On any day, thousands of Connecticut children need to be given medication while in child care centers, but many providers don’t know how to properly administer the medications, studies show.
To change that equation, the Yale School of Nursing developed a curriculum and has trained 75 nurse consultants to teach child care providers on how to correctly give medication to children in their daily care. Child care providers at more than 200 sites have been trained statewide.
“We have made some steady progress on this,” said Angela Crowley, a leader in crafting the curriculum and a professor and coordinator in the pediatric nurse practitioner specialty at Yale School of Nursing. “It is really exciting because we did something really innovative.”
State law requires providers who need to administer medication be trained in how to do so, but there is no uniform training method used by all providers, Crowley said.
The Yale curriculum was spurred in large part by a 2009 study by the Child Health and Development Institute of Connecticut (CHDI) that found one out of five child care centers in Connecticut lacked a provider trained in administering medications, and 40 percent of centers administered medications without a written order from a prescriber.
Of the more than 110,000 children enrolled in licensed care centers, Head Start, and home-based child care programs statewide, 10 percent have diabetes, asthma, epilepsy or other health issues, according to CHDI. Of those, 85 percent need to receive medication while in a provider’s care
Some parents told focus groups leaders their children were not accepted into child care programs because they required medication, even though that’s a violation of the Americans with Disabilities Act, Crowley said.
“This is a huge concern,” she said, adding providers need the tools to make informed decisions. “When providers are given all the support they need, they really are very comfortable. They have a lot on their plate, caring for children, and they need support.”
When MacKenzie Wilson and her husband, Ryan Sult, who live in Fairfield, chose a pre-school for their son with Type I Diabetes, the staff was willing to be trained about Type 1 Diabetes.
Dylan, 2, has been on an insulin pump since last January and this past fall began attending Small to Tall Scholars preschool in Fairfield two days a week for three hours each day.
“They had no had experience with Type I Diabetes,” Wilson said, but staff worked with a nurse consultant to learn how to check his blood sugar, be mindful of what he eats and act in case of an emergency.
They worked out a schedule where the child care staff does not administer insulin to Dylan, though they now know how to if they must. The nurse consultant visits the center and meets with Dylan weekly, Wilson said.
“They’ve been really responsive; they’ve been great to work with,” she said. “It makes me feel a lot better.”
Crowley said that having 75 nurse consultants trained in the curriculum is a good start, but more needs to be done to ensure all providers are educated.
Yale School of Nursing is spearheading the ongoing effort to increase awareness and use of the curriculum, with funding from CHDI and the state departments of Education and Social Services.
More children would benefit if the curriculum were wider spread, Crowley said, but additional funding is needed to expand training.
To that end, CHDI and Yale are pushing for more state funding and urging the state’s Office of Early Childhood (OEC) to make the curriculum the department’s preferred way all providers are trained, said CHDI President and CEO Judith Meyers. The curriculum is now optional.
At this point, OEC is not taking that step, said department spokeswoman Diana Lejardi.
“The health and safety of children are bolstered by having their teachers and caregivers know how to properly administer medication,” she said. “While OEC is not currently considering requiring a specific training, we are looking closely at how to increase the availability of high-quality training, such as the one developed by Yale, to more nurse consultants across the state.”
Those who use a consultant can benefit greatly from the experience, said Patty O’Hanlon, director at Westville Community Nursery School in New Haven.
Last year, the center enrolled its first child with diabetes, she said. “We were all really nervous about it because none of us really knew about diabetes and how life-threatening it can be,” she said.
The consultant’s training “was extremely helpful and made the teachers feel a little more at ease,” O’Hanlon said.
Before the consultant was hired, the child’s mother visited the school to explain to staff how medication should be administered. But that responsibility should not fall on parents, O’Hanlon said.
In addition to endorsing the curriculum, CHDI recommends that state officials:
• Require at least one certified medication administration trainer be present in every state-licensed child care program during operating hours, as is required in some other states.
• Provide professional development scholarships to assist child care providers in getting trained.
• Provide state funding to support training hubs where staff with appropriate training can respond to questions from providers, coordinate training and keep the curriculum up to date.
I would like to know why pharmacists, especially consultant pharmacists are not deeply involved in this process.