Research

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The California Childcare Health Program is engaged in several research projects. We will summarize our present research projects and some past projects, along with a list of the instruments used in our health and safety studies in ECE programs.

Present Projects

Past Projects

 

Present Projects

 

Healthy Beverages in Child Care: Putting Policy into Practice

This project aims to develop, pilot-test, and evaluate the utility and sustainability of standardized, online training for licensed providers on ways to create and maintain a healthy beverage environment for children in child care.

Funder - UC Agriculture and Natural Resources 4/1/2016 - 9/30/2019

Family Child Care Nutrition Pilot Intervention Project

Overall Project Goal:

  1. To inform the development and adoption of a statewide nutrition policy for family child care homes (FCCHs) in California.
  2. To support the implementation of new federal CACFP standards.
  3. To provide preliminary data and refined nutrition standards for the implementation of a larger, expanded cluster randomized-controlled intervention trial of comprehensive nutrition standards in FCCHs.

Pilot Intervention Project Objective:

To determine if a pilot educational intervention focusing on nutrition standards for family child care home providers is feasible, acceptable, cost-effective, and sustainable in California.

Funder - California Food Policy Advocates (CFPA) 10/1/2016-9/31/2017

Past Projects

Developing an Integrated Pest Management Program to Reduce the Exposure to Pesticides for Young Children in Family Child Care Homes in California

The overall goal of this three-year project is to reduce the exposure of pesticides for young children attending licensed family child care by providing an integrated pest management (IPM) program for family child care homes. In the first year we will conduct a qualitative study to determine the needs of the family child care providers in 3 regions of California and identify their pest management, knowledge and practices, and pesticide use. During the second and third years, we will conduct a pilot study. The 6-month quasi-experimental pilot study will evaluate changes in environment, policies, and practices in 21 family child care homes following a nurse-led IPM intervention. The intervention will include dissemination of the Integrated Pest Management: A Toolkit for Family Child Care Homes.

Funder - California Department of Pesticide Regulation 9/1/2014 - 3/31/2017

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California Statewide Disaster Plan and Emergency Preparedness for Early Care and Education

This project aims to minimize potential injury, loss, destruction, and disruption for children and families in the event of a disaster by writing a California Statewide Disaster and Emergency Plan for early care and education (ECE). The state disaster plan will coordinate emergency planning and ECE response activities with key state agencies and existing emergency operations. In addition, the project will provide guidance for ECE to develop custom emergency preparedness plans based on individual program needs and local resources.

Funder - California Department of Education Early Care and Education Division, 7/1/2015 -6/30/2016

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California Sudden Infant Death Syndrome Program 

Under the direction of the California Department of Public Health, Maternal, Child, and Adolescent Health Division, the California Sudden Infant Death Syndrome (SIDS) Program serves families and professionals affected by the sudden and unexpected death of an infant. The program provided support services, education, training and consultation

Funder - Federal Title V Block Grant through the California Department of Public Health, Maternal, Child, and Adolescent Health Division, November 1, 2013 - June 30, 2015

Integrated Pest Management Intervention Study in 45 Child Care Centers in Three Counties 

This research study evaluated the impact of a nurse-led integrated pest management (IPM) intervention and dissemination of the Integrated Pest Management: A Toolkit for Early Care and Education Programs. The IPM intervention included an IPM workshop for child care staff, an IPM Checklist assessment and photo summary of the problems identified, and a review of centers' pest management policies. An "IPM Toolbox" with items to implement IPM was given to each participating child care program. The goals of the project were to increase IPM knowledge and practices, reduce the use of pesticides in child care centers, and subsequently reduce the exposure to pesticides for children and staff.

Funder - Department of Pesticide Regulations, 08/01/2012 - 06/30/2015

Health and Safety Checklist for Early Care and Education Programs: Based onCaring for Our Children National Health and Safety Performance Standards - Third Edition

The Health and Safety Checklist is a 112-item tool developed to assess key health and safety standards and identify ways to improve health and safety in early care and education (ECE) programs. The Checklist includes 72 out of the 138 key health and safety standards in Stepping Stones Third Edition. The Checklist was reviewed by an advisory committee of health and safety experts and pilot tested by child care health consultants. The Checklist is user-friendly, easy-to-understand, and has links to theCaring for Our Children standards and other related resources. It can be used on a computer, electronic tablet or smart phone, or printed on paper and filled out by hand. The User Manual provides background information and guidelines for rating each item.

Funder - School of Nursing at the University of California, San Francisco, 2014

Early Childhood Comprehensive Systems 

Early Childhood Comprehensive Systems (ECCS) initiative encouraged primary care providers, social services, early childhood educators, and families to work together on seamless systems of care for children in the critical formative years from birth to age 3. The goal of ECCS was to help children grow up healthy and ready to learn by addressing their physical, emotional and social health in a broad-based and coordinated way.

Funder - Federal Health Resources and Services Administration through the California Department of Public Health, 2003-2013

Integrated Pest Management in Early Care and Education Programs 

An integrated pest management (IPM) Toolkit was developed for early care and education (ECE) staff to reduce the exposure of pesticides for children and staff in child care programs. The English and Spanish language toolkit includes a curriculum and complementary materials (laminated posters, Health & Safety Notes on individual pests, Fact Sheets for Families, and an IPM Checklist). The Toolkit was disseminated at workshops, to child care agencies, and is posted on the California Childcare Health Program website. To develop a standardized research instrument to assess pest control practices, an IPM Checklist was developed and pilot tested at 10 local child care programs. This collaborative project included researchers and content experts at University of California (UC) Berkeley Center for Environmental Research, Children's Health and UC Statewide IPM Program at UC Davis, and the California Department of Pesticide Regulation.

Funder - California's Department of Pesticide Regulation 11/1/08-5/31/11

Child Care Wellness Study: Promoting Nutrition and Physical Activity in Child Care Centers

DHHS, HRSA, MCHB, subcontract under University of North Carolina 
(7/01/08 – 08/30/10)

The Child Care Wellness Study (CCWS) was an experimental study conducted in CT, NC, and CA child care centers to study the effect of a nutrition and physical activity intervention on children’s weight, physical activity and nutrition. The intervention included nutrition and physical activity workshops for child care providers and parents conducted by a nurse child care health consultant. The study was conducted in 4-6 child care centers in each state. This multi-state study was conducted with colleagues at the University of North Carolina, Chapel Hill School of Public Health and Yale University School of Nursing and funded by the federal Maternal and Child Health Bureau.

Child Care Health Linkages Project (Year of completion 2005)

The Child Care Health Linkages Project, funded by First 5 California, included a three-year evaluation (September 2001 to June 2004) to study the effects of health consultation services provided by Child Care Health Consultants (CCHC) and Child Care Health Advocates (CCHAs) on the health and safety of children 0-5 years of age attending child care. The evaluation included three components. First, an evaluation of the California Training Institute (CTI) for Child Care Health Consultants and Child Care Health Advocates. Training was assessed using pre and post knowledge-based tests and process evaluations following each training session. Second, a formative evaluation was conducted, which was be a descriptive study of the Child Care Health Consultant (CCHC) and Child Care Health Advocate (CCHA) roles in early care and education settings and the implementation of these new roles and programs at county and center levels. Third, an outcome evaluation was conducted in five of the 20 counties to study the effect of the child care health consultation programs on the number of national health and safety standards met in the ECE programs, number and quality of the health and safety written policies, and the health status of the children in the centers.

Advocate Daily Encounter Form
The Child Health Record Review
CCHP Health and Safety Checklist--Revised
CCHP Health and Safety Policies Checklist

Instruments

Advocate Daily Encounter Form

In California, CCHCs work with Child Care Health Advocates (CCHAs). The CCHAs use a form that was modified from the DEF and is similar to the DEF. The form is called the Advocate Daily Encounter Form (ADEF). The ADEF documents the health and safety activities of the CCHAs. The ADEF was developed by the Child Care Health Linkages Evaluation Project, of the University of California, San Francisco School of Nursing.

Advocate Daily Encounter Form (PDF; 57k)

The Child Health Record Review

Early Care and Education Program Health Assessment (Child Health Record Review) was developed to assess children's health status based on information in children's health records located on-site at early care and education (ECE) programs. They are based on the Child Care Evaluation Worksheet and Guidelines for Completion of form developed by the University of North Carolina of Chapel Hill Quality Enhancement Project for Infants and Toddlers Quality Enhancement Project for Infants and Toddlers, 2001; and researchers' and Child Care Health Consultants' experiences.

The Child Health Record Review (PDF; 11k)

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CCHP Health and Safety Checklist--Revised

The CCHP Health and Safety Checklist-Revised is an 82-item observational measure that was developed to: 1) assess the health and safety status in early care and education (ECE) programs, 2) assess compliance with key National Health and Safety Performance Standards (American Academy of Pediatrics, American Public Health Association and National Resource Center for Health and Safety in Child Care, 2002), and 3) assist users to develop interventions to address the health and safety needs identified on the CCHP H&S Checklist.

The CCHP H&S Checklist was modified from the original CCHP Health and Safety Checklist based on several years of researchers' and Child Care Health Consultants' experiences using the measure. In addition, the new Health and Safety Checklist was modified to be more user-friendly, comprehensive and better organized than the original CCHP Health and Safety Checklist. An advisory group of experts met to review and prioritize the items.

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CCHP Health and Safety Policies Checklist

The California Childcare Health Program Health and Safety Policies Checklist (2005) was developed to objectively assess written health and safety policies in early care and education programs. The Checklist can be used by child care providers or directors, child care health advocates, child care health consultants, health professionals, and researchers. It assesses the quality of written health and safety policies and helps child care and health professionals identify how to improve written policies and target interventions. The Checklist is based on the University of North Carolina of Chapel Hills's Quality Enhancement Project and the National Health and Safety Performance Standards (AAP, APHA, NRC, 2002).

CCHP Health and Safety Policies Checklist (PDF; 239k; 13pp)


Health and Physical Development Foundations for California’s Early Care and Education (Year of completion 2009)

This project supported the development of research-based foundations for the State of California Department of Education Child Development Division’s 4-5 year olds attending child care programs on their physical development and general health. The foundations were reviewed by a national panel of experts and California’s child care agencies and providers. The Foundations provide the guidelines for new state curricula for 4-5 year olds on physical development and general health. CCHP was funded by WestEd for the project.

Integrated Pest Management Checklist for Early Care and Education Programs

This Checklist was developed by an interdisciplinary team including epidemiologist, entomologist, child care providers and administrators, and nurses. It includes observable items to assess in the indoor and outdoor environment to identify possible places that pests may enter a building or find shelter, water, or food. It also includes an introduction with a suggestions for tools to use when conducting the assessment and a explanations for why certain items are included in the Checklist. It was administered in 10 child care programs before and after the integrated pest management workshops were provided for child care staff on the Integrated Pest Management Toolkit.  

 

Research Articles

  • Alkon A, Boyce J. (1999). Health assessment in four child care centers: Parent and staff perceptions. Pediatric Nursing, 25: 439-42.
  • Alkon A, Genevro J, Kaiser P, Tschann J, Chesney M, Boyce WT. (1999). The epidemiology of injuries in four child care centers. Archives Pediatric Adolescent Medicine, 153:1248-54.
  • Alkon A, Genevro J, Kaiser P, Tschann J, Chesney M, Boyce WT. (2000). Injuries in child care centers: Gender- environment interactions. Injury Prevention, 6:214-18.
  • Alkon A, Tschann JM, Ruane SH, Wolff M, Hittner A. (2001). A violence prevention and evaluation project with ethnically diverse populations. American Journal Preventive Medicine, 20:48-55.
  • Alkon A, Sokal-Gutierrez K, Wolff M. (2002). Child care health consultation improves health knowledge and compliance. Pediatris Nursing, 28:61-5.
  • Alkon A. (2003). Nonparental Child Care. In Rudolph’s Pediatrics, 21st Edition, Rudolph AM, Rudolph CD (Editors), McGraw-Hill, NY, Chapters 5:512-515.
  • Alkon A, Ramler M, MacLennan K. (2003). Evaluation of mental health intervention in child care centers. Early Childhood Education Journal, 31:91-99.
  • Alkon A, Boyer-Chu L. (2004). Oral health care starts early. Young Children, 59(2): 47.
  • Alkon A, Farrer J, Bernzweig J. (2004). Roles and responsibilities of child care health consultants: Focus group findings. Pediatric Nursing, 30(4): 315-321.
  • Farrer J, Alkon A, To, K. (2007). Child care health consultation programs: Barriers and opportunities. Maternal Child Health Journal, 11(2): 111-8.
  • Alkon A, Bernzweig J, To K, Mackie JK, Wolff M, Elman J. (2008). Child Care Health Consultation Programs in California: Models, Services, and Facilitators. Public Health Nursing, 25(2):126-139.
  • Wayne W, Alkon A. (2008). Creating a State Strategic Plan for Integrating Services for Children Using Multiple Qualitative Methods. Maternal Child Health Journal, 12:15-23.
  • Ward, T, Gay, C, Alkon, A, Anders, TF, Lee, KA. (2008). Nocturnal sleep and daytime nap behaviors in relation to salivary cortisol levels and temperament in preschool-age children attending childcare. Biological Research for Nursing, 9(3):244-253.
  • Alkon, A, To, K, Wolff, M, Mackie, J, Bernzweig, J. (2008). Assessing health and safety in early care and education programs: Development of the CCHP Health and Safety Checklist. Journal of Pediatric Health Care, 22(6):368-377.
  • Alkon A, Bernzweig, J, To, K, Wolff, M, Mackie, JF. (2009). Child care health consultation improves health and safety policies and practices. Academic Pediatrics, 9(5):366-369.
  • Bernzweig, J, Ramler, M, Alkon, A. (2009). Mental health consultation in early childhood classrooms. Zero to Three, 30(1): 47-51.
  • Alkon A, To K, Mackie JF, Wolff M, Bernzweig J. (2010). Health and safety needs in early care and education programs: What do directors, child health records, and National Standards tell us? Public Health Nursing, 27: 3-16.

 

Reports

Health and School Readiness Literature Review

The purpose of this literature review is to summarize the health components, initiatives, and outcomes of key School Readiness Programs in the United States, not including California. The intent of this review is to provide relevant information for county First 5 staff renewing their School Readiness Programs and developing health interventions and/ or outcomes to address the required 'health and social services' element of their programs. This literature review summarizes key findings of program components and outcomes related to health and School Readiness.

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