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Standards, Recommendations, Guidelines, and Regulations
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A Standard is criteria set for a certain task.. It differs from a recommendation or a guideline in that it carries great incentive for universal compliance. It differs from a regulation in that compliance is not necessarily required for legal operation. It usually is legitimized or validated based on scientific or epidemiological data, or when this evidence is lacking, it represents the widely agreed upon, state-of-the-art, high-quality level of practice.

The agency, program, or health practitioner that does not meet the standard may incur disapproval or sanctions from within or outside the organization. Thus, a standard is the strongest criteria for practice set by a health organization or association. For example, many manufacturers advertise that their products meet ASTM standards as evidence to the consumer of safety, while those products that cannot meet the standards are sold without such labeling to undiscerning purchasers. In Caring for Our Children, specific standards define the frequency of visits to child care facilities and qualifications of health consultants to such facilities. Some states have adopted or even exceeded parts of these standards in their regulations, but many more have not done so. Facilities that use a health consultant, as specified in Standards 1.040 through 1.044, could be expected to be of higher quality than those that do not.

A Recommendation is a statement of practice that potentially provides a health benefit to the population served. An organization or a group of individuals with expertise or broad experience in the subject matter usually initiates it. It may originate within the group or be solicited by individuals outside the organization. A recommendation is not binding on the practitioner; that is, there is no obligation to carry it out. A statement may be issued as recommendation because it addresses a fairly new topic or issue, because scientific supporting evidence may not yet exist, or because the practice may not yet enjoy widespread acceptance by the members of the organization or by the intended audience for the recommendation.

For example, in Chapter 9 of Caring for Our Children , Recommendation 9.004 suggests that States should adopt uniform categories and definitions for use in their own licensing that cover the types of facilities addressed by the standards. While it is recognized that each State might differ in the specific definitions of services they choose to use, the recommendation says that each State should be sure that the sum of their licensing effort should address all the types of service specified in the standards.

A Guideline is a statement of advice or instruction pertaining to practice. Like a recommendation, it originates in an organization with acknowledged professional standing. Although it may be unsolicited, a guideline is developed in response to a stated request or perceived need for such advice or instruction. For example, the AAP has a guideline for the elements required to make the diagnosis of Attention-Deficit/Hyperactivity Disorder.

A Regulation takes a previous recommendation or guideline and makes it a requirement for legal operation. A regulation originates in an agency with either governmental or official authority and has the power of law. Such authority is usually accompanied by an enforcement activity. Examples of regulations are: State regulations pertaining to health and safety requirements for caregivers and children in a licensed child care center, and immunizations required for participation in group care. The components of the regulation, of course, will vary by topic addressed as well as by area of jurisdiction (eg, municipality or state). Because a regulation prescribes a practice that every agency or program must comply with, it usually is the minimum or the floor below which no agency or program should operate. Click here to view your state's licencing and regulation information.

This information was taken from Caring For Our Children National Health and Safety Performance Standards: Guidlines for Out-of-Home Child Care Programs. Because there are no federal child care standards the American Academy of Pediatrics and the American Public Health Association have compiled their recommendations in this joint publication. Caring for Our Children can be ordered from the AAP Bookstore or viewed online by clicking here.


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