Caring for Our Children (CFOC)

Chapter 1: Staffing

1.6 Consultants

1.6.0

1.6.0.1: Child Care Health Consultants

COVID-19 modification as of May 21, 2021 


*STANDARD UNDERGOING FULL REVISION*

After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).

A facility should identify and engage/partner with a child care health consultant (CCHC) who is a licensed health professional with education and experience in child and community health and child care and preferably specialized training in child care health consultation.

CCHCs have knowledge of resources and regulations and are comfortable linking health resources with child care facilities.

The child care health consultant should be knowledgeable in the following areas:

  1. Consultation skills both as a child care health consultant as well as a member of an interdisciplinary team of consultants;
  2. National health and safety standards for out-of-home child care;
  3. Indicators of quality early care and education;
  4. Day-to-day operations of child care facilities;
  5. State child care licensing and public health requirements;
  6. State health laws, Federal and State education laws [e.g., Americans with Disabilities Act (ADA), Individuals with Disabilities Education Act (IDEA)], and state professional practice acts for licensed professionals (e.g., State Nurse Practice Acts);
  7. Infancy and early childhood development, social and emotional health, and developmentally appropriate practice;
  8. Recognition and reporting requirements for infectious diseases;
  9. American Academy of Pediatrics (AAP) and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) screening recommendations and immunizations schedules for children;
  10. Importance of medical home and local and state resources to facilitate access to a medical home as well as child health insurance programs including Medicaid and State Children’s Health Insurance Program (SCHIP);
  11. Injury prevention for children;
  12. Oral health for children;
  13. Nutrition and age-appropriate physical activity recommendations for children including feeding of infants and children, the importance of breastfeeding and the prevention of obesity;
  14. Inclusion of children with special health care needs, and developmental disabilities in child care;
  15. Safe medication administration practices;
  16. Health education of children;
  17. Recognition and reporting requirements for child abuse and neglect/child maltreatment;
  18. Safe sleep practices and policies (including reducing the risk of SIDS);
  19. Development and implementation of health and safety policies and practices including poison awareness and poison prevention;
  20. Staff health, including adult health screening, occupational health risks, and immunizations;
  21. Disaster planning resources and collaborations within child care community;
  22. Community health and mental health resources for child, parent/guardian and staff health;
  23. Importance of serving as a healthy role model for children and staff.

The child care health consultant should be able to perform or arrange for performance of the following activities:

  1. Assessing caregivers’/teachers’ knowledge of health, development, and safety and offering training as indicated;
  2. Assessing parents’/guardians’ health, development, and safety knowledge, and offering training as indicated;
  3. Assessing children’s knowledge about health and safety and offering training as indicated;
  4. Conducting a comprehensive indoor and outdoor health and safety assessment and on-going observations of the child care facility;
  5. Consulting collaboratively on-site and/or by telephone or electronic media;
  6. Providing community resources and referral for health, mental health and social needs, including accessing medical homes, children’s health insurance programs (e.g., CHIP), and services for special health care needs;
  7. Developing or updating policies and procedures for child care facilities (see comment section below);
  8. Reviewing health records of children;
  9. Reviewing health records of caregivers/teachers;
  10. Assisting caregivers/teachers and parents/guardians in the management of children with behavioral, social and emotional problems and those with special health care needs;
  11. Consulting a child’s primary care provider about the child’s individualized health care plan and coordinating services in collaboration with parents/guardians, the primary care provider, and other health care professionals (the CCHC shows commitment to communicating with and helping coordinate the child’s care with the child’s medical home, and may assist with the coordination of skilled nursing care services at the child care facility);
  12. Consulting with a child’s primary care provider about medications as needed, in collaboration with parents/guardians;
  13. Teaching staff safe medication administration practices;
  14. Monitoring safe medication administration practices;
  15. Observing children’s behavior, development and health status and making recommendations if needed to staff and parents/guardians for further assessment by a child’s primary care provider;
  16. Interpreting standards, regulations and accreditation requirements related to health and safety, as well as providing technical advice, separate and apart from an enforcement role of a regulation inspector or determining the status of the facility for recognition;
  17. Understanding and observing confidentiality requirements;
  18. Assisting in the development of disaster/emergency medical plans (especially for those children with special health care needs) in collaboration with community resources;
  19. Developing an obesity prevention program in consultation with a nutritionist/registered dietitian (RD) and physical education specialist;
  20. Working with other consultants such as nutritionists/RDs, kinesiologists (physical activity specialists), oral health consultants, social service workers, infant and early childhood mental health consultants, and education consultants.

The role of the CCHC is to promote the health and development of children, families, and staff and to ensure a healthy and safe child care environment (11).

The CCHC is not acting as a primary care provider at the facility but offers critical services to the program and families by sharing health and developmental expertise, assessments of child, staff, and family health needs and community resources. The CCHC assists families in care coordination with the medical home and other health and developmental specialists. In addition, the CCHC should collaborate with an interdisciplinary team of early childhood consultants, such as, early childhood education, mental health, and nutrition consultants.

In order to provide effective consultation and support to programs, the CCHC should avoid conflict of interest related to other roles such as serving as a caregiver/teacher or regulator or a parent/guardian at the site to which child care health consultation is being provided.

The CCHC should have regular contact with the facility’s administrative authority, the staff, and the parents/guardians in the facility. The administrative authority should review, and collaborate with the CCHC in implementing recommended changes in policies and practices. In the case of consulting about children with special health care needs, the CCHC should have contact with the child’s medical home with permission from the child’s parent/guardian.

Programs with a significant number of non-English-speaking families should seek a CCHC who is culturally sensitive and knowledgeable about community health resources for the parents’/guardians’ native culture and languages.

COVID-19 modification as of May 21, 2021

In response to the Centers for Disease Control and Prevention’s COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, it is recommended that early childhood programs:

  • Follow guidance from your state and local health department as well as your state child care licensing agency.

Use child care health consultants (CCHCs) during COVID for their knowledge and relationships with local pediatric and public health professionals to:

  • Share up-to-date information with programs
  • Support implementation of new guidance for operation during COVID-19
  • Review and update pertinent health and safety policies
  • Offer opportunities to deliver timely staff trainings via webinar
  • Share updates on local COVID-19 vaccination efforts, be open to answer questions and listen to concerns from staff and families

Address the many delays in children’s health care due to missed health and dental appointments during COVID-19 by working with the CCHC to:

  • Develop a plan to identify and assess overdue childhood immunizations and missed medical, behavioral health and dental appointments
  • Connect families with health care resources that provide medical homes and support preventative care and developmental screenings
  • Regularly monitor the overall health status of children and follow up with needed referrals and resources

Consider alternatives to CCHC onsite consultation and schedule other methods for delivering services:

  • Use virtual video visits or phone conferencing to review health care plans, medications, address health and safety issues and any training needs
  • Share video of the environment, without children present, for the CCHC to review
  • Plan outdoor visits, if weather allows, using face mask and physical distancing

 Refer to the COVID-19 modifications in CFOC Standard 1.7.0.2: Daily Staff Health Check when on site visits are essential.

Additional Resources:

Centers for Disease Control and Prevention. COVID-19 Vaccine Toolkit for School Settings and Childcare Programs

American Academy of Pediatrics. Guidance Related to Childcare During COVID-19

Center for Health Care Strategies. COVID-19 and the Decline of Well-Child Care: Implications for Children, Families, and States

Child Care Aware of America. Conducting Child Care Program Visits During COVID-19 (childcareaware.org)

 

RATIONALE
CCHCs provide consultation, training, information and referral, and technical assistance to caregivers/teachers (10). Growing evidence suggests that CCHCs support healthy and safe early care and education settings and protect and promote the healthy growth and development of children and their families (1-10). Setting health and safety policies in cooperation with the staff, parents/guardians, health professionals, and public health authorities will help ensure successful implementation of a quality program (3). The specific health and safety consultation needs for an individual facility depend on the characteristics of that facility (1-2). All facilities should have an overall child care health consultation plan (1,2,10).

The special circumstances of group care may not be part of the health care professional’s usual education. Therefore, caregivers/teachers should seek child care health consultants who have the necessary specialized training or experience (10). Such training is available from instructors who are graduates of the National Training Institute for Child Care Health Consultants (NTI) and in some states from state-level mentoring of seasoned child care health consultants known to chapter child care contacts networked through the Healthy Child Care America (HCCA) initiatives of the AAP.

Some professionals may not have the full range of knowledge and expertise to serve as a child care health consultant but can provide valuable, specialized expertise. For example, a sanitarian may provide consultation on hygiene and infectious disease control and a Certified Playground Safety Inspector would be able to provide consultation about gross motor play hazards.

COMMENTS
The U.S. Department of Health and Human Services Maternal and Child Health Bureau (MCHB) has supported the development of state systems of child care health consultants through HCCA and State Early Childhood Comprehensive Systems grants. Child care health consultants provide services to centers as well as family child care homes through on-site visits as well as phone or email consultation. Approximately twenty states are funding child care health consultant initiatives through a variety of funding sources, including Child Care Development Block Grants, TANF, and Title V. In some states a wide variety of health consultants, e.g., nutrition, kinesiology (physical activity), mental health, oral health, environmental health, may be available to programs and those consultants may operate through a team approach. Connecticut is an example of one state that has developed interdisciplinary training for early care and education consultants (health, education, mental health, social service, nutrition, and special education) in order to develop a multidisciplinary approach to consultation (8).

Some states offer CCHC training with continuing education units, college credit, and/or a certificate of completion. Credentialing is an umbrella term referring to the various means employed to designate that individuals or organizations have met or exceeded established standards. These may include accreditation of programs or organizations and certification, registration, or licensure of individuals. Accreditation refers to a legitimate state or national organization verifying that an educational program or organization meets standards. Certification is the process by which a non-governmental agency or association grants recognition to an individual who has met predetermined qualifications specified by the agency or association. Certification is applied for by individuals on a voluntary basis and represents a professional status when achieved. Typical qualifications include 1) graduation from an accredited or approved program and 2) acceptable performance on a qualifying examination. While there is no national accreditation of CCHC training programs or individual CCHCs at this time, this is a future goal. 

CCHC services may be provided through the public health system, resource and referral agency, private source, local community action program, health professional organizations, other non-profit organizations, and/or universities. Some professional organizations include child care health consultants in their special interest groups, such as the AAP’s Section on Early Education and Child Care and the National Association of Pediatric Nurse Practitioners (NAPNAP).

CCHCs who are not employees of health, education, family service or child care agencies may be self-employed. Compensating them for their services via fee-for-service, an hourly rate, or a retainer fosters access and accountability.

Listed below is a sample of the policies and procedures child care health consultants should review and approve:

  1. Admission and readmission after illness, including inclusion/exclusion criteria;
  2. Health evaluation and observation procedures on intake, including physical assessment of the child and other criteria used to determine the appropriateness of a child’s attendance;
  3. Plans for care and management of children with communicable diseases;
  4. Plans for prevention, surveillance and management of illnesses, injuries, and behavioral and emotional problems that arise in the care of children;
  5. Plans for caregiver/teacher training and for communication with parents/guardians and primary care providers;
  6. Policies regarding nutrition, nutrition education, age-appropriate infant and child feeding, oral health, and physical activity requirements;
  7. Plans for the inclusion of children with special health or mental health care needs as well as oversight of their care and needs;
  8. Emergency/disaster plans;
  9. Safety assessment of facility playground and indoor play equipment;
  10. Policies regarding staff health and safety;
  11. Policy for safe sleep practices and reducing the risk of SIDS;
  12. Policies for preventing shaken baby syndrome/abusive head trauma;
  13. Policies for administration of medication;
  14. Policies for safely transporting children;
  15. Policies on environmental health – handwashing, sanitizing, pest management, lead, etc.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
1.6.0.3 Infant and Early Childhood Mental Health Consultants
1.6.0.4 Early Childhood Education Consultants
REFERENCES
  1. Alkon, A., J. Bernzweig, K. To, J. K. Mackie, M. Wolff, J. Elman. 2008. Child care health consultation programs in California: Models, services, and facilitators. Public Health Nurs 25:126-39.
  2. Alkon, A., J. Farrer, J. Bernzweig. 2004. Roles and responsibilities of child care health consultants: Focus group findings. Pediatric Nurs 30:315-21.
  3. Crowley, A. A. 2000. Child care health consultation: The Connecticut experience. Maternal Child Health J 4:67-75.
  4. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. 2005. Opportunities for health promotion education in child care. Pediatrics 116:499-505.
  5. Farrer, J., A. Alkon, K. To. 2007. Child care health consultation programs: Barriers and opportunities. Maternal Child Health J 11:111-18.
  6. Heath, J. M., et al. 2005. Creating a statewide system of multi-disciplinary consultation system for early care and education in Connecticut. Farmington, CT: Child Health and Development Institute of Connecticut. http://nitcci.nccic.acf.hhs.gov/resources/10262005_93815_901828.pdf.
  7. Crowley, A. A., J. M Kulikowich. 2009. Impact of training on child care health consultant knowledge and practice. Pediatric Nurs 35:93-100.
  8. Crowley, A. A., R. M. Sabatelli. 2008. Collaborative child care health consultation: A conceptual model. J for Specialists in Pediatric Nurs 13:74-88.
  9. Dellert, J. C., D. Gasalberti, K. Sternas, P. Lucarelli, J. Hall. 2006. Outcomes of child care health consultation services for child care providers in New Jersey: A pilot study. Pediatric Nurs 32:530-37.
  10. Alkon, A., J. Bernzweig, K. To, M. Wolff, J. F. Mackie. 2009. Child care health consultation improves health and safety policies and practices. Academic Pediatrics 9:366-70.
  11. Crowley, A. A. 2001. Child care health consultation: An ecological model. J Society Pediat Nurs 6:170-81.
NOTES

COVID-19 modification as of May 21, 2021 

1.6.0.2: Frequency of Child Care Health Consultation Visits

Content in the STANDARD was modified on 8/22/2013.


The child care health consultant (CCHC) should visit each facility as needed to review and give advice on the facility’s health component and review the overall health status of the children and staff (1-4). Early childhood programs that serve any child younger than three years of age should be visited at least once monthly by a health professional with general knowledge and skills in child health and safety and health consultation. Child care programs that serve children three to five years of age should be visited at least quarterly and programs serving school-age children should be visited at least twice annually. In all cases, the frequency of visits should meet the needs of the composite group of children and be based on the needs of the program for training, support, and monitoring of child health and safety needs, including (but not limited to) infectious disease, injury prevention, safe sleep, nutrition, oral health, physical activity and outdoor learning, emergency preparation, medication administration, and the care of children with special health care needs. Written documentation of CCHC visits should be maintained at the facility.
RATIONALE
Almost everything that goes on in a facility and almost everything about the facility itself affects the health of the children, families, and staff. (1-4). Because infants are developing rapidly, environmental situations can quickly create harm. Their rapid changes in behavior make regular and frequent visits by the CCHC extremely important (2-4). More frequent visits should be arranged for those facilities that care for children with special health care needs and those programs that experience health and safety problems and high turnover rate to ensure that staff have adequate training and ongoing support (2). In one study, 84% of child care directors who were required to have weekly health consultation visits considered the visits critical for children’s health and program health and safety (2). Growing evidence suggests that frequent visits by a trained health consultant improves health policies and health and safety practices  and improves children’s immunization status, access to a medical home, enrollment in health insurance, timely screenings, and potentially reduces the prevalence of obesity with a targeted intervention (5-11). Furthermore, in one state, child care center medication administration regulatory compliance was associated with weekly visits by a trained nurse child care health consultant who delivered a standardized best practice curriculum (12).
COMMENTS
State child care regulations display a wide range of frequency and recommendations in states that require CCHC visits (5,6,13), from as frequently as once a week for programs serving children under three years of age to twice a year for programs serving children three to five years of age (2,5,6,13).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
1.1.1.3 Ratios for Facilities Serving Children with Special Health Care Needs and Disabilities
1.6.0.1 Child Care Health Consultants
1.6.0.5 Specialized Consultation for Facilities Serving Children with Disabilities
3.6.2.7 Child Care Health Consultants for Facilities That Care for Children Who Are Ill
4.4.0.1 Food Service Staff by Type of Facility and Food Service
4.6.0.2 Nutritional Quality of Food Brought From Home
9.4.1.17 Documentation of Child Care Health Consultation/Training Visits
10.3.4.3 Support for Consultants to Provide Technical Assistance to Facilities
10.3.4.4 Development of List of Providers of Services to Facilities
REFERENCES
  1. Alkon, A., J. Bernzweig, K. To, J. K. Mackie, M. Wolff, J. Elman. 2008. Child care health consultation programs in California: Models, services, and facilitators. Public Health Nurs 25:126-39.
  2. Crowley, A. A. 2000. Child care health consultation: The Connecticut experience. Maternal Child Health J 4:67-75.
  3. Dellert, J. C., D. Gasalberti, K. Sternas, P. Lucarelli, J. Hall. 2006. Outcomes of child care health consultation services for child care providers in New Jersey: A pilot study. Pediatric Nursing 32:530-37.
  4. Gupta, R. S., S. Shuman, E. M. Taveras, M. Kulldorff, J. A. Finkelstein. 2005. Opportunities for health promotion education in child care. Pediatrics 116:499-505.
  5. Healthy Child Care Consultant Network Support Center, CHT Resource Group. 2006. The influence of child care health consultants in promoting children’s health and well-being: A report on selected resources. http://hcccnsc.jsi.com/resources/publications/CC_lit_review_Screen_All.pdf.
  6. Alkon, A., J. Bernzweig, K. To, M. Wolff, J. F. Mackie. 2009. Child care health consultation improves health and safety policies and practices. Academic Pediatrics 9:366-70.
  7. Crowley, A. A. & Kulikowich, J. Impact of training on child care health consultant knowledge and practice. Pediatric Nursing.,2009, 35 (2): 93-100.
  8. Nurse Consultant Intervention Improves Nutrition and Physical Activity Knowledge, Policy, and Practice and Reduces Obesity in Child Care.  A. Crowley, A. Alkon, B Neelon, S. Hill, P. Yi, E. Savage, V. Ngyuen, J. Kotch. Head Start Research Conference, Washington, DC. June 20, 2012.
  9. Benjamin, S. E., A. Ammerman, J. Sommers, J. Dodds, B. Neelon, D. S. Ward. 2007. Nutrition and physical activity self-assessment for child care (NAP SACC): Results from a pilot intervention. Journal of Nutrition Education and Behavior 39(3):142-9.
  10. Bryant, D. “Quality Interventions for Early Care and Education.” Early Developments, Spring 2013, http://fpg.unc.edu/sites/default/files/resources/early-developments/FPG_EarlyDevelopments_v14n1.pdf.
  11. Isbell P, Kotch JB, Savage E, Gunn E, Lu LS, Weber DJ. Improvement of child care programs’ policies, practices, and children’s access to health care linked to child care health consultation. NHSA Dialog: A Research to Practice Journal 2013;16 (2):34-52 (ISSN:1930-1395).
  12. Crowley, A. A. & Rosenthal, M. S. IMPACT: Ensuring the health and safety of Connecticut’s early care and education programs. 2009. Farmington, CT: The Child Health and Development Institute of Connecticut.
  13. National Resource Center for Health and Safety in Child Care and Early Education. 2010. Child care health consultant requirements and profiles by state. http://nrckids.org/default/assets/File/CCHC%20by%20state%20NOV%202012_FINAL.pdf.
NOTES

Content in the STANDARD was modified on 8/22/2013.

1.6.0.3: Infant and Early Childhood Mental Health Consultants

COVID-19 modification as of May 21, 2021 

Standard was last updated on September 13, 2022.



After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).

Early care and education programs should find and work with qualified infant and early childhood mental health consultants (IECMHCs) to help create environments that promote social-emotional development and health in early childhood, to help with behavioral concerns, and to lower staff stress.

Programs should find and work with IECMHCs who:

  • Have professional credentials and expertise in early childhood development and child mental health such as psychiatry, psychology, developmental-behavioral pediatrics, clinical social work, or nursing
  • Work well with children, families, and program staff from different racial, ethnic, and cultural/language backgrounds
  • Have an understanding of infants and young children who have developmental delays or disabilities
  • Are experienced in trauma-informed care of young children and families
  • Are familiar with early care and education policies, practices, and regulations
  • Can partner with program directors, staff, and families, and work together with professionals of other disciplines

Programs should expect an IECMHC to share or help develop:

  • An assessment of the program’s needs, strengths, and areas for improvement in mental health
  • Policies on child, family, and staff mental health
  • Individual observations of children and staff to assess children’s development, behavior, and related needs
  • Resources for teaching children about understanding their feelings, emotional regulation (managing or expressing their emotional responses effectively), coping strategies, conflict resolution, empathy, and social skills
  • Connections and/or referrals to community mental health providers and special education systems or resources
  • Resources to understand the mental health needs of specific children or families
  • Collaboration for screening or referral of children to early intervention services and/or local providers
  • Lists of community resources for families and staff who may need mental health support

Program staff should work with an IECMHC to develop the following skills:

  • Create and keep up healthy social-emotional environments and relationships in the program and with families
  • Understand and support staff to manage children’s challenging behaviors (such as aggression and tantrums) as well as internalizing behaviors (such as anxiety and depression), and how to respond appropriately
  • Recognize and respond to the needs of children who are sad or anxious, avoid others, or harm themselves
  • Partner with staff to make sure children with developmental delays and disabilities are included safely and meaningfully in all activities and experiences, within the scope of the mental health consultant’s expertise
  • Approach families about behavioral or mental health concerns for their children
  • Recognize the daily stressors and mental health needs of families and staff
  • Respond appropriately to child, family, or community crises (such as serious illness, homelessness, substance abuse, divorce, deaths, or natural events like tornados, floods, wildfires)
  • Understand staff’s obligations and required actions as mandated reporters
  • Identify and address staff’s work-related stress, responses to stress, and self-care needs 

Early care and education program leadership/staff and IECMHCs should meet regularly to discuss program needs and talk about concerns for children’s development and behavior. 

COVID-19 modification as of May 21, 2021

 

In response to the Centers for Disease Control and Prevention’s COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, it is recommended that early childhood programs:

  • Follow guidance from your state and local health department as well as your state child care licensing agency.

Infant and early childhood mental health consultants (IECMHCs) can support recovery and reduce harm from the social, emotional, and mental health challenges children and families face during COVID-19, such as:

  • Changes in families routines (e.g., physical distance from family, friends, worship community)
  • Disrupted learning environments (e.g., virtual learning environments, technology access)
  • Disrupted health care access (e.g., missed well-child and immunization visits, limited access to mental, speech, and occupational health services)
  • Missed significant life events (e.g., important events/celebrations, vacation plans, and/or milestones)
  • Lost security and safety (e.g., food insecurity and housing, increased exposure to violence and online harms, threat of physical illness and future uncertainty)

Refer to the Centers for Disease Control and Prevention’s COVID-19 Parental Resources Kit:

Ensuring Children and Young People’s Social, Emotional, and Mental Well-beingto support children and families with these challenges.

Use IECMHCs to deliver:

  • Individual and group staff consultation to guide their work with children and families
  • Child and family consultation and connect to resources and services as needed
  • Timely staff trainings virtually

Consider alternatives to IECMHCs  onsite consultation and schedule other methods for delivering services:

  • Use Virtual video visits or phone to review child social and emotional health needs, address health and safety issues and any training needs
  • Plan outdoor visits, if weather allows, using face mask and physical distancing

Refer to the COVID-19 modifications in CFOC Standard 1.7.0.2: Daily Staff Health Check when on site visits are essential.

Additional Resources:

Center of Excellence for Infant and Early Childhood Mental Health Consultation. COVID-19 and Infant and Early Childhood Mental Health Consultation (IECMHC): How to Provide Services When Everything Is Different

Center for Early Childhood Mental Health Consultation. https://www.ecmhc.org/
Early Childhood Learning and Knowledge Center. Head Start Heals Campaign
American Academy of Pediatrics. Guidance Related to Childcare During COVID-19

 

 

RATIONALE

Infant and early childhood mental health is essential to develop many life skills. 1-4 Many children learn these skills in early care and education settings.5–6 For example, children learn to take turns, wait for rewards, and respond to challenges and frustrations. However, many factors can interfere with this learning.

Many children have adverse childhood experiences early in life such as child abuse, domestic violence, homelessness, parental substance abuse, and racism.7–9 Greater exposure to these experiences often results in behaviors that lead to a child’s suspension or expulsion from early care and education programs.10 Staff may be aware of adverse experiences or see signs of a child’s distress such as acting out, persistent sadness, anxiety, or withdrawal from others.11 With training on trauma-informed practices, teachers can help lower the harmful effects of stress on children; this training creates safe, trusting environments for learning and forming relationships.12 Staff can help to identify children and families who may need referral for mental health care.

When children’s emotional struggles turn into challenging behaviors, they can disrupt group activities. These events may raise staff stress, sometimes causing harsh responses.13,14 Unintentional prejudices result in more suspension or expulsion of children with disabilities, children with behavioral challenges, and children of color.15–19 Program staff need strategies to effectively lower and deal with challenging behaviors. They also need to be more aware of their own experiences and biases, and have ways to recognize and lower their stress levels.

Infant and early childhood mental health consultation is an evidence-based strategy that has helped early educators address complex issues for better outcomes for children, families, and staff.20 Qualified consultants can work with a program, classroom, and individual children and families. Consultants can help form policies for child supervision, discipline, suspension/expulsion, preventing and reporting child abuse and neglect, inclusion of children with disabilities, confidentiality of records, and staff wellness, and help staff follow the policies. They can share lessons and classroom strategies to promote development of essential social-emotional skills, reduce challenging behaviors, and eliminate expulsions. They can also build a program’s capacity to identify and support the mental health needs of individual children, families, and staff. 13, 18, 21-23  An ongoing relationship with a consultant is strongly recommended for shared understanding and trust.24,25

COMMENTS

Programs may find qualified consultants by contacting local mental health and behavioral care providers (e.g., child clinical and school psychologists, licensed clinical social workers, child psychiatrists, developmental pediatricians, qualified health care providers). Some state, local, tribal, or territorial child care licensing, early education, or human service agencies may keep lists of qualified mental health consultants. Local colleges and universities may be able to help find graduate school professionals-in-training (trainees). The cost for trainees may be lower than for community professionals, but turnover is likely to be higher as trainees complete their studies. To make sure someone can provide the services, ask about credentials and experience (or ongoing supervision for consultants-in-training). This includes asking about up-to-date professional licensure and certifications, types of services, frequency of contact, and the cost. 

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
1.3.2.4 Additional Qualifications for Caregivers/Teachers Serving Children Birth to Thirty-Five Months of Age
1.4.5.2 Child Abuse and Neglect Education
1.6.0.1 Child Care Health Consultants
1.6.0.4 Early Childhood Education Consultants
1.6.0.5 Specialized Consultation for Facilities Serving Children with Disabilities
1.7.0.5 Stress Management for Staff
2.1.1.3 Coordinated Child Care Health Program Model
2.1.1.4 Monitoring Children’s Development/Obtaining Consent for Screening
2.1.1.5 Helping Families Cope with Separation
2.2.0.1 Methods of Supervision of Children
2.2.0.6 Discipline Measures
2.2.0.8 Preventing Expulsions, Suspensions, and Other Limitations in Services
2.2.0.10 Using Physical Restraint
3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation
3.4.4.4 Care for Children Who Have Experienced Abuse/Neglect
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.17 Documentation of Child Care Health Consultation/Training Visits
9.4.2.8 Release of Child’s Records
10.3.4.3 Support for Consultants to Provide Technical Assistance to Facilities
REFERENCES
  1. Whitebrook M, McLean C, August LJE, Edwards B. Early childhood workforce index 2018. Berkeley, CA: Center for the Study of Child Care Employment, University of California, Berkeley; 2018. Accessed August 26, 2021. https://cscce.berkeley.edu/wp-content/uploads/2018/06/Early-Childhood-Workforce-Index-2018.pdf

  2. Hammer D, Melhuish E, Howard SJ. Do aspects of social, emotional and behavioural development in the pre-school period predict later cognitive and academic attainment?. Aust J Educ. 2017 Nov;61(3):270-287. https://doi.org/10.1177/0004944117729514
  3. HammerD, Melhuish E, Howard SJ. Antecedents and consequences of social–emotional development: a longitudinal study of academic achievement. Arch Sci Psychol. 2018;6(1):105. http://dx.doi.org/10.1037/arc0000034

  4. Robson DA, Allen MS, Howard SJ. Self-regulation in childhood as a predictor of future outcomes: a meta-analytic review. Psychol Bull. 2020;146(4):324-354. doi:10.1037/bul0000227

  5. Qi CH, Zieher A, Lee Van Horn M, Bulotsky-Shearer R, Carta J. Language skills, behaviour problems, and classroom emotional support among preschool children from low-income families. Early Child Dev Care. 2020;190(14):2278-2290. https://doi.org/10.1080/03004430.2019.1570504

  6. Berry D, Blair C, Willoughby M, Garrett-Peters P, Vernon-Feagans L, Mills-Koonce WR, Family Life Project Key Investigators. Household chaos and children’s cognitive and socio-emotional development in early childhood: does childcare play a buffering role?. Early Child Res Q. 2016;34:115-127. https://doi.org/10.1016/j.ecresq.2015.09.003

  7. National Scientific Council on the Developing Child. Establishing a level foundation for life: mental health begins in early childhood: Working Paper 6. Updated Edition. Published December 2012. Accessed February 21, 2022. https://developingchild.harvard.edu/resources/establishing-a-level-foundation-for-life-mental-health-begins-in-early-childhood/
  8. Giano Z, Wheeler DL, Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health. 2020;20(1):1327. doi:10.1186/s12889-020-09411-z

  9. Merrick MT, Ford DC, Ports KA, Guinn AS. Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatr. 2018;172(11):1038-1044. doi:10.1001/jamapediatrics.2018.2537

  10. Zeng S, Corr CP, O’Grady C, Guan Y. Adverse childhood experiences and preschool suspension expulsion: a population study. Child Abuse Negl. 2019;97:104149. https://doi.org/10.1016/j.chiabu.2019.104149
  11. Cummings KP, Swindell J. Using a trauma-sensitive lens to support children with diverse experiences. Young Except Child. 2019;22(3):139-149. https://doi.org/10.1177/1096250618756898
  12. Bartlett JD, Smith S. The role of early care and education in addressing early childhood trauma. Am J Community Psychol. 2019;64(3-4):359-372. https://doi.org/10.1002/ajcp.12380

  13. Silver HC, Zinsser KM. The interplay among early childhood teachers’ social and emotional well-being, mental health consultation, and preschool expulsion. Early Educ Dev. 2020;31(7):1133-1150. https://doi.org/10.1080/10409289.2020.1785267

  14. Zinsser KM, Zulauf CA, Das VN, Silver HC. Utilizing social-emotional learning supports to address teacher stress and preschool expulsion. J Appl Dev Psychol. 2019;61:33-42. https://doi.org/10.1016/j.appdev.2017.11.006

  15. Zeng S, Pereira B, Larson A, Corr CP, O’Grady C, Stone-MacDonald A. Preschool suspension and expulsion for young children with disabilities. Except Child. 2021;87(2):199-216. doi:10.1177/0014402920949832

  16. Davis AE, Perry DF, Rabinovitz L. Expulsion prevention: framework for the role of infant and early childhood mental health consultation in addressing implicit biases. Infant Ment Health J. 2020;41(3):327-339. doi:10.1002/imhj.21847

  17. Hooper A, Schweiker C. Prevalence and predictors of expulsion in homebased child care settings. Infant Ment Health J. 2020;41(3):411-425. https://doi.org/10.1002/imhj.21845

  18. Miles E, Stoker J, Senehi N, et al. Suspension and expulsion in Colorado early care and education settings: child, program, and communitylevel predictors. Infant Ment Health J. 2021;42(6):767-783. https://doi.org/10.1002/imhj.21944

  19. Stegelin D, Leggett C, Ricketts D, Bryant M, Peterson C, Holzner A. Trauma-informed preschool education in public school classrooms: responding to suspension, expulsion, and mental health issues of young children. J Risk Issues. 2020;23(2):9-24. https://files.eric.ed.gov/fulltext/EJ1286553.pdf

  20. Trivedi P, deMonsabert J, Horen N. Infant and early childhood mental health consultation: overview of research, best practices, and examples. Published 2021. Accessed February 22, 2022. https://childcareta.acf.hhs.gov/sites/default/files/public/pdgb5_iecmhc_rtpbrief_acc.pdf
  21. Conners Edge NA, Kyzer A, Abney A, Freshwater A, Sutton M, Whitman K. Evaluation of a statewide initiative to reduce expulsion of young children. Infant Ment Health J. 2021;42(1):124-139. https://doi.org/10.1002/imhj.21894

  22. Centers for Disease Control and Prevention. Coughing and sneezing. CDC.gov Web site. Last reviewed April 22, 2020. Accessed November 3, 2021. https://www.cdc.gov/healthywater/hygiene/etiquette/coughing_sneezing.html

  23. Gilliam WS, Maupin AN, Reyes CR. Early childhood mental health consultation: results of a statewide random-controlled evaluation. J Am Acad Child Adolesc Psychiatry. 2016;55(9):754-761. doi:10.1016/j.jaac.2016.06.006

  24. Davis AE, Barrueco S, Perry DF. The role of consultative alliance in infant and early childhood mental health consultation: child, teacher, and classroom outcomes. Infant Ment Health J. 2021;42(2):246-262. doi:10.1002/imhj.21889

  25. Vuyk MA, SpragueJones J, Reed C. Early childhood mental health consultation: an evaluation of effectiveness in a rural community. Infant Ment Health J. 2016;37(1):66-79. https://doi.org/10.1002/imhj.21545

NOTES

COVID-19 modification as of May 21, 2021 

Standard was last updated on September 13, 2022.

1.6.0.4: Early Childhood Education Consultants


A facility should engage an early childhood education consultant who will visit the program at minimum semi-annually and more often as needed. The consultant must have a minimum of a Baccalaureate degree and preferably a Master’s degree from an accredited institution in early childhood education, administration and supervision, and a minimum of three years in teaching and administration of an early care/education program. The facility should develop a written plan for this consultation which must be signed annually by the consultant. This plan should outline the responsibilities of the consultant and the services the consultant will provide to the program.

The knowledge base of an early childhood education consultant should include:

  1. Working knowledge of theories of child development and learning for children from birth through eight years across domains, including socio-emotional development and family development;
  2. Principles of health and wellness across the domains, including social and emotional wellness and approaches in the promotion of healthy development and resilience;
  3. Current practices and materials available related to screening, assessment, curriculum, and measurement of child outcomes across the domains, including practices that aid in early identification and individualizing for a wide range of needs;
  4. Resources that aid programs to support inclusion of children with diverse health and learning needs and families representing linguistic, cultural, and economic diversity of communities;
  5. Methods of coaching, mentoring, and consulting that meet the unique learning styles of adults;
  6. Familiarity with local, state, and national regulations, standards, and best practices related to early education and care;
  7. Community resources and services to identify and serve families and children at risk, including those related to child abuse and neglect and parent education;
  8. Consultation skills as well as approaches to working as a team with early childhood consultants from other disciplines, especially child care health consultants, to effectively support program directors and their staff.

The role of the early childhood education consultant should include:

  1. Review of the curriculum and written policies, plans and procedures of the program;
  2. Observations of the program and meetings with the director, caregivers/teachers, and parents/guardians;
  3. Review of the professional needs of staff and program and provision of recommendations of current resources;
  4. Reviewing and assisting directors in implementing and monitoring evidence based approaches to classroom management;
  5. Maintaining confidences and following all Family Educational Rights and Privacy Act (FERPA) regulations regarding disclosures;
  6. Keeping records of all meetings, consultations, recommendations and action plans and offering/providing summary reports to all parties involved;
  7. Seeking and supporting a multidisciplinary approach to services for the program, children and families;
  8. Following the National Association for the Education of Young Children (NAEYC) Code of Ethics;
  9. Availability by telecommunication to advise regarding practices and problems;
  10. Availability for on-site visit to consult to the program;
  11. Familiarity with tools to evaluate program quality, such as the Early Childhood Environment Rating Scale–Revised (ECERS–R), Infant/Toddler Environment Rating Scale–Revised (ITERS–R), Family Child Care Environment Rating Scale–Revised (FCCERS–R), School-Age Care Environment Rating Scale (SACERS), Classroom Assessment Scoring System (CLASS), as well as tools used to support various curricular approaches.
RATIONALE
The early childhood education consultant provides an objective assessment of a program and essential knowledge about implementation of child development principles through curriculum which supports the social and emotional health and learning of infants, toddlers and preschool age children (1-5). Furthermore, utilization of an early childhood education consultant can reduce the need for mental health consultation when challenging behaviors are the result of developmentally inappropriate curriculum (6,7). Together with the child care health consultant, the early childhood education consultant offers core knowledge for addressing children’s healthy development.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
1.6.0.1 Child Care Health Consultants
1.6.0.3 Infant and Early Childhood Mental Health Consultants
REFERENCES
  1. Dunn, L., K. Susan. 1997. What have we learned about developmentally appropriate practice? Young Children 52:4-13.
  2. Wesley, P. W., V. Buysse. 2006. Ethics and evidence in consultation. Topics Early Childhood Special Ed 26:131-41.
  3. Wesley, P. W., S. A. Palsha. 1998. Improving quality in early childhood environments through on-site consultation. Topics Early Childhood Special Ed 18:243-53.
  4. Wesley, P. W., V. Buysee. 2005. Consultation in early childhood settings. Baltimore, MD: Brookes Publishing.
  5. Bredekamp, S., C. Copple, eds. 2000. Developmentally appropriate practice in early childhood programs serving children from birth through age 8. Rev ed. National Association for the Education of Young Children (NAEYC). Publication no. 234. Washington, DC: NAEYC. http://www.naeyc.org/files/naeyc/file/positions/position statement Web.pdf.
  6. The Connecticut Early Education Consultation Network. CEECN: Guidance, leadership, support. http://ctconsultationnetwork.org.
  7. Connecticut Department of Public Health. Child day care licensing program. http://www.ct.gov/dph/cwp/view
    .asp?a=3141&Q=387158&dphNav_GID=1823/.

1.6.0.5: Specialized Consultation for Facilities Serving Children with Disabilities


When children at the facility include those with special health care needs, developmental delay or disabilities, and mental health or behavior problems, the staff or documented consultants should involve any of the following consultants in the child’s care, with prior informed, written parental consent and as appropriate to each child’s needs:

  1. A registered nurse, nurse practitioner with pediatric experience, or child care health consultant;
  2. A physician with pediatric experience, especially those with developmental-behavioral training;
  3. A registered dietitian;
  4. A psychologist;
  5. A psychiatrist;
  6. A physical therapist;
  7. An adaptive equipment technician;
  8. An occupational therapist;
  9. A speech pathologist;
  10. An audiologist for hearing screenings conducted on-site at child care;
  11. A vision screener;
  12. A respiratory therapist;
  13. A social worker;
  14. A parent/guardian of a child with special health care needs;
  15. Part C representative/service coordinator;
  16. A mental health consultant;
  17. Special learning consultant/teacher (e.g., teacher specializing in work with visually impaired child or sign language interpreters);
  18. A teacher with special education expertise;
  19. The caregiver/teacher;
  20. Individuals identified by the parent/guardian;
  21. Certified child passenger safety technician with training in safe transportation of children with special needs.
RATIONALE
The range of professionals needed may vary with the facility, but the listed professionals should be available as consultants when needed. These professionals need not be on staff at the facility, but may simply be available when needed through a variety of arrangements, including contracts, agreements, and affiliations. The parent’s participation and written consent in the native language of the parent, including Braille/sign language, is required to include outside consultants (1).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Cohen, A. J. 2002. Liability exposure and child care health consultation. http://www.ucsfchildcarehealth.org/pdfs/forms/CCHCLiability.pdf.