Licensing and Administrative Regulations

sp-licensingThe Basics

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 a summary of the 2010 baseline data.5  Go to www.nrckids.org for the most recent national assessment data report, Achieving a State of Healthy Weight.

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:

    • In 2007, New York City implemented regulations for licensed group day care centers, including a) requiring 60 minutes of physical activity time per day; b) limiting viewing of television, videos, and other visual recordings to no more than 60 minutes per day of educational programs or programs that actively engage child movement; and c) requiring that food supplied to children be wholesome, of good quality, and properly prepared in accordance with nutritional guidelines.
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    • In 2009, Chicago passed a joint resolution that recommended specific nutrition, physical activity, and screen viewing standards be implemented in all of Chicago’s licensed centers, which the city has authority to regulate.  These standards included restrictions for beverages with added sweeteners, 100% juice, and screen viewing; and provisions for physical activity.  The resolution was amended in 2011 to include standards for milk.  Support to child care providers for implementing the standards was provided by the Chicago Department of Public Health through free technical support and training.7
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    • In January 2010, Arizona adopted the Empower program, a voluntary program in which licensed ECE facilities in the state could enroll and receive a 50% reduction in licensure fees by adopting 10 Empower policies and standards that support healthy eating, active living, and tobacco prevention. Based on the success of Empower, in October 2010, Arizona implemented mandatory rules and regulations for licensed ECE centers, including structured physical activity, screen time limitations, exclusion of any sugar-sweetened beverages, family-style meals, and breastfeeding accommodations.
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    • In August 2010, California passed legislation establishing healthy beverage standards for all licensed ECE facilities, including providing low-fat and nonfat milk for children 2 years and older, limiting portion sizes of 100% fruit juice, eliminating beverages with added sweeteners (natural or artificial), and increasing water accessibility.8

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  • In September 2014, the Broward County Commission (FL) passed a law strengthening previous county and state child care regulations. The legislation included a number of new requirements for ECE providers to follow including: providing at least 40 minutes of physical activity for every three and a half hours in care for children ages 1 to kindergarten enrollment, excluding nap/quiet time; restricting screen time for children under 2 years of age and limiting screen time to 2 hours per day for educational or physical activity only for children 2 and older; and not serving whole milk to children 2 and older.

 

 

State Example: Massachusetts

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.

Implementation

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:

  • reaching the 60-minute physical activity requirement
  • providing healthy foods and snacks, like fruits, vegetables and whole grains
  • providing water and low-fat or skim milk instead of whole milk or sugary drinks
  • spending more time being active and less time in front of the TV or computer

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.

Lessons Learned

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.

 

References

  1. NACCRRA. Center Child Care Licensing Requirements: Minimum Early Childhood Education (ECE) Preservice Qualifications and Annual Ongoing Training Hours for Teachers and Master Teachers. (Sept 2008). Available from http://www.naccrra.org/randd/data/TeacherTraining.php.
  2. U.S. General Accounting Office. Child Care: State Efforts to Enforce Safety and Health Requirements. Washington, DC: GAO; 2000. Pub. No. GAO/HEHS-00-28. Available from http://www.gao.gov/new.items/he00028.pdf.
  3. American Public Health Association and American Academy of Pediatrics. Caring for Our Children. National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs. Washington, DC: 1992.
  4. American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Out-of-Home Child Care Programs, 2nd edition. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association; 2002. Available from http://nrckids.org.
  5. National Resource Center for Health and Safety in Child Care and Early Education, University of Colorado Denver. Achieving a State of Healthy Weight: A National Assessment of Obesity Prevention Terminology in Child Care Regulations 2010. Aurora, CO: 2011. Available from http://nrckids.org.
  6. National Resource Center for Health and Safety in Child Care and Early Education. Individual States’ Child Care Licensure Regulations. Available from http://www.nrckids.org/STATES/states.htm.
  7. Using Local Authority to Create Healthier Child Care Settings: Chicago. Available from http://publichealthlawcenter.org/sites/default/files/resources/New%20York%20Fact%20Sheet-%202%2025%2014.pdf.
  8. California Bill No. AB-2804: Brownley. Child day care facilities: nutrition. Available from http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_2051-2100/ab_2084_bill_20100930_chaptered.html.
  • 90–120 minutes of physical activity per 8-hour day for preschoolers; 60–90 minutes for toddlers. Outdoors when possible and at least 30 minutes of teacher-led activity.
  • Screen time limited to half hour per week of educational or physical activity programming for children 2 years or older; no screen time for children younger than 2 years.
  • No beverages with added sweeteners.
  • Have water accessible and available throughout the day.
  • Limit juice to one 4- to 6-oz serving of 100% juice per day (1- to 6-year-olds).
  • 1% or lower-fat milk for children 2 years and older
  • Distribution of nutrition guidelines to parents for food brought into facilities from other sources
  • Support breastfeeding mothers