Licensing is defined as permission from the state to operate an ECE facility.1 All ECE programs and providers that are not legally exempt from licensing are required by law to meet state-specific minimum standards of care. In the United States, regulation of ECE facilities, including licensing, is the responsibility of the individual state, territories, and the District of Columbia, and each has an agency responsible for regulation oversight and enforcement.2 Regulations and enforcement standards vary considerably by state and, in some cases, may be legislated. Some municipalities, unless preempted by their state, have the authority to regulate ECE facilities within their jurisdiction and can pass more stringent standards. The public health law center has performed a legal review of all 50 states’ statutes and regulations pertaining to ECE to assess local government’s ability to establish standards for ECE facilities to inform state and local obesity prevention efforts. The results of their analysis are summarized here. .
What Should Licensing Regulations Include for Obesity Prevention?
National, evidence-based guidance for licensing regulations has been available since 1992 in the form of Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (CFOC).3 The third edition of CFOC (2011), contains the first standards specific to obesity prevention. These 49 standards, which include more than 250 components, are also published as a stand-alone document.4
How Well do Each State’s Regulations Include Obesity Prevention Standards?
A comprehensive assessment of how well any state incorporates all 250+ CFOC obesity prevention standard components has yet to be performed. However, since 2010, an annual national assessment has been completed to determine how well each state’s licensing regulations included 47 “high-impact” CFOC obesity prevention standard components. Results indicated that most components were either absent or insufficiently captured within regulations. Additionally, regulations in most states were found to contain language that was contradictory to at least one of the components.
Click here to view selected excerpts from state licensing regulations for nutrition, physical activity, and screen time compiled in 2011.
What are States and Communities Doing?
Increasingly, states and localities are pursuing this opportunity to help ensure that minimum standards for obesity prevention are required in most ECE facilities.6 For example:
Massachusetts revised the Department of Early Education and Care Child Care Licensing Standards by including a requirement that all children in licensed child care programs receive 60 minutes of physical activity a day in all full-day child care programs and 30 minutes a day in half-day programs. Becoming effective in January 2010, the revised regulation applies to all types of facilities (i.e., family child care, center-based, and after school). The physical activity regulation affected the more than 2,000 licensed child care centers in the state and was part of a larger set of new regulations that included revised standards on child tooth-brushing and provider training.
While they were aware of the regulation, ECE providers responding to a survey noted that few had the time or resources to do anything about it on their own. The MA Department of Public Health (MDPH) teamed up with members of the Departments of Early Education and Care (MDEEC) and Elementary and Secondary Education to create Massachusetts Children at Play (MCAP), a free policy development training program to help providers meet the requirement.
MCAP recruited and trained specialized child health consultants, referred to as MCAP Mentors, to help providers incorporate active movement and healthy food and beverage options into the setting. As one mentor put it, “The main barrier at the centers was a lack of knowledge, so as soon as I explained how they could easily make small changes, they were excited to do so.” During the first two years of implementing MCAP, program partners were able to make enhancements along the way, always asking: “What’s working? What could we do better?” The evaluation helped the workgroup pinpoint several areas in need of tweaking that would have otherwise gone unnoticed. Almost all MCAP providers and centers have made significant changes in their settings, including:
An MCAP Tool Kit was developed that incorporates Head Start’s I Am Moving, I Am Learning program and North Carolina’s Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC). Certified mentors use these and other tools to help child care centers develop practices to support healthy eating and create opportunities for increased physical activity to meet the new state regulation. To date staff in over 270 ECE centers and family child care providers have been trained to implement components of MCAP. In addition to this, MCAP trainings have been held for Massachusetts WIC program staff. In 2013 the MDPH continues to work with Early Childhood Services through their EEC “Race to the Top” grant and the state’s new Mass in Motion – Kids initiative (one of four Childhood Obesity Research Demonstration projects funded by CDC) to expand training and establish a professional learning community for ECE providers across the state.
MDPH and MDEEC spent nearly two years carefully laying the groundwork and securing stakeholder buy-in for the regulatory changes. This process was critical to facilitate the acceptance of the proposed regulations.
After draft regulations were approved by MDEEC’s Board of Directors, MDEEC delayed implementation of the regulations to ensure that the necessary information and resources were available to the ECE community to maximize compliance. Although other states have implemented new regulations in shorter periods of time, it was important to consider the substantial investment of time required for the regulatory change in Massachusetts.
Demystify” the concept of “policy” among child care providers by referring to it as a practice or as just an agreed-upon way of doing things in the center.