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Measuring the Outcomes of Day Care
Jeffrey R. Savers, Rochelle Beck, anc! Loan 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
-
~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 recognize
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.
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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
Sax 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
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
are likely to continue to do so.
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 ot care receiver 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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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, 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
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
abuse. Does the availability of day care decrease
families disintegrate under economic pressures or
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Representative terms from entire chapter:
child care
