Health consultation is a recognized method to promote the safety and well-being of youngsters in child care, but states differ in child care licensure standards and most consultation have been crisis-oriented, e.g., control of an infectious disease. Georgia State University School of Nursing surveyed their state’s child-care centers to identify what directors thought about health consultations, how they would pay for the service, and what consulting services they thought were important.

Surveys were mailed to a sample of Head Start Centers (n=30), licensed child-care centers (n=341) and registered home programs (n=391). Incentives suitable for the type of program, e.g., a book or video, were given upon return of a completed survey. Participation rates were 73%, 36% and 30% respectively.  The great majority of directors were interested in health consultations if free or affordable. Of the small percentage (10% or less) with consulting health education or services, public health nurses were more frequently used than other resources, including paid or volunteer nurses, physicians, dentists or dietitians. Center directors indicated that they could pay from their program’s budget, fees and/or fundraising efforts.

While health consultation focuses on population-based health education and policy development, many directors also identified Center needs for preventive health care services for staff (screening, wellness programs, annual physicals), and direct services for children (screening, medication administration). Some indicated concern for children’s emotional health. 

Cost was not as great a barrier as anticipated. Since health departments focus on populations, fee-for-service consultation may be an appropriate new (revenue-generating) activity for public health agencies. Public health nurses are well-prepared to deliver the service.

(Gaines S, Wold J, Spencer L and Leary J. Public Health Nurs 2005;22:8-16)

Comment: The American Academy of Pediatrics has developed materials for physicians as child care health consultants. This may also be a new arena for experienced elementary school nurses. —J.O.