National Standards for Health and Safety Guidance

Looking for Health and Safety Guidance? Caring for Our Children Can Provide Answers!

April Powell: Hello, everyone. Welcome, and thank you so much for standing by. My name is April Powell, and I am the resource program manager for the National Center on Early Childhood Health and Wellness. And I'm so pleased to welcome you all to today's webinar. Before we begin our presentation today, I have just a few announcements.

All of the participants will be muted throughout this entire presentation portion of the webinar. There's a slide presentation being shown through the webinar system that only the presenters have access to changing. If you have a technical question, please type it in the chat box on the left-hand corner of your screen. Keep in mind that everyone on the webinar can see your questions. There's a lot that we'll be covering within the next hour, but you can submit your questions about the content, again, at any time by typing it in the chat box on the left. We'll answer some of your questions as we go, and some we'll answer at the end of the webinar. On your screen, you also have a feedback survey. It's in a box titled Web Links. Only those who take the survey will get a certificate, and the certificate will be emailed to all survey-takers within 48 hours of the conclusion of the webinar.

And lastly, this webinar is being recorded, so a link to view the webinar will be available to everyone who registered. Whether or not they attended, they'll still get a link.

So, now I'm going to turn it over to Kimberly Clear-Sandor, who will introduce Linda Satkowiak and Nicole Patterson.

Kimberly Clear-Sandor: Thank you so much, April. It's always good to hear your voice. And welcome, everybody who's joined us on today's webinar. We're always so happy that you are joining us. So, my name is Kimberly Clear-Sandor, and I will be presenting today's webinar along with Linda Satkowiak and Nicole Patterson. They're going to be joining us from the National Resource Center. And our webinar is part of a quarterly webinar series designed for child care health consultants that work in all types of early care and education programs. They may be Head Start, child care, family child care, schools with early education programs, and so forth. So, while health folks can focus their attention on health and safety, we know that we carry out our health and safety through all of our education partners, teachers, administrators, staff, and families.

So, there's a lot of work that gets done by everybody, and we're hoping today's webinar that goes over how Caring for Our Children can be used in your program is really helpful. As I said, my name is Kim Clear-Sandor. I'm a senior training and technical assistance associate with the National Center on Early Childhood Health and Wellness. For over 20 years, I've cared for children and families in underserved areas as a nurse and a family nurse practitioner, and also as an independent child care health consultant. I love working with children and early care and education programs to advance children's health, safety, growth, and development.

So, at this time, I would like to turn it over to Linda and Nicole so that they can say hello and introduce themselves.

Linda Satkowiak: Hello, all. Again, I express my thanks for your joining us today. This is Linda, and I have been a pediatric nurse with Children's Hospital Colorado for over 20 years, and all of that time, I've worked in the community. And while working at Children's, I directed Healthy Child Care Colorado for about 13 years, and also worked as a child care health consultant at that time and consulted with quite a few Denver-area programs, including a very large Head Start program. I became very familiar with the National Resource Center for Health and Safety and Child Care and Early Education — the NRC at that time — and served on several of their technical panels and as a reviewer for Caring for Our Children. When I semi-retired in 2013, I continued working as part of a team at the NRC, which is now a partner with the National Center for Early Childhood Health and Wellness. I work with Nicole as the primary content manager for the CFOC standards, which you will learn more about today. And now, Nicole.

Nicole Patterson: Hello. My name is Nicole. I am a health and safety specialist and a research assistant for the NRC. I have been with the NRC since May of 2017, and much of my work involves research and revising standards for Caring for Our Children. I'm also a nutrition and dietetic technician registered with the Academy of Nutrition and Dietetics. I've spent well over five years working as a nutrition professional, most recent of which includes coordinating the nutrition program and providing nutritional support for one of the larger Head Start programs in El Paso County, Colorado. I'm passionate about research, and education, and teaching to a variety of audiences when it comes to the protection of a child's health, safety, growth, and development within the early care and education settings.

Kimberly: Well, thank you, both. We're so happy that you're joining us today and being able to share your great expertise with everyone on the phone. It's fun to know that everyone is talking today to the folks that write and coordinate Caring for Our Children, so, I hope all of you get a kick out of that as much as I do because they're a lot of fun to work with, and it's nothing like hearing it right from the source. So, I'd just like to quickly go over the learning outcomes. We're going to go over Caring for Our Children. We're going to think a little bit about what's the difference between a standard and a regulation, just so that we're all clear about the best practices put forth in Caring for Our Children.

We're going to find out what's in the Caring for Our Children standard. What kind of information can you find in there? And then even begin to think about what are the different ways we can use it? And Nicole and Linda are going to also talk about how do they create a standard? How does it get revised? So, that you can have a lot of confidence that when you use these standards, they're intended for early care and education programs that have kids together, and that they're really designed just for your audience. And just as we go through today, I know April mentioned that we will be answering questions as we go, but you all see that big chat box on the left-hand side of your screen. And we're going to be using that a little bit as we go through today. We're going to do a couple polls, so, we really do encourage you. We love seeing everybody saying hello from all the different places across the country. It's really fun to have such a diverse group on the phone to share their thoughts and ideas from all across the country.

So, as we go through today, we will be using the chat box to answer some questions and the polls. So, please keep that going. If we're not able to answer a question right off the bat or as the webinar goes along, we will be answering questions on an online community, which we'll let you know how to connect to at the end of the session. So, I just wanted to give you all a heads up about that. So, to get you using your interactive skills, we're going to go ahead and start off with a quick poll, and we're going to ask you to just select yes or no, whether or not you have use Caring for Our Children in your work. So, I'm going to ask Robin to go ahead and launch that poll. Oh. It looks like you are all answering it already. It's on the right-hand side of my screen. I'm not quite sure what side of your screen it's on yet. But if you can just click in there, yes or no, if you've used Caring Children in your work.

So, maybe we're talking today and it's the first time you've heard it, and maybe it's something you use every day. And with the numbers coming in, it looks like a lot of you have been using it, which is really super exciting for us to hear. I'll let you go ahead and give it another minute to finish up there. We do have a lot of folks registered for today's session — over 1,000 people registered for the session, wearing all different kinds of hats — Head Start, health managers, directors, health consultants, folks from child care and Head Start. Okay, so it looks like it's slowing down a little bit. We're about 80 percent, 85 percent of you have used Caring for Our Children in your work, so that is really great information for us to carry forward as we go through today's session. And with that, Linda, I will let you begin chatting.

Linda: Well, thank you so much. Hopefully, since so many folks are using or have used Caring for Our Children, this won't be too boring for you. But hopefully some things will come up, or may come up, that you did not know before, and that's certainly our hope today as we move this forward. What you're seeing on the screen right now is a picture on the left side of our website, and this is the home page of our website. And this is where we would ask that you keep in your mind to go to for the standards that are part of Caring for Our Children. It's the online database, and we'll talk in more detail about what you'll find there.

The white book that you see in the background on the right-hand side of the page is the third edition of Caring for Our Children, and many of you may have this in your libraries. It was published in 2011. However, in January of 2019, a new publication, CFOC 4, became available, and that's the new cover that you're looking at, also on the right-hand side. Keeping in mind, however, that the database itself contains over 600 comprehensive health and safety standards for early care and education programs. And we'll talk about the differences between the database and Caring for Our Children, Fourth Edition, as we move forward. Well, Linda, there's no surprise that there's over 600 standards. No matter how many times you I've used the book, every time I go back in, there's another new one that I didn't know was there before. I hear you. That happens to me, as well. I'm like, oh, we do have something about this.

Nicole: This is Nicole. I'm going to take us through a brief history and the mission of the NRC. The NRC has been led since 1995 by Dr. Marilyn Krajicek, a professor at the University of Colorado College of Nursing. The mission of the NRC since this time is to improve the quality of out-of-home child care and early education programs, and support the health and safety of the children they serve. The NRC supports the efforts, and the work that we do at the NRC supports the efforts, of a number of partners that we work with, so child care providers. This includes families, parents, as well as health professionals.

In 1992, the first edition of Caring for Our Children was published by the American Academy of Pediatrics and the Americas Public Health Association. The focus was on creating health and safety standards for children that were cared for outside of their home. These standards are now the nationally-recognized source for best practices in health and safety in early care and education settings. In earlier editions expert consensus was mainly used to develop the standards. As more research has been conducted in child care, there is more evidence to support the CFOC recommendations. The CFOC online database is a living document, meaning as new research becomes available, standards may be revised or updated on our website. The CFOC standards are voluntary, keep in mind. These standards are best practices, not regulatory requirements. Many early care and education leaders have used the standards to inform model regulations and develop health and safety policies, as well as procedures.

Linda: Yeah, and I find them so helpful because they're really designed for children in the group care settings, and also that we do talk about in the standards, what kind of settings they apply to. Really all of them, and the information contained, can be used for a lot of different reasons. And when you read the standards and you're going through them, they really reflect an understanding of the activities and the goals of the early care and education environment. And a lot of other resources don't necessarily understand. When you're just doing a Google search and you're coming up with a handout or an information sheet, they don't always reflect an understanding of the routines in the early care and education program, the interaction of staff and children with each other, et cetera. So, it's always reassuring to me that when you read and use the Caring for Our Children standards, you feel confident that they are using the best science and evidence that we have and applying it to that early care and education program. Nicole, you want me to advance it? Sorry. Yeah, that's perfect. I didn't want to jump the gun on you. We're ready. We're ready. Thank you.

Linda: So, oftentimes, we have to field questions about the words "standard" and "regulations." We often get asked if the CFOC standards are required; so, let's take a moment to discuss the difference between standards and regulations. Some standards in the field of early care and education are related to accreditation or quality improvement. You have some examples there on your slide. For example, NAEYC accreditation — N-A-E-Y-C — allows programs to provide more quality within their program and gain that accreditation nomenclature. Quality and rating improvement systems may also be another reason that standards are looked at. Those are QRIS systems. A CFOC standard is primarily a statement that really defines the goal of practice that should be conducted in early care and education programs. We feel they're the very strongest criterion for practice set by an organization.

We hope that there's some incentive for universal compliance so everyone can be doing things that relate to health and safety in approximately the same way. They're not required, necessarily, for legal operation, but they are legitimized and validated by scientific or epidemiological data, and they're widely agreed upon as the best practice or high quality practice. So, remember, they're voluntary, not mandatory. But a CCHC — and Kim, I'm sorry — can use them to understand the health and safety practices or to help create a plan to move forward from what's required toward best practice.

Kimberly: Yes, and I think that we're going to probably keep saying that a lot today, that the standards are voluntary best practice standards. So, you may hear us repeat that a number of times, so just letting you know we know we're repeating it.

Linda: Okay. So, how is a regulation different? And you can see the different things there. They're definitely required for legal operation. They have the power of law. And they're often linked to an enforcement activity, so child care programs that are regulated may, in fact, have visits by child care licensing to ensure that they are in compliance with the licensed care regulations. A little bit more about regulations. Each state is different and has their own set of regulations. Some programs or some states have regulations that differ from family child care to center-based care. But at a minimum, those licensed child care programs have to follow these regulations. The child care health consultant should also be aware of the regs, the government, the environments in which they work.

They should also know that evidence-based health and safety standards, such as Caring for Our Children, should also be known so they can support the program in moving along that quality continuum. So, we're meeting minimum standards that are part of regs, but how do we move forward and infuse some quality into the programs that we're working with? The slide shows you on the bottom that link of how you can link to the quality assurance center to locate the rules and regs that may be applicable in your state. And we also have a place on the NRC website where you can gain access to this information. The licensing regulation is also listed as one of the web links up in the upper right-hand corner of your slide deck-- of your program.

Kimberly: Yeah. And while many of you are probably aware of the regulations that govern your program, it's interesting to think about what's in a regulation, and then what also might be included in a standard. So, your child care regulations in your state might talk about how many sinks you need to have, where the sinks might need to be located. They may or may not go into very much depth about handwashing other than to say it needs to be done. And that's really where you can use the regulations as a minimum standard, and then use the Caring for Our Children standards to help you move along that quality continuum that Linda was talking about. [Inaudible]

Linda: Go ahead. I was just going to interrupt for a moment and say that often I think about regulations are the what should we be doing, and the Caring for Our Children standards are how should we be doing those different things within our child care program.

Kimberly: Very nice. Might have to use that. So, what about the Head Start program performance standards?

Nicole: Yeah. Thanks, Kim. I'll talk a little bit about the Head Start Standards. So, it is a little tricky when you talk about Head Start. Although we talked about some standards being voluntary, the Head Start Performance Standards are required. So, the Head Start programs must implement the Head Start Program Performance Standards, or AHSPPS, as they are federal requirements that all Head Start programs must meet to comply with their regulations and to meet the requirements of the Head Start Act. They're very comprehensive and include health services with a strong focus on health, safety, and wellness.

Linda: And the Head Start Program Performance Standards preamble, part one, page 58 — I know that's very specific — the Head Start Program Performance Standards make it clear that programs must meet local or state licensing requirements, regardless of whether the licensing entity requires that they be licensed. However, they do not require all center-based programs to actually be licensed because some states or local jurisdictions may not be able to license entities. So, I just wanted to, for those of you that are Head Start programs out there, remind you that although you may not be licensed, those regulations are still very much a part of what you are doing in your program. And as we had said earlier, if a child care health consultant is working with a Head Start center-based program, the thing is to know what standards the programs you're working with are required to meet. So, I hope that helps a little bit.

Nicole: And in general, it's important to understand the context of how early care and education programs work to promote children's growth and development. So, all programs have to meet specific requirements. So, CCHCs who know what agency regulates the programs they work with can be more effective. Some programs also choose to get accredited or participate in a QRIS program in their state. So, if programs choose to participate in these additional activities, the program may have to meet additional quality standards, as well, or these additional quality standards.

Linda: So, now that we've talked about CFOC standards and regulations, what about Caring for Our Children Basics?

Kimberly: So, yes, Nicole, there's also another document entitled Caring for Our Children, but with Basics at the end. And it has that very similar name, so we're wondering now if you'd participate in our next poll. How many of you have heard about Caring for Our Children Basics? Please take a moment to answer yes, I have heard about Caring for Our Children Basics, or no, I don't know what Caring for Our Children Basics is. I see those numbers starting to come in.

Linda: The poll's probably on the right-hand side of your screen in case you're looking for it.

Kimberly: All right. So, it looks about 60/40 or so, Linda.

Linda: Yes, thank you so much, and thanks to all who participated in the poll. So, it does seem like many of you have heard of Basics, but for those of you that have not, let me just take a moment to share what they are. As we said, state regulations are different across the nation, and many reflect those minimum health and safety standards. But children and group care can have many of the same needs, regardless of where that program is located. So, the Administration for Children and Families released Caring for Our Children Basics in 2015 to further identify a set of minimum health and safety standards that experts believe should be in place anywhere children are cared for outside of their home.

Kimberly: Yeah, and the recommendations set forth in Caring for Our Children Basics were intended to try and create a common framework to align basic or minimal health and safety standards. Because you can tell from our conversation today, if programs are accredited or not accredited, and the quality rating system and regulation — there's so many different standards that programs are working to understand that they must meet, that Caring for Our Basics was intended to create a common framework. And like Caring for Our Children, they are voluntary. They're not required. And I also just want to point out one thing. Linda, I'm not quite sure if you mentioned it yet, but when you look up at standard in Basics, it does not include everything that's in the Caring for Our Children online standards database. The online standards database has much more comprehensive information about that standard. Is that correct?

Linda: That is correct. And as you can see on the slide you have here, on the right side, you see the table of contents as part of Caring for Our Children Basics, and there's a number there. And that number references Caring for Our Children — the complete version. While Basics standard is certainly modified from the complete Caring for Our Children standard, you can use the standard number and the title to learn more about this topic in the Caring for Our Children online database. So, for example, if you were to look up standard 3.1.4.1 around, say, sleep, you would get a lot more information than is located in Caring for Our Children Basics. The standards also contain some additional information, like the rationale. There's often comments. There are references, and there are related standards. So, if you really want to better understand the standard mentioned in Basics, you really want to explore them in the Caring for Our Children online database.

Nicole: So, this is Nicole again. I want to give you kind of a brief background of how we developed the online database, so a brief history into the development of CFOC. We're talking about the published edition in 2011. We worked with a number of partners, as well as close contacts with a federal steering committee. We had several technical panels, researchers, writers, reviewers, and a number of content areas including child abuse, and nutrition, as well as infectious disease, just to name a few. This was then followed by an extensive stakeholder review that included parents and guardians, caregivers, teachers, as well as state and federal agencies such as Head Start. This led to the publication of the third edition of CFOC.

And as many of you know, print books become out-of-date pretty much immediately after they're published, so the NRC looked for ways to provide the most up-to-date standard, and the solution to that was the online standard database. So, let's look at, kind of, the revision process that's going on currently. So, the revision process in place since June 2011 — the revisions are led by an expert advisory group. Subject matter experts and this expert advisory group update these standards. They revise the standards based on new evidence, based on stakeholder feedback, and language that maybe needs to be clarified. Ultimately, the Office of Head Start, as well as the Office of Child Care and the Maternal Child Health Bureau, perform a final review and approve the revisions to be posted onto the website. So, since 2011, we have updated over 120 standards and six appendices that have been approved and posted to the website.

Kimberly: Sorry about that. So, thank you, Nicole. It's always interesting to hear how you guys go about updating, and it's amazing the amount of work that's gone into reviewing them and ensuring that they are going to work for the early care and education programs. So, hearing that 85 percent or so of you heard of Caring for Our Children and use it in your work, we're wondering if you can share with us a little bit about how you've used it in your work. What have you used it for? When have you gone to pick it up? What problems has it helped you solve? What successes has it helped you celebrate? If you could just go ahead and pop that into the chat box, that would be great. I have a paper edition that has a lot of printed-out, updated ones, and it doesn't take very long for the book to get tattered and in pieces. So, I see that Nancy shares that she provides TA for health professionals, and she uses it with that. Folks have used it to develop online training, which is great because there's such good information in there. And sometimes they even have resources that relate to some different training or information you might use, depending on the standard that you do. Debbie shared about updating — Yep?

Linda: I was just going to say, I like seeing that folks are using it to update policies and procedures, and that the rationale is helpful when they go to try to enforce or take a look at those new policies and procedures.

Kimberly: Yeah. Some folks have identified the posters and handouts being helpful. Again, using it in the training. You guys are probably reading all this much faster than I am. Nancy shares they use it to develop best practice education. Lucy — she uses it every day. Yay, Lucy. Right. We can understand that. She receives questions from child care providers, and she uses it to review curriculum for the health and safety training, which is great. And I think that's one of the times that you find everything that Caring for Our Children has in it is when you're trying to answer questions and you're like, wow, look. It's in there. It's always kind of like Christmas. Use the resource to guide facilities to know how to do a task. Awesome.

So, as we go through some of these next little slides here, it's kind of fun because some of the ways we've talked about using it is ways that you guys have already begun to use it already. Folks have talked about working with programs for formal star-rating assessments, so I'm guessing that's in a quality rating improvement system. Somebody wrote their safe sleep pacifier policy using it. A lot of policies and procedures. Folks like the appendices. Oh, this is great. There are a few questions about ECE that CFOC cannot answer, and that's right from Steve who is one of the big reviewers that updates a lot of our policies, and he sees them all. All right. Thank you, all, for sharing so much in here. I think it's really fun to see all the ways that you're using it. So, Linda, let's talk about some of the ways that we talked about it. And I think a lot of it, folks are beginning to use it that way, as well. So, take it away.

Linda: Absolutely. And this is going to be preaching to the choir, I can tell, because you have mentioned so many of the ways that we wanted to talk about today. And I got to tell you, I'm going to go back and take a look at some of these things, and we're going to add that to our repertoire because you've come up with some great ideas. Hopefully we've shared that there's a lot of expertise that goes into the development and the updates to the standards. Nicole talked about all the various people that look at them. They're not driven or created from here. We take a stab and try to incorporate some of the evidence as we know it, but we certainly reach out to experts throughout the country, and we even have some folks in Canada that we talk with on a regular basis for some of the standard revisions.

And so again, we'll take a look at the four ways that we've identified so far of ways that you might use those standards. So, quality improvement is a big one. Trying to support quality improvement can also be very challenging. Programs sometimes are just trying to meet those basic requirements, and then you come along as a consultant, or even as a health manager, and say, well, let's try to improve some things. And that can be challenging. So, what is the basis that you can do that? So, for example, discussing the standards related to playgrounds. You have several examples there. As you look at those standards, you learn about best practices that can promote quality in outdoor learning environments. You can consider with your program what's the safety of the play structure? What's their approach to pest management on the playground? How are they doing their ongoing safety checks?

Kimberly: Yeah, and when I think about using the standards, we put a list, so obviously this is not everything about playground quality that you can find in Caring for Our Children, but we thought it was an interesting smattering from some different areas, and things that might be a little bit outside of what we normally think about when we think about playground quality. And when you begin to dive into the standards — so for instance, standard 62.1.1, play equipment requirements-- you might dive into there and find a standard about inspection of indoor and outdoor play areas and equipment. And when you're in that standard, it might bring you to another standard about integrated pest management. So, as you are beginning to do your research and gather information to support your program in achieving their goals, just diving into the standards themselves hopefully will begin to open up even more the way we think about improving outdoor safety, playground equipment, and then be able to share those reasons with your program.

Linda: Yeah. I feel that certainly the related standards are a really great teacher, because as a child care health consultant, I may not be thinking of all the different things that could impact that outdoor play environment. Pest management is one of the things that when I think of outdoor play, do I think of that? Those are things that should happen when the kids aren't there. So, as a consultant, is that something that really rises to the top for me? And it may not be, but those related standards can help that. There's also an appendix included in this particular listing of standards. And please know the appendices are there to help you. They're full of great handouts, resources, forms. We saw on in the chats that some folks found the appendices invaluable. I know on the earlier slide, we said that six appendices have been updated so far, and we've just gone through a rash recently within the past couple of weeks. I would say there's probably even 10 or 11 that now have been updated, again, to reflect that most current information. So, another way that child care health consultants, or health managers, or anyone in the early care and education field may use the standards is to better understand an issue or a problem. And again, if you're trying to better understand health and safety issues around mealtime, when a child has food allergies, you can begin to explore some of the standards and come across standards that specifically address care for children with food allergies, how to create a care plan, assessing nutritional needs, modifying a feeding plan, and even an appendix, which is an information sheet that describes situations that may require medical attention right away.

Kimberly: Yeah. And as many of our participants shared in the chat box, using Caring for Our Children to understand issues and problems is my go-to as much as the folks in the chat box. And when working with programs that includes toddlers, I think one of the biggest issues and problems go-to that I go to Caring for Our Children for is biting.

Linda: Oh, yes. Standard 2.2.0.7, handling physical aggression, biting, and hitting.

Kimberly: That's it, Linda. It sounds like you've looked in there, too.

Linda: A few times.

Kimberly: A few times. But again, the standard is helpful because it includes rationale, and different comments, and explains why toddlers bite, and gives you some different approaches to it. And as a child care health consultant, the first time you're being asked to support a program to care for a child with food allergies, you might not know everything you need to know at that point. You may bring a lot of health education knowledge to your role, and need to understand what supports a program may need and what to begin to think about, and Caring for Our Children can help you do that with food allergies. And same with biting. I, myself, biting was not something I needed to cover in my practice as a registered nurse. So, I find it extremely helpful to be able to read the standard, understand about biting, and even understand how to contextualize and help the staff manage a child who is trying to figure something out, and has decided to bite instead.

Linda: Yeah. Caring for Our Children is a great place to start with any issue or problem to help you better understand it, to better understand some of the intricacies of the problem that the program may be having. It covers a lot of ground on issues that are related to health and safety.

Kimberly: So, we're wondering, now that we've showed you a couple of ways it sounds like that you're using them, with some different ideas of standards that you can look up related to those topics, we're going to throw it back out to you all and think about, if you were going to support a program to review and revise a policy or procedure, just like some of you shared, about exclusion, what might be some of the things that you would look up to inform your work? So, if you were going to go to that online standards database and start typing, or start flipping through your well-worn book, what are some of the things that you might want to explore? And I see fingers typing.

Linda: Yeah. And there were a lot of comments about policies and procedures. In fact, Katie already addressed the fact that she looks at policies and procedures around illness exclusions.

Kimberly: Yep. It's a big one, and there's so much depth in there, so many little things to know. So, I see it coming in. We have head lice exclusions, infectious disease — Handwashing for visitors. Communicable disease, caring for mildly ill children, fevers, signs, and symptoms — 

Linda: I think head lice has come up a couple times.

Kimberly: It's always a favorite.

Linda: It is. It is.

Kimberly: Pinkeye, as well. Pinkeye, lice, and rashes. I think Alexander hit the trifecta there.

Linda: He did. He did.

Kimberly: And, you know, I think — So, this is — this is Kim geeking out on Caring for Our Children a little bit. What's so nice to me is that when I go to the Caring for Our Children book and I'm reading those recommendations about some of these issues, it's nice to be able to say that they've been reviewed by expert panels in the American Academy of Pediatrics and other experts in the field. It's always reassuring to know that that's where these science-informed recommendations are coming from. And I think someone captured that. They said they use it to prove to people that it's an important thing to do. And they're really written in the way that it supports us in having those important conversations to explain why they are so important. I see folks hitting immunizations on there, the stomach virus, hand, foot and mouth — that's always a fun one, too. All right. So, with the — I see a lot of people are still typing, and I don't want to take that away from you. Lucy shares, oh, looking up when to provide notice to parents about a communicable disease. Yeah, that's a great standard in there. I have to say, I go to that one quite frequently. The flu vaccine. Rhonda asked about — 

Linda: Please keep putting in. Please keep putting in your responses, but I think in the interest of time, we're going to keep moving on.

Kimberly: Sounds good.

Linda: Certainly want to see those. I'm loving looking at all of these things. Oops, sorry. I think we both did it. Thank you so much. So, again, thank you so for all of the feedback that you have provided. There's a lot of information about exclusion that's in the Caring for Our Children standards. We've listed just a few things there. Certainly, that appendix A can be really helpful because it is that signs and symptoms chart. And we'll share a little bit later about where some of these resources that we provide in the appendices come from. But they can be used by the staff for education. They can be used to help you determine how to do a daily health check, which is a very important part of your program. And so again, just lots and lots of things that can influence how you manage infectious disease within a child care program, besides chapter 7 listing a lot of very specific information about specific infectious diseases. I wanted to share just a very quick example. One of my programs, when I was working as a consultant, wanted to update their exclusion policy. And they didn't know where to start.

And so, we took a look at what was in Caring for Our Children and were able to develop some things within their policy, that was part of their parent handbook, that really served to help them when they needed parents to really consider whether or not a child should be in group care. And that's really what we focus on — not so much a temperature that a child may have, it's really how are they behaving? And can they participate in the activities that are happening in that child care program? Rather than just a number on a thermometer. That's really key. Another way that you might use the standards is in some of the observations that you are making.

You may be wanting to create an observation checklist, or verify what you're seeing within a classroom, whether it meets the standards. For example, many programs that are doing toothbrushing have to have special storage, cleaning, labeling. But if you've never done it with a classroom of 3-year-olds, you could take a look at the standards to learn how the standards may impact how you're doing actual classroom practices. And again, it's that how to implement some of the things that you're looking at for quality improvement. And this, again, is another example of where the related standards can come into play. So, we can talk about oral health education, routine activities, and again, that's storing and labeling.

So, we thought about quite a few different ways that you can use the standards. And again, I'm hoping that we can keep those lists so we can add to that repertoire of things that we use the standards for. But we've talked about quality improvement. We've talked about understanding issues or further addressing a problem. We've talked about writing and procedures pretty extensively, and also doing observations.

Nicole: This is Nicole. I'm going to take us through a quick tour of the Caring for Our Children online database. So, let's start looking at the ways you can access the standards. You can access the CFOC standards by visiting www.nrckids.org/cfoc. And that's also on the top right Web Links section for you to access. So, there are three areas to access. The first is the CFOC Online Standards Database. To search a standard, you can type in the search bar — here identified by the green box — the standard number, the standard title, or keyword.

So, in this example, I've typed in 5134. This is the standard, safety guard for glass windows and doors. Before we go to that standard, I just want to mention the icons. So, you see the blue arrow down at the bottom of your screen-- icon legend. So, we have a green little foot. So, any standard that has that icon attached to it is a standard included in Stepping Stones, and we'll talk about Stepping Stones shortly. Next we have little notes icon. That notes icon will tell us that that standard has been revised recently. And it'll give you the revision date that that standard was updated. And then last, we have an FAQ icon. This is the frequently asked questions regarding that selected standard.

Kimberly: And Nicole, I think that not all of the standards have an icon, but some of them do. So, it's nice to know what those little icons mean if you see them pop up on there. And the Frequently Asked Questions are great because often when you read the standard, you may have questions, too. So, it has the FAQ there, always jump in there and check out what other folks have asked.

Nicole: Thanks, Kim. That's a good point. So, let's look at 5134 in the database. So, I typed it in, hit "Enter," it'll take me to the standard. So, this is what the standard looks like in the database. As you can see, the standard includes the chapter that you find it m the standard number — 5134, safety guards for glass windows and doors. You'll have standard language, followed by the rationale. You'll have a comment section, the type of facility for that standard, any related standard, and then the reference section for any citation.

Linda: And we picked this very short standard so that you could see all of the different components of what makes up a standard. Some of them are two or three pages long, though. I will warn you about that.

Nicole: Yeah, very long. [Laughter] The second section on the main CFOC page is a different way to get CFOC 4, so that's dictated by that little arrow in the middle, get CFOC 4. Click to download the free PDF version, or you can get a paper copy at the link provided. And then we also give you the suggested citation for anytime you're using the CFOC 4 download. So, this slide shows us the downloadable versions as well as the print version. So, there is a free PDF downloadable version. You can access it in that first link, followed by the print version. So, you can purchase the print version. Just note that the print version was updated in January of 2019. So, standards in CFOC, plus updated standards between June 2011 and May 2018, are included in this. But to reiterate again, any changes made since May 2018 are not in this downloadable version of CFOC 4, so the database is the best way to access the most current revisions of any standard.

Kimberly: So, we know a lot of folks still like to have a hard copy of Caring for Our Children because you may not have access to a computer or a phone while you're at your program. So, you may want to download that PDF copy. Again, just remember that the standards are only current through May of 2018. So, if you were to look up something, you may want to jot down that standard number and then double-check the database when you have access to a computer to make sure that nothing has changed. All of those standards that have been changed and the date they were updated in the database is part of the note that appears at the end of each standard. And the last way that you might access some of the standards is through Standards Based Resources, that third box over there on the right-hand side. So, the first thing you see there are Special Collections, and those are different topic areas. They pull the standards related to a specific topic. They include, say, sleep, oral health, environmental health, to name a few. And you have an example there. Just so you know, if you were to click on Caring for Our Children with special health care needs and pull up that collection of standards, it actually pulls from our database so that the collections will have the most up-to-date standards that you would be able to find. One of the collection on that page — go ahead.

Kimberly: No, I was just going to comment on all the different collections that are there. There's such a diverse number of topics. And if you decided your program really wanted to begin an oral health program, it's a nice way to just get oral health, or get infant and toddler. And you've already done the hard work of searching for all the related standards together, so those of us that might be using it for different reasons, whether it's a training or just starting a policy or procedure, the collections are a nice way to see everything all together without having to go to a standard and then a related standard and so forth. That was just a comment.

Linda: Thank you. Thank you. Thank you. So, as you noted, on that page of the collections, there is a resource called Stepping Stones. And it's definitely a standards-based resource. And it's a collection of those standards that represent the issues that can cause the highest morbidity and mortality in early care and education programs. These are the standards we felt were most important for a program to look at. So, over 600 standards can be very daunting. And you show that book, and you show all the standards, and programs are like, yeah, well, that's probably not going to happen. But if you, as their child care health consultant or their health manager, can really help them focus and evaluate whether or not they're meeting those 138 standards that are part of Stepping Stones, you're going to know those programs are safe and have a healthy environment for kids. There's a checklist that is available, as you can see on that website, that can help you help that program determine whether or not they have met the standards that are part of Stepping Stones.

Kimberly: So, Stepping Stones is -- by this collection, you use your — you know, the evidence and research to identify what are the standards that may be related to the highest morbidity and mortality and you collected all of them in one spot. So, again, it's such a little piece of gold that you've done all the hard work and said, hey, I'm starting Caring for Our Children. I'm just getting used to using it. Or maybe it's time to brush up on some policies and procedures. Let's just make sure we've covered all those that cause the high morbidity and mortality. So, Stepping Stones could be a nice starting place or reviewing place to make sure that you can have those conversations with your program if you identify some gaps in there or some practices that you might want to improve.

Linda: And if you take a look at that upper right-hand corner where it says, "Save as a PDF," if you were to click that button you when you were on this page of our website, it would pull up all of the Stepping Stones standards and it would be, again, the most current version of that standard, which we feel is very, very helpful so programs are seeing the most current things. On that page of additional standards-based resources, there's a link to the University of California at San Francisco child care health and safety checklist. This checklist was meant to be used in group care settings to evaluate the environment and practices for common health and safety issues, and it links with the Caring for Our Children standards within the document.

And this can be a great activity for those of you wondering, as a child care health consultant, what do you do after you say hello? What do I do with the program — especially if the program is paying me for those services how can I best provide them with some quality information that's going to direct them to a more quality program? This stage just shows a very brief picture of the checklist. And as you can see, the checklist actually links to the Caring for Our Children standards. For example — I think we need the next one. There you go. Yep, 5507 is talking about plastic bags, matches in the classroom. If you click there, you can actually link to that standard. And so, there's the one, 5507. That standard has a little foot icon. Remember that that standard's part of Stepping Stones.

Kimberly: Yeah, and somebody had asked in the chat box window about, oh, do you have to know the number? How can you do it if you don't know the number? So, I just want to reiterate that. You don't need to know the number. The numbers do line up with the chapter and sections in the book. Well, you can use the keyword search with just a term. Or perhaps you're doing something like this. You've done a printed checklist with a program, and there's a standard number there, and you want to go look it up. So, I just wanted to point that out.

Linda: Absolutely. So, we know that the checklist can be a really great learning tool. Also wanted to point out there's other resources that align with, and are rooted in, the standards. We certainly work to have consistent messaging. You're taking a look at a few of them up there. We know that these other resources are very helpful in your work, and they, along with Caring for Our Children, can really assist you in your programs as you're trying to keep children healthy and safe. And that's the goal for all of us. Thank you so much.

Kimberly: Thank you so much, Linda and Nicole, for joining us today and going through this information about how do we get the standards, how we can use them, how they're reviewed, and all the different ways to access all the great info there. I will invite our participants today, if you have any questions, go ahead and pop them into that chat box. I know we're coming into the top of the hour, but we do get a copy of the chat and can post any questions in our online community. So, I just want to use this moment to let everybody know there is an online community for child care health consultants where we can learn from each other, ask each other questions and strategies, share policies, share procedures. We're all working towards health and safety; so, somebody out there has tried to solve the same problem you're trying to solve, most likely.

So, there is this great online community, and we encourage all of you to search for it, and sign up, and join us in doing it. The online community is run by MangoApps; so, when you join the conversation by clicking that link and going ahead and filling out your information to register, you'll get an email back from MangoApps. And when you get that MangoApps email, you want to reply and follow the instructions in there. So, please continue the conversation with us and join us in our My Peers online community. I'm looking at the questions, Linda and Nicole. Did you catch any in there?

Linda: You know, I did see one that I wanted to respond to that was talking about those extra manuals, so, managing infectious disease, chronic illness, and also, the model child care health policies. Those are all available through AAP publications' department. Those are all resources that you would have to pay for. But again, we work very hard to make sure that the information in those resources is consistent with the information in Caring for Our Children.

Kimberly: Thank you, Linda. And then, we do record this pod -- this presentation today. I do post it in our MyPeers online community, and it will get posted, eventually, on the Early Childhood Learning and Knowledge Center. And as April closes us out, she will also let you know that you'll all be sent the link so that you can view the webinar again. So, I think with that, I'm going to send it back to April so that she can close us out.

April: Thank you so much to Kim and Nicole, and to Linda, for this engaging session. And thank you all for sticking with us. If you have any additional questions that pop in your head later, or if someone on your team watches this and has questions, feel free to email us. I just put our email address in the chat box. It's health@ecetta.info, and it's also right there on your screen. And just a reminder to take the post-webinar survey. It's in the box at the top, and you'll get your certificate emailed to you within 48 hours. So, if you go to Web Links, it's called Feedback Survey. So, go ahead and take your survey there.

We'll leave the webinar open for just a few minutes after we conclude. And again, let us know if you have any questions or comments. And thank you so much to everyone for joining us. And this concludes our webinar. Bye-bye.

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