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Measuring the Outcomes of Day Care Jeffrey R. Savers, Rochelle Beck, and Joan Bissell Day care in the United States comprises a very hetero- geneous collection of "programs"--some of them public, some private, some institutional, some informal. It can be a large, smoothly run, full-day nursery school in a splendid facility with highly professional staff; it can also be Mrs. Jones taking care of Mrs. Smith's kids in the Jones' family playroom. Its goals and functions are as varied as its sponsors and practitioners, and its clients range from infants to school-age children, from the poorest to the wealthiest families. This heterogene- ity poses major challenges for outcome measurement. It requires an arsenal of measures appropriate to different goals, different settings, and different client populations. Problems of measurement are exacerbated by the fact that day care is highly politicized, in the broadest sense of the term. Day care has many ~constituencies"; many groups with divergent interests have different perceptions of its proper goals and functions. A few examples illustrate the range: Day care can be seen as a service to children, intended to equip them with School readiness" skills or to support the development of their social skills and emotional strengths. It can be seen as a service to parents, designed to free them for work or other pursuits. It can be seen as a family support service, intended to strengthen families by allowing them to increase earnings while still meeting their child- rearing responsibilities. It can be seen as a societal tool, designed to increase employment and upward mobility, augment the tax base, and reduce the welfare rolls. It can be seen as a vehicle for delivering services such as 109

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110 health care, nutrition, parent education, family counsel- ing, and the like to low-income families. While these views are not necessarily incompatible, each points to a different kind of emphasis in outcome research. Day care also has organized opponents, who see it as undermining the family and who see government support for day care as unwarranted intrusion into family rights and responsibil- ities. This negative view, too, has implications regard- ing unintended outcomes, which should be considered in evaluating day care programs. Issues of measurement for day care demonstrations are rendered even more complex by the fact that demonstrations can address two distinct types of questions, which might be termed "program" questions and "policy" questions. Program questions have to with the best ways of operating day care programs, e.g., the most effective methods of recruiting and training staff, the most effective "curricula" or activities to use with children, or the most effective means of eliciting parent involvement. Policy questions have to do with the proper roles of the various levels of government and with the most effective means of achieving governmental goals. Examples include: Should the federal government encourage out-of-home care for young children, through subsidies or other incentives, or should it subsidize parents who stay home and care for their own children? Which day care subsidy mechanisms (e.g., vouchers, direct purchase of care, income disregards) maximize parental choice? Which maximize quality of care? Which maximize cost-effectiveness? What is the most appropriate and/or effective division of labor among the federal government, states, and localities in regulating and monitoring the quality of care? Should health and social services be delivered through "client-oriented" day care or through more l Income disregard is a system under which mothers receiving Aid to Families with Dependent Children (AFDC) under Title IV-A of the Social Security Act are allowed to earn income above the maximum levels normally permitted for those receiving such aid, provided that the surplus is spent for child care. The system is designed to prevent the cost of child care from becoming a barrier to prevent welfare mothers from entering the labor force.

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111 specialized service agencies, such as health clinics? Clearly, demonstrations addressed to these different levels of question require different outcome measures. For example, different measures are needed to assess an exemplary day care program designed to demonstrate innovative techniques for educating children and a model information and referral system or a voucher experiment designed to demonstrate ways to stimulate private initiative and maximize parental choice. Given the multiplicity of goals of day care programs, of day care constituencies, and of demonstrations in day care, it seems obvious that outcome research must itself be multifaceted. No single study could address all of the (quite legitimate) concerns sketched above. Thus day care confronts researchers with the need to stake out their turf clearly--to start with an explicit framework of values, goals, concepts, and questions and to recogniz that alternative frameworks exist and to take that broader context into account. While any one study must be limited in focus, it is important for researchers, and those who interpret research, not to draw erroneous policy conclu- sions from data that address only one domain of concern. For example, it might be the case, as some have argued, that the most cost-effective way to enhance children's cognitive development is through the education of parents and/or in-home intervention with very young children. But such a claim (if true) would not necessarily argue against support of developmental day care, since the latter potentially provides other benefits to families. (Other examples are cited below, particularly in connec- tion with our discussion of the effects of day care on employment and family income.) The admittedly ambitious aim of this paper is to map the broad terrain of outcome measurement for day care from a bird's-eye view. We begin with a brief overview of day care in the United States and a discussion of the concerns of the many constituencies of day care--children, parents, providers, researchers, and policy makers. The body of the paper provides a taxonomy of potential out- comes addressed to these multiple concerns, surveys the current status of measurement with respect to each class of outcomes, and suggests needed additions and improve- ments. The final section summarizes the paper's main conclusions about the state of outcome measurement for day care and its recommendations for the future. e

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112 BACKGROUND Day Care in the United States: An Overview The use of day care in the United States, although not entirely work related, is intimately linked to the labor force participation of women, which has increased dramat- ically in recent decades. In 1950 only one fifth of all mothers with children under 18 were employed; by 1978 the proportion had increased to more than one half. The largest percentage increase occurred among women with children under six, whose labor force participation nearly tripled (from 14 percent to 40 percent) during this period (Congressional Budget Office, 1978:44). Labor force participation of mothers is highest among women who head single-parent families. Among two-parent families, the labor force participation of mothers is greatest when the father's income is low (Johnson and Hayghe, 1977). The above data can be and have been interpreted as evidence for an abiding and increasing demand for child care. There is, however, heated controversy over the proper public response to this apparent increase in need. Some commentators, often remarking on the activist family policies of the governments of other industrial- ized nations, have argued for increased public subsidy of child care. Others have argued that the increase in demand has been exaggerated and that private market mechanisms are adequate to cope with it. Still others have decried the labor force trends as indicators of the decline of the family, construing the demand for increased subsidy as an invitation to increased government encroach- ment on family rights. It is not our purpose to take sides on these issues but to describe the day care "market" as it currently exists, the role of the govern ment within that market, and certain new developments that seem likely to raise salient program and policy issues in the 1980s. Subsequent sections of the paper outline concomitant issues of outcome measurement. We use the term "day care" broadly to mean care provided on a regular basis by persons other than immediate family members (parents, live-in grandparents, older siblings). However, our primary focus is on paid care by nonrelatives, provided in the child's home or elsewhere. Full- or part-time day care is an experience shared by large numbers of American children. According to a -

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113 national consumer survey published in 1975 (UNCO, Inc., 1975, Vol. II:6-8 to 6-11), more than 5 million children age 13 or younger were at that time cared for essentially full time by someone other than a parent, i.e., for 30 or more hours per week. Another 6 million children receiving care from persons other than their parents for periods between 10 and 30 hours per week. Somewhat more than half the children in full-time care were supervised by someone other than a relative, and about two thirds were in care outside their own homes--statistics that also imply, of course, that in-home care and care by relatives accounted for a large portion of full-time nonparental care. Most out-of-home care is "family day care," provided in the care giver's home to small numbers of children (six or fewer, including the care giver's own children, by federal regulatory definition.) According to the consumer survey, approximately 1.3 million family day care homes serve 2.4 million children full time, 2.8 million children from 10 to 29 hours per week, and much larger numbers on an occasional basis. Only about 900,000 children received care in centers during 1976-1977, according to a national telephone survey of more than 3,000 centers, roughly one of every six in the country (Coelen et al., 1978). (This survey employed a relatively strict definition of the term "day care center" and excluded mixed care arrangements, in which children are in nursery school for part of the day and in family day care for the rest of the day.) Children of different ages are distributed unequally across types of care. Preschoolers (ages three through five) are the predominant age group among children in full-time care by nonrelatives. School-age children predominate among those in part-time care. Among children who receive care in their own homes, more than half are of school age, and almost 30 percent are children under three (infants and toddlers); only 20 percent are in the preschool age range. Conversely, as suggested by the consumer survey and confirmed in the recent national telephone survey of day care centers (Coelen et al., 1978), most of the children served in centers (70 percent) are preschoolers; the remainder is divided equally between younger and older children. In family day care, children under three are the largest group served. There is some controversy over the proper interpreta- tion of those distributional facts. Surveys of parental

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114 preferences (e.g., Hill, 1977, 1978; Steinberg and Green, 1979; Rowe et. al., 1972; Fosburg and Hawkins, 1981) indicate that parents are relatively reluctant to place very young children in day care and, when they do so, prefer to use in-home care or home-like, family day care, often within close proximity to the home. As children approach preschool age, parents are more willing to use out-of-home care and are more likely to turn to day care centers as sources of group educational and social experiences that may help prepare children for school. When children reach school age, the school itself provides group experiences; parents again turn to informal in-home or family day care arrangements to provide supervision during after-school hours. On one hand, the existing pattern of care can be seen as a reflection of parental preferences, thereby reflecting--for those who believe that parents know what is best for their children--the interests of children. On the other hand, parents cannot choose forms of care that are unavailable or beyond their means, and they are unlikely to state preferences for forms of care about which they know little. Thus the widespread preference for and use of informal, small-scale arrangements may in part reflect a lack of awareness and/or access to other forms of care, particularly formal, enter-based care, especially for children of school age and those under three. Whatever the reasons for the distributional facts, the facts themselves represent important realities with which demonstration projects and outcome measurement must reckon. Outcome measurement in the domain of child development has, for valid historical and theoretical reasons, focused on the effects of center care; particular attention has been given to its effects on infants and toddlers. Though this research has yielded relatively clear and valuable insights, it has concentrated on the least-used form of care and on an age group that is underrepresented in that form of care. (Fewer than 40,000 children under two are in center care, most of them in the Southwest, as reported by Ruopp et al., 1979.) Until recently, research has neglected the informal care arrangements that affect most children under three and many older children as well. Although the role of government in child care is a bitterly debated topic, massive involvement of government at all levels, especially the federal level, is already a reality--with which outcome measurement must deal if it is to be relevant to policy. In fiscal 1977 estimated , _ _ _

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115 federal and state expenditures for day care and other early childhood programs exceeded $2.7 billion. This sum includes expenditures on services other than day care as conventionally defined, e.g., Head Start and the Department of Agriculture's Child Care Food Program, which provides food subsidies to child care facilities serving children from low-income families. However, its largest component is the $809 million spent on day care through grants to states under Title XX of the Social Security Act, followed by $500 million in tax revenues foregone under the child care tax credit. It also includes an estimated $500 million in state and local matching funds (Congressional Budget Office, 1978). Although federal funds are used to purchase care in all types of facilities, those monies targeted for the poor are disproportionately allocated to centers. About 70 percent of Title XX funds are spent in centers, 17 percent in family day care homes, and 14 percent on in-home care (U.S. Department of Health, Education, and Welfare, 1978). Approximately 200,000 children from low-income families receive center care that is wholly or partially subsidized. However, low-income parents who receive subsidies through the AFDC income-disregard mechanism disproportionally choose family day care over center care. Closely linked to governmental funding of child care is governmental regulation. States and a few localities maintain licensing codes, which set standards that child care facilities must meet in order to be allowed to operate. These codes affect virtually all centers and, in some areas, family day care homes as well. Most family day care, however, is unlicensed--90 percent, according to one survey (Westinghouse Learning Corp. and Westat Research, Inc., 1971)--and licensing requirements for family day care, where they exist, tend to be enforced erratically if at all. In-home nonparental care is not subject to licensing. In addition, the federal government maintains purchasing standards, which specify the types of facilities in which federal dollars may be spent. These standards, the Federal Interagency Day Care Requirements, established in 1968 and currently being revised (see the Federal Register, March 19, 1980) are stricter than the licensing-standards of most states, especially with respect to required ratios of numbers of staff to children and have therefore been controversial because of their potential cost implications. In practice, federal purchasing standards, like state licensing requirements,

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116 have affected centers more than family day care homes and are likely to continue to do so. Also, the federal standards primarily affect the care purchased by the states and their local delegate agencies using Title XX money; care purchased by the poor under the income- disregard mechanism and care purchased by middle- and upper-class families using the tax credit are effectively unregulated by the federal government. Thus, whether one views federal and state regulations as necessary and benevolent attempts to set a floor under the quality of care or an unwarranted intrusion of government in the child care market, some form of regulation is a reality for most centers but for only a fraction of family day care homes. In sum, government at all levels is heavily involved in child care. Government purchases or underwrites care for large numbers of children, primarily for the poor but also for the more advantaged classes (through tax credits). The principal policy tools used by government for influencing the type and quality of care received by children have been funding strategies and regulations. This public presence in the day care market has not been guided by a coherent national child care policy. It has arisen in part as a by-product of other policies designed to support low-income families or to induce low-income single parents to work, thus reducing welfare expendi- tures, and in part as an effort to provide tax relief to the middle class. Federal support for child care to low-income families coexists with other federal policies, such as Aid to Families with Dependent Children, which subsidizes parents to care for their children at home. In this regard, American day care policy stands in sharp contrast to the policies of other industrial nations in Europe. The European countries make a much larger relative investment in children and families, and they have relatively clear-cut policies designed to encourage either parental care or parental employment, depending on their respective labor markets (Kamerman and Kahn, 1978). There have been repeated calls by prestigious groups in the United States for a national child care policy (Keniston and the Carnegie Council on Children, 1977; National Research Council, 1976). It is impossible to say whether the 1980s will see a serious attempt to establish such a policy. However, with or without such an attempt, it is clear that debates about funding and regulation will continue, and that policy researchers will be called on to produce data relevant to those debates.

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117 An overview of the American day care scene would not be complete without some discussion of relatively new developments that may pose new policy questions for the 1980s. Some states, such as California, have begun to experiment with funding mechanisms such as vouchers, designed to increase parental discretion in the purchase of care and to capitalize on the responsiveness of private providers. A related development is the growth of infor- mation and referral services, some of them publicly subsi- dized; these services are designed to facilitate the match between parental needs and existing child care resources. The increased labor force participation of women also has led to the beginnings of new demands on unions and employ- ers to include child care in employee benefit packages. New experiments with union- or industry-supported child care may be in the offing. The financing of day care is likely to become an increasingly salient issue, as the field becomes increasingly professionalized and as day care workers--among the nation's lowest paid--seek recognition and increased compensation for their services. Informal, low-cost care by friends and relatives may absorb less of the latent demand than it has in the past as women who heretofore provided such services enter the labor force. These developments, and others as yet unforeseen, are sure to create needs for new forms of evaluation design and new outcome measures. Who Cares About Day Care- and What Do They Care About? As suggested earlier, day care has many constitu- encies--groups sharing common interests and perceptions of the aims and functions of day care. Some of these groups, such as children and parents, are beneficiaries of day care; others, such as researchers and policy makers, are gatekeepers r who control public information and decision making. Some are providers and the persons who train them. The interests and perceptions of the various groups are not mutually exclusive; they overlap and intersect at many points. Moreover, the views of the various groups need not necessarily receive equal weight in the choice or the development of outcome measures; a case could be made, for example, that the needs of chil- dren and families are paramount. Nevertheless it is useful to enumerate the constituencies and identify the outcome measures most salient for each, to provide a

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118 comprehensive framework within which existing measures can be located and evaluated. First among the constituencies are children. They are not a political constituency in the usual sense; they do not speak for themselves, individually or collectively, but rely on adult advocates to express their needs and defend their rights. Yet they nonetheless have needs and interests that may differ from those of every other group, perhaps even their parents. They need physical activities and educational experiences to stimulate their develop- ment. They need to interact with adults and other children in order to begin to learn about themselves-- what they enjoy, what they do well, what they want to be--and about how to form relationships with others. Some adult advocates feel that they need to begin to develop a sense of their cultural as well as personal identities. Moreover, given that many children spend 8 to 10 hours of their 12-hour waking day in care, the quality of life available to them while in care is a prime concern in itself, regardless of its developmental effects. Children need a safe and pleasant physical environment, appealing and nutritious food, and, in some cases, special services such as diagnostic screening and health care, which may be available only through day care. The need to measure development comprehensively--not to rely on traditional measures of cognitive skill or ability that have been used in evaluating other programs for children--has been widely recognized but only partially met by day care researchers. The need to measure immediate quality of life has barely been acknowledged as such, although relevant aspects of the environment have been studied. Second are parents, who may have several purposes for using day care in addition to providing the child with a pleasant and stimulating environment: to enable a second or single parent to enter the labor market, to learn about child rearing, to feel less isolated, to help get through temporary crises. Availability of day care might permit some mothers to participate in vocational education, thus improving their marketable skills. Availability of day care might permit single mothers to work, and fewer might apply for welfare as a result. Parents might feel more confident about their abilities to raise their families, as a consequence both of their improved economic situation and of the help and advice given by the day care providers. The consequent reductions in stress might even result in fewer single parents being

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119 institutionalized or referred for psychiatric care. Obviously, a wide range of measures is needed to address these questions and to capture the equally wide range of outcomes that parents might expect from day care. Third are families. As a unit the family has somewhat different needs from its individual members. For example, a family may need a day care program to help it maintain a viable income, to help it stay intact during a troubled time, to help its members interact more positively, or to prevent negative interactions such as spouse or child abuse. Does the availability of day care decrease the need for foster care or institutional placements? Would fewer families disintegrate under economic pressures or in times of illness or crisis if they had day care arrangements to relieve some of the daily burdens of child- rearing? Are families more nurturing if they have outside sources of respite or advice? Is the incidence of spouse or child abuse reduced as a result? Again, a range of measures that goes beyond that normally associated with day care is indicated. Fourth are communities. While we do not usually think of communities per se as having an interest in day care, there may be legitimate outcomes worth measuring from the perspective of the community. For example, a community with insufficient or low-quality day care programs may have higher welfare expenditures or it may discourage families with two wage earners from living in it. A community offering high-quality care, by contrast, may be able to attract businesses and families and thereby increase the tax base. Aside from the various economic implications, the availability of day care services may in part characterize a community as hospitable or not, intimate or not, accessible or not, a good place for families or not--a characterization that may itself affect families living in that community, their interactions, and their expectations for their children. Fifth are care givers. Employees in the growing day care industry comprise a wide variety of people: from neighbors with no training or professional experience, who baby-sit for several children, to highly trained professionals in large day care centers, with theories, equipment, and routines for handling groups of children. What is measured, how it is measured, and the interpreta- tion of the results directly affect livelihood, reputa- tion, self-image, and future income. While the employees often share with the children and parents a concern for many of the outcomes deemed important in child care (such

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