Guide for Implementing a CCHC Program

Hiring

Once funding is established, the next step is to determine which agency will hire and supervise the CCHC position. CCHCs are often hired by local agencies such as Local Health Departments or hospitals, Partnerships for Children or Child Care Resource and Referral Agencies, Head Start and Early Head Start, and other community-based agencies that support health, safety, and wellness for children. If different from the funding agency, a contract or memorandum of understanding (MOU) between the hiring agency and funding agency should be established.

All agencies considering hiring a CCHC should begin the process by considering the following with the support of a CCHC Coach:

• Develop a position description that meets the eligibility requirements for the NC CCHC Course requirements (sample position description)
• Post the position, recruit, and begin the interview process
• Before making a job offer, confirm with the NC Resource Center that the CCHC meets the requirements for acceptance into the NC CCHC Course.

Acceptance into the course is based on:

• Current job responsibilities that include providing child care health consultation services as outlined in the CCHC Program Manual
• Experience in or knowledge of
  • pediatric health,
  • community health,
  • health education,
  • early care and education.
• Be one of the following:
  • A licensed health care professional:
    • A registered nurse, physician, nurse practitioner, physician assistant, or paramedic with an active license that is unencumbered in the state where CCHC services are provided.
  • A health educator with either a minimum of:
    • A bachelor’s degree from a four-year college or university with a major in health education or related field such as community health or health promotion. Certified Health Education Specialist (CHES®) designation preferred.
    • A bachelor’s degree from a four-year college or university and at least three years’ experience working in public health education. Experience must include working primarily as a public health educator within the last five years.

Hiring a licensed health professional

Registered Nurse, Nurse Practitioner

Degrees for Registered Nurses are offered at both the associate (ADN) and bachelor (BSN) level. Although the licensure level is the same for both programs, the BSN requires more general and medical coursework. After graduating from a nursing program, a person must pass the National Council Licensure Examination (NCLEX-RN) to become licensed. Nurse Practitioners are RNs who have completed graduate-level degrees and have additional training, skills, and experience in advanced nursing practice.

An agency that hires a registered nurse (RN) should verify their license with the NC Board of Nursing before making a job offer. Contact the CCHC Coach for your region if assistance is needed in navigating the NC Board of Nursing website. A registered nurse should have an active license that is unencumbered in the state where CCHC services are provided. Nursing licenses are renewed every two years. Once hired, supervising agencies can receive free automated license and discipline notifications by signing up with Nursys E-Notify.

According to this NC Board of Nursing Bulletin (see page 10) Child Care Health Consultants who are nurses may be supervised by individuals who are not also nurses under certain conditions. An unlicensed person, or person licensed in a discipline other than nursing, may manage or supervise a licensed nurse only when the supervised activities:

• are not are of a clinical nature
• do not involve clinical assessment, judgment, or decision-making
• do not involve any activity included in the NC Nurse Practice Act’s definition of nursing.

Registered Nurses and other licensed health care professionals who provide CCHC services are using their education and experience to support health and safety in early care and education but are consultants, and do not provide direct clinical care to children or early educators.

Paramedic

Paramedics typically work as part of an Emergency Medical Services team, but have the highest level of training and qualifications in order to provide a wide range of emergency treatments. They also supervise and coordinate the work of other EMS team members.

To verify an individual’s license to practice as a paramedic, you must contact the NC Office of EMS or verify credentials on the National Registry of Emergency Medical Technicians.

Physicians and Physician Assistants

Licenses for Medical Doctors (MD) and Physician Assistants (PA) can be verified on the NC Medical Board website.

Hiring a Health Educator

Health Educators are professionals who design, conduct, and evaluate activities that help improve the health of all people. These activities can take place in a variety of settings that include schools, communities, health care facilities, businesses, universities, and government agencies.

A Health Educator may be a Certified Health Education Specialist (CHES®). CHES® are those who have met the standards of competence established by the National Commission for Health Education Credentialing Inc. and have successfully passed the CHES® examination. To verify that a CCHC holds a current CHES® certification, ask them to share their CHES® ID card. This can be found on the NCHEC website. Health Educators must renew their CHES® certification every five years by completing 75 continuing education hours and paying the annual certification fee.

Hiring an inactive CCHC

An inactive CCHC has previously taken the NC CCHC Course, but is not currently listed on the CCHC registry. Inactive CCHCs must retake the NC CCHC Course if they have not:

• worked as a CCHC in the past three years or
• successfully completed the NC CCHC Course in the past three years.

Inactive CCHCs who have worked or completed the NC CCHC Course in the past three years should contact a CCHC Coach for details on how to regain their active status.

First Steps and Orientation

1. The funding or hiring agency notifies the NC Resource Center of the new employee by contacting the regional CCHC Coach
2. The supervisor orients the CCHC to the hiring agency
3. The supervisor or CCHC schedules an introductory meeting with the CCHC Coach, supervisor, and CCHC to clarify roles and expectations
4. The CCHC Coach orients the CCHC to the program using the CCHC Orientation Guide and other guiding documents in the CCHC Program Manual. This orientation process can begin as soon after hiring as is appropriate and will continue throughout the course and beyond.
5. The CCHC applies for the NC CCHC Course by contacting the NC Resource Center or their regional CCHC Coach.

NC CCHC Course

Successful completion of the NC CCHC Course is required for a health professional to work as an active CCHC in North Carolina. The Course is offered by the NC Resource Center and is held twice a year starting in January and August and takes 12 weeks to complete. Information about the NC CCHC Course and other courses offered by the NC Resource Center are available on the NC CCHC Course page.

Pre-requisite Activities

• Review and sign the NC CCHC Course Training Agreement (sent to the CCHC after acceptance into the course)
• Read the NC CCHC Course information
• Continue meeting regularly with the CCHC Coach
• Complete Introduction to Public Health in North Carolina (Five training modules)
• Review state regulations and national best practice standards for early care and education programs:
  • North Carolina Child Care Regulations including General Statutes, Child Care Rules, and Sanitation of Child Care Centers (NC only)
  • Caring for Our Children (CFOC): National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs.

Course timeline and content

The 12-week NC CCHC Course includes

• completion of the online course content and assignments,
• participation in community-based interactions,
• attending weekly virtual meetings with peers (typically held Tuesdays 2-3 pm)
• a two-day in-person meeting in the Raleigh area near the end of the 12-week course, and
• successful completion of a three-week final project.

The final project involves conducting a full health and safety classroom observational assessment, development of a quality improvement plan, and report. Topics covered in the NC CCHC Course include:

• quality child care and regulations
• children with special health care needs and community/professional supports
• health education/health literacy
• consultation and coaching
• health, safety, and wellness practices and policy development/implementation
• introduction to the Environment Rating Scales
• administration of medication in child care
• observation at a child care facility
• training demonstration

Supervising a CCHC

For the CCHC to have a clear understanding of expectations, the hiring agency supervisor and funding agency representatives (if different) should meet with the CCHC and the CCHC Coach. This conversation should occur during or soon after the NC CCHC Course and include a discussion of local needs, priorities, and goals. Involving the CCHC coach in these conversations will help inform on-going coaching provided to the CCHC.

The needs, priorities, and goals should be documented on a logic model which is reviewed at least annually. Clear, written expectations help a CCHC both plan their work and meet the expectations.

CCHC supervisors should engage with the CCHC Coach for support on the CCHC Program. Ongoing supervision of a CCHC also includes:

• Knowledge of child care health consultation, including the CCHC Competencies, NC CCHC Service Model, and NC CCHC Standards of Practice
• Helping the CCHC establish relationships with community partners including regulatory agencies, other technical assistance providers in the community, key local health department contacts, and other CCHCs
• Engaging the CCHC in reflective supervision and joint planning regularly to review performance
• Observing the CCHC when delivering training and technical assistance to identify professional development needs
• Reviewing reports and data in NC HSAET to help the CCHC
  • meet goals and target outputs and outcomes and
  • meet the quality improvement needs of early care and education programs.
• Supporting membership and active participation in the NC CCHC Association
• Providing the CCHC opportunities to participate in activities required to maintain active CCHC status

Maintaining Active CCHC Status

CCHCs maintain an active CCHC status when meeting the requirements in the NC CCHC Standards of Practice.

CCHCs are asked to confirm that they are meeting these standards by responding to an annual CCHC survey that is available each January. Active CCHCs are:

• listed on the NC Resource Center CCHC Registry
• have access to all resources and training materials in the CCHC Resource Portal
• have access to the NC Health and Safety Assessment Tool.

The NC Child Care Health and Safety Resource Center

The NC Resource Center provides training and technical assistance in the form of coaching to all active CCHCs before, during, and after the NC CCHC Course. Resources available to active CCHCs include:

• Access to Training and Technical Assistance materials designed exclusively for CCHCs in the NC CCHC Resource Portal on a variety of topics including:
  • Accessible and Inclusive Environ
  • Bloodborne Pathogens
  • CCDF Health and Safety Trainings
  • Caring for Children with Special Health Care Needs (asthma, allergies, diabetes, enteral feedings, and seizures)
  • Enhanced feeding and nutrition
  • Infant and Child Social Emotional Wellbeing
  • Trauma-Informed Practices
  • Unintentional Injury Prevention
• Train-the-trainer courses including
  • Medication Administration and Child Care Development Fund (CCDF) health and safety training topics (as part of the NC CCHC Course)
  • ITS-SIDS Course
  • Emergency Preparedness and Response (EPR) Course
• Quarterly CCHC Learning Collaboratives on areas of CCHC expertise
• Access to the NC Health and Safety Assessment and Encounter (NC HSAET) tool and technical assistance in conducting assessments and developing quality improvement plans
• Resources and materials including posters, sample policies, newsletters, and web resources
• Advocacy for CCHCs with state and regional partners.

CCHC Coaches provide:

• Guidance to funding and hiring agencies in recruitment and selection of candidates for CCHC position. This may include reviewing the resumes received by the hiring agency to ensure the candidate meets eligibility requirements for the NC CCHC Course.
• Orientation and support for CCHCs throughout the NC CCHC Course
• Support hiring/funding agency and local CCHC in development and implementation of annual goals (including support in developing logic models based on local needs and priorities in the community).
• Ongoing support for established CCHCs including:
  • Working towards increased competency in all areas of CCHC expertise outlined in the National CCHC Competencies
  • Keeping updated on developments in the field of child care health consultation, including opportunities for professional development
  • Help understanding
    • Federal laws affecting child care (OSHA, ADA)
    • State laws and rules affecting child care
      • General Statutes
      • Child Care Rules
      • Sanitation of Child Care Center Rules
      • Immunization and Communicable Disease Rules
    • QRIS and NC rated licensing assessment requirements
    • Best practice standards for child care from the
      • American Academy of Pediatrics
      • National Association for the Education of Young Children
  • Ideas for relationship building and quality improvement strategies for early care and education programs
  • Support for using the NC Health and Safety Assessment and Encounter tool

The North Carolina Health and Safety Assessment and Encounter Tool (NC HSAET)

NC HSAET is a web-based assessment and encounter tool, updated in 2021 by the NC Resource Center for use by active CCHCs in North Carolina. The tool is used by CCHCs to collect and store data on:

• Encounters with child care facilities and community partners including trainings, meetings, and other communication
• Assessments of the health and safety aspects of child care environments and practices
• Quality improvement strategies

The sections of the NC HSAET align with the CCHC National Competencies:

1. Illness and infectious diseases
2. Children with special health care needs
3. Medication administration
4. Safety and injury prevention
5. Emergency preparedness, response, and recovery
6. Infant and child social and emotional wellbeing
7. Child abuse and neglect
8. Physical Activity
9. Nutrition
10. Oral health
11. Environmental health
12. Staff health and wellness
13. Policies

CCHCs receive training on the NC HSAET in the NC CCHC Course. CCHC Coaches help with incorporating this tool into the work of CCHCs. CCHCs and their supervisors must complete a new user form for the CCHC to gain access to the tool. Both CCHCs and their supervisors may access the NCHSAET demonstration site to view the tool. For questions about the tool, email the NC Resource Center: NCHSAET@unc.edu. The NC HSAET database is maintained by The UNC SHEPS Center and is stored on a secure server that preserves privacy, confidentiality, and security of all data.

The NC State Child Care Nurse Consultant

This position is located in the Department of Health and Human Services, Division of Child and Family Wellbeing and provides:

• Leadership in public health efforts in early education and promotes child care health consultation by establishing and maintaining links between CCHCs and early childhood stakeholders.
• Guidance and health and safety expertise.
• Leadership with the professional practice of child care health consultation in North Carolina.

NC Division of Public Health and Local Health Departments (LHDs)

• LHDs frequently function as hiring agencies for CCHCs. In addition, many staff at LHDs are critical partners of CCHCs including the immunization, communicable disease, and child health nurses.

NC Child Care Health Consultant Association (NC CCHCA)

• As a professional membership organization, the CCHCA holds quarterly regional meetings and hosts the annual CCHC conference to provide CCHCs with networking and professional development opportunities. It is highly recommended that CCHCs be required to maintain membership and participate in activities of the association such as attending meetings or serving on a committee.

NC Partnership for Children (NCPC)/Smart Start/Local Partnerships for Children

• NCPC and Local Partnerships for Children have historically provided funding and programmatic support for CCHCs and in some counties, is the hiring agency.

Local Child Care Resource and Referral Agencies

• Local CCR&R agencies may also provide funding for a CCHC or be the hiring agency for CCHCs.

Local community supports

In addition, local community partners provide support including:

• The Division of Child Development and Early Education Child Care (Licensing) Consultants
• Local Health Department Staff including Children’s Environmental Health Specialists (Sanitation) and Communicable Disease nurses
• Local Child Care Resource and Referral Agencies
• Head Start/Early Head Start
• Local Partnerships for Children

Ongoing professional development

CCHCs must continue to participate in professional development opportunities to meet the CCHC Standards of Practice. Opportunities available from the NC Resource Center and NC CCHC Association include:

• CCHC specific professional development
  • CCHC Learning Collaboratives
  • CCHC Quarterly Webinars
  • Regional CCHC Association Meetings
  • CCHC Annual Conference
• NC Resource Center Courses (online)
  • Infant-Toddler Safe Sleep and SIDS Prevention (ITS-SIDS)
  • Emergency Preparedness and Response (EPR)
• CCHC Certification/Endorsement after one year working as an active CCHC

Other professional development opportunities

• DCDEE pre-licensing workshop for child care centers and family child care homes
• Sanitation State of Practice (SOP) training
• Go NAPSACC consultant tools training
• Breastfeeding Friendly Child Care train-the-trainer
• Playground Safety train-the-trainer
• Recognizing and Responding to Suspicions of Child Maltreatment, Prevent Child Abuse NC (online)

If a CCHC plans to provide training or technical assistance (TA) on a topic they have not provided training or TA on in the past, they should use this CCHC Training Flow Chart to determine if they need to work with a partner or obtain additional professional development prior to training.