National Center on Tribal Early Childhood Development

National Center on Tribal Early

Childhood Development

Health and Safety Monitoring

DATE

National Center on Tribal Early Childhood Development 1

Presenters


Check-In Questions

◆ How have you used the Health and Safety

Worksheet this past month?

◆ What do you hope to gain from this

session?


Session Description

Title Description

Health and Safety Monitoring

This session will take a deeper dive into

monitoring, as detailed in Section 2.2 of the

Tribal CCDF Plan, and for P.L. 102-477 CCDF

grantees, question 11 of the OCC Program

Instruction CCDF-ACF-PI-2019-04, issued

July 12, 2019. The session will include

identifying the monitoring staff, identifying what

standards are being monitored, identifying the

number of providers that each monitor will be

responsible for, and discussing monitoring

qualifications, monitoring training, and

monitoring practices.


Meeting Objectives

Participants will

◆ receive an overview of the Tribal Child Care Management Systems Framework Health and Safety Monitoring system;

◆ attain a basic introduction to the health and safety monitoring and enforcement requirements;

◆ apply a “systems approach” to the development of a comprehensive health and safety monitoring and enforcement system supported by policies and procedures; and

◆ identify challenges and strengths with implementing the health and safety monitoring requirements.


Health and Safety Worksheet

◆ Reflective Worksheet

▪ Track your journey

▪Reflect and record

ideas and

strategies

▪Write down goals

▪Note next steps


Overview

◆ Tribal Child Care

Management

Systems

Framework: Health

and Safety

Monitoring


Source: Adapted from National Center on Program Management and Fiscal

Operations. (n.d.). Head Start management systems wheel [Graphic]. Office of

Head Start. https://eclkc.ohs.acf.hhs.gov/organizational-

leadership/article/management-systems

https://eclkc.ohs.acf.hhs.gov/organizational-leadership/article/management-systems

8National Center on Tribal Early Childhood Development

Source: Adapted from National Center on Program Management and Fiscal Operations. (n.d.). Head Start management systems wheel

[Graphic]. Office of Head Start. https://eclkc.ohs.acf.hhs.gov/organizational-leadership/article/management-systems


Guiding Questions

◆ Do we have enforceable

health and safety

standards in place?

◆ Do we have monitoring

and enforcement

practices in place for

each type of child care

provider?


Health and Safety Monitoring Requirements

Tribal Lead Agencies must have the following

requirements for health, safety, and fire

monitoring and inspection, by provider type:

◆ Licensed or regulated CCDF providers

require

▪ one pre-approval or prelicensure

inspection and

▪ an annual unannounced inspection.

◆ License-exempt CCDF providers require

▪ an annual inspection.

Tribal Lead Agencies also have the option to

describe an alternative monitoring approach

in their CCDF Plan and provide adequate

justification for the approach.


Source: Child Care and Development Fund, 45 C.F.R. §§ 98.42, 98.83 (2016).

Note: Tribal Lead Agencies are

not required to have licensing

requirements for child care.

Tribal CCDF Plan Section 2.2

Tribal Lead Agencies must do the following:

◆ Describe how they monitor CCDF providers

◆ Indicate who conducts monitoring visits (the Tribal Lead Agency or another entity)

◆ Do either of the following:

▪ Certify that they meet inspection requirements in the CCDF final rule

▪ Describe an alternative approach and provide justification

◆ 2.2.1: Enforcement of Health and Safety Requirements

◆ 2.2.2: Monitoring Inspectors

◆ 2.2.3: Ratio of Monitoring Inspectors

◆ 2.2.4: Exemptions for Relatives

Note: P.L. 102-477 grantees can refer to their response to Question 11 from the OCC Program Instruction on the P.L. 102-477 Consolidation Plan.


Health and Safety Standards by Required

Topic


Source: National Center on Tribal Early Childhood Development. (2019). FY 2020–2022 CCDF Tribal Plan Preprint trainings: Section 2: Establish standards and

monitoring processes to ensure the health and safety of child care settings (for all tribes). U.S. Department of Health and Human Services, Administration for Children

and Families, Office of Child Care. https://childcareta.acf.hhs.gov/resource/fy-2020-2022-ccdf-tribal-plan-preprint-trainings-section-2-establish-standards-and

a. Prevention (including immunizations) and control of infectious diseases

b. Prevention of sudden infant death syndrome and the use of safe sleep practices

c. Administration of medication, consistent with standards for parental consent

d. Prevention of and response to emergencies due to food and allergic reactions

e. Building and physical premises safety

f. Prevention of shaken baby syndrome, abusive head trauma, and child maltreatment

https://childcareta.acf.hhs.gov/resource/fy-2020-2022-ccdf-tribal-plan-preprint-trainings-section-2-establish-standards-and

Health and Safety Standards by Required

Topic





g. Emergency preparedness and response

h. Handling and storage of hazardous materials and the appropriate disposal of biocontaminants

i. Precautions in transporting children (if applicable)

j. Pediatric first aid and cardiopulmonary resuscitation (CPR)

k. Recognition and reporting of child abuse and neglect

Optional Topics


Health and Safety Standards: Optional Topics





Nutrition (including age-appropriate feeding)

Access to physical activity

Caring for children with special needs

Any other subject area determined by the Tribal Lead Agency to be necessary to promote child development or to protect children’s health and safety


Standards on Child-Staff Ratios, Group

Sizes, and Qualifications for CCDF Providers

◆ Tribal Lead Agencies are

required to establish standards

for the following:

▪ Child-staff ratios

▪ Group size limits

▪ Required qualifications for

providers

◆ Standards should reflect the

child care setting and the ages

of children served.

Considerations

◆ Tribal Lead Agencies have

flexibility in defining standards

and provider types that are

reflective of the culture and

language and that meet the

needs of the children and

families served.

◆ The final rule does not

establish a federal

requirement for group size

and child-staff ratios but does

include recommendations.

15

Source: Child Care and Development Fund, 45 C.F.R § 98.41(d) (2016).

National Center on Tribal Early Childhood Development

Discussion

◆ What are the

challenges with

implementing these

requirements?


Monitoring Providers

CCDF Administrators provide

oversight about their health

and safety requirements and

should ensure that

monitoring inspections are

happening according to the

processes indicated in their

Tribal CCDF Plan.


Source: National Center on Tribal Early Childhood Development. (2017). Developing child care monitoring and enforcement

systems: A guide for American Indian and Alaska Native grantees (p. 4–5). U.S. Department of Health and Human Services,

Administration for Children and Families, Office of Child Care. https://childcareta.acf.hhs.gov/resource/developing-child-care-

monitoring-and-enforcement-systems-guide-american-indian-and-alaska

https://childcareta.acf.hhs.gov/resource/developing-child-care-monitoring-and-enforcement-systems-guide-american-indian-and-alaska

Enforcement of Health and Safety Standards

What do you do if providers do not meet

the standards?

◆ Enforce standards according to policies

and procedures.

◆ Follow procedures to inform providers

about corrections and provide support.


Source: National Center on Tribal Early Childhood Development. (2017). Developing child care monitoring and enforcement systems:

A guide for American Indian and Alaska Native grantees (p. 15). U.S. Department of Health and Human Services, Administration for

Children and Families, Office of Child Care. https://childcareta.acf.hhs.gov/resource/developing-child-care-monitoring-and-

enforcement-systems-guide-american-indian-and-alaska


Enforcement Strategies

◆ Enforce standards

▪ Monitoring tools

▪ Inspections

▪ Plan of correction (also

called “corrective action

plan”)

▪ Administrative review

▪ Serious or repeated

noncompliance

◆ Follow policies and

procedures

▪ Process for staff

▪ Expectations for providers

▪ Due process

▪ Appeals



A guide for American Indian and Alaska Native grantees (pp. 8–15). U.S. Department of Health and Human Services, Administration

for Children and Families, Office of Child Care. https://childcareta.acf.hhs.gov/resource/developing-child-care-monitoring-and-



Monitoring Tools Aligned to Your CCDF Health

and Safety Standards

◆ Checklists for standards

◆ Inspection forms

◆ Surveys

◆ Observations

◆ Other forms for

assessing health and

safety


Source: National Center on Tribal Early Childhood Development. (2017). Developing child care monitoring and enforcement

systems: A guide for American Indian and Alaska Native grantees (p. 8). U.S. Department of Health and Human Services,

Administration for Children and Families, Office of Child Care. https://childcareta.acf.hhs.gov/resource/developing-child-care-

monitoring-and-enforcement-systems-guide-american-indian-and-alaska


Inspections

◆ Providers must know what the

standards are and how to meet them.

◆ Providers need to understand the

monitoring process and what to expect

before, during, and after the visit.

◆ Tribal Lead Agencies should create

processes and resources that help

everyone

understand responsibilities.



A guide for American Indian and Alaska Native grantees (p. 9–10). U.S. Department of Health and Human Services, Administration




Reasons to Monitor

◆ The primary purpose of monitoring is to determine

compliance with standards.

◆ Other purposes include the following:

▪ Supporting providers with meeting standards

▪ Identifying provider challenges

▪ Providing resources on health and safety, best

practices, and quality improvement

▪ Ensuring health and safety of children







Enforcement Tools

◆ Plan of correction: The Lead Agency and the

provider develop and outline how the provider will

correct the violation or violations found during the

visit.

◆ Administrative review: If the provider does not

meet the standard at a follow-up visit, the Lead

Agency can conduct an administrative review of

the monitoring or licensing record to decide

whether to continue subsidy payments.







Serious or Repeated Noncompliance

◆ Noncompliance letter

◆ Witnessed visits

◆ Office conference

◆ Consent agreement

◆ Contract cancellation

◆ Revocation and denial

◆ Emergency order



A guide for American Indian and Alaska Native grantees (p. 15-16). U.S. Department of Health and Human Services, Administration




Due Process and Appeals

◆ Whenever an enforcement action is taken against

a provider, the provider should have the right to

due process.

◆ Due process will look different for providers with

licenses, approvals, and contracts or

agreements.

▪ The elements of due process should be

outlined in policies and procedures.







Discussion

◆ Which enforcement

strategies are you

implementing

currently?

◆ Which enforcement

strategies present a

challenge at this

time?


Alternative Monitoring Approaches

◆ Tribal Lead Agencies have some flexibility in determining which monitoring requirements should apply to child careproviders, but they cannot use this flexibility to bypass these requirements altogether.

◆ Tribal Lead Agencies may introduce strategies that are culturally appropriate, financially workable, and able to meet the needs of the community.

◆ Refer to the OCC Program Instruction on alternative approaches for monitoring: https://www.acf.hhs.gov/occ/policy-guidance/guidance-alternative-approaches-purposes-conducting-background-checks-child


https://www.acf.hhs.gov/occ/policy-guidance/guidance-alternative-approaches-purposes-conducting-background-checks-child

Making the Connection


Health and Safety Standards

Training

Monitoring

Discussion

◆ How do you monitor your providers for compliance with your training requirements?

◆ What enforcement strategies for health and safety trainings are working best for your program?

◆ Which enforcement strategies for health and safety trainings present a challenge?


Qualifications and Training for Monitoring Staff

◆ Tribal Lead Agencies must have policies and

practices that ensure that individuals who are

hired as inspectors are qualified to inspect child

care providers and facilities, including:

▪ Inspector qualifications

▪ Training for inspectors on health and safety

requirements, appropriate to the type of provider

and ages of children served


Source: Child Care and Development Fund, 45 C.F.R § 98.42 (2016).

Training for Monitoring Staff

Monitors for your CCDF program must be qualified

and trained on the following:

◆ CCDF regulations

◆ Program standards

◆ Monitoring policies and procedures

◆ Tools and checklists

◆ Enforcement processes







Training for Providers on the Monitoring Process

Lead Agencies can support providers by

providing the following:

◆ One-on-one technical assistance and

case-specific guidance

◆ Resource materials

◆ Provider trainings







Poll 1: Challenges

◆ What challenges do you face with implementing the monitoring requirements?

▪ Establishing enforcement strategies

▪ Monitoring the training and professional development requirements

▪ Training monitoring staff

▪ Time for completing monitoring visits

▪ Technical assistance for providers

▪ Obtaining approval from Tribal leadership to implement enforcement strategies


Brainstorming

◆ What strategies can

you use to overcome

the challenges

identified?


Relative Care Providers


◆ Tribal Lead Agencies have the option to exempt relatives from some or all of the inspection requirements if the individual cares for related children only.

◆ Do you exempt any of the monitoring requirements for relative providers?

Source: Child Care and Development Fund, 45 C.F.R§ 98.2(2); § 98.42(c) (2016).

Coordinating with State Licensing

◆ Coordinating with the state licensing agency

ensures that providers are meeting

standards of both the state and the Tribal

Lead Agency. Considerations include:

▪ Establish and maintain a relationship with the

state licensing agency

▪ Consider developing formal agreements

▪ Know and understand state requirements

▪ Provide culturally relevant information


Brainstorming

◆ How do you ensure that your state-licensed providers are in compliance with the licensing requirements?

◆ What are ways to ensure effective communication between the Tribal Lead Agency staff and state licensing staff regarding the health and safety monitoring and enforcement requirements?


Health and Safety Monitoring System

Health and

Safety

Monitoring


Source: Adapted from National Center on Program Management and Fiscal

Operations. (n.d.). Head Start management systems wheel [Graphic]. Office of

Head Start. https://eclkc.ohs.acf.hhs.gov/organizational-

leadership/article/management-systems-leadership/article/management-systems

“To document responsibility for

implementation, monitoring, and

enforcement for staff parents and

providers.”

—Region VIII tribal grantee call


Health and Safety Monitoring System, con.

◆ The Health and

Safety Monitoring

System includes all

necessary elements

to implement

standards, training,

and monitoring

requirements


Source: Adapted from National Center on Program Management and

Fiscal Operations. (n.d.). Head Start management systems wheel

[Graphic]. Office of Head

Start. https://eclkc.ohs.acf.hhs.gov/organizational-

leadership/article/management-systems


Health and Safety System

40

CCDF final rule

Standards

Policies and procedures

Training and professional development

Provider licensing or approval or

both

Monitoring

Enforcement

National Center on Tribal Early Childhood Development

Monitoring System Considerations

◆ Record keeping

◆ Monitoring tools

◆ Training for monitoring staff

◆ Provider orientation

◆ Ongoing communication with providers

◆ Expectations for compliance

◆ Enforcement strategies

◆ Collaboration with partner agencies


Brainstorming

◆ Let’s think about

some action

steps to develop

your health and

safety monitoring

system in your

CCDF program.


Questions


Pause for Mapping

◆ List out each provider type on your

map and then write down who will monitor

each of the provider types.


Mapping Example


Putting a Plan into Action

◆ What is one key takeaway

you have from this session?

◆ How do you plan to put that

takeaway into action?

◆ What technical assistance

might you need to support

you in implementing your

takeaway?


Worksheet Activity

◆ Write down key

takeaways from this

session.


What’s the Next Step in Our System?

◆ Start thinking about temporary operating standards in the event of an emergency or disaster.

◆ Guiding questions:

▪ Have you implemented any temporary health and safety standards during the COVID-19 pandemic?

▪ What are the health and safety standards that may need to be revised in the event of a future disaster or emergency?

▪ Are there lessons learned from the COVID-19 pandemic around temporary operating standards?


Health & Safety Standards

Training

Monitoring

Next Session

◆ Temporary Operating

Standards

◆ Date:

◆ Time:


Before We Meet Again

◆ Look at Section 2.4.2 of the Tribal CCDF Plan or Question 14 if you are a P.L. 102-477 grantee.

◆ Review your Tribal CCDF Plan to see if you included temporary operating standards in your response to Section 2.4


Resources


◆ Office of Child Care. (2019). Guidance on alternative approaches for purposes of conducting background checks of child care staff and monitoring and inspection of child care providers (CCDF-ACF-PI-2019-05), https://www.acf.hhs.gov/occ/policy-guidance/guidance-alternative-approaches-purposes-conducting-background-checks-child

◆ Health and safety monitoring webinar for Tribal Lead Agencies, https://childcareta.acf.hhs.gov/sites/default/files/public/developing_monitoring_and_enforcement_systems.pdf

https://www.acf.hhs.gov/occ/policy-guidance/guidance-alternative-approaches-purposes-conducting-background-checks-child

https://childcareta.acf.hhs.gov/sites/default/files/public/developing_monitoring_and_enforcement_systems.pdf

Resource Spotlight: Monitoring Toolkit

◆ Three guides

▪ Developing Monitoring

Systems

▪ Monitoring Centers

▪ Monitoring Homes

◆ Sample forms

◆ Three videos

▪ Tribally operated centers

▪ Center-based providers

▪ Home providers


These guides were originally published by the National Center on Tribal Child Care Implementation and Innovation under contract #HHSP23320110017YC.

The current versions were updated in 2017 by the National Center on Tribal Early Childhood Development (under contract #HHSP233201600353G) for the

Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services.

Available at https://childcareta.acf.hhs.gov/resource/american-indian-and-alaska-

native-child-care-and-development-fund-monitoring-toolkit

https://childcareta.acf.hhs.gov/resource/american-indian-and-alaska-native-child-care-and-development-fund-monitoring-toolkit

Resources


◆ Health and Safety Resource List: Standards, Policies, and Monitoring, https://childcareta.acf.hhs.gov/sites/default/files/public/hands_resource_list_standards_policies_monitoring.pdf

◆ Health and Safety Resource Page, https://childcareta.acf.hhs.gov/health-and-safety-resource-page

◆ Sample monitoring and enforcement policies and procedures

◆ Sample action plan for monitoring and enforcement

◆ National Center on Early Childhood Quality Assurance’s curriculum on Monitoring License-exempt Programs

https://childcareta.acf.hhs.gov/sites/default/files/public/hands_resource_list_standards_policies_monitoring.pdf

https://childcareta.acf.hhs.gov/health-and-safety-resource-page

National Center on Tribal Early Childhood Development,

A Service of the Office of Child Care

9300 Lee Highway

Fairfax, VA 22031

Phone: 877-296-2401

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National Center on Tribal Early Childhood Development