1. Child Care Quality Rating System in Milwaukee and Waukesha Counties Team Members: Kristin Anderson James Beix Benjamen Jones Bridget Gnadt 2009 Cohort 23 – Wisconsin Group

2. Executive Summary Development and implementation of a Quality Rating System in child care centers (QRS) –Partnership between regional preparedness consortium and local public health agencies –Assessment above and beyond minimum state licensing standards –Resulting in improved quality of care

3. Target Market Milwaukee and Waukesha Counties –25% of States population –34,000 children under age 5 –Almost 700 group child care centers Milwaukee/Waukesha County Consortium for Emergency Public Health Preparedness –14 local health departments

4. Needs Assessment Communicable Disease Outbreaks –Vaccine Preventable Diseases Measles, mumps, pertussis Poor immunization rates (54% of 2 year olds up-to-date) –Gastrointestinal E coli, shigella Milwaukee/ Waukesha Rate* National Baseline Rate* (3 yr average) Magnitude of local outbreak 2007 Shigella outbreak (children less than 5 years old) 253.515.25> 16 times 2006 Mumps Outbreak13.190.089> 148 times 2004 Pertussis Outbreak136.13.22> 42 times * All rates are per 100,000 population

5. Needs Assessment (cont.) Preparedness Deficiencies Survey –83% claimed plans but 29% didnt have in writing –Many plans lacked key areas such as: evacuation, armed intruder, sheltering, etc. Child care interest survey –Majority of child care centers interested in QRS –Would be willing to pay for services Parent Interest Survey –Majority of parents would value QRS –Would be willing to pay for services at child care center

6. Definition of Plan Assessment –Criteria developed by Milwaukee Waukesha preparedness consortium –Completed by RN through an onsite 2-4 hour evaluation initially for City of Waukesha child care centers –Findings taken to Milwaukee / Waukesha Consortium Board for scoring.

7. Definition of Plan (cont.) Second Onsite Visit –Within 1 month RN will discussing rating level with child care director –Provide information on fee for service activities available to improve rating level Immunization Records Management On-site Immunization Clinics Emergency Preparedness plans Education Programs for Families, Staff & Students

8. Definition of Plan (cont.) Posting of QRS Scores –Updated bi-monthly on the Waukesha County Public Health website –Twice per year the QRS will be extensively promoted through MetroParent Magazine.

9. Outagamie Regional Phase in of QRS YEAR OF PHASE IN AND REGION / CITY YEAR 1 City of Waukesha YEAR 2 Waukesha County (excluding City of Waukesha) YEAR 3 Initial ½ Milwaukee County Suburbs YEAR 4 Remaining ½ Milwaukee County Suburbs YEAR 5 City of Milwaukee CHILD CARE CENTERS 30 148 64 95 379

10. Operations (cont.) Human Resources –2 full time RNs initially with an additional full time RN hire each year in years 2-4 –Part time (20 hours per week) administrative assistant hired in year 2 –By year five an additional 6 full time RNs will be hired to reflect the number of potential participants as all of Milwaukee and Waukesha counties are phased in.

11. Operations (cont.) Waukesha County Public Health Division –Fiscal Agent –House staff –Managerial Information Technologies –Laptop for each RN with internet and e-mail –Signature pad for on-site immunization clinic –IT support from Waukesha County under Public Health contract

12. Operations (cont.) Measures of Success –Predicted number of participants complete QRS assessment (79%) –Annual increase in the average rating level –Goals for 1 st Year: 80% NAEYC approved curriculum 80% utilize on site trainings 80% Up-to-date immunization records 75% Comprehensive Emergency Plans

13. Operations (cont.) Evaluation and Quality Improvement –Annual evaluation by child care centers –Specific program evaluations –Milwaukee / Waukesha consortium board approves all QRS program changes

14. Industry Analysis WI does not currently have a QRS program. Many other states have successful QRS programs –North Carolinas Star Rated License –Iowa QRS –Oklahomas Reaching for the Stars program

15. Marketing Commercials during Supernanny and the WISN morning news will begin in program year 3 The marketing strategy will be multi- phase, targeting both child care centers and parents Marketing will initially focus on child care centers and will later shift to parents to create a parent-driven program

16. Timeline Time FrameActivity November 2009 Proposal for grant funding due to Healthier Wisconsin Partnership Program March 2010 Notification of grant award Begin staff hiring process Work with M/W Preparedness Consortium to develop preparedness criteria July 2010 Staff officially hired Purchase start-up equipment and supplies Staff attend trainings Initial group of child care centers are notified of project (City of Waukesha) Begin 5-year implementation plan by region

17. Competition and Partners Competitors National Accreditation Program Continuing Education Providers Childhood Vaccination Providers Partners Milwaukee/Waukesha Consortium MetroParent Magazine © American Red Cross

18. Risks, Regulations and Exit Risk Failure to obtain grant Political will to launch program Regulation Exit Strategy Incorporate into Nonprofit Org, type 501(c)(3)

19. Year 1 Budget 2010 Expenditures and Revenues ExpendituresQ1Q2Q3Q4Total Total Personnel$27,305.00 $109,220.00 Total Equipment$18,330.00$150.00 $18,780.00 Total Other$28,261.48$3,977.80$4,565.80$7,337.80$44,142.88 Total Expenditures$73,896.48$31,432.80$32,020.80$34,792.80$172,142.88 RevenueQ1Q2Q3Q4Total Healthy WI Partnership$150,000.00$0.00 $150,000.00 Onsite Trainings$3,120.00$9,360.00 $31,200.00 Record Management Fee$801.00 $3,204.00 Immunization Clinic Fee$1,818.00$2,727.00 $9,999.00 Home Preparedness Kits$0.00$2,720.00$4,080.00 $10,880.00 Hosting LPHA (in kind)$2,469.00$165.00$190.00$165.00$2,989.00 Total Revenue$158,208.00$15,773.00$17,158.00$17,133.00$208,272.00 Net Difference$84,311.52($15,659.80)($14,862.80)($17,659.80)$36,129.12

20. 5-Year Budget Expenditures20102011201220132014 Total Personnel$109,220.00$179,171.60$235,346.75$293,207.15$606,803.36 Total Equipment$18,780.00$56,975.00$74,124.00$102,058.70$227,675.87 Total Other$44,142.88$68,368.50$79,054.60$82,443.05$147,079.13 Total Expenditures$172,142.88$304,515.10$388,525.34$477,708.90$981,558.37 Revenue Healthy WI Partnership$150,000.00 -- Onsite Trainings$31,200.00$183,300.00$249,600.00$315,900.00$704,600.00 Record Management Fee$3,204.00$18,000.00$24,400.00$30,800.00$68,800.00 Immunization Clinic Fee$9,999.00$57,675.00$78,438.00$99,201.00$221,472.00 Home Preparedness Kits$10,880.00$63,960.00$87,080.00$110,240.00$245,840.00 Hosting LPHA (in kind)$2,989.00$6,507.00$8,273.00$10,045.70$20,078.87 Total Revenue$208,272.00$479,442.00$597,791.00$566,186.70$1,260,790.87 Net Difference$36,129.12$174,926.90$209,265.66$88,477.80$279,232.50

21. Thank You! Questions?