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



Health in State Plans: ColoradoNotes from OCCThe Colorado 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 a state' waiver requests, if applicable, and implementation plans for unmet requirements.OCC has not made a determination as to whether Colorado’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 review of payment rates during upcoming implementation monitoring visits. Section 1: Health in CCDF Leadership and Coordination with Relevant SystemsThe Colorado Department of Human Services is the lead agency for the state plan.The state consulted with multiple health-related stakeholders in developing the CCDF plan, including:County departments of health services during monthly statewide meetings. Input from counties was incorporated into the plan.Two consultations with the Early Childhood Leadership Commission, which is the State Advisory Council for Colorado. Committee members made recommendations on professional development, new health and safety pre-service requirements, and the option that exempts relative legally exempt providers from annual inspections and pre-service trainings/orientation. These recommendations were incorporated into the implementation plans of the state plan.Meetings with the Ute Mountain Ute and Southern Ute tribes. The agenda included discussion of the state professional development system and ensuring the tribes’ access to the Professional Development and Information System and other opportunities.A consultation with staff from the Colorado Department of Education to discuss Part B of the Individuals with Disabilities Education Act (IDEA) and the Colorado Preschool Program. A second consultation was a joint planning session between infant/toddler and professional development staff from the Office of Early Childhood and the Department of Education. A plan to implement comprehensive training and supports for providers on inclusive care will be developed over the next year and incorporated, as appropriate, as an amendment to the state plan.A consultation with CDOE’s Early Intervention Program (Part C of the IDEA) about developing consumer information on Early Intervention for CCDF families and increasing access to developmental screenings for infants and toddlers in the Colorado Child Care Assistance Program (CCCAP). The Child Care Licensing and the Licensing Advisory Committee provided recommendations on criminal background checks and on new requirements related to monitoring and pre-licensing training for legally exempt providers. The plan did not specify if those recommendations were incorporated into the state plan.The Head Start/Early Head Start collaboration director will develop a plan to increase coordination between Head Start and the Colorado CCCAP through policy development and training. The results of follow-up work sessions will be incorporated into the state plan as an amendment. A Child and Adult Care Food Program (CACFP) staff discussion focused on the possibility of including non-relative legally exempt providers as participants on CACFP.Childhood health advocate organizations, including the American Heart Association and Children’s Hospital Colorado, were consulted on the changes necessary to comply with CCDBG regulations on WIC, childhood nutrition (including breastfeeding support), and childhood obesity prevention. Healthy Communities, Colorado’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program.The Early Childhood Mental Health Unit, with discussions on developing a state plan on early childhood mental health, policies, and methods of disseminating consumer education. That plan is expected to be completed in 2017 and will be incorporated as an amendment to the state plan “as appropriate.”Child care resource and referral agencies and early childhood councils.Colorado reports that it has formed partnerships with a variety of public and private entities. The Early Childhood Leadership Commission was established in 2010 to “promote the coordination of policies and procedures that affect the health and well-being of Colorado children.” The Commission is part of the Colorado Department of Human Services and serves as the state’s Advisory Council for early childhood. It has worked to advance early learning; family support and parent education; social, emotional, and mental health; and health.The Colorado Department of Human Services has a Policy Advisory Committee (PAC), which submits recommendations to the department’s Executive Director. It submitted recommendations for, among other things, local implementation of the state’s QRIS and alignment of state and federally funded programs for child development, child care, and other early childhood education programs and services.The state also has a partnership with the Early Childhood Professional Development Advisory to support workforce initiatives. Colorado states that it has substantially implemented a statewide child care disaster plan. It has not met the requirement to develop guidelines for continuing CCDF assistance and child care services after a disaster. The deadline to meet that requirement is September 30, 2016.Section 2: Health in Family Engagement Through Outreach and Consumer EducationColorado certifies that it has partially implemented the CCDBG consumer education requirements. The following requirements have been partially implemented: Information on other programs; information on IDEA programs; and policies regarding the social emotional/behavioral and early childhood mental health of young children. The state child care licensing regulations require centers to have procedures in place to provide individualized social/emotional intervention supports and to utilize early childhood mental health consultants. There are several unmet consumer education requirements, including information on 1) IDEA programs and services, and 2) research and best practices in all domains of early child development including social and emotional development, cognitive development, physical health and development (particularly healthy eating and physical activity), and meaningful parent and family engagement. Both of these requirements are scheduled to be met by September 30, 2016.The state Office of Early Childhood has information on its website about Temporary Assistance for Needy Families (TANF); Supplemental Nutrition Assistance Programs (SNAP); Women, Infants and Children Program (WIC); Child and Adult Care Food Program (CACFP); Children’s Health Insurance Program (CHIP); Individuals with Disabilities Education Act (IDEA); the Colorado Preschool Program; the Maternal Infant and Early Childhood Home, the Nurse Home Visitor Program; and Early Childhood Mental Health Specialists.The Colorado Shines website, , focuses on the state QRIS and provides resources to providers, parents, and the general public. The site links to , where English- and Spanish-language information is available about the Colorado Early Learning and Development Guidelines. Links to national organizations such as ZERO TO THREE and the National Association for the Education of Young Children (NAEYC) also are included on the Colorado Shines website.The state partners with early mental health specialists, local CCR&R agencies, and Early Childhood Councils to make information available about research and best practices in child development.Certain additional consumer education materials are available on three websites: Colorado Shines (), the Colorado Early Learning and Development Guidelines website (), and the Office of Early Childhood website (). Information includes policies on expulsion of preschool-aged children and policies regarding the social-emotional/behavioral and early childhood mental health of young children. Training modules that address the social emotional/behavioral and early childhood mental health are offered by the state’s Professional Development Information System.Colorado reports that it has a written policy on preventing expulsion of preschool children. State child care licensing regulations require providers to adopt a policy that reduces both suspensions and expulsion. The Office of Early Childhood has developed guidance for providers, and information on best practices and research that will be posted at . The state has partially implemented the requirements to develop procedures for providing information on and referring families to existing developmental screening services. The unmet requirement is a description of how a family or provider receiving CCDF may utilize the resources and services to obtain developmental screenings for children who may be at risk for cognitive or other development delays, which may include social, emotional, physical, or linguistic delays. Implementation of this requirement is to be met by September 30, 2016.Some county departments of human services have developed relationships with local Early Intervention organizations (Part C) for purposes of referrals into the Colorado Child Care Assistance Programs. The Early Childhood Councils throughout the state are responsible for fostering comprehensive, coordinated systems for all early childhood services which include children with disabilities.The plan asserts that Colorado has partially implemented the requirements for a state consumer education website. Unmet requirements include:Sharing of provider-specific information about health and safety, licensing or regulatory requirements met by the provider (including the last date of inspection, and any history of violations). This is scheduled to be fully implemented by November 19, 2017. A description of health and safety requirements and licensing or regulatory requirements for child care providers. The target implementation date is September 30, 2017.Provision of annual aggregate information about the number of deaths, serious injuries, and incidences of substantiated child abuse in child care settings. To be implemented by September 30, 2016.A consumer-friendly website. Scheduled to be implemented September 30, 2016.Section 4: Health in Supply Building Strategies to Meet Needs of Certain PopulationsCounties have an option of developing contracts for slots with licensed child care centers, infant/toddler programs, and family child care homes. These contracts increase the supply and quality of child care settings, and serve vulnerable and underserved families.County departments of human services may opt to pay higher reimbursement rates for children with special needs (no percentage increase provided in the plan).The state QRIS uses a rubric to award points for certain high need factors; points inform the awarding of quality improvement funds. Programs report enrollment counts for children receiving services and supports through an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). Section 5: Health in Standards and Monitoring Processes to Ensure the Health and Safety of Child Care SettingsLegally exempt relative providers are not subject to most licensing requirements except for fingerprint-based criminal background checks, and child abuse registry and sexual abuse registry checks. The state requires that all legally exempt providers who serve children in their homes or the home of relative children sign a self-assurance form that addresses building and physical premises safety, and completion of health and safety trainings. Per CCDBG, by October 2016, non-relative exempt providers will be monitored annually and will complete pre-service training.AgeCenters CFOCCenters ColoradoFCC CFOCFCC ColoradoGroup CC Homes ColoradoI/T Home<12 months4:15:1 (6 week+)6:1, with no more than 2 children under 2 yearsOverall requirements (birth – 5 years): 2 additional school-age children may be present during non-school times, including related children under 12 years. Max # of children allowed in home at any one time is 6, plus 2 additional school-age children during non-school hours.2:1, with no more than 2 children under 2. Max # of children allowed in a home at any one time is 7-12 children birth - 18 years, with no more than 2 children under 2 years. There must be a second provider when 9 or more children are present, including related children under 12 years.4:1, with no more than 2 under 2 years. 2 additional school-age children allowed during non-school times, except for no children over the age of 3.13-23 months4:15:1 (1-2 years)2:1 No more than 2 children under 224-35 months4:1-6:17:1 (3 years) 8:1 (30-36 months)8:1 with 1 provider. 12:2 with 2 providers. No more than 2 children under 2 years.3 years9:110:1Maximum 7:18:1 with 1 provider. 12:2 with 2 providers. No more than 2 children under 2 years.4-5 years10:110:1 (4 years) 12:1 (5 years)Maximum 8:18:1 with 1 provider. 12:2 with 2 providers. No more than 2 children under 2 years.Mixed ages10:1 (30-59 months)6:110:1 (no more than 3/10 under 16 months) 12:1 (3-10 years)The plan indicates that Colorado has substantially implemented the CCDBG health and safety requirements. For the following unmet requirements, the state must develop and implement rules for legally exempt, non-relative providers on:Prevention of and response to emergencies due to food and allergic reactionsFirst aid and cardiopulmonary resuscitation (CPR) certificationPrevention of shaken baby syndrome and abusive head traumaPrevention and control of infectious diseasesPrevention of sudden infant death syndrome and use of safe sleeping practicesEmergency preparedness and response planning for emergenciesPrecautions in transporting childrenFor the additional unmet requirements below, the state needs to develop and implement rules for legally exempt, non-relative providers and family child care homes:Building and physical premises safety Prevention of shaken baby syndrome and abusive head traumaHandling and storage of hazardous materials and the appropriate disposal of bio contaminantsTo fully implement the CCDBG health and safety requirements, the plan specifies the state will do the following:Develop online content for prevention of shaken baby syndrome and abusive head trauma for all provider typesImplement rules to require legally exempt, non-relative providers to complete pre-service orientation trainingsImplement family child care home, center, and school age rules requiring professionals to complete all ten pre-service orientation trainingsEnsure that the emergency preparedness and response plan is included in the state Emergency Operation PlanAdd required training topics into ongoing requirements for family child care homesThe 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: Colorado has regulations addressing the proper feeding of infants and toddlersPhysical activity: Children must have the opportunity for daily gross motor activitiesCaring for children with special needs: All child care facilities must be ADA-compliantRecognition and reporting of child abuse and neglect: Colorado regulations require annual training on this topicOther: Family child care homes are required to complete annual training on topics including child growth and development, healthy and safe environments, developmentally appropriate practices, guidance, and social-emotional development.The plan certifies that the state has policies and practices to ensure compliance with applicable licensing and health and safety requirements for CCDF providers.In order to ensure that the monitoring and compliance system has adequately trained monitors, the lead agency requires training on all child care rules and regulations, language and cultural diversity, mandated child abuse reporting, identifying safety hazards, and recognition of health requirements. Colorado has not met all requirements re: licensing and monitoring. It has yet to require inspectors to perform annual, unannounced inspections of all licensed CCDF providers for compliance with all licensing standards, including compliance with health, safety, and fire standards. Section 6: Health in the Recruitment and Retention of a Qualified and Effective Child Care WorkforceThe state certifies that it has fully implemented the training and professional development requirements to promote the social, emotional, physical and cognitive development of children and to improve the knowledge and skills of the child care workforce.Colorado has a training curriculum that has been aligned with the domains of Colorado’s Early Learning and Development Guides, to include physical development and health, social and emotional development, and cognitive development.The state incorporates knowledge and application of the state’s health and safety standards by requiring training in the review and maintenance of child immunization records; safe sleep environments; and health, safety and nutrition. New regulations limit the amount of screen time and sugary drinks, and define the daily gross motor activities children in child care must get. Colorado also requires training in emergency preparedness. Training modules will be available to all providers through the Professional Development Information System.Colorado also has additional training requirements for professionals who work with infants and toddlers. The state career ladder incentivizes professional development for children with high needs, including children with disabilities. Trainings that earn additional “high needs” credential points include special education/needs, inclusion, disabilities, developmental delays, social/emotional, and differentiation.The plan indicates that Colorado will use targeted and quality expansion funds to support the training and professional development of the child care workforce. The state will use infant-toddler set-aside and quality expansion set-aside funds for TA for providers to enhance children’s cognitive, physical, social, and emotional development and support children’s overall well-being.In addition, the state funds consultants to provide coaching for child care professionals working with preschool-age children on the Colorado Early Learning and Development Guidelines.Colorado requires a certain number of pre-service and ongoing training hours, depending on the provider:Licensed center-based care: 8-hour orientation for infant program staff; 15 hours annual trainingLicensed group child care homes: 15 hours of pre-service training; 15 hours annual trainingLicensed family care provider: 15 hours of pre-service training; 15 hours annual training Any other eligible provider: 15 hours annual trainingThe state requires that 3 of the 15 annual training hours be focused on social-emotional/behavioral issues and early childhood mental health intervention models. Section 7: Health in the Support of Continuous Quality ImprovementThe plan indicates that infant/toddler set-aside funds will support the state’s Expanding Quality in Infant Toddler Care Initiative (EQ). The initiative is a statewide system of T/TA in increase the quality and availability of infant/toddler care. A primary activity is a 48-hour training course, aligned with the Early Learning and Development Guidelines.Quality set-aside funds are used for inspection, monitoring, training, and health and safety standards.Both quality set-aside and infant/toddler set-aside funds support state or local efforts to develop high-quality program standards on health, mental health, nutrition, physical activity, and physical development.Colorado Shines, the state’s QRIS, is embedded in licensing. The QRIS framework includes child health as one of its five categories related to early education and care program quality.The Colorado Shines framework is based on standards in five categories related to early education and care program quality: (1) workforce qualifications and professional development; (2) family partnerships; (3) leadership, management and administration; (4) learning environment; and (5) child health. This new rating system based on an accumulation of points within the standards categories and results in a rating level of 1 to 5. Programs that meet current early education and care program licensing criteria will result in a Level 1 quality rating. Level 1 demonstrates that a program is licensed and in good standing. If a program chooses not to pursue higher quality levels within Colorado Shines, then it will remain at a Level 1 unless licensing compliance changes. There are no requirements that programs be rated beyond the licensing requirement of a Level 1.Programs that wish to gain a higher rating can voluntarily apply for a higher rating (Levels 2 - 5) by providing evidence to meet the level requirements. Level 2 demonstrates that providers have taken additional steps towards building quality by completing a self-assessment related to quality indicators and meet staff training requirements. Program ratings of levels 3 - 5 are obtained through higher levels of points across the standards categories. The Colorado Shines Quality Rating and Improvement System framework includes a standard area for Child Health Promotion, which includes standards that support screenings for health and development, and providing medical resources. Other focus areas include the promotion of physical activity on safe play spaces, nutrition education, and hands on gardening (farm to table) experiences. The Colorado Shines point structure additionally awards points to programs who employ or contract with a Mental Health Consultant: QRISPDF-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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