title: Use of a statewide system to improve health and safety in child care facilities.
abstract: BACKGROUND
  The Early Childhood Education Linkage System (ECELS) in Pennsylvania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly developed statewide systems and about how users compare with nonusers of such a system.
  
  
  OBJECTIVE
  Our objectives were 1) to assess knowledge and use of ECELS among child care providers in PA, 2) to compare users and nonusers of ECELS with 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 child care centers (CCCs) and providers of 400 registered family child care homes (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% had used ECELS's services in the previous 12 months. Significantly more nonusers than users consulted doctors, whereas more users consulted health professionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing infants 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 practice (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.
  
  
  CONCLUSIONS
  This statewide system reached most child care providers surveyed: more outreach is needed to providers in FCCHs. The health concerns, safety practices, and advice-seeking preferences of child care providers described in this article can inform others who are developing similar collaborative 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.
authors.affiliation: Division of General Academic Pediatrics, Childrens Hospital of Pittsburgh, PA, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Dayie
authors.forename: S S
authors.initials: SS
authors.lastname: Aronson
authors.forename: L
authors.initials: L
authors.lastname: Jansen-McWilliams
authors.forename: K J
authors.initials: KJ
authors.lastname: Kelleher
mesh_terms: D000704:Analysis of Variance; D002654:Child Care / Q000592:standards* / Q000639:trends; D002656:Child Day Care Centers / Q000592:standards* / Q000639:trends; D002669:Child Welfare; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006266:Health Education / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000592:standards / Q000639:trends; D008297:Male; D010414:Pennsylvania; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013398:Sudden Infant Death / Q000517:prevention & control; D011795:Surveys and Questionnaires