Outline of Nevada Nevada State Profile

Nevada is a largely rural state with a decentralized system of child care licensing. In 2005, Nevada completed an analysis of its child care licensing regulations as a step toward alignment with national standards.

  • Licensing: There are no regulations governing child care health consultation to most child care facilities in Nevada. Child care centers for ill children are required by licensing to contract with an “on call” physician who must make quarterly inspection visits.
  • Funding: Currently, there are no funds dedicated to providing Child Care Health Consultant CCHC services at the state level.
  • Auspices: Two part—time CCHCs—public health nurses—are employed by the Washoe County District Health Department. However, there is no funding for the CCHC component and services are sporadic.
  • CCHC Role: The two public health nurses employed by Washoe County have CCHC training. They provide health consultation services to early care and education (ECE) sites on a limited basis when there is a public health concern.
  • CCHC Training: Healthy Child Care Nevada (HCCN) has been revitalized recently with the addition of new staff. In 2007, three participants attended training at the National Training Institute for Child Care Health Consultants.

History and Development

The lead agency for the HCCN initiative is the Bureau of Family Health Services within the Nevada State Health Division. Partners include the state Divisions of Child and Family Services, Welfare, and the State Department of Education. In addition, community partners such as Head Start, the University of Nevada, Area Health Education Center of Southern Nevada, parents, and foundations are represented.

HCCN objectives have been integrated into the Early Childhood Comprehensive System (ECCS). The ECCS in Nevada, housed within the Bureau of Family Health Services, coordinates efforts to obtain sustainable resources and policy development that support the education, safety, health and well–being of all children and their families. With objectives closely related the HCCN and the ECCS, the coordinators are working together with its partners to improve child care standards and incorporate CCHC’s into child care systems in Nevada.

Challenges and Lessons Learned

  • Inconsistent Standards: The child care licensing system in Nevada is fragmented. All licensed providers throughout the state are required to comply with minimal state regulations. In several urban jurisdictions, providers must comply with additional local regulations. The standards required by local jurisdictions may vary. Consequently, there is no statewide consistency. In many areas, child care regulations do not meet the criteria established by Caring for Our Children.
  • Rural Access to Resources: Meeting the health and safety needs of child care providers is difficult in this largely rural state with limited resources.
  • Reimbursement: Efforts to build a cadre of CCHCs in Nevada have been challenged by the absence of mechanisms to reimburse agencies for the service. The Nevada State Health Division and community–based agencies have been reluctant to train nurses and ECE specialists to provide CCHC services unless they can be reimbursed. The experience of HCCN leaders is that ECE providers are unlikely to support consultation through fee–for–service in the absence of a licensing requirement to retain a CCHC.

Ingredients for Success

  • Continuity: The HCCN Advisory group is being re–established as a sub–workgroup under the ECCS Health and Child Care workgroups.
  • Standards-Based Regulation Changes: In 2005, Nevada completed an analysis comparing child care licensing regulations against national standards. New regulatory language has been drafted based on this analysis. The process of approving and adopting new regulations will take several years. The goal is to put more stringent licensing standards in place to drive quality improvement efforts in ECE, including building a demand for CCHCs.

Moving Forward

  • Building a Base: A diverse group of leaders in Nevada feel that the first step in creating a high quality system of early childhood services is to increase awareness and build support through advocacy and education of the general public and policy makers.
  • Organize Stakeholders: Leaders with an interest in early childhood services have identified a need for stakeholders to create a body that can work together to take a systematic look at services for young children. This group will take the lead in identifying stakeholders with an interest in the education, safety, health and well-being of all children.

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Information as of August 2007