Expert Resources Lost: Budget Crisis Shrinks Vital Program for Child Care Providers

November 2010Andrew Schwartz

If prevention is the watchword of modern health care, then ideally, it starts early. That has always been the thinking behind the California Childcare Health Program. Since 1987, the program has offered an array of research-based services, health information and health education for child care providers and families so they can help children get a healthy start in life. 

Beginning in October 2010, however, the California Childcare Health Program (CCHP) had to significantly scale down its services, as the state budget eliminated funding for the California Child Care Healthline, the program’s largest project.

Abbey Alkon “Hopefully, this is just another shrinking period before a time of regrowth,” says Abbey Alkon, who has been executive director of the CCHP since 2001, when the UCSF School of Nursing began administering this statewide program. “Still, it is painful – both for the jobs we have to eliminate and the lack of capacity to be quickly responsive to the child care and health communities’ changing needs. We are more limited now in what we can do for children in child care.”

An epidemiologist and pediatric nurse practitioner, Alkon understands well how much is at stake in the CCHP’s work. She is widely recognized for research that sheds light on the interactions among children’s homes, child care environments, and mental and physical health.

Many Children, Many Health Needs

According to the Federal Interagency Forum on Child and Family Statistics, in 2005, “61 percent of children ages 0-6 who were not yet in kindergarten (about 12 million children) received some form of child care on a regular basis from persons other than their parents.” 

Depending on the setting, these children and their child care providers navigate health and safety challenges that range from simple colds to the H1N1 flu virus, severe allergic reactions, asthma and devastating accidents. Some children arrive at their child care program without breakfast or after taking medications for their chronic conditions, such as asthma or allergies. And in a study of children in child care in 20 counties in California, 24 percent of the children, says Alkon, had special needs of one type or another.

These facts matter because children’s health affects how prepared they are to learn when they enter kindergarten, and because if children develop healthy habits early, it can have a positive, lifelong impact on their mental and physical health.

“Despite this, health and safety is not usually a significant part of the training for child care providers, who have a very high turnover rate,” says Alkon.

Perhaps this ongoing need for reliable health and safety resources explains why the CCHP website receives between 1,700 and 1,900 visitors daily.

Services to Strengthen Communities

Through October 10, 2010, the CCHP offered a number of services to fulfill its mission to improve the quality of child care. The services included:

  • The California Child Care Healthline, a toll-free telephone service whereby child care providers could consult with a nurse and other specialists in child health and safety.
  • Training for child care providers and health care consultants on health and safety best practices.
  • A wealth of CCHP-produced, evidence-based, up-to-date, culturally sensitive materials for child care professionals and families, including a monthly newsletter, fact sheets and training curricula.
  • The program’s website, which features a Spanish language version, and the offering of some materials in Farsi and Chinese.
  • Translational research that advances the health and safety of child care settings.
  • The California Early Childhood Comprehensive Systems project, a statewide network of child care health consultants, primarily registered nurses who work with child care providers on health and safety issues.
  • A new toolkit on integrated pest management in early care and education programs.

The October budget cuts eliminated all of the services in the first three bulleted items above.

Translational Research

When UCSF and Alkon assumed leadership of the CCHP, their first task was to administer a major grant from First 5 California – a state-sponsored program serving parents and caregivers of young children. The First 5 grant led to a research-based, 17-module training program for child care health consultants that today is used throughout the country. 

An evaluation of the training program found it yielded improvements in the number and quality of health and safety policies at participating sites, as well as in a number of basic health and safety practices such as hand washing, the number of children with up-to-date immunizations and the ability of centers to meet special health care needs, such as those of children with asthma or allergies.

The Child Care Wellness Study is another example of research that is quickly translating into real-world applications. A randomized, controlled trial, the project studied the effect of a nutrition and physical activity intervention in 18 child care centers across three states. The CCHP is now measuring the effect of the intervention by looking at the body mass index, physical activity and nutritional intake of the children in the study. Results are expected early in 2011.

The CCHP’s latest project, which is funded by a grant from the California Department of Pesticide Regulation, is an integrated pest management toolkit designed to help child care staff reduce the exposure to pesticides of children and staff in child care programs. Produced in both English and Spanish, the toolkit includes a curriculum, an assessment checklist, and complementary publications, handouts and posters.

Reaching People Where They Are

Rahman Zamani with California Child Care Healthline nurses Victoria Leonard (left) and Bobbie Rose (photo by Elisabeth Fall) Turning such research into materials that are usable by anyone who might need them can be a considerable challenge, says physician Rahman Zamani, who for years directed the CCHP’s healthline and oversaw all of its publications. Zamani is among those whose jobs have been lost to the budget cuts.

“We’ve had experts here who translate the research and write it in a friendly manner so it is appropriate for health professionals, child care providers and parents at all literacy levels,” says Zamani.

Newsletter topics came from healthline personnel and feedback from providers and agencies. Often what began as a newsletter piece became a fact sheet for families and child care centers. Zamani notes that the CCHP has always rigorously screened the materials to ensure they meet national licensing standards as well as best practices promoted by organizations like the American Academy of Pediatrics.

“We are proud of the work we’ve done serving the children of California,” says Alkon. “Now, how we direct our time and energy will be different. And we have to hope that as times change, we can go back to serving a much larger group of concerns.”