title: Child care health consultation programs: barriers and recommendations.
abstract: OBJECTIVE
  While many studies describe the need for health services in early care and education (ECE) settings and the role of child care health consultants (CCHCs), little information exists about the challenges to developing health consultation programs. The goal of this paper is to provide insight for the development of current and future child care health consultation programs by describing the barriers identified by CCHCs related to program implementation in 20 California counties.
  
  
  METHODS
  Forty-four child care health consultants participated in nine focus groups during their health consultation training at the California Training Institute. Participants were asked to discuss the barriers they encountered while establishing new county-wide child care health consultation programs. Themes were assigned to each response, and frequency and percentage of each theme were documented and trends were identified.
  
  
  RESULTS
  The four general themes describing barriers to program implementation were: Program Management, Child Care Culture, Geography and Community Services. Twenty additional sub-themes, including Multi-agency involvement, Chaos, Travel time, and Fragmentation, were assigned to each response. The most frequent general theme was Program Management. The most frequent sub-theme was Professional Support.
  
  
  CONCLUSIONS
  The barriers identified by the child care health consultants can be valuable for administrators and clinicians establishing or developing child care health consultation programs. Program managers should be prepared for the unique challenges of child care health consultation and provide flexibility and support for child care health consultants.
authors.affiliation: Department of Family Health Care Nursing, University of California, San Francisco School of Nursing, California Childcare Health Program, 1333 Broadway, Suite 1010, Oakland, CA 94612, USA. jfarrer@ucla.edu
authors.forename: Joanna
authors.initials: J
authors.lastname: Farrer
authors.forename: Abbey
authors.initials: A
authors.lastname: Alkon
authors.forename: Kim
authors.initials: K
authors.lastname: To
mesh_terms: D002140:California; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003253:Consultants; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans