Executive Summary

In the United States, about 8.3 million children younger than five years are cared for in licensed child care facilities [1]. Children may spend 10 hours per day, five days per week in care settings outside their homes [2]. Children may also be enrolled in other programs, such as Head Start. The term “early care and education” (ECE) applies to all of the places where young children may be cared for outside of their homes.

Determining the number of children at risk for harmful environmental exposures across the United States is challenging. Limited data are available to estimate how many ECE programs and children in those programs might be at risk for exposures. Using data from one state and extrapolating it to the rest of the country is one way to try to calculate and estimate, even if it has limitations. Using this strategy, ATSDR estimates that 1.35 million children are in programs that warrant additional evaluation to ensure the site is safe, and about 174,000 children might currently be exposed to harmful contaminants.¹

When an ECE program is improperly located, consequences can result. Most importantly, children and ECE staff can be exposed to harmful levels of hazardous contamination. Also, the mere presence of contaminants at an ECE program can cause stress and fear among staff and parents, even if exposures are not significant. It can also lead to financial and legal consequences for the ECE program.

ATSDR has worked on sites across the country where ECE programs have been in locations that were not safe. To help protect children from health risks caused by locating ECE programs on or near places where chemical or radiological hazards are present, ATSDR created the Choose Safe Places for Early Care and Education (CSPECE) Guidance Manual. This manual offers tools and resources to help state and local public health agencies and other partners build programs to protect children in their communities.

How Does the CSPECE Manual Tie into Other ECE Initiatives?
The CSPECE manual enhances efforts to protect children from environmental exposure by providing a conceptual model for building a safe siting program to address the environmental safety of an ECE site. The Administration for Children and Families (ACF), a division of the U.S. Department of Health and Human Services, is responsible for several programs that directly influence ECE programs across the United States. Two of these programs, the Office of Child Care and the Office of Head Start, recently released updated rules to help ensure the safety of children who attend child care and Head Start programs. These rules are the Head Start Program Performance Standards, and 2016 Child Care and Development Fund Final Rule, which was based on the Child Care and Development Block Grant Act of 2014.

In promulgating these rules, ACF referred to Caring for Our Children Basics: Health and Safety Foundations for Early Care and Education Settings, released in 2015. Caring for our Children Basics is voluntary guidance which presents the minimum health and safety standards experts believe should be in place where children are cared for outside of their homes—regardless of program or funding stream [3].
Several of the minimum health and safety standards in Caring for Our Children Basics tie in with the guidance in this manual. The guidelines presented here can help states or locales in meeting parts of the ACF standards, including sections:

• 4.2.0.6 Availability of Drinking Water.
• 5.1.1.2 Inspection of Buildings.
• 5.1.1.5 Environmental Audit of Site Location [3].

This guidance manual provides a conceptual model for building a safe siting program to address the environmental safety of an ECE site. Also, tools and resources are provided that can be used throughout the process of implementing a safe siting program.

What Are Safe Places for ECE?
The location—or site—of an ECE program can influence the types and amounts of environmental exposures to children in the program. Safe siting means locating an ECE program in a setting that is safe from hazardous contaminants that could be present at or near the property or building. The safe siting of an ECE program includes a thorough analysis of the following:

• Former site uses that might have left chemical or radiological hazards on the property (including the building and the land).
• Migration of harmful substances onto the site from nearby properties or activities.
• Naturally occurring harmful substances on-site.
• Drinking water contamination.

ATSDR is directed by congressional mandate to

• Assess the presence of health hazards at specific sites.
• Help prevent or reduce further exposure and the illnesses that result from such exposures.
• Expand the knowledge base about health effects from exposure to hazardous substances [4].

This guidance manual addresses hazardous substances in the environment. ATSDR recognizes that many other environmental and safety issues, beyond the scope of this manual, are important to consider to keep children safe. Appendix A and ACF’s Caring for Our Children Basics  provide some additional resources and guidance for minimal health and safety guidelines for a range of potential hazards [3].

How Does the Guidance Manual Fit into ATSDR’s Work?
This guidance manual is the cornerstone of ATSDR’s work to protect children nationwide from harmful chemical exposures in ECE settings. It provides guidance, policy examples, tools, and resources that can be used to ensure that ECE programs are located on sites where hazards have been considered, addressed, and mitigated to protect children’s health.

This manual describes

• Gaps in regulations and policies that can lead to improper ECE siting (Chapter 2).
• Vulnerabilities of children and staff to chemical and radiological hazards from improper siting of ECE programs (Chapter 2).
• Potential hazards resulting from poorly located ECE programs that could put children at risk (Chapter 3).
• What can be done to identify and remediate those hazards (Chapter 4).

In addition, this manual provides

• A conceptual model for developing a program at the state or local level to implement safer siting (Chapter 5).
• Tools (Chapter 6) and resources (Appendix) that can be used throughout the implementation process.

Who Are the Stakeholders and How Can They Use this Manual?
Protecting children and workers from environmental contaminants in ECE settings relies on the commitment and expertise of people from various disciplines and sectors. Stakeholders can include

• ECE licensing agencies.
• State, local, territorial and tribal public health and environmental protection staff.
• State, local, territorial and tribal ECE administrators and professional organizations.
• Certification and accreditation organizations.
• ECE program directors.
• Head Start program administrators.
• Planning, zoning, and other land-use decision makers.
• Policy makers.
• Parents and the public.
• Non-governmental partner organizations.

This manual suggests ways stakeholders can use ATSDR’s guidance to best protect children from environmental exposures at ECE program locations. Because working together across agencies and sectors is crucial, this manual provides tips on starting and maintaining cross-sector partnerships. It includes case studies that show the effect of siting decisions on ECE programs.

¹See Appendix D for how these data were calculated and limitations of the data.