States Have Undertaken A Variety of Quality Improvement Initiatives, but More Evaluations of Effectiveness Are Needed
GAO-02-897: Published: Sep 6, 2002. Publicly Released: Oct 7, 2002.
The demand for child care has increased dramatically in the past several decades as the number of mothers who work outside the home has grown. Welfare reform has further increased this demand. To support low-income parents moving into the workforce, welfare reform established the Child Care and Development Fund (CCDF). In fiscal year 2000, states spent $5.3 billion in CCDF funds to subsidize child care for low-income families. Out of concern for the quality of care that the CCDF funds, welfare reform legislation also required states to set aside at least 4 percent of the total grant to improve the quality and availability of child care. Department of Health and Human Services (HHS) regulations provide examples of allowable activities, such as providing child care providers with financial incentives for meeting state and local standards, improving the compensation of child care staff, and offering resource and referral services. However, the regulations do not limit states' use of funds to these activities; rather, the fund's block grant structure allows states considerable flexibility in choosing appropriate quality and availability improvements to pursue. Using primarily the four percent quality set-aside, states reported undertaking a variety of child care quality improvement initiatives, such as training caregivers, raising the compensation of caregivers, referring parents to child care providers, and efforts to enhance the safety of child care facilities. Although few states have evaluated the effects of their quality improvement initiatives on children's development, some studies provide useful findings about them. The research on child care quality does not evaluate initiatives as actually implemented by states, but a few studies, using rigorous methods, show that some of the attributes of child care quality that these initiatives address, such as caregiver qualifications, affect children's social, emotional and cognitive development.
Recommendation for Executive Action
Status: Closed - Implemented
Comments: The Child Care Bureau developed agreements with Miami-Dade County, FL, and Illinois to conduct studies of child care quality improvement initiatives under its multiyear evaluation of state child care policies. Miami-Dade County planned to evaluate a training curriculum designed to change caregivers' behavior and improve children's developmental outcomes. Illinois planned to evaluate the effect of increasing child care provider eligibility guidelines on child care quality. Both studies planned to employ experimental designs to analyze the child care quality improvement strategies' effects. In 2004, the Child Care Bureau provided funds to projects investigating the Impact of a State-Wide Unified Professional Development System on Child Outcomes and assessing the impact of cash incentives on early childhood workforce development and program quality. And in 2005, CCB funded researchers reported findings on WI quality initiatives under CCB's Child Care Policy Research Consortium.
Recommendation: Health and Human Services should include in its planned multiyear evaluation of the net impact and benefits of state child care policies, an analysis of the effects on children's development of selected state quality improvement initiatives, such as off-site caregiver training or enhanced inspections.
Agency Affected: Department of Health and Human Services