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A Systems Approach

Managing a child and youth program is challenging and complicated. Your program is a complex system comprised of many parts that are interdependent (people, facilities, resources). Each part contributes to the system’s overall purpose but no part can achieve that purpose by itself. A systems approach helps you find solutions to problems by looking for patterns and making adjustments based on feedback. For example, several times a week you have to send a staff member to cover ratio in a particular school-age classroom (problem). You could either continue to send someone to cover when the issue arises, or you could determine that a particular staff member is leaving early every Monday and Wednesday (pattern). Once you recognize that there is a pattern in behavior, the situation can be addressed in a more systemic way.

Organizational expert Peter Scholtes described systems thinking as "the general reflex or habit of conceiving of reality in terms of interdependencies, interactions and sequences." To show how this works, think about when children are on the playground. The interdependencies are the staff members who are positioned in zones to provide active supervision. The interactions are the staff members communicating with one another regarding the status of a child who fell off the monkey bars. The sequences are the taking of face-to-name head counts prior to entering the playground and when exiting the playground. This example demonstrates that there is a system to keeping children and youth safe while on the playground.

A lack of systems thinking is evident in your program if:

• Getting through the day is the norm instead of focusing on long-term planning.
• There is a focus on blame instead of the root causes of problems.
• Individual accomplishment is more important than focusing on the achievement of program goals.

As a Program Manager, you must recognize the importance of systems, implement effective systems, and think systematically in order to achieve results. The most important systems in your program are those that keep children and youth safe from harm.

Creating a Culture of Compliance

When families leave their children at your program they are expecting that their children will be safe and nurtured throughout the day. There is nothing more important in your day-to-day work than protecting the children and youth entrusted in your care from harm. You alone can't keep the children and youth in your program safe; you must rely on the commitment of others (staff, families, and children) to do their parts and have systems in place to monitor compliance with your PUBLICprogram's safety regulations and policies. However, it is up to you to demonstrate a zero tolerance for unsafe practices. As a Program Manager, what you say and what you do creates a program culture that is vigilant about protecting children and youth from harm.

Risk Management and Mitigation

As the Program manager, it’s your responsibility to manage and mitigate risks before they can pose serious harm. To do this, you need to ensure that a documented risk-management plan is in place and staff are trained to follow the plan.

Staff need to conduct daily inspections using playground safety checklists; classroom safety checklists; and facility checklists to ensure concerns are identified and reported. The concerns are recorded to document when the request was submitted and resolved. This proactive and collaborative process mitigates and manages risks before they can lead to harm.

There's an old saying that an ounce of prevention is worth a pound of cure. Most childhood accidents and tragedies in this country could have been prevented. When you make the safety of children and youth your top priority and utilize safety systems, you and your staff become risk mitigators.

Systems for Record Keeping

One of the most effective strategies for minimizing risk is to maintain a record keeping system that addresses collection, storage, access, release and disposal of confidential and sensitive information. Effective managers realize that this is so much more than paperwork; they realize that the effective management of information protects and even saves lives.

Your day-to-day work involves multiple record-keeping systems, from maintaining ratios to maintaining your facility. Refer to your PUBLICprogram's Standard Operating Procedures for specific instructions for each record-keeping system you use.

Here are few things to consider when it comes to record-keeping systems. It is common for schools to have nut-free zones even if there are only a few children who have allergies. Why? Because it eliminates the risk of inconsistent compliance to policies and procedures. The inconsistent application of safety policies and regulations negates the benefits of the entire system and increases the risk of harm.

Record keeping helps prevent unqualified people from harming children, helps keep unauthorized people from picking up children, helps keep children from getting the wrong dosage of medication, helps keep people informed on appropriate action for children with special health-care needs, keeps vehicles properly inspected, and helps keep playgrounds and facilities safe.

As a Program Manager, you must have zero tolerance when it comes to employing people who are unfit to work with children and youth. You are responsible for ensuring that children are cared for by qualified personnel. It is administrative negligence if background checks are not processed in a timely manner or if results aren't read as soon as they are received.

Staff members need to exercise diligence when it comes to knowing who can and cannot pick up children and youth. Staff cannot be timid about asking for an ID to see if it matches a name on the pickup authorization form. If the person is authorized, they shouldn't mind showing identification.

Here are some management practices that support a systems approach:

• Read and thoroughly understand your PUBLICprogram's Standard Operating Procedures.
• Know your chain of command.
• Know how to access government websites that provide electronic updates of regulatory requirements, such as signing up for alerts from the Consumer Products Safety Commission.
• Utilize technology to support compliance-monitoring efforts.
• Utilize electronic mechanisms for tracking compliance monitoring and updating children's and staff member's files.
• Meet regularly with your program team to update program safety policies and practices when regulatory changes are made and seek input from staff, families and stakeholders.
• Communicate regulatory changes to staff and families immediately in writing.
• Provide training to staff and families when changes in standards are announced.
• Use time at staff meetings to review the effectiveness of policies and procedures or issues related to compliance; use if-then scenarios to identify potential issues and solutions.
• Create a risk-management plan that identifies concerns and noncompliance, a monitoring process, a protocol for corrective action and timelines for addressing noncompliance.
• Address issues immediately and implement systems to ensure they don't reoccur.
• Continue to learn about management principles and apply new approaches in your day-to-day work.
• Maintain an electronic tracking system for the submission and results of background checks.
• Maintain a record-keeping system that addresses collection, storage, access, release and disposal of confidential information.

Ongoing Professional Development

As a Program Manager, it is your responsibility to ensure that staff members complete and demonstrate competence in required safety training so they can prevent or respond to injury and illness. Refer to your PUBLICprogram's list of required trainings.

While there are specific safety training requirements for staff, it's also important that there be ongoing professional development related to safety practices. The following are topics that should be offered on a regular basis to ensure that staff members are up to date with safety standards and procedures

First Aid and CPR

Your staff must be certified in first aid and CPR. Children and youth are active, and even when safety systems are in place, injuries will occur. It is important that staff are trained and prepared to provide first aid.

Equally important is ensuring that staff have access to fully stocked first-aid supplies at all times. Emergencies are not the time to be running around looking for supplies. Refer to your PUBLICprogram's requirements for first-aid kits.

No one ever wants to be in an emergency situation, but everyone wants someone who is trained if an emergency arises. There are a lot of ways to keep on top of required trainings; the important thing is to use a method that works for you.

Inappropriate Guidance and Discipline

You need to make clear to your staff that inappropriate discipline will not be tolerated and that if it occurs, dismissal may be the only course of action. What is appropriate and what is not should be addressed during orientation and on an ongoing basis both by you and your trainer.

You need to convey to your staff on an ongoing basis that they must recognize their limits, and if they get close to a breaking point, they need to summon help. The same is true if a staff member sees another staff member start to lose control. Without intervention, stress can escalate into an abusive situation where everyone involved is harmed.

Safe Sleep and Tummy Time Practices

Staff members who care for infants need ongoing training to reinforce that the sleep position of infants is a matter of life and death. In the past few years, there has been a significant decrease in the number of infants who have died from sudden infant death syndrome (SIDS), partly as a result of Back to Sleep efforts. There are Internet presentations that are great sources of information that you can use to drive home the importance of this topic. It's worth repeating that constant supervision is critical to keeping infants safe during sleep and tummy time.

Responding To Injury and Illness

Providing ongoing training on how to respond to injuries and illness assists staff members in remembering your PUBLICprogram’s policies ; for example, staff should know your program’s process for parent notification of any accidents, illnesses, or injuries, including having guardians sign accident reports. Knowing what to do in an emergency reduces the risk of further injury and the spread of disease. This topic will be covered in greater depth in the Healthy Environments course.

Identifying and Responding to Concussions in Child and Youth Settings

As children are growing and learning, accidents are bound to occur. But what happens when a child suffers a significant head injury? What if they are too young to communicate how they feel as a result? With increasing research about the long-term effects of traumatic brain injuries, it is important for caregivers to understand how to properly identify and respond to head injuries in young children. As a Program Manager, use the following information regarding head injuries, as well as what you already know about responding to injuries, to ensure staff members are prepared to identify and respond to possible concussions in children and youth.

Childhood concussions are common. They can affect a child’s ability to think, learn, and interact with the world around them. According to Dr. Sam Torbati of Cedars-Sinai Hospital (2021), a concussion is “a mild, temporary form of brain injury that can result after a forceful blow to the head or jolt to the body which causes the brain to bounce against the skull.” Concussions are often thought to be the result of sports injuries, however, the most common reasons for a concussion in younger children are falls or collisions with objects such a ball, peer, table, or wall. The following are a few scenarios in which a concussion could occur:

• 11-month-old Sammy is learning to stand independently and take a few steps. He is rolling a ball on the floor and crawling after it. The ball stops under the snack table and Sammy crawls to get it. Instead of crawling away, he tries to stand up to walk and hits his head on the edge of the table.
• Katie is building a tower using large wooden blocks. She reaches to place two blocks on the very top but drops one. When she bends over to pick it up, she bumps into the structure by accident, and it falls over on top of her. She immediately shouts, “Ouch! My head!”
• Chad and Jason are playing tag outside after school. Jason is not paying attention to where he is running and collides with Chad running toward him. The two children run into one another and hit their heads.

Symptoms of a concussion can appear immediately following the injury or up to a few days afterwards. For this reason, it is important for caregivers to carefully observe the child and track their symptoms over the course of several days. Below are common symptoms to note:

Common Symptoms of Concussion by Age

Infants & Toddlers

• Frequent vomiting
• Excessive crying (especially when moving head)
• Significant changes in sleep patterns
• Changes in appetite
• Decreased interaction

Preschoolers & School Age

• Vomiting
• Headache
• Dizziness/ balance problems
• Changes in vision
• Sensitivity to light or sound
• Difficulty concentrating
• Memory loss/ slowed response time
• Changes in mood
• Significant changes in sleep patterns
• Changes in appetite

Regardless of the perceived severity of the head injury, caregivers should take the following actions (as outlined above) after a blow to the head occurs. Consider where you can best support staff members in the event of a head injury.

1. Stay calm: We know that young children’s actions and feelings are affected by their caregivers’ responses. When you remain calm, the child can focus on calming themselves if they are upset.
2. Take action: Staff members should use their knowledge of the typical appearance and behavior of the child. If anything seems out of the ordinary, or any of the symptoms listed in the table above are present, seek appropriate medical care. Once the situation has been evaluated, provide appropriate first aid (stop any bleeding, clean any cuts or scrapes, apply bandages or cold compress). It might be helpful for the staff member to receive a second opinion from you regarding the child’s behavior and appearance.
3. Notify: Whenever a child suffers a head injury, providers should contact the child’s family to notify them of what occurred and the status of the child. If immediate medical attention is needed, you may be asked to contact the family or Emergency Medical Services (911).
4. Document: Ensure the correct incident reporting form used by your program is completed by the staff member caring for the child at the time of the injury. This is an important step as symptoms of a concussion may not appear for a few days. Refer to your program or Service specific guidelines for additional required documentation.

Concussion symptoms in infants and younger toddlers are especially important to note as children under 2 years of age are at a higher risk for more serious brain injuries. If excessive vomiting occurs in younger children, seek medical attention right away. Additional symptoms that warrant an emergency visit to a doctor or hospital (in all ages) include worsened headache, increased confusion, inability to stay awake, slurred speech, weakness, seizures, and loss of consciousness.

As evident in the information above, symptoms of a concussion will look different for every child. The recovery time will look different as well. Regardless of how the injury occurred or presented in a child, monitoring and rest is important for all ages to properly recover from a concussion. For older children, modifications to their learning environment and school workload may be necessary. �Թ��� staff members making appropriate modifications to their environment, curriculum, or schedule. If mild symptoms persist for longer than a week or signs of a regression in the child’s development are observed, encourage staff members to talk with the child’s family about contacting their pediatrician for follow-up care.

Administration of Medication

While this topic will be explored in greater detail in the Healthy Environments course, it's important to understand the safety risks associated with administering medication. According to the Institute of Medicine, 400,000 preventable drug-related injuries occur in hospitals each year. These injuries happen even when medication is administered by highly trained medical professionals. Imagine the opportunity for injury in your program, where medication is administered by staff members who are not medically trained.

To administer medication correctly, it's imperative that you have systems in place to ensure that the right children get the right medicine and dosage at the right time.

Supervise & �Թ���

Management Practices That �Թ��� Training and Ongoing Professional Development

The chart below summarizes your key responsibilities when it comes to ensuring that staff members receive and understand required training and ongoing professional development.

Listen and observe the systems that are put into place to keep children safe.