Connecticut State Profile

 

• Licensing: Connecticut child care licensing regulations require centers and group homes to engage the services of an early childhood educational consultant, a health consultant (who can be a physician, physician assistant, advanced practice registered nurse, or registered nurse), a dentist or dental hygienist consultant, a social service consultant, and, for programs serving meals, a registered dietitian consultant. All centers and group homes which enroll children up to 24 months of age and those centers and group homes which include children between 2 and 3 years of age must have a weekly health consultant visit. For those centers and group homes that enroll children between 2 and 3 years of age on a part-day basis, a monthly visit is required.
• Auspices/Funding: Healthy Child Care Connecticut (HCCCT) pursues Healthy Child Care America goals and develops infrastructure to support the state’s child care regulations involving consultants. HCCCT activities are funded by the Early Childhood Comprehensive Systems Project, known as Early Childhood Partners, and through cost-sharing with the Healthy Child Care New England Regional Collaborative (HCCNE). Originally a project of the state’s Head Start State Collaboration Office, HCCCT obtained supplemental funding from that Office and from the Child Health and Development Institute of Connecticut in its early years.
• CCHC Role: Licensing regulations define a limited role for child care health consultants (CCHCs) and require centers and group homes to obtain a written plan about the consultative services they receive.
• CCHC Training: HCCCT began offering annual consultant training based on the National Training Institute's Child Care Health Consultation curriculum in 2002. To further build and support consultants' capacity, in 2003 HCCCT joined with other New England states to create the HCCNE Regional Collaborative. HCCNE provides joint training annually to CCHCs and, when possible, offers training to consultants in the fields of education, social service, and mental health, as well as child care directors. HCCCT's CCHC training modules were also incorporated into Connecticut's mental health consultant training. The CT Nurses’ Association receives funds to support and implement the training each year.

History and Development

Beginning in 1996, HCCCT brought together a Core Committee of stakeholders from more than 50 organizations with a key role in planning and delivering child care and health care services to children and families. A collaborative team composed of representatives from the Department of Public Health, the Children’s Health Council, Carey Consulting, and Yale School of Nursing via the Connecticut Head Start State Collaboration Office provided leadership. A major study of child care health consultation by a Yale University faculty member provided the HCCCT Core Committee with timely, critical data on child care consultation utilization.
HCCCT developed a best practice curriculum and a training-of-trainers medication administration program for early care settings. The HCCCT Medication Administration Training Curriculum (1997, revised 2004) is used extensively within and outside of the state. The curriculum’s effectiveness is supported by posttest measures of content retention for training participants.

In 2000, the Yale School of Nursing published a report that compared the state’s child care licensing regulations to the National Health and Safety Performance Standards for Out-of-Home Child Care included in Caring for Our Children and Stepping Stones. In 2001, HCCCT organized a broad base of public and private stakeholders through its Quality Assurance Subcommittee to embark on an extensive review of this comparison and to recommend regulatory revisions to better align state practices with national standards. HCCCT managed this effort in a broadly inclusive manner that led to strong support of the final recommendations. The Yale School of Nursing provided key leadership and process evaluation services.
HCCCT has consistently pursued an interdisciplinary focus to child care consultation and helped create a fully-funded, statewide mental health consultation system in 2003.
In 2005, as a result of HCCCT activities, the Head Start State Collaboration Office and the Child Health and Development Institute funded a statewide symposium and a corresponding white paper, Creating a Statewide System of Multi-Disciplinary Consultation for Early Care and Education in Connecticut. Building on symposium presentations and discussions, the paper outlines a receptive state policy and regulatory context and offers practical guidance on design and implementation from existing consultation programs.

Challenges and Lessons Learned

• Consultant’s Roles and Responsibilities: A lack of training to inform consultants of regulatory role expectations, plus limited state monitoring, contributes to great variation in how providers make use of consultants. The review of Connecticut’s child care regulations as compared to national standards mentioned above is likely to lead to role expansion and more role specificity through regulatory changes. Installing consultant training as a project of the CT Nurses’ Association in partnership with HCCNE will ensure annual training to educate consultants on role expectations in state regulations.
• Funding Consultant Services: Child care providers pay CCHCs directly on a fee-for-service basis, and limited financial resources pose a major barrier to providers’ ability to fully access consultant services. Although there is regulatory support for increased use of child care consultants, providers need assistance to meet licensing requirements. As a result of the state’s ECCS effort known as Early Childhood Partners, Connecticut early childhood stakeholders have prioritized the development of a cohesive, interdisciplinary, child care consultation system that addresses the current patchwork approach to funding, training and implementation.

Ingredients for Success

• Regulations: Having a state regulatory mandate for child care health consultants has helped raise awareness and focus attention on this critical role in early care and education (ECE) settings. Such interest and recognition of consultants’ potential has helped HCCCT’s efforts to forge a system to support consultants’ work.
• Champions: HCCCT benefits significantly by having a national leader in child care health consultation on its leadership team—Dr. Angela Crowley, Yale University School of Nursing faculty. Dr. Crowley conducts extensive research on health consultation in the state and has helped guide HCCCT’s direction with evidence-based findings. Dr. Crowley continues to assist HCCCT, as well as other states leaders, in policy and training development that are aligned with challenges confronted in the field.
• Location within Head Start State Collaboration Office: HCCCT’s location in the Head Start State Collaboration Office provided the program with key insights into high-quality early care and education. As a result, HCCCT embraced Head Start principles related to a comprehensive approach to child development (i.e. health, mental health, nutrition, family involvement, etc.). Head Start Collaboration office continues to advocate and support child care health consultation, and interdisciplinary consultation.
• Higher Education Linkages: Higher education institutions are key players in building strong, knowledgeable CCHC and ECE workforces, and HCCCT has engaged in a number of initiatives with colleges and universities. By reaching out to nursing and child development programs, HCCCT is building bridges across academic disciplines and providing essential information about consultants’ important roles in high-quality care.

Moving Forward

• Interdisciplinary Consultation: The Early Childhood Partners strategic plan recommends the creation of a statewide interdisciplinary consultation system including health, mental health, and education consultation to the full spectrum of ECE settings. Extending interdisciplinary consultation will be possible with the development of a statewide infrastructure for networking, training, and supporting consultants, and assisting program directors to effectively access and utilize consultation services.
• CCHC Professional Development: Regular training and network-building for consultants will continue to be sponsored by the Connecticut Nurses’ Association.
• Updates to CCHC Database: The Department of Public Health continues to address updates to the database of consultants in the state.   CCHCs trained through the annual HCCNE Child Care Consultant training are encouraged to enroll in the NSC registry.

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Information as of August 2007

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