Delaware State Profile

 

Delaware’s Division of Public Health (DPH) maintains a network of independent consultants who provide non-licensing-related child care health consultation services. Of the 18 consultants who are actively marketing their skills to child care providers, half are Delaware-licensed nurses, and the other half are early childhood specialists. Of the nine early childhood specialists, one has a doctorate in education and three have master’s degrees in education and/or public health. All of the consultants have more than 10 years of experience working with young children and their families.

• Licensing: Delaware child care licensing regulations require that providers identify a medical professional to serve as their child care medical consultant as part of the licensing application. While many programs make arrangements with a local physician or public health nurse, no proof of the arrangement is required. Only regulations related to Day Care for Sick Children define a scope of work for the medical consultants.
• Funding: The state uses dollars from its Early Childhood Comprehensive System (ECCS) grant and several other funding streams to purchase child care health consultant (CCHC) services to support programs in improving the quality of their health-related services. Local child care providers also hire CCHCs for training and consultation. Family and Workplace Connection (FWC), the state’s child care resource and referral agency (CCR&R), has provided limited marketing for the CCHC initiative when federal funding was available to support the effort.
• Auspices: The state’s CCHC initiative is managed by its Division of Public Health.
• CCHC Role: Delaware uses its trained CCHCs to support quality improvement efforts in at-risk centers, to improve access to medical homes and insurance, and to support other state initiatives. Consultants provide training and technical assistance (T/TA) on a wide range of health-related topics including obesity prevention, State Children’s Health Insurance Program (SCHIP) enrollment, and social-emotional development of children.
• CCHC Training: DPH has partnered with the Wesley College School of Nursing to develop a community nursing elective for undergraduates and graduates based on the National Training Institute for Child Care Health Consultants (NTI) curriculum. The college provides the training annually to medical professionals, nursing students, or early care and education (ECE) specialists who are interested in becoming CCHCs. Wesley’s Adult Studies Department and the Delaware Nursing Association also offer continuing education credits (CEUs).
• Website: The Healthy Child Care Delaware (HCCD) website includes a directory of trained CCHCs and information on how to contact them.

History and Development

Delaware’s CCHC initiative has its roots in the HCCD program. With Healthy Child Care America (HCCA) funds, the DPH’s Social Service Administrator partnered with FWC to develop a CCHC database that FWC used to market CCHC services to child care programs in the state. During the HCCA period, the Administrator also used HCCA dollars to leverage funds from other state programs. For example, the DPH provided funds to the Department of Education (DOE) to support its use of CCHCs as trainers in a DOE/Head Start Collaboration Office effort to provide training to local programs on supporting children’s mental health. Since launching the CCHC initiative, 37 CCHCs have been trained through the collaboration with the Wesley College School of Nursing. The Social Service Administrator continues to support the CCHC initiative in her new role as state ECCS director.

Challenges and Lessons Learned

• Need to Build a Qualified CCHC Workforce: DPH has undertaken a number of initiatives to ensure that CCHCs have the training and support they need to provide services to child care providers. In addition to the partnership with Wesley College of Nursing described above, DPH established a Delaware CCHC Association to provide training and ongoing support. Since 2005, CCHCs have met quarterly to discuss issues and to receive NTI updates and training.
• Need to Build Recognition of the Value of CCHC Services: Because current child care regulations do not require providers to use the Wesley College-trained CCHCs to meet the health consultation licensing requirement, many local program directors are not aware of how independent CCHCs can support their efforts to improve program quality. To help expand providers’ awareness, the state ECCS grant includes limited funding for CCHC consultation to provide free or reduced cost quality improvement assistance to at-risk centers. The state also uses Child Care and Development Fund (CCDF) monies to launch a statewide project which links a CCHC with a licensing specialist and a center director to develop an action plan for T/TA services to address health and safety compliance issues. DPH uses both of these projects to build trust and market the skills of a CCHC to assist in quality improvement initiatives.

Ingredients for Success

• Commitment and Creativity: DPH has creatively used grant and foundation funding to deploy CCHCs to meet several of the state’s child health goals. DPH accessed funding from the Robert Wood Johnson Foundation to engage CCHCs in recruiting and enrolling families in Medicaid and SCHIP. CCHCs provided T/TA on social and emotional competency of young children through an initiative funded through the Head Start State Collaboration Project. With the aid of a Nemours Health and Prevention Services-supported obesity prevention program, CCHCs also provided T/TA on the importance of physical activity.

Moving Forward

• Recognition of the Role and Importance of CCHCs: DPH is drafting a Memorandum of Understanding (MOU) between DPH, the Office of Child Care Licensing, and the Department of Health and Social Services (DHSS) Child Care Office to acknowledge the training and expertise of NTI-trained CCHCs until such a time when there is a national standard or state licensing regulation regarding the use of CCHCs in ECE environments.
• Licensing Regulation: The state has proposed a licensing regulation that mirrors the National Association for the Education of Young Children’s (NAEYC) health consultant standard for all infant and toddler programs. While the regulation’s definition of a health consultant remains a licensed medical professional or public health nurse, DPH staff will continue to advocate for the use of CCHCs in this role.
• System Development: The state is currently developing a cross-sector early childhood development system that includes CCHCs. ECCS expects that the roles and qualifications of CCHCs will continue to be refined through this process.

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Information as of August 2006

HCCC-NSC is a part of EDC’s Center for Children & Familites.
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This website was developed with funding from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services under contract number HHSH240200535013C.