Calling All Licensors: Child Abuse Prevention and Injuries, Prevention of Infectious Diseases, Immunizations, and Developmental Quotients

This post will deal with several outcome variables related to our health and safety licensing system and a slight excursion into the program quality domain. But let’s start with the health and safety variables: prevention of child abuse and injury, keeping children healthy, prevention of infectious diseases, and immunizations. This post is intended for those who license early care and education programs. Usually when we talk about child outcomes, the research focuses more on the relationships between quality elements and how well children are doing in the respective programs. In this post, the focus is more on the licensing health and safety end of the continuum.

Prevention of child injury is a difficult variable to deal with. Children get injured when active even when supervised. Ask any parent, it just happens. The parents are not being neglectful although that clearly has an impact but even when parents are watching their children closely, injuries do occur. We need to be realistic in what we can accomplish in child care centers. So, now we take a large group of children and place them in a child care center. And if we learned anything from the pandemic, the density of individuals has an impact on health and safety. In the research literature, the size of the program doesn’t have much predictive ability until we come to child injuries where it does have. Larger programs have more injuries than child care centers that are smaller in size. But this makes a great deal of sense, the more children needing supervision is going to place increased demands on staff for observing and making sure children are safe. What would be a realistic goal when it comes to the prevention of child injuries? Hopefully the rates are lower than what we are seeing in children’s homes and in their indigenous neighborhoods for starters. As a footnote, the number of complaints regarding a program is a predictor of child injuries, the more complaints, the more injuries. There does not appear to be a relationship between child injuries and adult child ratio or group size which would be expected, especially with there being a relationship between child injuries and the size of the program. But this might be a place to utilize a new regulatory metric called the “Contact Hours Metric”. More about this metric when discussing the prevention of infectious diseases below.

Prevention of child abuse is equally difficult to deal with. But in this case, it is more about how well the child care staff are trained in identifying and reporting of suspected child abuse. We do know that child abuse prevention training programs vary a great deal across the USA. We also know that the incidence of reporting child abuse in child care is extremely low. This is wonderful if it is true and not because child care staff are not being properly trained on what to look for and how best to report.

Prevention of infectious diseases is and has always been a perennial problem in child care. Parents know all too well that until their child builds up the immunity to the various viruses circulating in a child care setting their child is going to get sick. Emphasis on preventive efforts such as hand washing helps but let’s face it when we bring the large numbers of children together, it is one of the by-products of this interaction and our emphasis of helping children to learn about sharing and to engage in such activities. What we have learned from the pandemic the spread of infectious disease is a difficult bug to prevent. Obviously through reducing adult child ratios, group size and increasing the amount of space for children helps to reduce to a certain extent the spread of infectious diseases along with vigilant hand washing. Several methodologies were created during the pandemic that may be helpful in ongoing monitoring of this issue, such as a new Contact Hours metric which was mentioned above regarding child injuries. For additional information regarding this new regulatory metric, please consult the following: Contact Hours: A New Metric for Monitoring Child Injuries and Illnesses in Child Care Centers, November 2023, DOI: 10.13140/RG.2.2.11768.21767.

The one area when it comes to rules and regulations that has surfaced as a direct intervention that leads to healthy development in young children has to do with immunization status. Immunization status is both a process and outcome variable. There is a direct relationship between this rule in that it clearly demonstrates an outcome with children who are properly immunized. The other aspect of this rule is that it is a good predictor rule for all regulatory compliance. So it does double duty by seeing compliance with this specific rule.

On the program quality end of things, licensing and health & safety standards can only go so far when it comes to impacting the developmental quotients for children. An excursion into program quality that focuses on the qualifications of teachers and their interaction with all children needs to be the focus. But even with this focus positive results will only occur with a true partnership with parents and families. It is clear in the ECE research literature that parents are the key to a child’s development and family involvement and a parental focus and partnership is key for a lasting developmental change. There is growing evidence and research in this area demonstrating the key linkages between staff qualifications, interactions, and program philosophy & curriculum. This is a hopeful development that should continue to demonstrate the linkages between licensing and quality initiatives.

The reason for this post is to make individuals aware of the key outcomes when it comes to early care and education licensing and monitoring and what the limitations are. We need to be realistic in our expectations and what are the best ways to protect children. So much additional research is needed here. I have always been amazed by the need to do research in the licensing domain but have found it lacking. Here is probably the most influential policy making arena that impacts all early care and education but so little research has focused on the impact of regulatory compliance on children. Albeit, I have suggested that we need to go well beyond licensing in order to deal with children’s developmental status by utilizing more of an integrated form of monitoring which combines health and safety standards with program quality focused standards.