Compliance of child care programs with health and safety standards: Impact of program evaluation and advocate training

A 72 hr training program for workers in child care programs (day care and Head Start) on advocacy for health and safety was designed, implemented, and evaluated in the Southeast Region of Pennsylvania. From 142 day care sites that were involved in the study, 117 trainees were enrolled in groups of approximately 20 trainees over a 2 yr period. Overall attendance averaged 88%. Trainee satisfaction with individual sessions varied from 96% to 76%. 92% of enrolled trainees completed the course. Most completed four out of the five course assignments. A pretest and posttest of health knowledge showed significant gain in all areas covered by the training; this knowledge was retained in a follow-up test 7 mth after the completion of training. Changes in desired opinions related to health advocacy were limited to an increase in the number who agreed that health issues can be grasped by individuals who are not health professionals. Pretraining assessment of program compliance with accepted health and safety standards revealed widespread need for improvement. Participation in the evaluation aspect of the study alone was associated with improved compliance of programs with health and safety standards, but in a number of health and safety aspects of the program, participation in training was associated with greater improvements in compliance than evaluation alone. This finding suggests a benefit to be derived from both monitoring and training provided for health and safety aspects of child care programs. Changes in compliance by programs were associated with increased involvement of the trained advocate in health and safety activities in the program. This greater involvement was manifested by the advocates as an increase in the combination of advocating and performing of activities and a decrease in only performing.