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



Health in State Plans: MissouriNotes from OCCThe Missouri 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 the state’s waiver requests, if applicable, and implementation plans for unmet requirements.Missouri will be on a corrective action plan for the health and safety training provision (5.1.6b) starting October 1, 2016 and will have an additional year to achieve this goal. A formal letter that shows the extended timeline for implementing the requirement is due from the state administrator to the Office of Child Care (OCC) by August 13, 2016.OCC has not made a determination as to whether Missouri’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 Block Grant (CCDBG) Act of 2014; OCC will prioritize the review of payment rates during upcoming implementation monitoring visits.Section 1: Health in CCDF Leadership and Coordination with Relevant SystemsPresentations and discussions were held with the Missouri Coordinating Board for Early Childhood and its workgroups during the development of the state plan. A representative from Public Health Nurse Consultation participated in quarterly meetings with the lead agency. In addition, information and requests for feedback on the draft plan were given to the Municipal League of Missouri and the County Commissioner’s Association of Missouri. The plan does not mention if any feedback was received and, if so, whether the feedback was incorporated into the plan.A presentation was made before the Coordinating Board for Early Childhood Mental Health Workgroup about CCDBG and the corresponding changes to child care subsidy and quality services. The Board includes representatives from the Department of Mental Health and community mental health providers. The state plan did not indicate whether the Board provided input.The lead agency in Missouri is the Department of Social Services, the state’s child welfare agency. The draft plan was presented to and discussed with the agency’s management team.The following agencies/organizations were also consulted, although the state plan also did not indicate the outcomes of the consultations, if any:The Department of Elementary and Secondary Education (DESE), Early Childhood, including discussions regarding Part C of the Individuals with Disabilities Education ACT (IDEA)The Department of Health and Senior Services (DHSS), Section for Child Care Regulation, MOU in placeStaff from the Child and Adult Care Food Program (CACFP) office, located within DHSSThe Family Support Division of Temporary Assistance for Needy Families (TANF); in Missouri, TANF is responsible for determining child care eligibilityMissouri Health Net (part of the Department of Social Services), which is responsible for Medicaid/Early Periodic Screening, Diagnostic and Treatment (EPSDT)The state plan did not indicate that the agency responsible for childhood obesity prevention was engaged. Coordination with Partners to Expand Access/Continuity of CareThe lead agency:Has established an interagency team, which includes DESE; DHSS, Section for Child Care Regulation; the Department of Mental Health; and Missouri State Head Start Collaboration Office to address implementation of inclusion services for children with special needs and the quality and availability of infant and toddler care. Participates in quarterly meetings with DHSS, including the Nurse Health Consultation Program, to review child care provider training needs and parent education related to health and nutrition.Participates in the Coordinating Board for Early Childhood’s mental health workgroup, with the goal of developing mental health consultation for child care providers.Meets monthly with the Section for Child Care Regulation, CACFP, and the Division of Finance and Administrative Services to discuss strategies to enhance child care services in Missouri for all children.Has a MOU with DESE that addresses, among other things, inclusion services.The state has a contract with Child Care Aware? of Missouri. Child Care Aware? of Missouri’s activities include collaborating and partnering with business and civic leaders to make child care safe. The plan did not specify what safety measures have been taken or are planned. Child Care Aware? of Missouri also offers inclusion support services such as providing information and referrals as requested and referring families for parenting education, child care assistance, health insurance assistance, and other benefit programs for low-income families.Missouri’s plan indicates that the state has substantially implemented emergency and disaster response requirements. It has not yet met the requirement that child care providers have in place procedures for staff and volunteer emergency preparedness training and practice drills. By September 30, 2016, the state will complete a series of tasks and activities to bring the state into compliance. Section 2: Health in Family Engagement Through Outreach and Consumer EducationMissouri reports it has partially implemented the CCDBG consumer education requirements. The unmet requirements include:The availability of information about child care assistance. Currently that information is posted on the Department of Social Services website. The state will be requesting that the information also be posted on additional public and private sites by September 30, rmation regarding IDEA services and programs, which is available on DESE. The lead agency’s website will add a link to DESE by September 30, 2016.State policies regarding social emotional/behavioral issues and early childhood mental health. The state, in partnership with the Early Childhood Intervention Team, will develop the policies by September 30, 2016. Once policies are developed, the lead agency will develop information packets and T/TA for providers.Missouri states that it has implemented the requirement on research and best practices in child development, including social and emotional development, and physical health and development (particularly healthy eating and physical activity). Information is made available through agreements with DESE, Educare contractors, Opportunities in a Professional Education Network, and Child Care Aware? of Missouri’s Department of Social Services. The lead agency partners with ParentLink, which has a resource library and a toll-free network where parents, providers, and the general public can make inquiries about all domains of child development. Educare programs are based within universities or community partnerships; they provide T/TA to state-registered family home providers and to unlicensed child care providers. DHSS has a MOU with the Child Care Health and Safety Consultation program, which supports local health agencies’ staff through consultations with and/or education to all providers about health issues in child care settings and health promotion activities for children in child care. Child Care Aware? of Missouri provides parenting resources, providers’ resources, training, and general information based on research and best practices. The Missouri Afterschool Network (MASN) provides T/TA to afterschool programs including research-based information about the social-emotional, cognitive, and physical health and development of school-age children.For dissemination of consumer education materials, the lead agency has a contract with Child Care Aware? of Missouri, which provides information packets to those who call or come in requesting information. Among other things, the packets contain information on inclusion of children with special needs and the MO HealthNet health insurance programs. The lead agency’s website contains information on all income support programs, downloadable brochures, FAQs, and links to partnering agencies. The Family Support Division (FSD) provides information on SNAP, TANF, Medicaid, and the Children’s Health Insurance Program (CHIP) through its various intake processes: in person, by mail, through the FSD website, and via a call center. The state’s contract with Child Care Aware? of Missouri requires families making inquiries about child care to be referred to FSD for other benefit programs for which the family may be eligible. Missouri contracts with 111 local agencies to provide WIC certification and nutrition services; information about WIC is provided by TEL-LINK, the DHSS toll-free information and referral line for maternal and child health care. CACFP is administered by the Community Food and Nutrition Assistance office within DHSS, which provides information via publications, the web, various outreach opportunities, and TEL-LINK. The DESE website provides information on IDEA and special education services. The Missouri Early Childhood Comprehensive Systems provides information on home visiting programs; the information lives on the DHSS website.Missouri provides information on behavioral intervention support model to parents through ParentLink and Child Care Aware? of Missouri; and to providers and the general public through ParentLink, Child Care Aware? of Missouri, Educare providers, and the Child Care Health and Safety Consultation program.The state does not have a written policy regarding preventing expulsion of preschool children in programs receiving child care assistance. The state also has not implemented procedures for providing information about and referring families to existing development screening services. By September 30, 2016, Missouri is to draft procedures on accessing screenings and services through EPSDT and IDEA.Missouri reports that it has substantially implemented CCDBG requirements for a state consumer education website. The unmet requirement involves the provision of annual aggregate information about the number of deaths, serious injuries, and substantiated child abuse incidences in child care settings. By September 30, 2016, the state will publish the missing information on the Lead Agency’s website, and a link to the Information will be placed on the DHSS and CCRRT websites.Section 4: Health in Supply Building Strategies to Meet Needs of Certain PopulationsThe state uses contracts to ensure that quality services are available to infants and toddlers, and to children with disabilities or special needs. It requires that in-home care providers meet some basic health and safety requirements. There is a 25 percent reimbursement rate differential for children with special needs—meaning that providers that serve children with special needs earn a bit more when a child with a disability is enrolled in one of their available slots. There is also a rate differential to providers whose enrollment is more than 50 percent children from low-income families, meaning that providers that enroll and serve low-income children will get a bit more money per child.Section 5: Health in Standards and Monitoring Processes to Ensure the Health and Safety of Child Care SettingsAgeCenters CFOCCenters MissouriGroup CC Homes MissouriFCC Missouri<12 months4:14:14:1No ratios for any age. Max. group size of 10. Max. of 5 children not related to provider within the 3rd degree by blood, marriage, or adoption. Provider can care for an additional 1/3 of licensed capacity for up to 2 hours/day to accommodate school age children.Exempt FCC homes may not have more than 4 unrelated children.13-23 months4:14:18:124-35 months4:1-6:18:18:13 years9:1Not specifiedNot specified4-5 years10:1Not specifiedNot specified Mixed ages8:1 if more than four 2 years in group 10:1 for mixed age groups 3-5 years10:1Missouri certifies that it has substantially implemented the CCDBG health and safety requirements. The state develop requirements for training on all of the mandated topics: Prevention and control of infectious diseases (including immunization)First aid and cardiopulmonary resuscitation (CPR) certificationPrevention of sudden infant death syndrome and the use of safe sleeping practicesAdministration of medication, consistent with standards for parental consentPrevention of and response to emergencies due to food and allergic reactionsBuilding and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular trafficPrevention of shaken baby syndrome and abusive head traumaEmergency preparedness and response planning for emergencies resulting from a natural disaster or a man-caused eventHandling and storage of hazardous materials and the appropriate disposal of bio contaminantsPrecautions in transporting childrenThe state reports that it does not have pre-service, orientation, or ongoing training requirements related to the topic areas listed above.Missouri certifies that it has policies and practices that ensure that licensing inspectors in the state are qualified, have received training in related health and safety requirements, and are trained in all aspects of state licensure requirements. It further certifies that it has policies and practices regarding inspections for licensed CCDF providers. Missouri reports that it meets all federal requirements about child abuse and neglect reporting. Section 6: Health in the Recruitment and Retention of a Qualified and Effective Child Care WorkforceMissouri reports that it has fully implemented CCDBG training and professional development requirements. The state has a framework that defines standards for early childhood professionals, The Core Competencies for Early Childhood and Youth Development Professionals. To comply with CCDBG, the lead agency will begin to require pre-service and core trainings for registered providers. The trainings include first aid and CPR, safe sleep practices, preventing SIDS, preventing shaken baby syndrome and abusive head trauma, and child abuse and neglect reporting. More advanced trainings will also be offered to registered providers: infectious disease prevention and control, hand-washing and universal health precautions, medication and parental consent, sanitary food handling, prevention and response to food allergy emergencies, building and physical premises safety, emergency and disaster response, handling and storage of hazardous materials, protection for hazards that can cause bodily harm, the physical, social, and emotional development of children, and transportation of children. Most of the trainings would meet the state’s child care regulations, for those registered provider who wanted to become licensed. For licensed providers, the state has rules in place about specific training requirements. Approved statewide training aligned with the core competencies is offered via Child Care Aware? of Missouri’s workshop calendar at . Regularly scheduled topics include a curriculum on infant/toddler development, a 10-part module on preventing child abuse and neglect, and a four-part module on social and emotional foundations for early learning. A 14-module series on inclusive environments and working with children with special needs is available from DHSS.The plan indicates that Missouri will use some of the quality set aside funds for training on social, emotional, physical, and cognitive development of children, including topics related to nutrition and physical activity, using scientifically-based, developmentally-appropriate, and age-appropriate strategies.All training provided via the statewide training calendar is aligned with the Core Competencies for Early Childhood. CCDF-funded Educare services are available to non-licensed providers and licensed in-home providers; services consist of on-site visits for the purpose of safety checks, TA, incorporation of Strengthening Families Initiative Protective Factors, and delivery of a research-based curriculum to increase providers’ knowledge of child development, social-emotional development, child/parent interactions, child behaviors, etc.The state also CCDF to partially fund T.E.A.C.H. Missouri.All licensed providers are required to undergo 12 hours of ongoing training each year. Section 7: Health in the Support of Continuous Quality ImprovementMissouri has indicated that quality set aside funds will support, among other things, compliance with state requirements for inspection, monitoring, training, and health and safety DF quality funds also help the state support compliance with health and safety regulations through child care health and safety nurse consultations and trainings, child care sanitation inspections, and licensure inspection software.-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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