What Is the Quality of Care in the United States?

What Is the Quality of Care in the United States?

The evidence reviewed above indicates that child care quality has meaningful effects on children and their parents. Our next question considers the quality of the care that is available in the United States. One part of this question is a determination of whether high-quality care (of the sort that fosters positive developmental outcomes) is the norm or the exception. The flip side of this question is a determination of the likelihood that children are in poor-quality care that can impair development. Unfortunately, at the current time it is not possible to provide a definitive response to these questions, because observations of process quality have not been conducted for a nationally representative sample of children. In the absence of such a report, we must reply on existing data from multisite studies that provide suggestions about the distribution of quality of care in the United States.

This distribution of quality scores in the observed settings, however, may be an optimistic view

The Cost, Quality, and Outcomes Study (Helburn et al., 1995) provides a perspective on center-based care. ECERS assessments were conducted in 398 centers located in four states that varied in economic health and child care regulations. In that study, 12 percent of the centers received ECERS scores lower than 3, indicating care that was less than minimal quality, and 15 percent received ECERS scores higher than 5, indicating good-quality care. The remainder of the centers were evenly divided between those receiving scores in the 3s (37 percent) and scores in the 4s (37 percent). The observed centers represented only 52 percent of the eligible centers; the remainder declined to participate. It seems likely that the nonobserved settings offered care that was lower in quality.

The study sample of 1,364 families was drawn from hospitals at the 10 research sites and included ethnic minorities (24 percent), mothers without a high school education (10 percent), and single-parent households (14 percent) as well as white, middle-class and two-parent households

The Relative and Family Day Care Study (Kontos, Howes, Shinn, and Galinsky, 1995) provides a perspective on quality of care in homes. FDCRS scores were obtained in 226 child care homes and relative care settings in three communities. Minority race, low-income Louisiana installment loans, and nonregulated home settings were over sampled so that the investigators could study the effects of these factors on observed quality. In that study, 34 percent of the child care homes received FDCRS scores of less than 3 and were described as “inadequate,” 58 percent were “adequate/custodial,” and 8 percent were “good.” These unadjusted quality estimates are probably negatively biased, because two of the three states (Texas and North Carolina) have less stringent regulations for child care homes than other states and because nonregulated and low-income settings were over sampled.

Perhaps the best available estimate of process quality for children 3 years or younger is provided by the NICHD Study of Early Child Care. Observations were conducted in nine states (Arkansas, California, Kansas, Massachusetts, North Carolina, Pennsylvania, Virginia, Washington, Wisconsin) and included urban, suburban, and rural communities. The distribution of child care regulations in those states paralleled those in the United States. Observations were conducted in all types of nonmaternal care settings, including grandparents, in-home caregivers, child care homes, and centers. A total of 612 child care settings were assessed at 15 months, 630 child care settings at 24 months, and 674 child care settings at 36 months.

At 15 months, 17 percent of the households had incomes below established poverty levels (income-to-needs ratio < 1.0). An additional 18 percent of the sample had incomes near poverty (income to needs ratio 1.0 –1.99) (NICHD Early Child Care Research Network, 1997). The sampling plan yielded a large and diverse sample, but it is not nationally representative. The sampling plan also did not include adolescent mothers (3.8 percent of the potential families in the hospitals), mothers who did not speak English (4.4 percent), and infants of multiple births, with obvious disabilities, or extended hospital stays postpartum (7.7 percent of the births).