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1 ~ Conclusions and Recommendations for Policies and Programs THE CHILD CARE ISSUE Like many other individual scholars and commissions of experts who have considered child care in recent years, the Panel on Child Care Policy recognizes that the issues are complex and controversial. In the United States, as in other developed countries, the majority of children now have mothers who work outside their homes; as a result, child care now includes an important and growing component of services provided in an array of out-of-home settings. Child care is no longer simply a protective or remedial service for poor children or those from troubled families; it is an everyday arrangement for the majority of children in the United States. With the dramatic increase in mothers' labor force entry, child care increasingly has become a large and diverse enterprise of public and pri- vate, for-profit and not-for-profit services. The revenues of this sector are currently about $16 billion per year and are expected to grow to $48 billion by 1995. As a result of these changes, the terms of the child care policy debate are very different in the late 1980s than they were just a generation ago. It is now recognized that the significant economic costs of caring for children must be borne by parents, employers, governments, or some com- bination of these sources. Since a mother who cares for her own child is not paid a wage for doing so, her labor is not counted as productive economic activity in official government statistics. Nevertheless, child care provided in this traditional mode is not free. Families "pay" in the income lost from mothers' absences from the labor force, and the mothers "pay" in the 288

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CONCLUSIONS AND RECOMMENDATIONS 289 long-term cost of lost employment opportunities and perhaps permanently lower earning potential. There is general agreement-regardless of one's political philosophy or ideological perspective that mothers are in the labor force to stay and, thus, that children need to be well cared for in safe and healthy environments. But the agreement ends there. Debate over who should provide care, who should pay for it, and who should regulate it is bitterly waged in the Congress, in state legislatures, in city councils, and in corporate boardrooms. 1b what extent should parents bear the responsibility and the economic burden? What role should employers play? What role should the federal, state, and local governments play? Moreover, how does the generally recognized need for more and better child care relate to competing social policy priorities, including health care, education, child welfare, housing, and law enforcement? What public policy ought to be, of course, depends on assessments of the needs and preferences of families in different social, economic, and cultural circumstances, as well as judgments about the costs and benefits of providing and financing child care and the individual and social costs of inadequate or insufficient care. It also depends on consideration of who reaps the benefits and who pays the costs. But rigorous cost-benefit analyses have not been undertaken both because there are insufficient data and because many of the costs and benefits may be inherently unquantifiable: for example, how does one measure the benefit to society of an improved future for a child? Despite the limitations on economic analyses, research and best pro- fessional practice clearly show that the quality of care that children receive has significant implications for their social, emotional, and cognitive de- velopment, as well as for their physical health and safety. Yet the United States does not have public policies to ensure that employed parents are able to provide adequate and appropriate care for their children. In the absence of any overall policy, child care services have developed haphaz- ardly: an uncoordinated patchwork of programs, supported by a variety of public and private funding sources, serving some but far from all of the families who need out-of-home care. The absence of national policies is sometimes linked to the limited knowledge about the costs, effects, and feasibility of alternative policies and programs. Although the relevant body of empirical research has grown over the past decade and a half, knowledge of the effects and effectiveness of formal and informal, public- and private-sector responses to the child care needs of working families has not kept pace with social change. Scientists have learned a great deal about the characteristics of childrearing environments and caregiver interactions that foster healthy development,

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290 WHO CARES FOR AMERICA'S CHILDREN? but there is insufficient evidence to predict the magnitude of effects of alternative policy and program proposals on children's development. In the previous chapter we made a number of recommendations for future data collection and research aimed at expanding the body of empiri- cal evidence to inform child care policy. We agree with scholars who assert that much more should be known about this and other difficult social policy issues. However, building the knowledge base will take time, and the policy process and the nation's children will not wait for scientists to produce complete and flawless data. Policy makers at all levels of government, as well as decision makers in the private sector, face difficult choices about how best to support the health and development of the nation's children and how to enhance the productivity of today's and tomorrow's work force. Accordingly, it is critically important to draw upon existing information, while acknowledging its shortcomings, to inform today's policy and program debates. FINDINGS AND CONCLUSIONS 1. Existing child care services in the United States are inadequate to meet current and likely future needs of children, parents, and society as a whole. For some families, child care services are simply unavailable; for many others, care may be available, but it is unaffordable or fails to meet basic standards of quality. The general accessibility of high-quality, afford- able child care has immediate and long-term implications for the health and well-being of children, parents, and society as a whole. Developmen- tally appropriate care, provided in safe and healthy environments, has been shown to enhance the well-being of young children. It enables parents who need or want to work outside the home to do so, secure in the knowledge that their children are being well provided for. It can contribute to the economic status of families and enhance parents' own personal and career development. And since today's children are tomorrow's adult citizens and workers, their proper care and nurturance will pay enormous dividends to society as a whole. 2. Of greatest concern is the large number of children who are presently cared for in settings that do not protect their health and safety and do not provide appropriate developmental stimulation. Poor-quality care, more than any single type of program or arrangement, threatens children's development, especially children from poor and minority families. Quality varies within and across programs and arrangements provided under differ- ent institutional auspices. High-quality and low-quality care can be found among all types of services, whether they are provided in the child's home or outside it, in schools, child care centers, or family day care homes, in programs operated for profit or those operated not for profit.

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CONCLUSIONS AND RECOMMENDATIONS 291 3. Irrespective of family income, child care has become a necessity for the majority of American families. Yet specific gaps in current programs and arrangements mean that many children and families lack access to services. Families with infants and toddlers, those with children with dis- abilities, those with mildly or chronically ill children, those with school-age children, and those in which parents work nontraditional schedules often have particular difficulty arranging appropriate child care services. 4. Arranging quality child care can be difficult, stressful, and time con- suming for all families. However, the problems are inevitably compounded for low-income families who lack time, information, and economic re- sources. For these families, the choices are often more limited, and the consequences of inadequate care are likely to be more severe. Therefore, in addressing specific child care needs, public policies should give priority to those who are economically disadvantaged. 5. The most striking characteristic of existing child care services is their diversity. The current system is an amalgam of providers, programs, and institutional auspices that have little interconnectedness and do not share a sense of common purpose or direction. This diversity is at once a source of strength and a challenge to the development of a more coherent system that meets the needs of all children and all families. On the positive side, the diversity means that parents seeking child care outside their homes have a range of programs and arrangements from which to choose. On the negative side, the diversity means that the costs, availability, and quality of care vary substantially. Preserving parents' choices in the care and rearing of their children is essential; however, it has to be balanced against the need to plan and coordinate services in a way that ensures their quality and accessibility to all families who need them. 6. There is no single policy or program that can address the child care needs of all families and children. The nation will need a comprehensive array of coordinated policies and programs responsive to the needs of families in different social, economic, and cultural circumstances and to children of different ages, stages of development, and with special needs. 7. Responsibility for meeting the nation's child care needs should be widely shared among individuals, families, voluntary organizations, employ- ers, communities, and government at all levels. Americans place a high priority on individuals' values and on the rights of parents to raise their children according to their own beliefs. Therefore, all child care policies should affirm the role and responsibilities of families in childrearing. Gov- ernments, community institutions, and employers should support rather than detract from that role.

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292 WHO CARES FOR AMERICA'S CHILDREN? GOALS OF A CHILD CARE SYSTEM The panel has identified three overarching policy goals that should guide the future development of the child care system in the United States: achieve quality in out-of-home child care services and arrange- ments; improve accessibility to quality child care services for families in different social, economic, and cultural circumstances; and enhance the affordability of child care services for low- and moder- ate-income families. Achieving all three of these goals is critical to the development of an improved child care system in which all children and families have access to affordable programs and arrangements that meet fundamental standards of quality and parents have increased choice in combining child care and employment. In the absence of fiscal constraints, these goals are not mutually exclusive, nor do they necessarily reflect competing priorities; in the current environment, however, pursuing them simultaneously will inevitably involve some difficult tradeoffs. In the long run, reaching the goals will be costly. Just how costly is difficult to estimate precisely since it will depend not only on the particular public and private policies and programs that are adopted, but also on how parents respond to them and to other future changes in the economy and society, in their choices regarding childbearing, labor force participation, and child care arrangements. However, it seems clear that far more real resources will have to be devoted to the care of the nation's children, with government at all levels contributing a substantial share, at least for low-income families. Moreover, in the absence of a revolutionary reversal of recent trends in women's labor force participation, the current $16 billion that is the monetized portion of resources devoted to child care will certainly have to grow substantially. Because the well-being of children is critical to the nation's future, we believe that a major investment of financial resources by governments, as well as by employers, community organizations, philanthropists, and parents who are able, is necessary and warranted in the long run. The panel believes that the long-term goals of quality, accessibility, and affordability should be pursued simultaneously and in a coordinated fashion, with recognition that they will require different types of policy instruments and programmatic approaches. Those instruments and approaches will include subsidies to parents to enhance their choices and ability to pay for the services and arrangements that best meet their needs, as well as parental leave policies that will allow them the choice of caring for their infants themselves. They will include subsidies to provider organizations to improve their facilities and the salaries and qualifications of caregivers and

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CONCLUSIONS AND RECOMMENDATIONS 293 to subsidize the costs of care and special services for children in low-income families and those with special needs. And they will include subsidies to states and communities to establish the infrastructure needed to effectively mobilize public and private resources, administer programs, assist parents and providers, and monitor the quality of care. Goal 1: Achieve Quality in Out-of-Home Child Care Services and Arrangements All families, regardless of their social, economic, or cultural back- ground, should be able to place their children in child care settings that meet fundamental standards of quality. Regardless of geographic location or the type of program or arrangement in which children are placed, certain characteristics of the setting, the caregiver, and the program are important indicators of the quality of care that is being provided. Although a specific definition of quality is somewhat elusive, the existing body of scientific research and best professional practice indicate that there are clearly iden- tifiable features of child care that are associated with quality. Some of these are regulatable: that is, they can be specified according to objec- tive standards that can be promulgated and enforced, including staffIchild ratios, group sizes, features of the physical facilities, and caregivers' train- ing. Other features are more subjective and cannot be regulated, including the nature and frequency of caregiver-child interactions, the stability of relationships between children and their caregivers, teaching and learn- ing styles, and the sensitivity of a program to the cultural heritages and preferences of the children and families it serves. Regulatable Features of Care For the regulatable features of child care quality, research and best practice provide reasonable ranges, which depend on the age of the children and on other characteristics of the child care setting (see Chapter 4~. For example, appropriate stafI/child ratios for 3-year-olds can range from 5 to 10 children per caregiver: the appropriate level in any particular setting depends on other related features of the setting, including group size, the availability of other adult caregivers, the arrangement of physical space, and the qualifications of the caregivers. Standards for the regulatable features of out-of-home child care, therefore, are expressed in terms of ranges rather than precise numbers. Staff/Child Ratios Research shows that the staf~child ratio is most critical for infants and young toddlers (0 to 24 months). For those youngest children, the ratio should not exceed 1:4. For 2-year-olds, acceptable ranges

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294 wHo CARES FOR AMERICA'S CHILDREN? are 1:3 to 1:6; for 3-year-olds, 1:5 to 1:10; and for 4- and 5-year-olds, 1:7 to 1:10. Group Size Children benefit from social interactions with peers; how- ever, larger groups are generally associated with less positive interactions and developmental outcomes. Acceptable ranges are a maximum of 6 to 8 children during the first year of life, 6 to 12 for 1- and 2-year-olds, 14 to 20 for 3-year-olds, and 16 to 20 for 4- and 5-year-olds. Careg~ver Paining and E'cper~ence Caregivers in child care centers, family day care homes, and school-based programs should have specific training in child development theory and practice. In addition, research shows that more years of general education contribute to caregiver perfor- mance and children's developmental outcomes. Physical Space and Facilities Space should be well organized, orderly, differentiated, and designed for children's use. Specific activities should have assigned areas within a child care center or family day care home (e.g., an art table, a dramatic play corner, a block-building corner, a reading corner). Facilities and toys should be age appropriate for the children using them. Unregulatable Features of Care Research also suggests that the regulatable and unregulatable features of quality are highly correlated. Good things tend to go together, so that programs and arrangements that adhere to high standards on regulatable dimensions tend to maintain high standards on unregulatable dimensions as well. Programs that comply with appropriate staff'child ratios and group sizes and that hire and maintain well-qualified staff, for example, are very likely to also be programs in which children receive plenty of nurturant one-on-one attention, in which the balance between activities that empha- size cognitive and social development is appropriate and in which children are given opportunities to initiate and pace their own activities with appro- priate caregiver support. Conversely, programs that do not maintain high standards on regulatable dimensions of care also frequently fail to achieve appropriate levels on unregulatable dimensions. Daily programs in child care settings should include some learning activities that permit children to choose and initiate their activities and to pace themselves. Learning activities should foster both cognitive and social development. They should be structured, yet flexible enough to accommodate the developmental needs of individual children. Learning activities should be balanced by time for unstructured play and exploration.

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CONCLUSIONS AND RECOMMENDATIONS 295 Furthermore, if programs are able to pay staff at levels commensurate with their training, experience, and responsibilities, they are also likely to attract well-qualified caregivers, to avoid high rates of turnover, and to provide stability in children's relationships with their caregivers. Children benefit from stable relationships with caregivers over time. The assignments of caregivers to particular groups of children should be maintained in order to foster the formation of trusting, affectionate relationships between individual adults and children. Importance of Quality Care Throughout this report we have highlighted the fact that quality care can play a particularly important role in enhancing developmental outcomes among children from economically disadvantaged and highly stressed fam- ilies, as well as those from middle- and upper middle-class families. Re- search shows that high-quality cognitive enrichment programs have positive implications for the intellectual development of children from low-income families who are at risk for school failure. And the effects are not only short term. Studies of the long-term effects of child care (although they are few) offer evidence that the quality of child care in the early years is related to later psychosocial and behavioral outcomes. Conversely, poor-quality child care threatens the health and development of children, especially those from poor and minority families. Juggling jobs and childrearing responsibilities is difficult for most par- ents. Coordinating work and child care schedules, managing the demands of jobs and housework, being psychologically as well as physically available to children and to employers, and coping with the inevitable emergencies and unforeseen demands that arise in both domains create high levels of stress and anxiety. For single parents, especially those who are economically disadvantaged, the pressures are especially difficult. Quality child care that is reliable and dependable can help to alleviate parental stress and buffer children as well as parents from the problems associated with combining work and parenting roles. Improving Poor-Quality Care A great deal of available out-of-home child care appears to be of poor quality. Numerous studies of center care and family day care in this country have shown that many children are in programs that do not meet the fundamental standards of quality we have outlined, although it is impossible to calculate the precise number of inadequate programs and the number of children they serve. The regulatory policies of many states do not resect knowledge from research and best practice about appropriate ranges for

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296 WHO CARES FOR AMERICAS CHILDREN? staf~child ratios and group sizes for children of different ages, about the organization and design of physical spaces, or about the desirable education and qualifications of staff. Even in states with regulations that establish high standards for care, many state regulating agencies have inadequate staff to appropriately and effectively monitor compliance, so that enforcement is all too frequently sporadic and ineffective. And as detailed in this report, many programs and providers are exempt from licensure and are unregulated. It also appears that many providers, especially those that operate outside the regulated system, lack the knowledge and economic resources required to improve their programs to acceptable levels of quality. Relatedly, as we have discussed at many points throughout this report, child care workers are underpaid relative to their education and training, experience, and levels of responsibility. Low salaries have been shown to jeopardize the quality of care that children receive by contributing to high turnover rates and instability in child care centers and by discouraging many well-qualified caregivers from entering or remaining in the market. In states and localities that have launched special initiatives to increase salaries, staff recruitment and retention have improved. Raising wages for caregivers with more education has been shown to be especially effective in increasing the quality and stability of staff. In the long run, achieving the levels of quality in out-of-home child care that are fundamental to support and nurture children's health and de- velopment will require action on several fronts. State regulations governing child care programs and settings will have to be changed to reflect what is known about the ways in which regulatable features of care influence qual- ity. At the same time, alternative quality control mechanisms that reward regulated and unregulated providers for meeting performance standards will have to be developed and implemented. Incentives and opportunities for improving caregiver qualifications will have to be developed. And, fi- nally, the salaries and wages of caregivers will have to be increased to levels commensurate with their training, experience, and responsibilities. Goal 2: Improve Accessibility to Quality Child Care Services and Arrangements for Families in Different Social, Economic, and Cultural Circumstances Regardless of their social, economic, or cultural backgrounds and circumstances, all families should have access to quality child care services and arrangements. If parents' right to choose freely from a diversity of options is to be the guiding principle for child care policy and the delivery of services, then parents must have options. For too many families, particularly low-income families, there are too few choices.

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CONCLUSIONS AND RECOMMENDATIONS Is There a Shortage of Child Care? 297 Data on the supply of and demand for child care services are inade- quate to allow us to reach a definitive answer to the question of whether there is a shortage of child care. The available national data on demand and the limited information on supply lead us to conclude that in a narrow economic sense there is no generalized shortage of child care services. That is, most parents who have ample financial resources and time to search can arrange the care they want for their children. But for parents without time and resources, choices may be severely restricted. Moreover, several specialized types of child care services are in short supply: organized in- fant and toddler care programs, before- and after-school care programs, child care and preschool education programs for children with disabilities, comprehensive care programs for economically disadvantaged children and those at risk of later school failure, and services for children whose parents do not work traditional daytime schedules. As difficult as many parents find it to arrange care for their 3- to 5-year-olds, parents who need out-of-home care for their younger and older children, as well as those who require care for children with special needs, often face long and frustrating searches that end with less than satisfactory results. For a variety of reasons the market has not independently responded to the needs of these parents and children, and in the absence of government intervention, it seems unlikely that it will. There is also significant evidence of a shortage of quality child care. Even when the market functions well in a narrow economic sense, it often does not produce care of appropriate quality for the healthy development of children; for low-income families, this is a particularly serious problem. Studies show that children from economically disadvantaged families are less likely to be in quality programs in the absence of special access and subsidies. Infant Care Care for very young children is difficult and expensive to provide. Regulations that limit the number of children per caregiver (although in many states not to levels recommended by professional performance standards) increase the staff costs associated with infant care. Special caregiver training requirements and equipment also add to these costs. In centers that operate solely on parent fees, the tuitions of preschool-age children partially subsidize the costs of caring for infants and toddlers. If the supply of care for the nation's youngest children is to grow to meet the projected demand over the next decade, substantial additional public and

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298 WHO CARES FOR AMERICA'S CHILDREN? private resources will be needed to establish facilities, train caregivers, and help subsidize the costs of care for children in low-income families. Before- and After-School Care Before- and after-school care is also in short supply in many com- munities (see Chapter 6~. Barriers to the use of school buildings and staff have limited the opportunities to establish school-based programs, and although many proprietary and not-for-profit centers have established programs, these are usually most appropriate for 5- to 8-year-old children. Most of the programs that do exist require parent fees and therefore may limit the access for children in low-income families who cannot pay. From a cost perspective, relatively modest levels of public funding can benefit large numbers of children: school buildings that are not used during nonschool hours and when school is not in session provide well-equipped facilities. Coordination with other community-based programs and facilities, such as parks and recreation department programs, can widen the range of activ- ities and options to meet the needs and interests of children aged 5 to 12. Although some states and communities have begun to develop exem- plary before- and after-school care models, further experimentation and development are needed. Care for Children With Special Needs Federal programs for the development of child care and preschool programs for children with disabilities (including those under P.L. 99- 457) make funds available to states to distribute to local schools or other community-based organizations that serve this population. Given the many needs of many of these children and their families, communities should be encouraged to develop and evaluate model programs that provide compre- hensive health, education, and parent education services for children with handicapping conditions. Out-of-home child care services are in short supply for mildly ill children and those whose parents work nontraditional schedules. The ac- cessibility of care when children are sick and during evenings, nights, and weekends is generally limited and may affect parents' decisions to accept employment as well as time lost from work For shift workers who earn low wages and who are single parents, the problems of arranging quality child care may be exacerbated. Accordingly, special services to meet the needs of these children and families are needed to facilitate parents' employment and to ensure that their children receive adequate care.

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304 WHO CARES FOR AMERICA'S CHILDREN? child care must be a central component of any policy to help poor families achieve economic self-sufficiency through employment. This idea is repre- sented in the Family Support Act of 1988, although in light of the current constraints on public budgets, sufficient additional resources required to meet the needs of all low-income families and their children are unlikely to be immediately available. Nevertheless, there is an urgent need for federal and state governments to take steps to increase funds allocated to child care for this population. Implementation of the Family Support Act of 1988 is expected to give added impetus for such action by increasing the demand for nonparental child care by up to 10 percent (Kisker et al., 1989~. Several specific funding mechanisms are available to channel support for low-income families for child care, including: (1) changing the depen- dent care tax credit to meet the needs of low-income families; (2) expanding the earned income tax credit or converting the personal tax exemption for children to a refundable credit; (3) providing additional support for the purchase of services through grant programs such as the Social Services Block Grant program; and (4) allocating additional support for child care and early childhood education provided by the public school systems. As we discussed in Chapters 7 and 8, each approach has particular strengths and weaknesses. The politically popular dependent care tax credit is the one federal child care program that has expanded substantially since the early 1980s. Intended to expand the choices available to employed parents who use out-of-home child care services, the credit currently provides an estimated $3.9 billion of financial assistance to working families. However, the credit largely benefits middle- and upper middle-income families. Working parents who do not pay income taxes because their wages are low cannot use the credit. In order to benefit those parents, the credit would have to be changed-to make tax benefits refundable to low-income families and to make benefits available to parents on a timely basis (rather than at the end of the year) to allow them to use the additional income to pay for child care services. Estimates of the added costs of making the dependent care tax credit fully refundable at current benefit levels are approximately $300 million. Estimates of the added costs of making the credit refundable and raising the benefit level to the projected average costs of purchasing quality care of $4,000 per child under age 6 per year and $2,000 per child aged 6 to 13 per year are as high as $10 billion. However, if the higher benefit levels were limited to low- and moderate-income families, the total additional costs would be much less, and they could be lowered further by eliminating the current subsidy for high-income taxpayers. Since increasing the earned income tax credit would target additional funds to low-income working families with children without tying those

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CONCLUSIONS AND RECOMMENDATIONS 305 funds specifically to the purchase of child care, this type of child allowance subsidy also increases families' options with respect to child care arrange- ments. In a similar vein, many advocates of policies that would encourage, or at least not discourage, mothers in two-parent families to remain at home and care for their children themselves have supported increasing the personal income tax exemption. The personal tax exemption provides a form of allowance to families with dependent children, but in its current form it provides little or no benefit to low-income families. If the exemp- tion were converted to a refundable tax credit, it could effectively target needed assistance to economically disadvantaged parents regardless of their employment status. Increasing the Social Services Block Grant program or other programs that subsidize child care providers who serve children from low-income families would also enhance the affordability of services for this popula- tion. At the same time, it could improve the availability of programs in low-income communities and neighborhoods where proprietary providers have few economic incentives for developing programs. The Social Services Block Grant program and similar programs also offer significant opportu- nities to link funding to compliance with performance standards that are likely to be associated with higher quality care. Funding for the Child Care Food Program, in particular, has been an effective mechanism for bringing family day care homes into the licensed system and for developing routine structures for monitoring compliance with regulations and standards of care. The panel is neutral as to the specific funding mechanism for chan- neling general support for low-income families for child care. We strongly endorse the fundamental tenet that public policy should enhance parents' ability to choose programs and arrangements that meet their special needs and preferences, but we also recognize that quality programs will not de- velop in many poor communities unless providers are directly subsidized to seine those consumers. Existing scientific data and analyses shed light on the likely direction of effects of these alternative policies. But they do not provide a sufficient basis for recommending any particular my among the various types of direct consumer subsidies, which provide income support to economically disadvantaged families (whether restricted to working parents and paid child care or not), and provider subsidies, which provide direct support to the individuals and institutions that care for poor children. 2. In partnership with the states, the federal government should expand Head Start and other compensatory preschool programs for income-eligible 3- and 4-year-olds who are at risk of early school failure.

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306 ECHO CARES FOR AMERICA'S CHILDREN? Over two decades of experience with the federally funded Head Start program and major evaluation studies provide convincing evidence of the ef- fectiveness of high-quality comprehensive early childhood education. These programs provide economically disadvantaged and at-risk preschool chil- dren an early educational experience that improves their chances of later academic success. Comprehensive care programs are costly, from $2,500 to $3,500 per child for a typical Head Start part-day program and more for more intensive academic or social services components or if the program is combined with extended-day child care services. Not all children require comprehensive services, nor should they receive them. But for children from very poor or disorganized families, these programs have a positive effect on their social, emotional, and cognitive development as well as on their physical health and well-being. Head Start has an impressive record of success, yet it currently serves less than 20 percent of the income-eligible population; and, as a part-day program, it is not responsive to the schedules and child care needs of many employed parents. Other privately sponsored programs in communities across the country have achieved similarly posi- tive results, but they, too, serve only a small fraction of those children who need them and would benefit from participation in them. Accordingly, the panel concludes that the Head Start program should be expanded to serve all income-eligible 3- and 4-year-olds in need of comprehensive child development services. In addition, Head Start pro- grams should be integrated with community child care programs to provide extended-day care for children whose parents are employed. They should also be coordinated with other public and private school and child care programs serving children in low-income families and children with disabil- ities in this age group to ensure that appropriate services are accessible to all children and families who need them. For low-income families who do not require intensive comprehensive child care programs that combine health, education, and social services, publicly provided compensatory education programs should be expanded. The majority of 4-year-old children now participate in an organized group program. For middle- and upper middle-income children, nursery and preschool programs have become a common experience. For economically disadvantaged children at risk of school failure, many public school systems are developing compensatory preschool programs to boost early social and cognitive development and to enhance children's ability to participate in regular elementary school classes at age S or 6. These programs have been shown to substantially improve school readiness for children from economically disadvantaged or disorganized families and those whose na- tive language is not English. Although they are expanding, they are not currently available to all children who would benefit from participation.

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CONCLUSIONS AND RECOMMENDATIONS 307 Accordingly, the panel concludes that the federal government, in partner- ship with the states and local school systems, should coordinate funding for and the development of compensatory programs for 4-year-olds at risk of later school failure. In some communities, public schools could be the providers of these services; in others, services could be provided under the auspices of other community-based institutions and coordinated with programs provided by the schools. 3. Governments at all levels, along with employers and other private-sector groups, should make investments to strengthen the infrastructure of the child care system. Improving the accessibility of quality child care to low- and moderate- income families will depend in part on developing a child care system that meets the needs of all children and families. The current uncoordinated patchwork of programs and arrangements provides services of varying cost and quality to some, but not all, who need and want them. Improving the capacity of the existing system to match consumers and providers, to offer information and referral to parents, to provide training and technical assistance to family day care providers, and to support effective planning and coordination of policies, programs, and resources at all levels would enhance the quality and accessibility of services to all families. The panel urges several specific steps to strengthen the infrastructure of the child care system. a. Expand resource and referral services. Public policy toward child care has been increasingly aimed at ensuring the right of parents to choose the form of care that best meets their needs and fits their values concerning childrearing, and a diverse and decentralized assortment of child care services and arrangements has evolved. But parents can only take advantage of the available choices if they understand what is available and practical and if they understand how to gain access to them. Resource and referral services, which have developed in several states and communities, provide an effective mechanism for matching consumers and providers, for providing information and consumer education to parents, for providing information and technical assistance to providers, especially family day care homes, and for providing information and support to state and local planning groups. They are not a panacea for all the ills of an incoherent and competitive child care system, but they can provide an essential part of the necessary infrastructure of a more coordinated system and can help the existing market function more effectively. Accordingly, the panel recommends that government at all levels, in partnership with employers and the voluntary sector, support the establish- ment and operation of independent local resource and referral services.

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308 WHO CARES FOR AMERICA'S CHILDREN? Resource and referral services models should be further developed, re- fined, and evaluated as a basis for future decision making concerning the most effective means of organizing and delivering these essential child care support services. b. Improve caregiver training and wages. The quality of child care is inextricably linked to the qualifications and stability of caregivers. As we have discussed throughout this report, well-trained and consistent staff are an important ingredient of high-quality care. Caregivers who have had training in child development as well as basic health and safety practices are better able to meet children's fun- damental physical and developmental needs, and the amount of formal education obtained by caregivers is a strong predictor of appropriate care- giving behavior. Specialized training is especially important for those who care for infants, children with disabilities, and children of diverse cultural backgrounds. Quality child care also requires settings and conditions that value adults as well as children. Indeed, the quality of children's experiences in child care is directly linked to the well-being of their caregivers. Instability that results from high rates of staff turnover has been found to be directly attributable to low wages and poor benefits. Child care workers are underpaid relative to their education and training, experience, And levels of responsibility. But raising the wages of caregivers will inevitably raise the costs of care and result in fees for services that are beyond the means of many families. As the Child Care Staffing Study (Whitebook et al., 1989) reports, in the face of a rapidly growing demand for services, an increasing number of consumers with a limited ability to pay, and restricted government and corporate support, the United States has implicitly adopted a policy that relies on child care providers to subsidize the cost of care through their low wages. The panel concludes that improving the quality of child care will inevitably require professional preparation and adequate compensation for caregivers. The federal and state governments should expand support for preservice and in-service training programs for child care providers, and they should take steps to increase salaries for qualified caregivers by earmarking state funds for increasing salaries and increasing reimbursement rates for publicly funded child care in order to reflect the full cost of care based on improved salaries. c. Expand vendor-voucher programs. Since the early 1980s the use of vendor-voucher programs has grown in many states as a way of subsidizing child care for low-income families and maximizing their options. Some employers are also beginning to offer

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CONCLUSIONS AND RECOMMENDATIONS 309 vouchers as a fringe benefit. These initiatives have enhanced parents' ability to choose particular child care arrangements, if options are available in their communities, and they have created opportunities for many low- income parents to place their children in center care rather than relying solely on relative care and unregulated family day care. In this regard, vouchers represent an important policy tool for fostering integration of children from low- and moderate-income families in child care. Their effectiveness, however, depends on the availability of an efficient resource and referral system to inform parents of their options and to help them gain access to programs in the community. The panel recommends that state governments and private community agencies expand support for vendor-voucher programs as a way of subsi- dizing child care expenses for low-income families and that employers be encouraged to support vendor-voucher programs as a benefit of employ- ment. The provision of vouchers should be linked to use of licensed or other regulated forms of care. States should allocate funds to develop, re- fine, and evaluate models for linking vendor-voucher programs to effective resource and referral services. d. Encourage the organization of family day care systems. Networks or systems of family day care providers have expanded rapidly over the past several years, largely in response to requirements for receipt of Child Care Food Program subsidies. Although systems vary in size and in the types of supports and services they offer, they have been shown to be effective mechanisms for assisting providers to meet the administrative requirements for public subsidies, disseminating information concerning best practices, providing preservice and in-service training, sharing toys and other educational resources, organizing emergency backup care, and providing client referrals. In addition, family day care systems provide a potentially powerful mechanism for monitoring compliance with national standards for family day care and providing technical assistance to providers to improve the quality of their services. Networks and systems are currently sponsored by a variety of not-for-profit community organizations. The availability of public support would provide an incentive for the further expansion of these systems. Therefore, the panel recommends that the federal and state governments allocate funds for the establishment of family day care systems to provide training and support to family day care providers and to monitor their compliance with child care standards. e. Improve planning and coordination. The emergence of a diverse set of decentralized child care services has meant that in many communities there is little coordination among programs, providers, and agencies. They frequently do not share a set of

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310 WHO CARES FOR AMERICA'S CHILDREN? common goals or purpose, and in the absence of a community infrastructure to link them, they are likely to compete for financial resources, staff, and space. The panel concludes that planning and coordination must occur at all levels of the policy process. At each level of government- federal, state, and local there must be an institutional structure that can serve as the focal point for coordinating resources across agencies, for establishing priorities, and for designing and implementing policy. At each level, planning must involve the array of relevant public- and private-sector groups and must be based on systematically gathered data about children, their families, and available resources. ~ be effective, state and local planning and coordination should not simply consist of another "blue-ribbon" commission or task force that out- lines needs and announces goals, but fails to resolve the ' difficult issues of jurisdiction that exist among education, social services, welfare, eco- nomic development, and health and mental health programs, providers, and professional interests. Instead, planning and coordination must in- volve a process that will develop a long-term view of what the state's and the community's pattern of child care should be, how that view can be translated into legislative initiatives for policies and programs, and how administrative structures can be organized and empowered to carry them out. Developing and empowering effective institutional mechanisms for planning and coordination will inevitably be a lengthy process. There have been several effective models (see Chapter 6), and the panel concludes that steps should be taken to expand their development. 4. The federal government should initiate a process to develop national standards for child care. The lengthy and painful effort to promulgate federal quality and safety standards or regulations for the delivery of child care services was termi- nated with the elimination of the Federal Interagency Day Care Require- ments in 1982, and the states became the sole authority for establishing regulations and enforcing them. The content of state regulations varies dramatically across jurisdictions, not as a reflection of the different devel- opmental needs of children but as a reflection of different views of the role of government in developing standards or regulations and the will and ca- pacity of state systems to see that they are maintained. Within jurisdictions, different institutions that serve children of the same age are governed by different regulatory policies or are exempted altogether. The 'panel concludes that uniform national child care standards based on current knowledge from child development research and best practice from the fields of public health, child care, and early childhood education are a necessary (though not sufficient) condition for achieving quality in out-of-home child care. Such standards should be established as a guide

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CONCLUSIONS AND RECOMMENDATIONS 311 to be adopted by all states as a basis for improving the regulation and licensing of child care and preschool education programs. Unfortunately, there are few economic or political incentives for the states to take this step. Existing regulations have been established through a process of political negotiation, and in most states the systems for monitoring and enforcing regulations are not adequate for effective oversight of the rapidly growing array of programs and providers in their jurisdictions. Thus, incentives must also be created to encourage state involvement: for example, linking federal funding to compliance with national standards. 1b develop national standards, the panel recommends that the federal government establish a national-level task force to bring together repre- sentatives of the states, the relevant professional organizations, service providers, and appropriate federal agencies. Current knowledge from child development research and existing professional performance standards can provide the basis for developing health and safety requirements, acceptable ranges for stafI/child ratios, group size, caregiver qualifications, and physical facilities, as well as program content. Such a process should also address the practical considerations of states' adoption of standards, such as the cost of services to parents and the cost to states of ensuring compliance. These standards should reflect the common needs of children of different ages, from different cultural heritages, and with special needs, regardless of the setting in which they are served. At the same time, they should take account of the physical and administrative differences between child care centers, schools, and family day care homes. 5. The federal government should mandate unpaid, job-protected leave for employed parents of infants up to 1 year of age. Child care is most demanding during the first year of a child's life. For parents, it is often a difficult period of personal and social adjustment, which is frequently exacerbated by the stress and lack of sleep that accompany a baby's arrival. For employed parents, combining work and family roles may compound the difficulties. The establishment of strong relationships between parents and children in the early months of life has been shown to have significant implications for children's later development. And these relationships are more likely to develop when parents have time and emotional energy to interact with their young children. Parental leave policies that permit parents to remain at home to care for their own children for a defined period of time after birth or adoption have been implemented in many European countries and have been widely discussed in recent years in the United States. Researchers, professionals, and parents alike agree that too many children enter out-of-home care before they and their parents have "had a good start together" (Kahn and Kamerman, 1987~. In many cases parents are unable to remain at home

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312 WHO CARES FOR AMERICA'S CHILDREN? because they cannot afford the lost income or because they would have to forfeit their job to do so. Given the shortage of high-quality infant care services, many observers worry about the long-term effects of exposing very young children to inadequate care and of forcing their parents back to work before they are psychologically ready to return. The panel has concluded that, in the current infant care market, some parents are forced to make choices they should not have to make. Often those who choose employment have difficulty finding quality infant care at a cost they can afford. And many of those for whom the pressure for employment is greatest single parents and those employed in low-wage jobs may be forced to place their very young children in poor-quality care. Research has shown that children from low-income and highly stressed families are especially vulnerable to the potentially damaging effects of poor-quality care. Alternative polices to increase parental choice and improve the infant care market can take several forms. One option is to improve the supply of quality infant care. Although the panel favors policies to improve the accessibility of quality infant care, the inherent tensions among availability, affordability, and quality also lead us to recommend a complementary policy of parental leave to provide parents the opportunity to care for their very young children themselves. After weighing the evidence on the estimated costs and benefits of al- ternative policies, the panel acknowledges that on narrow economic grounds the case for parental leave is inconclusive. Clearly there are a number of monetary and nonmonetary costs and benefits associated with such poli- cies. For example, mandated parental leave would entail costs to some employers for recruiting and training replacement employees, and it may result in discrimination against women of childbearing age. But the poten- tial benefits are also significant, including fostering equal opportunity for women workers by increasing their attachment to the labor force and their seniority in their jobs, increasing work force stability, and reducing welfare costs. The potential costs of not having parental leave are also significant, although they are less easily measured in monetary terms. An array of studies highlights the potentially detrimental developmental problems for young children, parents' stress in attempting to combine parenting roles and employment during the early months after the birth or adoption of a child, and women's lost wages (short and long term) and increased welfare costs if women have to quit their jobs. These considerations led the panel to recommend parental leave as one important component of a national child care policy. Even among those who agree that parental leave policies should be implemented, there is little consensus about whether leaves should be paid or unpaid and, if paid, at what level of wage replacement, for what period

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CONCLUSIONS AND RECOMMENDATIONS 313 of time, at whose cost, and with what assistance for the particular problems of small employers. Our conclusion, based on a review of the available research and the panel's professional judgment, is that, in the long term, policies should provide paid leave with partial income replacement for up to 6 months and unpaid leave for up to an additional 6 months, with job-related health benefits and job guarantees during the year. We recognize, however, that the costs to employers and governments will make the implementation of paid parental leave impossible in the near term. Accordingly, as a first step, we recommend that the federal government mandate that employers ensure unpaid, job-protected leave, with continued health benefits, for up to 1 year for all parents who prefer to remain at home following the arrival of a new baby. We acknowledge that without wage replacement, parental leave will not be a viable option for many families, and we look forward to the eventual implementation of policies to provide paid leave. In sum, in keeping with the panel's objective of enhancing families' choices among child care arrangements for infants, parental leave as well as quality out-of-home care should be an option regardless of parents' economic status. CONCLUSION As we stated at the beginning of this chapter, the panel's framework for policy and program development is organized around three fundamental goals: to enhance the quality of out-of-home child care services and ar- rangements; to enhance the accessibility of child care services and arrange- ments to families in different social, economic, and cultural circumstances; and to enhance the affordability of child care services for low-income fami- lies. Our five recommendations are intended as immediate steps to further these goals. It is important to recognize that none of our recommended policy and programmatic actions alone can solve the complex problems of child care in the United States; nor can any single strategy address the needs and characteristics of all children and parents. In presenting several strategies for achieving the goals, we have tried to take account of the diversity of children, families, employers, and communities of different values, different social, economic, and cultural backgrounds, different ages and stages of development, and different community support systems. But the strategies, as well as the goals themselves, are interdependent: in the long term, they need to be pursued simultaneously and in a coordinated fashion, although in the short term they will inevitably require difficult tradeoffs. As we have stressed throughout this book, there are no easy answers or quick fixes. Nor are there any cheap solutions. Developing a coherent child

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314 WHO CARES FOR AMERICA'S CHILDREN? care policy and delivery system in the United States will require a major investment of new resources at all levels of government and continued support from employers and the volunteer sector. It will also require a sustained, coordinated commitment by policy makers, service providers, employers, and parents. Everyone is touched by the issue of child care, and everyone must contribute to the development of an effective child care system. Indeed, investments in child care must be viewed as investments in the health and development of all American children, the well-being of all American families, and the future productivity of the American work force. REFERENCES Cherlin, A., ed. 1988 The Changing American Family and Public Policy. Washington, D.C.: The Urban Institute Press. Kahn, A., and S. Kamerman 1987 Child Care: Facing the Hard Choices. Dover, Mass.: Auburn House. Kisker, E.E., R. Maynard, ~ Gordon, and M. Shain 1989 The Child Care Challenge: What Parents Need and What Is Available in Three Metropolitan Areas. Princeton, N.J.: Mathematica Policy Research. Whitebook, M., C. Howes, and D. Phillips 1989 Who Cares? Child Care Teachers and the Quality of Care in America. Executive summary of the National Child Care Staffing Study. Oakland, Calif.: Child Care Employee Project.