Chapter IV
Technical Assistance Consistency
It became evident throughout this study a principal concern among child care providers and licensing specialists is how consistent specialists are in enforcing child care regulations and providing technical assistance. Providers noted a key element in assisting them comply with regulations is for licensing specialists to be consistent in the information and assistance offered, particularly during the inspection process, and for providers to have a thorough understanding of the regulations. Providers note consistent implementation of regulations and providing technical assistance go hand-in-hand; technical assistance is of limited value if licensing specialists are not implementing regulations in a consistent manner.
The child care licensing/inspection process was examined (to the extent it relates to technical assistance provided under the study scope) to determine if the community based regulation division is taking steps to ensure consistency in implementing regulations and providing technical assistance. It is important to note, no matter what steps the division takes, there will never be 100 percent consistency in applying regulations or providing technical assistance, as long as there is a "human element" involved. The committee believes the regulations for center-based facilities and family day care homes are varied and undoubtedly open to different interpretations by licensing specialists.
Approach to Technical Assistance
Licensing specialists are currently required to only provide assistance specifically addressing current regulations or licensing process. Specialists are not to offer assistance on areas outside what is specified in regulation, such as business practices or fee structures.
Licensing specialists are also instructed to offer suggestions, rather than absolute answers, to child care providers for correcting regulatory violations. The committee was told specialists should not require providers to correct problems in a definitive manner. Consistency problems could occur if another specialist cites the provider for the same problem during a subsequent inspection, even though the provider followed a previous specialist's specific instructions. Instead, specialists are instructed to provide alternatives for correcting problems, based on either best practice or solutions that have worked for other providers with similar problems.
Interpretive Guidelines
A very useful process for ensuring technical assistance/regulatory consistency among licensing specialists is the continual development of "interpretive guidelines" documents for family day care homes and center-based facilities. The documents describe each child care regulation and include acceptable interpretations.
The interpretive guideline documents were reviewed and both are important components for increasing consistency in applying regulations. The documents provide plain language interpretations to various regulations and are developed without changing the regulations' original intent. Specialists noted the documents serve as reference tools and help ensure regulations are defined and implemented in a consistent manner. As such, they believe technical assistance becomes more effective.
One problem with the interpretive guidelines process is providers are not aware the guidelines exist. Without this information, providers are unaware of the acceptable interpretations to the regulations as used by licensing specialists. Allowing providers access to the guidelines would give them vital information and a "technical assistance tool" to assist them in attaining and maintaining state child care regulations. It would also be a strong proactive move toward ensuring maximum compliance with regulations before providers are cited for violations during inspections.
The committee believes regulatory compliance would be more effective if licensing specialists and providers use the same information pertaining to regulations and their interpretations. For example, during site visits with licensing specialists several family day care providers were cited for their water temperature being too hot. Unlike center-based regulations, family day care regulations do not specifically require a certain water temperature. These citations were made under a broader category of "hazardous conditions." The citations were made even though compliance cannot be achieved if providers are not fully aware of the requirements. Providers are generally told although the regulations do not specifically state acceptable water temperatures, the department uses a specific range that should be followed. Licensing specialists would also benefit if providers had access to comparable regulatory information because providers would be presumably more aware of regulatory requirements and their interpretations.
Internal meetings
The Division of Community Based Regulation holds various types of internal meetings in part to address child care regulation and technical assistance consistency issues. For example, licensing specialists meet among themselves in what is called a "peer group." The group discusses various scenarios and issues encountered in the field by licensing specialists. Using the information the group determines how regulations and technical assistance can be applied more consistently. When appropriate, the group makes formal recommendations to division managers.
Committee staff observed a peer group meeting, which included discussion of several pertinent issues regarding inspections and regulations. A review was also made of all meeting minutes and recommendations made by the group over the last four years. The group keeps detailed minutes and receives feedback on its recommendations from supervisors and managers. Several licensing specialists told committee staff the peer group meetings are useful, particularly for newer specialists.
Regular staff meetings and supervisory and managerial meetings also take place to discuss relevant issues, including the overall effectiveness of implementing child care regulations and how technical assistance should be applied.
Scope and Severity
An important component for ensuring consistency among licensing specialists deals with "scope and severity" of violations found during inspections. Specific training was given to specialists approximately a year ago outlining the division's practice for determining both the scope of a violation and its relative severity. Scope refers to "the extent to which a condition exists and the range or number of times the same condition exists." Severity means "the intensity or seriousness of the condition."
The training gave licensing specialists written guidelines for determining whether conditions observed during inspections constitute violations. In its broader context, the training and accompanying guidelines go to ensuring child care regulations are applied in a consistent manner among specialists. The committee believes, however, the training needs to be frequently reinforced with licensing specialists and reviewed by division management to determine its overall effectiveness.
Technical Assistance Protocols
As mentioned in Chapter II, a technical assistance protocol for new providers has been developed for licensing specialists. The protocol establishes a structured approach for offering technical assistance to new providers, both family day care and center-based. A written protocol document was finalized at the beginning of this study in early 2001 and distributed to the specialists for implementation. Although the protocol provides written procedures licensing specialists are to follow, the committee found at least one instance where the protocol did not correspond with actual practice, and notified the division of the inconsistency.
Supervisory Accountability Methods
The three licensing unit supervisors told committee staff they ensure consistency among licensing specialists in several ways, including accompanying specialists on field visits and reviewing inspection reports looking for disparities in applying regulations. Information they collect is used to assist specialists in offering providers uniform technical assistance information and applying regulations in a consistent manner.
Complaint Investigation and Hearing Process Summary
Early in this study committee staff was provided a document developed in late 2000 by a statewide child care association for its members. The document outlined the various components of the child care regulatory enforcement process for providers' use. It was distributed as a way to inform providers of the processes used by the division. Although a more generic version was available on the department's website, a comparable document specific to child care providers had yet to be developed by the Division of Community Based Regulation. The division subsequently developed its own document on the complaint inspection and enforcement processes for child care providers in late-2001, which is available on the department's child care licensing webpage.
Child Care Licensing Program Website
A webpage dedicated solely to the child care licensing program has been part of the public health department's website since the beginning of 2001. The webpage was reviewed and the following observations are made:
· the child care licensing webpage includes relevant, useful, and timely information for child care providers;
· numerous forms are available on-line for providers and prospective providers to use;
· the webpage describes several licensing and enforcement processes, lists provider training programs, shows the locations of current providers, and includes the full text of child care regulations; and
· a "frequently asked questions" component is lacking.
Policies and Procedures
Although the examples in this chapter point to efforts to implement child care regulations and technical assistance in a more consistent manner, the committee believes until recently there has been little accomplished in terms of written/dated policies and procedures regarding a structured technical assistance approach. For example, until the technical assistance protocols described above were completed in mid-2001, the division lacked any type of written policies and procedures for providing technical assistance to new providers. For the most part, any formal written/dated guidelines provided to committee staff were developed or implemented relatively recently. Overall, the division's approach to ensuring licensing specialists' consistency in applying regulations and offering technical assistance seems to be improving, yet has been primarily implemented with limited attention to a formal written and dated policies or procedures manual or to analyzing overall effectiveness.
Provider feedback. The committee determined no uniform structure or system exists to consistently gauge the types, frequency, or levels of technical assistance providers are interested in or require. These are vital components of ensuring providers receive the technical assistance they require in a consistent manner for attaining and maintaining compliance with child care regulations.
Survey Response
A survey was distributed to a random sample of licensed providers throughout the state regarding technical assistance services received from DPH child care staff (full description in Chapter V.) Providers were asked, in part, whether there have been times within the past year they have been given conflicting or inaccurate information by DPH child care staff regarding the regulatory requirements for providers. Overall, of the 341 respondents to the question, 84 percent answered they have not been given conflicting or inaccurate information, while 16 percent answered "yes." When analyzed separately, 88 percent of family day providers and 75 percent of center-based providers responded "no."
Summary of Findings
· Written and dated policies and procedures relating to providing technical assistance are limited and need to be enhanced.
· No uniform structure/system exists to frequently gauge the types, frequency, or levels of technical assistance providers are interested in or require. There is no formal system to collect feedback from providers on a consistent basis.
· Although there are multiple efforts underway to ensure consistency in applying child care regulations, there does not seem to be a broad analysis of how well inspectors are applying them.
· According to a committee survey, 84 percent of providers surveyed said they have not received conflicting or inaccurate information from DPH child care staff regarding child care regulations.
Recommendations
9. The Division of Community Based Regulations shall make its interpretive guidelines for center-based and family day care home regulations available to the public on its website by March 1, 2002. Where appropriate, the division should fully cross reference the guidelines with additional resource information dedicated to child care and include "best practices," as determined by the division. DPH should also include a disclaimer the guidelines do not substitute state child care regulations.
10. The Division of Community Based Regulation shall develop written and dated policies/procedures for internal use for providing technical assistance during each phase of the licensing and enforcement processes. The policies and procedures shall become part of the division's technical assistance master implementation plan.
11. The Department of Public Health shall include a "Frequently Asked Questions" (FAQ) component on its Child Care Licensing Program webpage. Additional technical assistance information for child care providers, such as bilingual regulations, should be included on the website as determined by DPH.