Health in State Plans: - Child Care Aware® of America



Health in State Plans: IndianaNotes from OCCThe Indiana Child Care and Development Fund (CCDF) plan for the period of June 1, 2016, through September 30, 2018 has been conditionally approved. A "conditionally approved" plan is a fully approved plan with conditions to be met based on your waiver requests, if applicable, and implementation plans for unmet requirements.OCC has not made a determination as to whether Indiana’s payment rates are sufficient to provide access to child care services for eligible families that are comparable to those provided to families that do not receive subsidies, as required by the Child Care and Development Blog Grant (CCDBG) Act of 2014; OCC will prioritize review of payment rates during upcoming implementation monitoring visits. Section 1: Health in CCDF Leadership and Coordination with Relevant SystemsState Consultation on State Plan with Health-Related AgenciesThe state consulted with multiple health related stakeholders in developing the CCDF plan, including:The agency responsible for Child and Adult Care Food Program (CACFP)The agency responsible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), nutrition (including breastfeeding support), and childhood obesity preventionThe agencies providing early childhood and school age/youth developmental servicesState Collaborations on Health IssuesThe lead agency consults with local and state health departments on child health issues like illness and injury prevention and responses. Recently, the lead agency and the state collaborated to allow for child care provider access to immunization records through the Children and Hoosier Immunization Registry Program (CHIRP) registry.The lead agency also consults with the Indiana Association for Infant and Toddler Mental Health (IAITMH). The lead agency supports implementation of Infant Mental Health Endorsements (IMH-E) and other initiatives that facilitate access to consultation and training on infant mental health topics for families and providers. Initiatives are designed to improve access for providers and families to mental health consultants and mental health training opportunities. Another example is the Happy Babies Brain Trust workgroup, which is a collaborative convened by the lead agency with funding from Kellogg Foundation and ZERO TO THREE. The lead agency partners with the Division of Mental Health and Addiction (DMHA) to support child mental health and sits on the leadership council for Project LAUNCH, a grant funded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Indiana’s Nurse Health Consultant program is housed in the lead agency and providers local commutes with webinars and training on health issues, such as injury and illness prevention, medication administration, chronic diseases (such as asthma), and nutrition. The nurses also assist programs with emergency preparedness and response planning. The state has plans to collaborate with CACFP to share compliance data in order to improve compliance in both programs and to align nutrition standards and coordinate trainings between systems. The ultimate goal is to ensure access to the program, nutrition, and nutrition information. The lead agency coordinates with the Indiana State Department of Health to increase immunization rates, prevent obesity, support and encourage breastfeeding, prevent lead poisoning, and promote developmental screenings. The lead agency works with partners to increase enrollment in the state’s public and private insurance programs to increase overall health but also to help children access developmental screenings. It has also stated that it with will partner with the Division of Mental Health and Addiction to increase awareness of early childhood mental health resources and trainings for parents and providers. Emergency and Disaster ResponseThe state CCDF plan indicates that it has substantially implemented emergency and disaster response requirements. While continuous operation plans are in place at the state level, rule changes are required to mandate that child care providers have evacuation, relocation, shelter-in-place, lock-down, communication and reunification with families, continuity of operations, accommodation of infants and toddlers, children with disabilities, and children with chronic medical conditions. The state also must develop guidelines for continuing CCDF assistance and child care services after a disaster occurs. Section 2: Health in Family Engagement Through Outreach and Consumer EducationIndiana affirms that it meets all of the CCDBG consumer education requirements. The state asserts that it partners with multiple organizations that promote child health, including TANF/SNAP and First Steps (IDEA Part C Early Intervention and the Indiana Department of Education, which is responsible for preschool special education services. Applications for CCDF services are coordinated with TANF and SNAP benefits to target vulnerable populations and facilitate access; TANF intake agents and CCR&Rs are required to sign an MOU that stipulates that they will work together and share information about each program’s information with families. The state also requires MOU agreements that stipulate parties will provide information to families about SNAP, Early Intervention Program (IDEA Part C) and Preschool Special Education Transitions, WIC, CACFP, Medicaid, and CHIP. The lead agency has provided all intake agents, CCR&R agencies, and child care licensing consultants with the FSSA Resource Guide. Indiana provides information regarding social emotional/behavioral and early childhood mental health available through Paths to QUALITY information and on the state’s websites: childcarefinder. and .CCR&Rs are responsible for providing enhanced referrals to families with children with special needs, where an inclusion specialist works with the family to provide information on social emotional/behavioral and mental health as well as to find a program that can meet the specific needs of the child and family. CCR&Rs support providers by offering training and assistance. The CLIMBS project offers a targeted intervention that is available to providers through the CCR&Rs inclusion specialists. Lastly, the lead agency has partnered with Indiana Association for Infant and Toddler Mental Health (IAITMH), a subsidiary of Mental Health America of Indiana (MHAI), to help infant/toddler and inclusion specialists obtain Level 2 of the Infant Mental Health Endorsement (IMH-E) and to develop 10 online modules on infant and toddler mental health.The state has a written policy regarding preventing expulsion of preschool children in ECE programs receiving child care assistance. Parents are informed of the policy during On My Way Pre-K enrollment. However, the CCDF plan does not indicate that this policy applies to child care centers or family child care providers. The lead agency partners with multiple stakeholders to ensure children may access developmental screenings. CCR&Rs provide families and providers to existing developmental screening services; monthly online trainings and onsite technical assistance is also available to providers on Ages and Stages 3 (ASQ-3) and the Ages and Stages Social/Emotional (ASQ-SE) trainings. ASQ-3 and ASQ-SE kits are available for check-out by parents and providers from each of the nine CCR&Rs throughout the state. Project LAUNCH in Southeastern Indiana and a few other providers in the state have implemented additional screening programs in child care settings. The consumer education website does not yet meet all requirements of CCDBG. The state still must record death and injuries that occur in child care settings on the website. Section 4: Health in Supply Building Strategies to Meet Needs of Certain PopulationsThe state uses contracts to ensure that quality services are available in low income areas throughout the state. This helps ensure that regardless of community demographics, quality providers are available to serve low income families, including families with children who have special needs or medical concerns. Additionally, reimbursements to providers that serve children with special needs may exceed the market rate by 10 percent. Section 5: Health in Standards and Monitoring Processes to Ensure the Health and Safety of Child Care SettingsAgeCenters CFOCCenters IndianaFCC CFOCFCC Indiana<12 months4:14:1 (6 weeks to walking)6:1 (under 24 months) unless 2 or more are under 16 months13-23 months4:15:1 (less than 30 months)24-35 months4:1-6:15:1 (2 year olds)7:1 (30-36 months)3 years9:110:1 (3 year olds)Maximum 7:14-5 years10:112:1Maximum 8:1Mixed ages6:110:1 (no more than 3/10 under 16 months)12:1 (3-10 years)The plan indicates that Indiana has partially implemented the requirement to have health and safety requirements for CCDF providers. The state must change rules for licensed centers, licensed homes, and legally licensed exempt homes and centers to require providers take the following trainings:Prevention and control of infectious disease trainingAdministration of medicationEmergency preparedness and response planningHandling and storage of hazardous materials and the appropriate disposal of bio contaminantsThe state must also create a rule that requires that providers receive pre-service or orientation training in the areas as required by CCDBG. The state has indicated that it plans to develop both online and face-to-face trainings that are readily accessible for all staff. The state has additional health and safety requirements related to nutrition, physical activity, screen time, children with special needs, and abuse and neglect recognition and reporting. They are as follows: Nutrition: Licensed centers with food programs are required to be approved for infants through 12 years of age; Registered ministries, licensed homes, and legally licensed exempt homes and centers, and providers shall make available to each child in the provider's care the following:Appropriately timed, nutritious meals and snacks in a quantity sufficient to meet the needs of the childDrinking water at all timesAccess to physical activity: Licensed centers and homes are required to have a fenced-in play area; licensed centers must utilize playground equipment that meets CPSC guidelines; Registered ministries, licensed homes, and legally licensed exempt homes and centers shall make available daily activities, including daily outside play, appropriate to the age, developmental needs, interests, and number of children in the care of the provider.Screen time: Licensed centers must not permit the use of televisions for infants/toddlers. The use of televisions must be for educational purposes and part of the lesson plans for children 2-12 years of age.Caring for children with special needs: Licensed center directors must attend an inclusion training and rules pertaining to required documentation and training for staff.Recognition and reporting of child abuse and neglect: Licensed centers, licensed homes, legally licensed exempt homes and centers must have staff attend training, approved by the OECOSL, on the prevention, detection, and reporting of child abuse and neglect.In order to ensure that the monitoring and compliance system has adequately trained monitors, the lead agency requires training on health and safety requirements, the Indiana Early Learning Foundations, Safe Sleep, Provider Orientations, and training related to the language and cultural diversity of providers. Section 6: Health in the Recruitment and Retention of a Qualified and Effective Child Care WorkforceThe lead agency provides many trainings on health topics, including safety, social and emotional development and mental health, nutrition, physical activity, oral health, and disabilities/inclusion topics. The state has a goal to develop and implement a comprehensive training system; part of that system development will include a review of existing trainings to ensure alignment with Indiana Early Learning Foundations and best practices. This would be an opportunity to align with Caring for Our Children, 3rd Edition standards on health. CCDF professional development offerings are required to align with the Indiana Early Learning Foundations. The physical growth and health in sections of the Early Learning Foundations contain indicators on social emotional/behavioral development and are used to support or indicate use of mental health interventions or social emotional curriculum implementation. The CLIMBS project, which is a contract given to CCR&Rs, also supports social emotional Early Learning Foundations’ training for providers. The plan indicates that Indiana will use some of the quality set aside funds for training on social, emotional, physical, and cognitive development of children, including those related to nutrition and physical activity, using scientifically-based, developmentally-appropriate and age-appropriate strategies, such as:Good nutrition and physical activity including how CACFP supports can be utilizedSupporting social, emotional and physical health of childrenMultiple approaches to supporting cognitive developmentThe trainings are aligned with the Indiana Early Learning Foundations and with CDA competency areas.Paths to Quality Coaches also provide support to child care providers on social emotional development of children and healthy and supportive teacher/child interactions.The state also funds infant/toddler specialists, inclusion specialists to provide one-on-one technical assistance to providers on social emotional development of infants and toddlers or inclusion of children with disabilities in child care settings. Indiana’s state CCDF plan highlights the Nemours funded Taking Steps to Healthy Success initiative, which supports training and technical assistance to providers on childhood obesity. The project provides five full-day learning sessions and onsite technical assistance between trainings. Fifty-six programs across the state are currently participating in this project. The CCR&R system is funded through Quality Set-Aside Dollars to conduct CSEFEL infant/toddler series and preschool series trainings to staff. The system also provides training and technical assistance on behavior management and biting. Paths to Quality coaches also provide coaching support on behavior management.In addition to the trainings in section 2 on Ages and Stages screening tools, CCR&R agencies offer disability awareness trainings, trainings on inclusion and curriculum modification and on environmental modifications for children with disabilities. Center directors are required to participate in a six-hour training on the Americans with Disabilities Act (ADA). A live webinar is hosted monthly that covers disability awareness and an introduction to the ADA for child care providers. Starting September 30, 2016, all caregivers, teachers, and directors must complete a state approved Basic Health and Safety Orientation training within three months of employment. The online training is 10 hours long; caregivers, teachers, and staff must complete 12 hours of continuing education in the educational development, care and safety of children, which would include the Basic Health and Safety Orientation. Section 7: Health in the Support of Continuous Quality ImprovementThe state has indicated that quality set aside dollars will support, among other things, efforts to develop program standards relating to health, mental health, nutrition, physical activity, and physical development. They plan to use general quality set aside and infant/toddler set aside for this purpose. Infant/toddlers specialists will be funded to provide training and coaching on topics such as safe sleep, breastfeeding friendly child care, and social emotional development for infants and toddlers.Indiana will also use general quality set aside and infant/toddler set aside dollars to facilitate compliance with state requirements for inspection, monitoring, training, and health and safety standards. The state’s technical assistance and monitoring systems are aligned to ensure compliance with state health and safety standards:These strategies include licensing consultants to support programs, Paths to QUALITY (the State's QRIS), and technical assistance (TA) specialists. Other strategies include targeted intensive coaching, training, blended training and TA, and Indiana's Child Care Health Consultant Program. The lead agency supports a cadre of licensing consultants to monitor programs for compliance on all state child care regulations and to provide support for ongoing compliance .The lead agency contracts with nine local CCR&Rs to provide training and onsite technical assistance and coaching to programs who participate in Indiana's QRIS, Paths to QUALITY. The local CCR&Rs provide specialized trainings to support providers with compliance on all regulatory requirements and QRIS standards. If a program is found to be out of compliance by a licensing consultant, they can be referred to their local CCR&R for onsite TA and coaching to assist them in rectifying the issue of non-compliance.The state's QRIS, Paths to QUALITY, has established Quality Standards for each level of the QRIS that include quality indicators for health, mental health, nutrition, physical activity, and physical development. The system identifies four tiered levels of quality that each build upon the previous level. Level 1 focuses on health and safety standards. As programs progress through the levels, significant improvements in program quality are made at each stage. The QRIS program standards can be found at -9144007543800About Child Care Aware ? of AmericaChild Care Aware of America is our nation’s leading voice for child care. CCAoA works with state and local Child Care Resource and Referral agencies (CCR&Rs) and other community partners to ensure that all families have access to quality, affordable child care. CCAoA leads projects that increase the quality and availability of child care, offer comprehensive training to child care professionals, undertake research, and advocate for child care policies that improve the lives of children and families. To learn more, visit usa.. Follow them on Twitter @USAChildCare and on Facebook at usachildcare.00About Child Care Aware ? of AmericaChild Care Aware of America is our nation’s leading voice for child care. CCAoA works with state and local Child Care Resource and Referral agencies (CCR&Rs) and other community partners to ensure that all families have access to quality, affordable child care. CCAoA leads projects that increase the quality and availability of child care, offer comprehensive training to child care professionals, undertake research, and advocate for child care policies that improve the lives of children and families. To learn more, visit usa.. Follow them on Twitter @USAChildCare and on Facebook at usachildcare. ................
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