March 28, 2021

Cynthia Carneal Heflin

Program Consultant

Department of Social Services

801 East Main Street

Richmond, VA 23219

Dear Ms. Carneal Heflin,

Thank you for the opportunity to provide public comment related to the Department of Social Services’ intention to repeal and replace the outdated regulatory guidance for voluntary registered family day homes (22VAC40-180), as published in the Virginia Register of Regulations, Volume 37, Issue 14, March 1, 2021.

Child Care Aware of Virginia is a statewide nonprofit organization operating across Virginia to help families find child care, educate consumers as to key questions to ask when searching for child care, support the professional development of individuals working in child care, and to support child care providers in offering a safe and high-quality setting for children (in child care centers and family child care homes, including current and prospective voluntarily registered providers). In partnership with network member agencies ChildSavers in Richmond, The Childcare Network in Fredericksburg and Sentara Health Systems Family Connections in Harrisonburg, and through our work with the Department of Social Services, Division of Licensing Programs, Department of Education and other community partners, we have an on-the-ground view of the strengths and weaknesses of the current voluntary registration family day home guidance.

We commend the Department on its initiative to incorporate current health and safety criteria and to expand emergency preparedness requirements related to the program standards. We fully agree that replacing the guidance for voluntary registered providers is necessary for the protection of the public health, safety, and welfare of families with children (as well as the providers who are offering child care services) and is an opportunity to provide clearly written and easily understandable guidance.

As the Department considers modifications to the guidance, we offer the following suggestions to update the regulations to ensure that children in registered family day homes are safe and child care providers have the information and training they need to best promote the safety and healthy development of the children in their care.

Promoting the Health and Safety of Children

• All child care providers, all other adults who live in the home, and any staff or volunteers should be required to satisfactorily undergo a comprehensive background check prior to approval of any voluntary registration (VR) application (or renewal). Such screenings should be repeated every five years (unless Virginia implements Rap-Back, which would make the re-screening process unnecessary).
• All child care providers (and staff and substitutes) who may be alone with children should be required to obtain certification in cardiopulmonary resuscitation (CPR) specific to the age of children in care and first aid to ensure that in times of emergency, providers have the competencies to administer life-saving and first aid techniques. CPR training must include an in-person competency demonstration.
• Child care providers who operate VR homes who wish to administer prescription medication must satisfactorily complete a Medication Administration Training program developed by the Board of Nursing and taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist (i.e., the same requirement that applies to licensed care and vendors participating in the Child Care Subsidy Program).

Emergency Preparation to Protect Children

• All child care providers shall have a written emergency preparedness plan that addresses caregiver responsibility and home readiness with regard to emergency evacuation, relocation, lockdown, and shelter-in-place procedures. Such plans shall also include procedures to communicate with parents about the existence of the emergency plan, and procedures when a provider based on emergency situations invokes the emergency plan.
• In addition to evacuation drills, the health and safety checklist should include that providers have working smoke detectors on every floor of the home and a fire extinguisher for use in emergencies.
• The current regulatory requirement (22VAC40-180-120) that says “If the provider does not have a working telephone, the caregiver shall demonstrate that one is quickly and easily accessible in case of emergency” should be modified to say that a provider shall have a working telephone accessible at all times.

Precautions to Prevent Accidents and Injuries

• Similar to licensed child care centers and family day homes as well as license-exempt care, VR providers should be required to comply with safe sleep guidelines recommended by the American Academy of Pediatrics. Safe sleep guidelines are particularly important given the number of deaths of infants and toddlers in Virginia in primarily unlicensed homes. Providers ‘don’t know what they don’t know.’ Access to information and training about best practices in safe sleep placement can save lives. Any safe sleep training should be updated/renewed every 5 years as professional knowledge and practices evolve.
• Information about shaken baby syndrome and the dangers of shaking a baby should be made available to all VR providers. Any training related to safe sleep practices could also share information about shaken baby syndrome and offer strategies to avoid such actions by child care providers.
• The current health and safety checklist includes a reference to cribs and playpens. The current guidance for licensed family day homes does not specifically reference playpens; however, in the crib section, cribs are prohibited from having mesh sides. To promote consistency (particularly for those VR providers who may want to become licensed), we suggest conforming the two regulatory approaches. Playpens are not to be used in licensed or VR care.

Responsibility to Uphold Laws and Regulations Important to the Protection of Children

• Under this section of the health and safety checklist, there is no reference to following public health guidance from the Centers for Disease Control (CDC), the Virginia Department of Health (VDH), or other public agencies (such as VDSS or VDOE) to promote the health and safety of providers and the children in their care (e.g., implementing social distancing requirements, sick policies, using personal protective equipment, and shutdown procedures that were required as a result of the current public health pandemic). Any future guidance (including health and safety checklists) should include such a requirement.
• Pre-service or orientation training should be required of VR providers to ensure the basic knowledge that is necessary to safely and effectively provide paid child care services. Orientation training, including the following topics, would help promote the safety of children in VR settings:
  • Building and physical premises safety
  • Emergency preparedness and response planning
  • Prevention of sudden infant death syndrome (SIDS) and safe sleep practices
  • Administration of medication, consistent with standards of parental consent (separate from MAT training, which is related to the administration of prescription medicine)
  • Prevention of shaken baby syndrome and abusive head trauma
  • Prevention of and response to emergencies due to food and allergic reactions
  • Recognizing child abuse and neglect and reporting responsibilities (as well as how to handle the situation – not just the reporting of suspicions)
  • Preventing the spread of disease, including immunization requirements
  • Handling and storage of hazardous materials and appropriate disposal of diapers and other items contaminated by body fluids
  • Transportation
  • Foundations of Child Development
  • Inclusion: Exploring the meaning and mindset (e.g., strategies to provide a welcoming environment for children with varying abilities, including special needs)
  • Oral health
  • Optional but encouraged: introduction to the Child Care Subsidy Program
• In addition to pre-service or orientation training, there should be an annual ongoing minimum training requirement for voluntary registered providers of at least 12 hours.
• CPR, First-Aid and MAT training are recommended in addition to initial orientation training, but could be counted toward annual training hour requirements.
• Under the provider eligibility section of the current guidance (22VAC180-30), a family day assistant shall be 14 years of age or older. The health and safety self-checklist says “I never leave children alone with an assistant younger than 18 years of age.” We urge the Department to consider increasing the age of any assistant to 16 years and requiring in the guidance that no child shall be left alone with an assistant under 18 years of age, and that assistants under age 18 not be allowed to administer medicine. This would be consistent with the current regulatory guidance for providers who care for children receiving subsidy assistance.
• The current VR guidance under staffing requirements (22VAC40-180-110) should eliminate the reference to nine children in care and refer to the current point system (which counts all children in care with points allocated by age and includes any children of the provider or who live in the home).

Supporting Voluntary Registered Providers to Best Promote the Healthy Development of Children in their Care

• Current Rates for VR Administration. There are few nonprofit agencies throughout Virginia that currently contract to register VR providers. Over time, the number of agencies interested in administering this program has dwindled. In part, this is likely due to the extraordinary staffing costs compared to the contract rate (e.g., VR providers pay $50 for a 2-year registration - which amounts to $25 per year, and VDSS pays $75 per provider annually). The cost to actually administer the program is far more than this modest level of reimbursement. At the same time, the VR program is a potential gateway to licensed care and offers an opportunity for nonprofit agencies to work with VR providers to (1) promote best practices (to establish minimum standards for health, safety and quality, whether such providers begin the journey to licensing or not, which benefits all children in care) and (2) helps establish relationships of trust that may increase the likelihood that providers may want to become licensed one day. We recommend fully funding the administration of the VR system, to include certification, monitoring and support services.

The remaining recommendations relate to a fully-funded, state-supported VR system and the potential that the program could be used to help reduce child care deserts and increase the likelihood that providers may decide to become licensed once they feel more supported. More than 40% of Virginia families live in a child care desert. Support through a more vibrant VR program could help better serve families who need child care and potentially increase the number of providers who may one day want to seek licensure.

With a well-funded VR system, we recommend:

• Annual home visits with each VR provider to support review of the health and safety checklist (in addition to supports that could be identified to help promote healthy child development)
  • If annual monitoring is not state-funded, referrals should be made for Technical Assistance/Professional Development Specialists to conduct a visit and recommend supports if needed.
• Align the health and safety checklist with requirements for home-based Subsidy Program vendors so that VR providers can have a more seamless entry into the Subsidy Program, should they wish to serve subsidy recipients.
• Incent collaborative partnerships so that VR providers feel linked-into training and support networks through professional development organizations like Child Care Aware of Virginia and the Infant Toddler Specialist Network. For example, CPR and First Aid, Emergency Preparedness, Trauma-Informed Care, and Strengthening Business Practices could create a pathway toward licensing through training and the building of trusted relationships. Child Care Aware of Virginia would be excited to offer training to encourage VR providers to pursue licensure, to take the anxiety and questions out of the process, which could be supplemented with TA and access to our online Family Child Care Toolkit offered through our Virginia Shared Services Network.

While the number of VR homes has declined in recent years, we see an opportunity to provide more robust support for VR providers, which could attract more home-based providers to the field and result in more licensed care in the long-term. The real beneficiaries of a more robust VR system would be the children, parents, employers, and communities that rely on child care – particularly now with the focus on economic recovery. We appreciate the opportunity to provide comments on this process and look forward to supporting the program and its participants as new requirements are implemented. Enhancing the VR system has the potential to better support Virginia families and further develop the child care workforce.

Should you have any questions, please contact Child Care Aware of Virginia Executive Director, Angela Wirt, at angela@vachildcare.com. We would be glad to provide further input or assistance. Thank you for taking the initiative to modernize the VR guidance.

Sincerely,

Angela Wirt

Angela Wirt

Child Care Aware of Virginia