Health Consultants For Pre-School Age Children Can Improve Health; Report Urges Policy Changes in CT

Research shows that the presence of a health consultant, usually a nurse by training, in child care centers leads to positive outcomes including improved nutrition, better sanitation and infection control, increases in access to preventive health care, specialty health care, mental health care, and oral health services. That’s according to a report by the Child Health and Development Institute (CHDI), which recommends health consultation as a “key strategy for integrating health into early learning systems and maximizing the contribution of early learning programs to children’s healthy development.”

“We rely on child care health consultants to ensure children’s health and safety in early care settings according to child care licensing regulations, but these providers are not fully supported nor utilized by our child health systems,” said Lisa Honigfeld, co-author of the report and vice president for health at CHDI. “Policy reform can strengthen and expand the role of child care health consultants to connect parents, child health providers, and child care centers to better promote health and developmental outcomes for children.”

CHDI’s “IMPACT, Promoting Children’s Health in Early Care and Education Settings by Supporting Health Consultation,” summarizes research on the role and benefits of health consultation in early learning settings, and reviews policies, regulations, training, and payment structures used in Connecticut and other states. The report concludes that Child Care Health Consultants (CCHC) can be “instrumental in contributing to the achievement of pediatric population health goals in Connecticut by monitoring the health of young children at the community level and contributing to community health system efforts.”

The 30-page report provides a framework for Connecticut to integrate health into early learning systems by taking advantage of opportunities presented as part of the state's overall health reform efforts. Recommendations include:

1. Develop infrastructure within the State to support health consultation with training, reimbursement, and quality improvement.
2. Strengthen licensing requirements to collect and report detailed health consultation information for all licensed child care sites.
3. Advocate for inclusion of CCHCs in Connecticut’s health reform plans.
4. Use a multi-disciplinary oversight group to develop a system of health consultation services to the meet the needs of Connecticut’s child care programs.

The report notes that a majority of children younger than age five spend “significant time” in early care and education settings, with more than 98,000 children enrolled in licensed child care centers, Head Start programs, and family child care homes.

“Unlike mental health consultation,” the report states, “overall health consultation is not supported with state level infrastructure and payments for health consultants to early Childhood Education sites. For private child care or preschool programs, the cost to hire a health consultant is borne by the program, with no system in place to ensure the quality of the CCHC workforce or ensure that health consultation is implemented to maximize the health and safety of children in child care.”

Connecticut regulations allow child care sites to employ a registered nurse, advance practice registered nurse, physician, or physician assistant to serve as the site’s health consultant.  Child care licensing requires child care sites that serve children ages three to five have quarterly health consultation visits.

Indicating that “several states and initiatives are testing innovations to better support integration of primary care medical services and community services,” the report suggests that “Connecticut, too, is poised to promote increased cross-sector collaboration in early childhood,” citing the establishment in 2013 of the Office of Early Childhood at the state level, which brought under one roof a range of services and responsibilities that had been housed in a number of different state agencies.

In most states, including Connecticut, a CCHC is typically a licensed registered nurse, according to a survey of states undertaken for the report.  Two states (Hawaii and Indiana) require that the CCHC be a physician, the research found, and four states (Illinois, Maine, Maryland, and North Carolina) allow licensed practical nurses to be health consultants. North Carolina allows other disciplines (sanitarian, nutritionist, and dietician) to be trained and credentialed as a health consultant.

The report points out that “CCHCs need specialized training, skill sets, and experience to address health issues for individual children and for the group setting as a whole. They also need to be aware of health and community resources so they can link child care facilities and families to appropriate services when needed. Programs with a significant number of non-English speaking families benefit from the services of a CCHC who is culturally sensitive and knowledgeable about community health resources for parents’/guardians’ native cultures and languages.”

The Child Health and Development Institute of Connecticut (CHDI), a subsidiary of the Children’s Fund of Connecticut, is a not-for-profit organization working “to ensure all children have a strong start in life with ongoing supports to ensure their optimal health and well-being.” CHDI advocates for “effective policies, stronger systems, and innovative practices.”