title: Health and safety needs in early care and education programs: what do directors, child health records, and national standards tell us?
abstract: OBJECTIVE
  To identify the overlapping and unique health and safety needs and concerns identified by early care and education (ECE) directors, health records, and observed compliance with national health and safety (NHS) standards.
  
  
  METHODS
  Cross-sectional study. 127 ECE programs from 5 California counties participated in the study, including 118 directors and 2,498 children's health records.
  
  
  METHODS
  Qualitative data were collected using standardized ECE directors' interviews to identify their health and safety concerns; and objective, quantitative data were collected using child health record reviews to assess regular health care, immunizations, health insurance, special health care needs, and screening tests and an observation Checklist of 66 key NHS standards collected by research assistants.
  
  
  RESULTS
  The overlapping health and safety needs and concerns identified by the directors and through observations were hygiene and handwashing, sanitation and disinfection, supervision, and the safety of indoor and outdoor equipment. Some of the health and safety needs identified by only one assessment method were health and safety staff training, medical plans for children with special health care needs and follow-up on positive screening tests.
  
  
  CONCLUSIONS
  Comprehensive, multimethod assessments are useful to identify health and safety needs and develop public health nursing interventions for ECE programs.
authors.affiliation: Department of Family Health Care Nursing, University of California, San Francisco, California 94143-0606, USA. abbey.alkon@nursing.ucsf.edu
authors.forename: Abbey
authors.initials: A
authors.lastname: Alkon
authors.forename: Kim
authors.initials: K
authors.lastname: To
authors.forename: Joanna F
authors.initials: JF
authors.lastname: Mackie
authors.forename: Mimi
authors.initials: M
authors.lastname: Wolff
authors.forename: Jane
authors.initials: J
authors.lastname: Bernzweig
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D001294:Attitude to Health; D002140:California; D002656:Child Day Care Centers / Q000458:organization & administration*; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004869:Equipment Safety; D017408:Guidelines as Topic; D055991:Health Records, Personal; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D017053:Infection Control; D015404:Nursing Methodology Research; D011637:Public Health Nursing; D036301:Qualitative Research; D017751:Safety Management / Q000458:organization & administration*; D011795:Surveys and Questionnaires