BILL ANALYSIS                                                                                                                                                                                                    �






                                  SENATE HUMAN
                               SERVICES COMMITTEE
                          Senator Leland Y. Yee, Chair


          BILL NO:       AB 290                                       
          A
          AUTHOR:        Alejo                                        
          B
          VERSION:       May 20, 2013
          HEARING DATE:  June 11, 2013                                
          2
          FISCAL:        Yes                                          
          9
                                                                      
          0
          CONSULTANT:    Mareva Brown                                  


                                        

                                     SUBJECT
                                         
                  Child day care: childhood nutrition training

                                     SUMMARY  

          This bill requires that a newly licensed teacher or  
          director of a day care center or family day care home who  
          receives health and safety training shall also have at  
          least one hour of childhood nutrition training, including  
          information about age-appropriate meal patterns, and  
          information about reimbursement rates for the federal Child  
          and Adult Care Food Program (CACFP), as specified.

                                     ABSTRACT  

           Existing law:

              1)   Establishes the California Child Day Care  
               Facilities Act to establish a statewide comprehensive,  
               quality system for licensing child day care facilities  
               to ensure a quality day care environment. (HSC 1596.7  
               et seq.)


                                                         Continued---




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             2)   Establishes in federal law the Child and Adult Care  
               Food Program (CACFP) and identifies nutritional  
               standards for meals in such facilities. (7 CFR 226.20)

             3)   Requires that state child care centers adhere to  
               CACFP nutrition standards, but leaves open the option  
               to participate in the reimbursement program. Family  
               Child Care Homes are not required to adhere to CACFP  
               standards. 

             4)   States legislative intent to encourage any person  
               who provides child care in a licensed child day care  
               facility to have completed "elementary" health care  
               training such as cardiopulmonary resuscitation,  
               pediatric first aid, preventative health practices  
               such as food preparation, sanitation, and practices  
               that reduce the spread of infectious disease.

             5)   Requires that at least one director or teacher at  
               each day care center, and each family day care home  
               licensee who provides care, shall have at least 15  
               hours of health and safety training, as specified, to  
               include:

                  a.        Pediatric first aid
                  b.        Pediatric cardiopulmonary resuscitation
                  c.        A preventative health practices course or  
                    courses that include instruction in the  
                    recognition, management, and prevention of  
                    infectious diseases, including immunizations, and  
                    prevention of childhood injuries. (HSC 1596.866)

             6)   Establishes that training may include instruction  
               in child nutrition, food handling, caring for children  
               with special needs, and the identification and  
               reporting of signs and symptoms of child abuse. (HSC  
               1596.866 (a)(3))

             7)   Requires that at least one staff member of a day  
               care center or family day care home who has completed  
               the training be on-site whenever children are present  
               on- site or during off-site trips. (HSC 1596.866 (b))

             8)   Requires the state's Emergency Medical Services  
               Authority to establish training standards for child  





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               care center directors and teachers and providers in  
               licensed child care homes. (HSC 1596.8661 (b))

           This bill:

              1)   Makes various findings and declarations about  
               obesity in children, childhood nutrition and eating  
               habits.

             2)   Makes various findings and declarations about the  
               prevalence of child care use among American families  
               and within California, and about the benefit to  
               children of having trained child care providers.

             3)   Through additional intent language, encourages any  
               person who provides child care also receive training  
               in childhood nutrition and practices that support  
               overall health.

             4)   Adds one hour of childhood nutrition education to  
               the required 15 hours of training for directors and  
               teachers at day center centers and licensed family day  
               care homes, as specified. 

             5)   Provides that the additional hour of required  
               training apply only to licenses issued after January  
               1, 2015 and be included as part of the preventative  
               health practices course or courses.

             6)   Requires that childhood nutritional training  
               include content on age-appropriate meal patterns based  
               on the most current Dietary Guidelines for Americans.

             7)   Requires that the training shall contain  
               information about reimbursement rates for the United  
               States Department of Agriculture's Child and Adult  
               Care Food Program (CACFP) and that child care  
               providers be directed to the state Department of  
               Education's CACFP for information on eligibility and  
               enrollment.


                                  FISCAL IMPACT 

          An analysis by the Assembly Appropriations Committee found  





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          that because the cost of training is borne by child care  
          providers, any costs to the state should be minor and  
          absorbable within existing resources.

                            BACKGROUND AND DISCUSSION  

           Purpose of the bill  :

          The author states that while research indicates child care  
          provider training has the greatest impact on the quality of  
          child care programs, California's licensing laws do not  
          require providers to undergo any nutrition training. With  
          nearly 25% of preschool-aged children overweight or obese,  
          thousands of California's youngest residents face a  
          lifetime of health challenges (e.g., diabetes, heart  
          disease, cancer) related to poor nutrition, the author  
          states. The author also states that with more than 45,000  
          licensed child care facilities in California serving more  
          than one million children, child care providers are  
          uniquely positioned to help ensure young children are  
          exposed to good nutrition during the early years. 

          According to the author, requiring providers to take one  
          hour of early childhood nutrition as a part of the  
          licensing process ensures that licensed child care  
          providers learn about the importance of healthy meals and  
          snacks, cost-effective strategies, and age-appropriate meal  
          patterns and serving sizes. This idea is in line with the  
          First Lady's Let's Move! Child Care campaign and supports  
          complimentary efforts to improve the nutritional quality of  
          school meals. Children who practice healthy eating habits  
          during the first five years of life are more likely to  
          extend those healthy habits into adulthood.

          In 2012, the Governor vetoed a similar bill by this author.  
           AB 1872 would have required child care providers to adhere  
          to federal nutritional standards and to keep a daily menu  
          of all meals and snacks available for parents to see. 

          This bill responds to the Governor's veto message which  
          stated, "I can support a measure that helps family child  
          care providers learn about nutrition and serve healthier  
          foods at a lower cost, but this bill goes beyond that.   
          Small businesses such as family day care providers don't  
          need another confusing mandate that adds to their struggles  





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          to stay afloat."

           Obesity among children

           The prevalence of obesity in children has more than doubled  
          in the past 30 years among young children aged 2 to 5,  
          according to the U.S. Department of Health and Human  
          Services. It has tripled among youth ages 6 to 11, and has  
          more than tripled among adolescents ages 12 to 19.  
          According to the Centers for Disease Control, more than one  
          third of children and adolescents were overweight or obese  
          in 2010.

          Two national studies - the USDA's Nationwide Food  
          Consumption Survey and the Continuing Survey of Food  
          Intakes by Individuals - demonstrate changes in eating  
          patterns among American youth that illustrate the  
          complexity that exists in relating food intake to the  
          increased prevalence of obesity. These include:

                     There has been a decline in breakfast  
                 consumption - especially for children of working  
                 mothers. 
                     Average portion sizes increased for salty  
                 snacks from 1.0 oz. to 1.6 oz. and for soft drinks  
                 from 12.2 oz. to 19.9 oz. between 1977 and 1996. 
                     Only 21 percent of young people eat the  
                 recommended five or more servings of fruits and  
                 vegetables each day.
                     Nearly half of all vegetable servings are fried  
                 potatoes. 

          Obesity in children is a strong predictor of health  
          problems and continued health problems in adulthood,  
          according to numerous studies. One study showed that  
          children who became obese as early as age 2 were more  
          likely to be obese as adults.

          Other studies have shown that obese youth are more likely  
          to have risk factors for cardiovascular disease, according  
          to the Centers for Disease Control. In a sample of children  
          aged 5 to 17, 70% of obese youth had at least one risk  
          factor for cardiovascular disease. Obese adolescents are  
          more likely to have pre-diabetes, are at greater risk for  
          bone and joint problems, sleep apnea, and social and  





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          psychological problems such as stigmatization and poor  
          self-esteem, according to a variety of studies cited by the  
          CDC.<1>

           Child Care training requirements

           Current law requires that at least one director or teacher  
          at each day care center, and each family day care home  
          licensee who provides care, must have at least 15 hours of  
          health and safety training on preventative health  
          practices. 

          Included in the required training is pediatric CPR;  
          pediatric first aid; recognition, management, and  
          prevention of infectious diseases, including immunizations;  
          and prevention of childhood injuries. State statute  
          requires the state Emergency Medical Services  
          Administration to establish standards for the training. 

          Additionally, the training may include training in sanitary  
          food handling, child nutrition, emergency preparedness and  
          evacuation, caring for children with special needs, and   
          identification and reporting of signs of child abuse. This  
          bill would change the permissive training for child  
          nutrition to a mandate.

           CACFP

           The USDA's Child and Adult Care Food Program (CACFP)  
          provides day care providers with cash reimbursement for  
          serving up to two meals and one snack per day to enrolled  
          children that meet federal nutritional guidelines. Program  
          payments for day care homes are based on the number of  
          meals served to enrolled children, multiplied by the  
          appropriate reimbursement rate for each breakfast, lunch,  
          supper, or snack they are approved to serve.
           
          Other states  

          According to research by the California Food Policy  
          Advocates, many other states have nutrition training for  
          licensed daycare centers and family day care homes.  
          Massachusetts requires two hours of training in nutrition  
          for young children. Delaware requires that Early Childhood  
          -------------------------
          <1> http://www.cdc.gov/healthyyouth/obesity/facts.htm




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          Caregivers complete three hours of nutrition training  
          within a mandated 60-hour training course on early care and  
          education. Nevada requires child care facility employees to  
          complete at least two hours of annual training on the  
          subject of lifelong wellness, health and safety of children  
          which includes training relating to childhood obesity,  
          nutrition and physical activity.

           Let's Move!
           
          Responding to statistics that indicate nearly one in three  
          children in America are overweight or obese, the First Lady  
          launched the Let's Move! initiative nationally in 2010 with  
          the stated goal of putting children on the path to a  
          healthy future during their earliest years. The program is  
          focused on giving parents helpful information and fostering  
          environments that support healthy choices, providing  
          healthier foods in schools, ensuring that every family has  
          access to healthy, affordable food and encouraging children  
          to become more physically active.
           
           Related Legislation  

          AB 2084 (Brownley) Chapter 593, Statutes of 2010,   
          specified the amount of juice and type of milk to be served  
          at licensed child day care facility and prohibited serving  
          sweetened beverages, as specified.

          AB 1872 (Alejo, 2012) would have required child care  
          providers to adhere to federal nutritional standards and to  
          keep a daily menu of all meals and snacks available for  
          parents to view. 

                                    PRIOR VOTES
           
          Assembly floor:          77 - 0
          Assembly Appropriations: 17 - 0
          Assembly Human Services:   7 - 0


                                    POSITIONS  

          Support:       California Food Policy Advocates (sponsor)
                         Advancement Project
                         Atkins Center for Weight and Health at UC  





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          Berkeley
                         Asian Law Alliance 
                         California Association of Food Banks
                         California Center for Public Health Advocacy
                         California Federation of Teachers
                         California Teachers Association
                         Child Care Food Program Roundtable
                         Child Development Associates, Inc.
                         Choices for Children
                         Community Child Care Council (4C's) of  
                    Alameda County
                         Crystal Stairs, Inc.
                         Feeding America San Diego
                         First 5 Fresno County
                         State Council on Developmental Disabilities
                         1 individual 
                         
          Oppose:   None.






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