Health and Safety in Family Day Care Homes: Association Between Regulatory Non-compliance and Lower Median Income
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Health and Safety in Family Day Care Homes: Association Between Regulatory Non-compliance and Lower Median Income Marjorie S. Rosenthal1,2 • Sangchoon Jeon3 • Angela A. Crowley3
Published online: 23 December 2015 Ó Springer Science+Business Media New York 2015
Abstract Objectives To determine frequency of noncompliance with child care regulations among family day care homes (FDCH) and identify the role of income in compliance. Methods We analyzed non-compliance in 746 routine, unannounced inspection and re-inspection reports of FDCH collected by the Connecticut Department of Public Health licensing specialists in 2007–2008 and linked results to median income of zip code data. We grouped the 83 state regulations into 12 regulation categories, analyzed 11 categories, and used latent class analysis to classify each FDCH as high or low compliance for each category. We used logistic regression analysis to estimate the odds ratios of low compliance. Results Among the 746 FDCH inspections (594 first inspections and 152 re-inspections), we found high rates of non-compliance in inspection regulations in immunizations (32.9 %), water temperature (35.6 %) and hazards (30.0 %). Among the 11 regulation categories, 4 categories (indoor safety, emergency preparedness, child/family/staff documentation, and qualifications of provider) had regulations with high noncompliance. Median household income of FDCH zip code was lower for re-inspection sites than for inspection sites ($34,715 vs. $57,118, p \ 0.0001) and FDCH in the lowest quartile of income had greater odds of low compliance in indoor safety (OR 1.86, 95 % CI 1.04, 3.35, p \ 0.05). Conclusions The majority of FDCH were in compliance
with the majority of regulations, yet there are glaring noncompliance issues in inspections and re-inspections and there are income-based inequities that place children at higher risk who are already at high risk for suboptimal health outcomes. Keywords Child care Family child care homes Regulation compliance Income inequity
Significance This paper describes the frequency of non-compliance with state-mandated child care regulations among family day care homes (FDCH) in Connecticut and identifies the role of income in compliance. We found high rates of non-compliance in specific regulations: immunizations, water temperature, and hazards, and in 4 categories: indoor safety, emergency preparedness, child/family/staff documentation, and qualifications of provider. The majority of FDCH were in compliance with the majority of regulations, yet there are glaring non-compliance issues and there are income-based inequities that place children at higher risk who are already at high risk for suboptimal health outcomes.
Introduction & Marjorie S. Rosenthal [email protected] 1
Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
2
Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA
3
Yale School of Nursing, Orange, CT, USA
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The child care envi
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