Use of a statewide system to improve health and safety in child care facilities

Background.-The Early Childhood Education Linkage System (ECELS) in Pennsyl vania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly de veloped statewide systems and about how users compare with nonusers of such a system. Objectives.-Our objectives were 1) to assess knowledge and use of ECELS amo ng child care providers in PA, 2) to compare users and nonusers of ECELS wi th regard to health concerns, advice-seeking preferences, and infant sleep positioning, and 3) to assess satisfaction among users of ECELS. Methods.-Cross-sectional telephone survey of directors of 400 licensed chil d care centers (CCCs) and providers of 400 registered family child care hom es (FCCHs) in PA. Results.-The proportion of children with certain special health care needs mirrored the prevalence in the national child population. Of the facilities surveyed, 88% of CCCs and 71% of FCCHs had heard of ECELS. Among these, 85 % bad used ECELS's services in the previous 12 months. Significantly more n onusers than users consulted doctors, whereas more users consulted health p rofessionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing inf ants on their backs only to sleep. Users who placed infants on their backs were more likely than nonusers to have a written policy about the correct p ractice (55% and 26%, respectively; P = .02). Overall, 46% of users and 28% of nonusers reported having a sleep position policy (P = .02). Users were at least 95% satisfied with ECELS's services. Conclusion.-This statewide system reached most child care providers surveye d: more outreach is needed to providers in FCCHs. The health concerns, safe ty practices, and advice-seeking preferences of child care providers descri bed in this article can inform others who are developing similar collaborat ive services in each state. Further research on the impact of HCCA programs on health and safety practices (such as correct infant sleep positioning) is warranted.