A wide variety of approaches might be used to improve child care. Figure 7 provides a path model that attempts to identify the various links between interventions and quality, taking into account parents’ resources.
Most of the interventions would be included in the elements of the left column. These include the provision of information, licensing requirements, placement activities, subsidies to compensate child care workers, training programs for providers, tuition subsidies for students who enroll in early childhood education, increased tax credits to cover the cost of care for lower- to middle-income families, incentive payments to individual teachers and assistants who remain in the same center for a minimum of 3–4 years, and even direct provision of care. In the longer run, we need research to help better identify those factors that best improve the quality of child care. In essence, we need better understanding of the production of high-quality care, which may differ for children of different backgrounds.
The minimum roles for the public sector are as providers of information on available slots, hours of operation, structural quality features, costs of care and education, and training of personnel. The government might also establish a certification program to certify providers who met certain requirements. Minimum standards need to be strengthened in many states. Incentives might be offered to providers who meet certain requirements. Other government activities to increase the availability of high-quality care include operation of training programs and covering the cost of instructors and facilities for these programs. Information on the successful completion of such programs could be disseminated by the public sector as part of its information activities.
A more ambitious role designed to increase the pool of well-qualified individuals who enter (and remain) in the field of early childhood education would be some form of tuition subsidy for those willing to major in this field. There is a long tradition of such programs when shortages are feared; examples include nursing education and medical school. An alternative might be a college loan forgiveness program based on years spent as a child care provider following college, or Associate degree completion. Another approach to increasing the pool of qualified providers is to raise salaries. This seems especially important given the relatively low salaries in child care compared to other occupations (see Figure 1 and the discussion of the figure above). Such increases might result from increased information to parents, tax credits to parents, and the expansion of subsidy programs or direct payment to providers by the public sector. An innovative program might reward the stability of providers by paying a bonus after some specified period of years.
Current programs to improve child care quality exist and might be replicated or expanded. For example, a broad-based community initiative in North Carolina (Smart Start) has been successful in improving child care quality (Bryant, Maxwell, and Burchinal, 1999). This initiative, established by the governor of North Carolina in 1993, is a partnership between state government, local communities, service providers, and families. Twelve county partnerships were initially selected based on competitive review to receive funds for new and improved child care services. Data to evaluate the effectiveness of the initiative were obtained in 1994 and 1996 from over 180 child care centers in 12 counties. Local quality improvement activities (in 1996) were distributed as follows: training workshops (83 percent), funds to attend training activities (53 percent), on-site consultation or technical assistance (58 percent), higher child care subsidy rates (35 percent), increased subsidies for meeting higher standards (29 percent), funds to improve quality by purchasing new equipment (70 percent), funds to improve quality by purchasing new educational materials (63 percent), funds to achieve higher licensing level (26 percent), funds to achieve national accreditation (13 percent), funds to improve services for children with disabilities (11 percent), teacher substitute pool (20 percent), transportation services (18 percent), lending library (51 percent), and provider compensation programs (35 percent). The mean number of improvement activities per center was 5.3 in 1994 and 5.8 in 1996, with a range of 0 to 14 activities each year. In both years, ECERS scores were significantly related to the number of local quality improvement activities in which individual centers participated. In addition, process quality was significantly higher in 1996 than in 1994. Only 14 percent of centers were rated as good quality in 1994. In 1996, this figure was 25 percent. Participation in the Smart Start initiative also was related to a significant increase in the percentage of centers that obtained the higher-level Associate of Arts licensure credential.
Other efforts to improve quality might be to mandate certain minimum requirements. These can take the form of reducing child:adult ratios, reducing group sizes, establishing and enforcing safety regulations, and education and training. An example of such regulations is a model standard that applies to small family home caregivers. The National Health and Safety Performance Standard (American Public Health Association and American Academy of Pediatrics, 1992) states that one small family caregiver who does not have an assistant “shall not care for more than six children, including no more than two children under age 2. These numbers include the caregiver’s own children under the age of six. If any child under age 3 is in care, there shall be no more than four children, including the caregiver’s own children under the age of six. If only children under age 2 are in care, there shall be no more than three children, including those of the caregiver” (Chapter 1, Staffing).
We also have training programs for providers of child care. The Department of Labor, Bureau of Apprenticeship and Training, West Virginia Child Care Development Specialist Registered Apprenticeship Program offers child care apprentices 4,000 hours of supervised on-the-job training and 300 hours of classroom instruction. The child care providers earn their salaries while they are in the program and receive incremental wage increases as their skill, ability, and knowledge increase. The DOL reports that employers report almost no turnover among child care providers and that providers remain highly satisfied with their careers (www.dol.gov/dol/wb/public/childcare/child3.pdf).
Private employers may sometimes directly or indirectly provide resource and referral services. Some employers contract with private agencies to assist employees in learning about the range of child care options. The government could encourage such activities by providing subsidies or tax credits to firms if they provide such assistance. An example of this is the program at the Virginia Mason Medical Center which offers child/family resource and referral services.
Recent reports suggest that although some federal funds are available to improve access to higher-quality care among lower-income families, some states have not made these funds available or have set up programs that result in low take-up rates. According to “Access to Child Care for Low-Income Working Families” released in October 1999, 1.5 million children of 14.7 million (about 10 percent) in low-income households were receiving child care subsidies. The major source of funds is the Child Care and Development Fund (CCDF), a federal program that provides funds to states to subsidize child care. According to federal law, children living in families with incomes up to 85 percent of median income in the state could be eligible, but states have set lower limits (http://www.acf.dhhs.gov/news/ccreport.htm). The levels set and the take-up rates differ across states. The report details coverage in each state and take-up rates. Expanding eligibility to the federal maximum level and/or encouraging take-up of the existing subsidies through outreach are ways to increase the demand for high-quality care.
Data aggregated from state agencies indicate that the child care arrangement most frequently chosen by parents receiving direct federal subsidies is center-based care (Phillips, 1995), see Figure 8.
This evidence indicates that families do respond to available subsidies. The profile of arrangements used by these low-income parents is strikingly different from that used by all low-income families. Siegel and Loman (1991) found, as well, that AFDC families in Illinois showed different distributions of child care use based on whether they received a child care subsidy and which subsidy they received. Families receiving a child care benefit that reimbursed them for their child care costs 30 to 60 days after they had incurred these costs were discouraged from using child care options they could not afford with their disposable income. Their patterns of use were similar to those of unsubsidized, low-income families. In contrast, families who received subsidies through programs that either subsidized providers directly or enabled the families to pay providers when fees were due showed substantially higher rates of reliance on center-based and formal family day care arrangements.
Subsidies can help low-income families gain access to the same range of quality options that are available to higher-income families. The Urban Institute’s survey of resource and referral agencies in six communities provides evidence that the quality of care received by subsidized children was as high as that for higher income, fee-paying children, as perceived by resource and referral staff (Phillips, 1995).
Another approach that could be combined with subsidies for very young children would be to provide universal coverage for child care (or coverage for children whose parents worked more than 20 hours per week) for pre-school-age children. Such a program could expand existing prekindergarten programs to a full day and include after-school care. These programs could be established for 3- and 4-year-olds through a combination of direct provision through a local school district, existing community-based programs, and vouchers that would be accepted by certified providers. Part of the costs of this care would be offset by eliminating tax credits and current government subsidies for 3- and 4-year-olds. States and local communities would decide on the details of the provision of care, and financing would be shared across levels of government. Part of a coordinated, high-quality child care system for toddlers also might include community- and school-based centers and family day care networks. Because of the necessary low child:adult ratios (and their attendant expense), part of a coordinated child care policy for infants might include vouchers that would allow a parent to stay home and care for the infant during the first year.
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