minimum educational requirement. We are in the middle of a complete re-write of what was a complex, multi-part document that had been written in pieces over decades. We’re aiming to be consistent across different types of facility – family child care homes, centers, and our state-run preschool program called ECEAP.
  2. Set clear expectations about consequences for violations. Safe sleep violations put vulnerable infants at risk of crib death. Keeping your paperwork in order so you don’t waste the licensor’s time checking everyone’s CPR training status is important, but perhaps not as much as safe sleep. We’re “weighting” the rules so our licensors and the small businesses we regulate can see how seriously violations of different rules will be treated.
  3. Training our staff. We’re planning to engage in a continuous review process on the new rules. Licensors will gather in groups to work through responses to common (and uncommon) situations that often get different responses and ensure that we’re all treating things the same way. We’ll document these cases to use as training for new licensors, and make them available to providers to see actual examples.

This isn’t an overnight project. The rules revision alone has already taken most of a year and we expect another 6-10 months of feedback, analysis and work to finalize the changes. It’s hard enough to change rules that we want to get it right. This is called the “Alignment” project, and you can read about it here.

We’re in the middle of the “weighting” process now, and are using a somewhat complicated but evidence-based approach to this to ensure that lots of stakeholders have input into the weights. Read about the weighting process here. 

Part of ensuring consistency of application of these rules is having an appeals process that makes sense. Our current process is just to have the supervisor of the original licensor review the decision. This doesn’t result in a lot of corrected actions and also doesn’t help build consistent practice. We’re moving to a new system where appeals go to a rotating group of experienced licensors who get to look at appeals monthly, without identifying information. This eliminates any implicit bias we may have about a provider and gets a single interpretation across the whole agency of the issue that’s come up. Our new process should roll out this spring. 

In addition to the formal steps we’re taking, we are investing in upgrading our software infrastructure so that licensors can track their observations on regular monitoring visits. Our new system is based on Salesforce.com and works in the cloud.  We expect it to be easier to manage as well as being a useful tool to see how peers react to concerns a particular licensor may have. 

Building a regulatory system that is too extreme can result in significant compliance costs for providers. There needs to be some rules (not having enough adults in the building is cheaper, but very, very dangerous) but having too many onerous rules can push providers out of the licensed world. Sometimes it’s hard for parents to tell the difference, but it matters. We shut down an unlicensed facility in 2016 when we discovered there were way too many infants for one provider to manage and a person living in the household who was a level one sex predator with a gun collection. You might not be able to see this from the outside, but you don’t want your kid there. 

Finding the right balance is tricky, and we depend on public input to make the determination. It’s like taxes. It always feels to a taxpayer that their taxes are too high, but the societal costs of having an inadequate education system that the taxes pay for are much more severe. The safety and outcome implications of getting the balance of childcare regulation wrong are pretty severe as well, and it’s worth being thoughtful about how we approach it. 

We’ll keep updating and engaging with you over the next year as the projects I mentioned above move forward.

Sincerely, 







Ross Hunter
Director, Washington State Department of Early Learning



Wednesday, August 31, 2016

Back to School Immunizations

It’s back to school time… are you and your family ready? August is typically the time of year that many families get their children ready for school, and are busy checking the school supply list to ensure their children have the proper school supplies for a successful start to the school year.  There is no denying that this is an important part of school readiness. Often overlooked, but equally important are immunizations.

Schools, child care facilities, and preschool programs are prone to outbreaks of infectious diseases.  Children enrolled in these settings can easily spread illness to one another due to poor or improper hand washing techniques, interacting in crowded environments, and not covering coughs or sneezes.

Vaccines provide a safe and powerful tool to protect children from serious infectious diseases, such as measles, mumps, and chicken pox to name a few. 

When children are not immunized they are at an increased risk of contracting infectious diseases.  They can easily spread the disease to others in their classrooms, playgroups, to family members with weakened immunity due to age or health conditions, and the community they live in.

To help families navigate the requirements for immunizations and how to obtain a copy of a child’s immunization, or to answer questions about the safety of immunizations, the Washington State Department of Health (DOH) and the Centers for Disease Control and Prevention (CDC), have the following links that can provide valuable and current information regarding immunizations and vaccinations.
    Together let’s keep all children in Washington healthy and ready to learn.

     

    Friday, June 12, 2015

    Whooping Cough in Washington: Protect Yourself and Your Kids

    According to a recent King 5 News story, whooping cough is on the rise in Washington. Unfortunately, there have been more than 700 cases in 2015. This is a massive increase as one year ago, there were around 130 cases.


    According to the Washington State Department of Health (DOH), whooping cough (Pertussis) spreads easily by coughing and sneezing. In a recent letter from DOH, parents and caregivers are urged to consider vaccination--especially those who care for young children and babies.
    The letter states, 
    "as a parent, there is nothing more important than safeguarding your child’s health. That’s why you should know the facts about whooping cough (pertussis) and the vaccine that protects against it. Make sure you and your family get the right dose at the right time." 
    The dangers of whooping cough.
    Whooping cough is most dangerous for babies. They can get it from adults or other children who have whooping cough. Babies can have severe coughing spells that make it hard to breathe. Whooping cough can lead to pneumonia, seizures, brain damage, and death.

    Call your doctor if prolonged coughing spells cause you or your child to:
    • Vomit
    • Turn red or blue
    • Seem to be struggling to breathe or have noticeable pauses in breathing
    • Inhale with a whooping sound
    How can I protect my child from whooping cough? 
    The best tool for protection is the whooping cough vaccine. In addition to the vaccine, make sure that you and your child: 
    • wash your hands, 
    • cover your cough, and 
    • stay home and away from others when you are sick. 
    It is especially important to protect babies and pregnant moms. If you suspect that you or your child have whooping cough, seek immediate medical care. 

    Who should get the vaccine and when should they get it? 
    • Babies* get a dose of DTaP (diphtheriatetanus, and whooping cough (pertussis)) at 
      • 2 months
      • 4 months
      • 6 months
      • 15-18 months
    • At 4-6 years of age, they should receive a 5th DTaP dose. 
    • When kids are 11 or 12 years old, they get a dose of Tdap (Tetanus, diphtheria, and pertussis). 
    *Newborn babies can’t get a whooping cough vaccine until they are 6 weeks old. 

    The best way to protect babies is for pregnant women to get vaccinated in their third trimester, between 27 to 36 weeks. Adults that haven’t had a Tdap dose, especially those who are healthcare workers or take care of young babies, need to get a dose Tdap. Child care and school requirements Children entering child care or preschool must be up-to-date with their immunizations. 

    When considering Kindergarten Readiness, think beyond your child's social, emotional and intellectual development. Consider their medical vaccination needs, too. In Washington State, it is required for children entering kindergarten to have 5 DTaP shots.

    Where can I find the whooping cough vaccine? 
    Ask your doctor, nurse, or local health department to find out more about the Tdap or DTaP vaccine and where you can get it. 

    Washington provides all recommended vaccines at no cost for kids through age 18, available from providers across the state. Providers may charge an office visit fee and an administration fee to give the vaccine. People who can’t afford the administration fee can ask to have it waived. Call the Family Health Hotline at 1-800-322-2588 or go to ParentHelp123 to find a healthcare provider or immunization clinic. 

    For more information about whooping cough, visit the Washington State Department of Health at www.doh.wa.gov/whoopingcough.

    Tuesday, June 2, 2015

    Educate Yourself About Safe Sleep

    Thousands of infants die suddenly and unexpectedly each year in the U.S. The medical term for these deaths is sudden unexpected infant death (SUID) or Sudden Infant Death Syndrome (SIDS). Although the causes of death in many of these children can’t be explained, most occur while the infant is sleeping in an unsafe sleeping environment.

    Researchers are not sure how often these deaths happen because of accidental suffocation from bedding or overlay (another person rolling on top of or against the infant while sleeping). Commonly, these deaths occur during unsupervised sleeping time. There are currently no tests to tell SIDS apart from suffocation.

    Research shows parents and caregivers can take the following actions to help reduce the risk of SIDS and other sleep-related causes of infant (less than 1 year old) death:
    • Always place babies on their backs to sleep for every sleep.
    • Use a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
    • Have the baby share your room, not your bed. Your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else.
    • Keep soft objects, such as pillows and loose bedding out of your baby’s sleep area.
    • Prevent exposure to smoking during pregnancy and after birth because these are important risk factors for SIDS. The risk of SIDS is even stronger when a baby shares a bed with a smoker. To reduce risk, do not smoke during pregnancy, and do not smoke or allow smoking around your baby.

    Another great resource for caregivers and parents is DEL's training video. This training outlines the differences and similarities between SUID and SIDS, myths and facts about these causes of infant death and additional tools to help inform and instruct the public about safe sleep.

    Also in the video is an in-depth exploration of safe sleep tactics such as placing infants on their backs versus placing babies on their stomachs to sleep--referencing the "Back to Sleep" campaign of 1992. 
    This training explains the importance of protecting infants during a crucial time of their development. Learn about SIDS and other sleep-related causes of infant death; what you can do to reduce the risk of SIDS with recommendations by the American Academy of Pediatrics, focusing on a safe sleep environment.

    While the topic of SIDS and SUID is complex and sensitive, it is important for parents and caregivers to educate themselves on research and best practices to promote safe sleep. If you are responsible for an infant, consider reputable resources such as the Center for Disease Control site and research-based campaigns such as the "Protect the Ones You Love" initiative and the "Safe to Sleep" education program with helpful graphics like the one below.






    Thursday, May 21, 2015

    Child-Care Providers: Immunization Course Available and More Resources

    The role adults play in preventing diseases is often overlooked, but child-care providers and educators of young kids may consider further education and training on the topic
    of immunizations.

    A number of immunizations may be required as an adult, so if you’re not sure if you need one or if you've already been vaccinated, talk to your doctor or a public health professional. A good place to begin looking for more vaccination information is the Washington Department of Health's web page on vaccinations. The state's requirements for parents and child-care providers is clearly represented in multiple languages.



    Another resource targeted specifically at people who care for children is the recently available, free course offered by the Coalition for Safety and Health in Early Learning (CSHEL) and WithinReach. 

    “Adult Immunizations” is a free online course offering 2 STARS credits. English and Spanish
    versions are currently available.

    Immunizations protect you, your family, and the children in your care. Taking this course will allow you to learn more about the immunizations adults need in the child care setting and beyond.
    Topics include:
    • How immunizations work
    • Diseases vaccines prevent
    • Vaccine safety
    • Community (herd) Immunity
    • Requirements in the child care setting
    • Reporting & disease investigations in the child care setting
    To participate, go to www.cshelwa.org.
    To view the official flyer click here: Official "Adult Immunizations" Flyer.

    The Washington Department of Health cites clear reasons to get vaccinated:
    • To keep you and your family healthy.
    • To keep your community healthy.
    • To protect loved ones from disease.
    • To stop the spread of disease to the most vulnerable populations.
    • Because other parents and experts agree it’s the best thing you can do to keep your family healthy.
    If you are a child-care provider, an educator of young children, or a parent, consider furthering your education and training about the required vaccinations and schedules. For even more information on childhood disease prevention, visit DEL's web page dedicated to that topic.

    Monday, October 3, 2011

    National Child Health Day -- helping children lead healthy lives

    Today is the 83rd annual National Child Health Day. The U.S. Department of Health and Human Services created a website to feature important resources that assist families in finding health care services. Resources featured on the website include the 311 Prenatal Hotline, Insure Kids Now, Family-to-Family Health Information Centers, Text 4 Baby, Find a Health Center Locator and the Maternal and Child Health Program.

    Take a look at http://mchb.hrsa.gov/childhealthday/