For the past 15 years, Alice Elio fought a killer of infants that medical experts cannot predict.
“The number of babies dying from sudden infant death syndrome in secondary care is appalling,” Elio said from her office at the Buncombe County Child Care Center where she began working 11 years ago.
Elio, now a Buncombe county health-care consultant and leader of the ITS-SIDS child care training workshop in downtown Asheville, began her career in child care at the Mamieo Stookey school for children with special needs in Illinois. She taught essential SIDS prevention techniques to child care providers in Asheville after working for Buncombe County’s disease control division.
“The prevalence of SIDS deaths in child care was the whole reason that a new law in 2003 was enacted by the Division of Child Development,” Elio said. “Looking at the statistics showing that the number of kids dying in child care was way too high they said, ‘What is going on here?’”
The 2003 Safe Seep legislation mandates N.C. child care providers complete educational programs designed to teach preventative measures for SIDS.
Elio’s classes, held in a conference room at the BCCCC, uses the American Academy of Pediatrics’ 64-page instruction manual as the foundation for teaching concepts to aspiring child care providers.
“If the class is mostly new students, then I usually give a lecture-style presentation of the material,” Elio said. “But when the majority of the folks are re-training, it’s more call-and-response or activity-based.”
One activity involves teaching students to diagnose whether an environment is lawfully compliant for a sleeping infant. The most important instruction is Elio’s demonstration on how to position the infant for sleep.
Experts believe the greatest defense to SIDS is to place the child to sleep supine, meaning flat on their backs, according to the AAP.
“Increase in back and side sleeping was a result of the American Academy of Pediatrics recommendation on sleep position published in 1992,” she said. “And the success of the Back to Sleep campaign, an initiative to encourage parents to place their infants to sleep in the supine position, begun in 1995, was very influential in reducing the risk of SIDS while the child was home.”
But the rate of SIDS in child care did not follow the same downward trend. An AAP report stated that infants in child care are 18 times more likely to die of SIDS. Furthermore, approximately 20 percent of SIDS deaths occur while the infant is in the care of a non-parental caregiver, a statistic which has remained static since 1992.
“Parents are doing it all right,” said Elio. “(When) They are taken to child care and they are placed to sleep on their tummies for the first time, which, for a developing child, can be traumatic. This is what we’re working to change.”
Her training courses appear critical to lowering the child care SIDS rate. Yet, in the 10 years she and others have been teaching SIDS prevention there has been no visible statistical reduction.
“The techniques being taught, the formula of the classes and the level of enforcement provided by state sanctioned agencies seem adequate,” said Elio. “But the lack of implementation of proper techniques when workers are not being observed may be hindering the progress.”
Compared to occupations requiring similar levels of education, child care providers wages fall short of the norm, according to Gordon Cleveland, senior lecturer of economics and division of management at the University of Toronto.
“Neither job experience nor education is adequately rewarded, so there is little incentive for licensed child-care workers to improve their abilities and stay in the sector,” he said.
Cleveland teaches courses in labor economics and industrial organization. An American Economic Association member, he has also written eight books and numerous journal articles on the subject of the benefits and costs of good child care.
“As a result of low wages and the lack of prospects for advancement, the rate of job turnover is very high, with negative implications for maintaining an acceptable quality of care,” Cleveland said.
Elio defends her course’s value and doesn’t think the lopsided SIDS rate is the result of employers cutting corners by hiring workers who simply have not received the mandated training or the fault of the DCC loosely checking provider’s qualifications.
“The training is the strongest tool we have to educate care givers and, because the training is mandatory, it is typically paid for by the facility,” she said. “Truly, the DCC does check. Providers do not want to get caught not having this documented. If nothing else, they get liability!”
However, Elio recognizes the demanding task of supervising multiple infants at once, which can lead to breakdowns in proper procedure.
“I think they do not always follow the procedure because it is difficult when you have five infants in your care and one will not sleep,” she said. “It may be that the child is not used to sleeping on its back or is used to sleeping with an adult. Then, I sometimes find infants in swings.”
Being overworked and underpaid inversely correlates to “burnout” and indifference towards one’s job, according to a study performed by the Clearinghouse on Elementary and Early Childhood Education.
“Cleveland is right on target,” said Elio. “As a state we have been very cognizant of this. Teachers need the education to be excellent caregivers. What we do find is that we do a lot of training but not a lot of retaining.”
Discontent with a position in a field without many avenues for promotion often results in workers quitting after only a few years
“Obviously, workers seek employment where they can get a higher pay grade,” said Elio.
Taking objection to the idea that overworked employees contribute to the N.C. SIDS rate, Diana Sutton defended her facility as one of the highest quality child care centers in Western North Carolina.
“Our employees do a fantastic job, and we have a low turnover rate because we pay our employees as much as possible while keeping up with the rent. We are not turning a profit,” said Sutton, co-owner of the Asheville based child care facility Regent Park Early Childhood Development Center. “We follow every single mandated procedure and have a ratio of three babies to every employee, which is better than the state mandated 5-to-1.”
Sutton recognizes the disproportionate amount of child deaths in day care as a disturbing statistic and something she hopes to never have to deal with at RPECDC.
“Our employees are very aware of the causes of SIDS and are keeping up-to-date with SIDS education mandated by the state,” said Sutton. “Having a child die in your care would be one of the worst things possible.”
Sutton says parents share part of the responsibility of placing a strain on the system. Increased enrollment has created higher child-to-caregiver ratios and more frequent worker turnover in other day cares.
“Part of the problem is the parents. Child care is very often on the low end of priorities for parents,” said Sutton. “They don’t have appreciation for staff or concern for who is taking care of their child.”
“Regardless of the arguments over the myriad causes of SIDS, continuing and expanding the courses increases the likelihood that infants will survive the first 18 months of life,” Elio said.
“The majority of SIDS deaths in child care occur on the first day, which is really scary,” she said.
No comments:
Post a Comment