In 2004, I applied for a position as a Health Care Consultant at a not-for-profit company. As the interview came to a close, they asked if I had any questions. I asked what type of duties I would be expected to accomplish. The CEO answered: “We don’t know.”
I asked: “What could I expect to do on a day to day basis?” The CEO answered: “We don’t know.”
I asked: “Is there anyone who can tell me more about this position?” The CEO answered: “It is going to be your job to figure that out.”
So when they offered me the position, I of course accepted.
Little did I know that accepting a position that I would be expected to create would not be the biggest challenge that I would face. I came into the position with a number of preconceived notions:
1) I already knew pretty much everything I would need to know for this part-time job.
2) New York State child day care licensing regulations would be clear and easy to follow.
3) There would be resources and training available for this new position.
My preconceived notions were soon proved wrong. Still, much was learned during the process. Sharing those lessons can help usher in a future for New York State where Child Care Health Consultants play a critical role in promoting health and quality in early care and education settings.
Health Professional vs. Health Care Consultant:
First, some background. To the new position, I brought an excellent background in pediatrics: inpatient hospital experience with infants and toddlers, Maternal Child Health Bureau long-term traineeship in neurodevelopmental disorders, a Masters of Nursing in Pediatrics, and a Pediatric Nurse Practitioner Certification that I’ve maintained. I also had experience as both an elementary school nurse and a consultant.
Yet, the learning curve I faced in this new field of child care was steep. My first lesson was that it’s not ‘day’ care; “days don’t need care, but children do”. The field of early care and education has its own language, its own skill set, as well as its own daunting list of abbreviations.
I was fortunate to begin practice in this field within the supportive environment of a Child Care Resource and Referral agency (CCR&R). As I posed the multitude of inquiries, my supervisors and co-workers were able to answer my questions, guide me, and direct me to resources. However, an all too often answer to particularly perplexing issues was “It’s the State”, meaning the Office of Children and Family Services (OCFS).
New York State Child Care Licensing Regulations:
This brings me to my notion that the child day care regulations would be clear and easy to follow. They really aren’t, but that is because keeping children safe and healthy is both complex and imperative. OCFS, or more accurately the Division of Child Care Services, is charged with setting and enforcing the child day care regulations for all modalities of child care with a few limited exceptions. http://ocfs.ny.gov/main/childcare/daycare_regulations.asp
OCFS’ goal of maintaining the health, safety, and protection of children outside the care of their own home means that the regulations must consider complex circumstances and cover all potential hazards. This is much more complicated than I initially understood when starting as a health care consultant.
In recent years, OCFS has revised the child day care regulations to make them easier to understand. The Health and Infection Control section of the regulations, which is the area that we must thoroughly understand as health consultants, was reorganized into logical sections.
Over time, I became familiar with the pertinent regulations for a health care consultant. Additional resources that helped with this process are:
It is organized by the modality of child care and adheres closely to the Health and Infection Control regulations. A few areas, specifically the exclusion criteria and the appendices, include information from expert resources and Caring for Our Children.
These are documents intermittently published by OCFS to clarify existing regulations, address questions frequently asked by care providers, or clarify state and federal requirements to which child care programs are subject.
OCFS sends information directly to the child care community in the form of letters. They can address a timely issue, inform the community of a policy change, etc.
Lastly, seeking clarification directly from a child daycare licensor or their supervisor at the Regional OCFS office, or the registrar or their manager that may work for your local CCR&R, is an excellent way to gain an understanding of the intent of the child day care regulations.
Resources for Health Care Consultants:
Finally, onto my expectation that there would be resources and training for this new position: There were not. As I mentioned previously, I was fortunate to have the support of the CCR&R staff that was immensely helpful as I learned about the field of child care. I, like many other HCCs, became a Medication Administration Training (MAT) Trainer and that helped me understand the medication specific regulations and best practice standards.
The single most helpful resource that was available was the collaboration and support of the other CCR&R HCCs that were in the same predicament. We banded together, shared resources, ideas, and experiences as we developed the role of the Health Care Consultant in New York.
In 2010, the Council on Children and Families (CCF) sent 4 people from New York to the National Training Institute for Child Care Health Consultation (NTI CCHC) in Chapel Hill North Carolina. I was fortunate to be one of those people and following completion of the training became a Child Care Health Consultant trainer.
This was an exciting opportunity because I had contacted NTI CCHC to attend training a few times since 2004. Previously, I was not able to attend the training because the mission of NTI CCHC was to train CCHC trainers, not providers of HCC services, which was my current role. In 2013, NTI CCHC was closed following their loss of funding, but the training materials are available at this website: http://ncemch.org/child-care-health-consultants/index.php
Moving Forward:
You will have noticed that the terminology in this article has transitioned from Health Care Consultant to Child Care Health Consultant (CCHC). The role of the CCHC is defined in Caring for Our Children (CFOC), which contains the national health and safety standards for early care and education. Here is the website: http://cfoc.nrckids.org. These national standards describe a much broader role for the Child Care Health Consultant than the Health Care Consultant as defined by New York State child day care regulations.
When I started my path as an HCC/CCHC I was fortunate to have been employed by a CCR&R that supported a broad definition of health, inclusive of the health of the whole child and family. In addition to activities specifically supporting the Health Care Plan, I was allowed to develop programming for the child care community that promoted healthy active living, environmental health, social-emotional health, and parent advocacy for children with special health care needs. At the time, I was not aware that my own practice model was in fact consistent with the training I would then obtain at NTI CCHC.
Since that time, I have had the opportunity to provide CCHC training to CCHCs in a number of formats including traditional didactic training and a variety of distance learning formats. In 2014, CCF partnered with Docs for Tots to develop a system for training NY’s CCHC workforce.
Finally, in 2016 NY has a Child Care Health Consultant resources website www.nyscchcresources.org, which contains 5 video training modules specific to NY child care health consultation and based on the NTI CCHC training modules and standards from Caring for Our Children.
This is an exciting time for health professionals in the field of child care to embrace both the roles of Health Care Consultant as defined in New York State and also the more comprehensive role of Child Care Health Consultant from the national standards to promote the health and well-being in New York’s young children served by early care and education settings.
