CSPECE Story Map Report 2017-2019

The Choose Safe Places for Early Care and Education (CSPECE) program offers towns, cities, and states practices to ensure early care and education (ECE) programs are located away from chemical hazards.

What is APPLETREE? ATSDR’s Partnership to Promote Local Efforts to Reduce Environmental Exposure (APPLETREE) Program is a cooperative agreement that funds 28 state health departments. APPLETREE helps states increase their capacity to advance ATSDR’s goal of keeping communities safe from harmful chemical exposures and related diseases.

In 2017, ATSDR expanded the scope of APPLETREE to include CSPECE.

Preschool children at an early care and education center interacting with the teacher.

Over the past three years (2017-2019), ATSDR’s APPLETREE states developed and piloted new early care and education (ECE) interventions for CSPECE. All 28 APPLETREE states participated in the below CSPECE activities, customized by geographical intervention area, chemicals of most concern, and each state’s ECE licensing program:


Creating partnerships to build collaboration and sustainability

Screening and Response

Developing processes to screen for harmful environmental hazards

Responding to identified potential hazards

Responding to identified potential hazards through education, recommendations, and technical assistance


Providing training and educational materials for ECE stakeholders

System Level Change

Changing state licensing systems that increase environmental considerations for licensing ECEs

Heading text banner showing "Partnerships".

During this period, APPLETREE states developed 216 unique partnerships to enhance collaboration and sustainability of their CSPECE programs. Partners supported development and delivery of programs in the following ways:

Adult hands and children hands holing a heart. With text that states 216 partnerships were developed by CSPECE states.
  • Provided licensing policy/processing information to adapt program plans to state needs
  • Planned screening, response, and education activities
  • Developed and provided referrals for screening and educational materials
  • Provided screening checklists, outreach, education, and training
  • Connected state programs to partners
  • Integrated environmental considerations into systems-level processes
  • Contributed to special projects on topics like radon, lead, and private wells
  • Provided data and facilitated data sharing for screening and program data
APPLETREE states developed partnerships with diverse organizations and experts:
State and local childcare and health
  • State or local ECE licensing agencies
  • State or local family or children’s health and wellness agencies or organizations
  • Head Start or community based child care programs
  • Non-profits serving children or families
  • Resource and referral agencies
  • Local or tribal health authorities
Environmental programs
  • State environmental agencies
  • Specific environmental programs (e.g. childhood lead poisoning prevention, radon)
Subject matter experts
  • Universities
  • Private consulting firms
  • Planning and zoning authorities
  • Data and tracking programs
  • Cooperative Extension programs
Heading text banner showing "Screening and Reponse".

States developed several processes to screen for harmful environmental hazards at ECE locations. Processes included site visits, data analysis, screening questionnaires or checklists used by providers or inspectors, and screening protocols or manuals.

Someone filling out screening documents. With text that states 33 screening products were developed ,177 technical assist and health assessment documents completed, and 9,176 referrals were received and screened by state CSPECE programs.

Over the three years, states received and screened 9,176 referrals. A screening process started when a partner (e.g., ECE provider, licensing inspector, or partner agency) submitted referrals or data. Some states started special screening activities for radon, asbestos, or other hazards. When a potential hazard was identified, states responded through providing education, technical assistance, and recommendations to reduce or prevent exposure.

Screening Models: In most states, programs marketed a screening tool to ECE providers and asked providers to opt in by completing and submitting the tool. A few states used a list of new ECE location data to screen when ECE providers applied for a license. Some states were able to establish a process with state licensing inspectors to obtain referrals for screening.

Screening Products: States developed 33 screening products that

  • Show standard procedures for receiving referrals and screening for environmental hazards
  • Help narrow the list of possible locations for ECE providers
  • Prepare state health agencies and partners to respond to hazards

Examples of screening products include checklists, questionnaires, surveys, protocols and manuals, online tools, hazard assessments, notification letters or reports, and certificates.

States distributed screening materials through state licensing partners, other program partners, and directly through their own program. The chart below shows methods used by states for reaching and introducing ECE programs to the CSPECE program or for screening.

State Licensing Partners
  • Mandatory or voluntary pre-licensing course
  • Partner’s pre-licensing or annual inspection process
  • Informational licensing website
  • Application packet
  • Direct referral
  • Email
Other Program Partners

Realtors, planning and zoning officials, resource and referral, nonprofits, local health authorities through

  • Mailing lists
  • Websites
  • Direct distribution
Directly through APPLETREE Program
  • During education, outreach, and training opportunities
  • CSPECE website
  • Newsletters
  • Statewide mailing
  • Statewide distribution of educational/promotional materials

Response: States provided 177 occurrences of technical support (technical assists and public health assessment documents). A technical assist can be as simple as a record of a phone conversation. A technical assist does not contain public health conclusions but might offer recommendations. A health assessment document evaluates a site for hazardous substances, health outcomes, and community concerns.

Heading text banner showing "Education".

Health educators with text that states 73 educational products were developed, 4,584 program stakeholders receive direct educational training, and 55,683 received indirect educational training from state CSPECE programs.

The goal of education is to increase knowledge about children’s environmental health to help ensure ECE sites are safely located away from potential environmental hazards. States provided direct educational training and created and distributed educational materials for many stakeholders.

States developed educational products including factsheets, websites, infographics, training materials, marketing materials, brochures, and videos. Audiences included providers, licensing staff, state health departments, environmental health professionals, parents, planning professionals, and other APPLETREE partners.

Twenty-one states delivered education either directly by an educator or indirectly through flyers, brochures, infographics, and other means. Trainings focused on the following:

  • General introduction to CSPECE
  • ECE and environmental hazard information: recognizing hazards, environmental health issues, and children’s unique vulnerability
  • Contaminant-specific information: safe drinking water, private wells, lead, radon, indoor air quality, integrated pest management, and green cleaning
  • CSPECE program specifics: screening tool, screening process, mapping tool, and criteria for safe siting
Heading text banner showing "System-Level Changes".

Image of preschool students with their teacher with text that states 13 system level changes were adopted and 13 are in progress through state CSPECE programs.

Have you heard the term “safe siting?”
“Safe siting” is the public health term that describes practices and policies used to locate early care and education centers in places free of chemical and physical hazards. This includes careful consideration of:

Former site use
Nearby sites and activities
Naturally occurring contamination
Safe drinking water

Integrating changes into a state licensing system that increase environmental considerations for licensing ECE and education programs can have a major effect. The changes implemented by grantees reached all ECE providers in a state or intervention area and laid a foundation to protect children from environmental exposure in ECEs. The 13 systems-level changes adopted during the three years of the program included the following:

  • Adding voluntary screening questionnaire or checklist into licensing application materials
  • Adding screening questionnaires, checklists, or safe siting considerations into the licensing process
  • Including safe siting or Children’s Environmental Health educational curriculum into state continuing education system for ECE providers
  • Integrating safe siting training and screening into mandatory state licensing training for all new ECE providers
  • Acknowledging through a statewide certificate program all ECE providers who participate in APPLETREE programs to assess environmental exposure
  • Partnering with state licensing agencies to integrate CSPECE into the state’s Health and Human Services (HHS) Child Care and Development Block Grant (learn more about block grantsexternal icon)

There are also systems-level changes in progress that states intend to adopt in the next grant cycle, including adjusting city policies to protect ECEs from hazardous environmental exposures and developing guidance to prioritize funding for facilities in areas with environmental health concerns.

Success Stories
Page last reviewed: February 8, 2021