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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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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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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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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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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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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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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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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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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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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.
Representative terms from entire chapter:
care services
