Outline of Arizona Arizona State Profile

 

Arizona has a coordinated system for child care health consultant (CCHC) services in one large urban county (Pima). In addition to managing the county CCHC program, the Pima County Early Childhood Nurse Consultant works with the Arizona Early Childhood Development and Health Board to assist in the development of a statewide system of child care health consultation.

  • Licensing: Arizona child care licensing regulations do not require early care and education (ECE) providers to have a health consultant nor do they address the scope of work or qualifications of CCHCs.
  • Funding: The Arizona Department of Health Services (ADHS), through the MCH Block Grant funds, supports annual CCHC training and the Early Childhood Comprehensive Systems (ECCS) grant funds support a nurse consultant to assist the School Readiness Board (SRB) to develop a statewide CCHC system. CCHC work in Pima County—the one county in Arizona with a comprehensive CCHC system—is funded by a combination of Title V dollars and county tax revenue. In 2006, the United Way of Tucson and Southern Arizona solicited private foundation dollars to support additional child care health consultants.  These additional CCHCs are part of the ongoing quality improvement project in Pima County under the auspices of United Way. As of 2007, there is no funding yet available to support a coordinated statewide CCHC system.
  • Auspices: CCHCs work in a variety of settings in Arizona, including county health departments, school districts, Head Start, and Cooperative Extension. There is no organized system across the state to link ECE providers with health consultants.
  • CCHC Training: Two nurse consultants from Arizona are National Training Institute for Child Care Health Consultants (NTI) graduates. Annual trainings offered through the ADHS Office of Maternal and Child Health are based on the NTI curriculum—with 60 classroom hours and field work offered over a three–month period—and, to date, there are 46 graduates. While nurses and other health professionals are given priority to attend training, graduates also include ECE professionals, social workers, and nutritionists.

History and Development

Leaders from Healthy Child Care Arizona have been strong voices in the development of statewide ECE initiatives—including ECCS and Governor Napolitano’s School Readiness Board. They have successfully advocated for full integration of HCCA objectives into the Arizona School Readiness Action Plan.

One objective of Arizona’s School Readiness Action Plan is to develop a statewide CCHC system. A statewide CCHC system was identified as one of four priorities in the first year of ECCS implementation. Currently, there is one pilot in Pima County in place. The goal is to have another pilot in Maricopa County by the end of 2008 and a statewide CCHC system in place by 2009.

Challenges and Lessons Learned

  • Infrastructure: Arizona has been training CCHCs since 2003. While building a CCHC workforce is necessary to make health consultation available to ECE providers, it is not sufficient. One lesson learned by Arizona is that CCHCs need not only training but also an infrastructure within which to provide services. A clearly identified lead agency to assume leadership and provide a home for the CCHC system and a strategic plan to build state and local infrastructure to deploy and sustain consultants are critical components of this effort.

Ingredients for Success

  • Leadership: The Governor’s office provides strong leadership in the area of ECE and school readiness.
  • Consensus: As Arizona moves toward improving child care quality, there is broad consensus among providers, parents, licensing officials, and advocates that health and safety is a priority. All agree that health is a critical component of child care quality and school readiness. There is agreement that a statewide CCHC system should exist.
  • Tracking Systems: Pima County has adapted the Omaha System of Nursing Documentation. This provides a standardized way to assess the need for services and monitor the number and type of activities provided by consultants. Child Care Health Consultation Pathways—standardized nursing care plans—help CCHCs select and evaluate appropriate interventions using the Omaha System.
  • Model County: While there is no statewide CCHC system as of 2007, Pima County is implementing a successful model with five nurse consultants based in a local health department. This allows for experienced CCHCs to serve as mentors and trainers as the CCHC system goes to scale.

Moving Forward

  • Vision: Arizona’s long-term goal is to be able to first offer health consultation to any licensed child care center in the state, then to any out-of-home care setting. CCHCs would operate statewide from regional area bases like county health departments, community health centers, or Indian Health Service clinics. These “CCHC hubs” could provide malpractice insurance and physician oversight for the CCHC as well as medical consultation, quality assurance review, standing orders, and requested training in specified health care methods and techniques.
  • Next Steps: The SRB commissioned a comparison of national standards to state licensing regulations to identify areas needing revision. It is now exploring stable sources of funding for regionally based CCHCs and is seeking an entity to serve as the lead agency. Arizona would like to develop state standards for credentialing of CCHCs.
  • Quality Rating System: The Arizona Quality Rating System (QRS) for child care providers is also a component of the School Readiness Action Plan. The QRS is under development and will include criteria related to CCHC involvement in staff training and practice improvement on health and safety.

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Information as of August 2007