Use of the omaha system to modify child care health consultation services within a quality improvement and rating system

In 2006 Arizona voters passed an initiative that funds early childhood development through an .80 per pack tobacco tax. Quality First, the signature program of First Things First, the state agency created by the initiative, works to improve the quality of early education services in child care programs through a voluntary quality improvement and rating system (QIRS)which incorporates the services of child care health consultants (CCHCs). The Omaha System, a research-based, comprehensive practice and documentation standardized taxonomy designed to document client care was selected to capture and monitor the CCHC process. Use of the Omaha System's Problem Rating Scale for Outcomes allowed early identification of needed modifications in the delivery model for CCHC services. Findings included: 1. Initial ratings which showed child care programs fell well below scores which should be anticipated for programs meeting regulatory compliance; 2. Sluggish improvement in health and safety outcome scores; 3. Higher health and safety outcome scores for child care programs not participating in the QIRS but receiving the independent services of a CCHC. A new tiered service model, based on the National Training Insititute for Child Care Health Consultants' foundational principle that "child care health consultation occurs between a professional helpgiver and a helpseeker" and an assessment of the child care program's readiness to receive either sporadic short-term problem consultation or intensive health and safety quality improvement consultation is demonstrating vigorous, rising outcome scores. Use of the Omaha System has informed this population-focused intervention keeping services effective and maximizing taxpayer dollars.