1. Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

2. The Power of Partnerships Lexie’s Law: Making Change Happen in Kansas National Association of Regulatory Administration Licensing Seminar September 13, 2011 Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Rachel Berroth, Director Early Care and Youth Program Section Mary A. Murphy, Director Compliance and Regulation Development Unit

3. Lexie Engelman July 6, 2003 – August 10, 2004 Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

4. Overview Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" I.Kansas Child Care Licensing II.How It All Began… III.Partnerships and Advocates IV.Legislative Session V.Lexie’s Law VI.Lessons Learned VII.Impacts/Next Steps VIII.Questions

5. Kansas Child Care Licensing 105 counties covering an estimated 82,000 square miles –Mostly frontier and rural –Three major urban areas Generally considered politically conservative KDHE contracts with local health departments to conduct inspections and provide regulatory services for approximately 7,000 child care facilities –More home-based facilities (n=5,645 or 81%) than center- based facilities (n=1,290 or 19%) –More capacity in center-based facilities (n=84,914 or 59%) than home-based facilities (n=58,468 or 41%) Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

6. How It All Began… Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" 2006 legislative interest in reducing licensing requirements and oversight The Department introduced bills during the 2006, 2007, 2008, and 2009 sessions (testimony and involvement but no resolution) Trend data on child deaths in child care settings was alarming NACCRRA Study “Leaving Children to Chance” published a score of 0 for Kansas Formation of the Child Care Licensing Systems Improvement BEST Team 2007 public listening tour Personal advocacy by Kim and Bryan Engelman

7. How It All Began… Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Master’s project led to compiling death data and tracking/reporting system for child care injuries and deaths KDHE experienced an increase in serious injuries and deaths reported in child care during calendar year 2007, compared with years 2004 to 2006 KDHE implemented new procedures for reporting and investigating injury and death Licensing database was enhanced to support electronic tracking and reporting

8. How It All Began… Implemented new procedures in 2007 in order to: –Guide investigations of serious injury (requiring medical attention) and death in child care –Gain additional information for sudden, possibly unexplained deaths of infants (children under 18 months) –Ensure uniformity in the collection and documentation of information obtained in such investigations across the State of Kansas –Facilitate the development of standardized tracking of data in the licensing database Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

9. Serious Injury & Death: What We Track in the System Identifying information for facility and child Circumstances surrounding the injury or death Staff and children present and locations Medical attention received (on site/once transported) Other agencies involved in the investigation Type of injury or official cause of death (per DC) If infant death (0 to 18 months), additional information collected Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

10. Serious Injuries in Child Care Under current regulations, child care homes and facilities are not required to report serious injuries to the health department or KDHE (only school age programs report), making it impossible to accurately track total number of serious injuries Programs are required to immediately report injuries requiring medical attention to parents Most common type of injury since tracking began is a fracture; data reveals young children are at greatest risk Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

11. Child Care Deaths Deaths occur across the state, urban and rural areas Most common cause of death is sleep related (Sudden Infant Death Syndrome--SIDS); most vulnerable child is a newly enrolled infant under 1 year Providers lack training and understanding on safe sleep practices and reducing the risks of unintentional suffocation Child care practices are a contributing factor -Supervision -Unsafe sleep position -Unsafe sleep location and/or surface Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

12. Death Data by Calendar Year Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

13. Response to the Data Increased awareness of parents, providers, and public regarding recommended child care practices that protect children and reduce risks Mailed safe sleep inserts to new and existing providers Collaborated with agencies and organizations in Kansas: Vital Statistics, Child Death Review Board, Safe Kids Kansas, SIDS Network Public education provided through the Safe Child Care Task Force (KS Chapter AAP, SIDS Network, KACCRRA, Safe Kids, KDHE, Child Death Review Board, KS Action for Children, parent and family advocates) and Child Care Safety website Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

14. Safe Child Care Task Force http://www.kdheks.gov/safekids/child_care.htm Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

15. Partnerships & Advocates Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Governor’s Child Health Advisory Committee and the SIDS Network interest in infant deaths Pre-K and school readiness initiatives Early Learning Coordinating Council (ELCCO –the state’s early childhood advisory council. Provides oversight for the KS Early Childhood Comprehensive Systems (KECCS) Plan Child Care Providers Together/ ASFCME the union for family child care providers KS Association for the Education of Young Children Child Providers Coalition of KS Child Care Aware of KS

16. 2010 Legislative Session Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Kansas Action for Children (KAC) included the inspection of registered family day care homes in their 2010 legislative platform Inspect the Rest Campaign Billboards Website Email blasts Lobbying Fact sheets Advocacy

17. 2010 Legislative Session Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Kim and Bryan Engelman worked with their legislator to introduce a bill in the Senate to strengthen supervision The Department’s bill to inspect registered homes was not advancing in the assigned House Committee KAC worked with the Engelmans and the assigned Senate Committee to add language to inspect registered homes to the supervision bill After extensive re-working the bill passed the Senate and went to the House Committee that had not acted on the Department’s original bill Advocates pressed hard in support of the bill

18. 2010 Legislative Session Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" The House Committee held several hearings and significantly re-worked the bill The NACCRRA report was central to the deliberations The bill narrowly passed the house Conference committee between the Senate and House resolved the differences between the two versions Lexie’s Law passed and was signed by the Governor on May 27, 2010

19. Lexie’s Law Senate Substitute for HB 2356 Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Effective July 1, 2010 Landmark legislation with sweeping regulatory reforms Named after Lexie Engelman, a 13 month old child that died of injuries sustained while in child care (day two) Grassroots initiative of early childhood advocates

20. Lexie’s Law Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Key Elements: –Eliminated the category of registered family day care home and provided for the transition of 2,400 registered homes to licensed day care homes As of July 1, 2011, the category of registered family day care home was eliminated, and all previously registered providers became licensed or voluntarily closed –Prioritized inspecting the registered family day care homes –Allowed health departments to consider not inspecting child care facilities in compliance at the time of the last inspection between July 2010 and June 2011

21. Lexie’s Law Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" –Required new applicants to be a high school graduate or the equivalent such as having a GED –Required the Department to develop, through the rules and regulation process, requirements for the competent supervision of children and additional health and safety requirements necessary for the protection of children –Created a fee fund that authorized an increase in licensing fees to fund approximately 2,600 additional inspections –Required a late fee the same amount as the renewal fee for those failing to renew within 30 days of the expiration of the license

22. Lexie’s Law Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" –Required the Department to issue licenses with an expiration sticker, stating the expiration date of the license –Permanently prohibits a licensee from maintaining or working in a facility if a license is revoked under certain conditions –Permitted the Department to release identifying information such as the names, addresses, and phone numbers of applicants/licensees effective May 2011 –Required the Department to design, develop, and implement an online information system so parents and the public can access child care provider compliance history (CAPP Project)

23. Lessons Learned Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Research and data were central to building support -Child death -School readiness -Brain development -Results of the listening tour -Research on frequency of inspections -NACCRRA data and research -NARA data and research

24. Lessons Learned Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Legislators respond to their constituents The Agency’s legislation did not go anywhere The Engelmans’ efforts and strategic advocacy made the difference Develop talking points to assist constituents in the message Constituents target key legislators to provide the information and education

25. Lessons Learned Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Messaging is important -Get the word out -Stay on target with the message -Keep it simple and direct -Use multiple mediums Social media is effective

26. Lessons Learned Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Building lasting relationships is critical Broad-based support is essential -Parents -Local health departments -Child care providers, associations and Union -Resource and referral -Education -Early childhood partners -Social Services

27. Lessons Learned Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Take a long view Take advantage of opportunities and timing Identify champions -Legislative -Individuals -Organizations Compromise

28. Impacts/Next Steps Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Change in total capacity to serve children after Lexie’s Law

29. Impacts/Next Steps Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Change in facilities by program type after Lexie’s Law

30. Impacts/Next Steps Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It" Fee increase/fee fund Expiring licenses Burdensome: multiple modernization initiatives Requirement for applicants to be a HS graduate Online Information System Proposed regulations Track impact of Lexie’s Law

31. Child Care Licensing Website http://www.kdheks.gov/kidsnet Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

32. Questions Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

33. Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"