Tennessee: Monitoring and Technical Assistance System

Oct 01, 2012


Babies and toddlers are vulnerable to illness and injury due to their early stage of growth and development. Ensuring that they stay healthy and safe every day in child care requires knowledgeable providers and clear health and safety procedures. State child care licensing policies set out specific regulations, governing procedures, and practices for licensed providers to prevent illness and injury in child care settings. For example, proper sanitation practices-such as those on hand washing and diapering-and safe sleep procedures-such as requiring babies sleep on their backs to reduce the risk of  Sudden Infant Death Syndrome (SIDS) and suffocation-are critical to protecting the well-being of very young children. Regular monitoring of child care providers that includes unannounced inspections can increase the likelihood that key health and safety regulations are implemented correctly and consistently followed.

In Tennessee, safety concerns from transportation-related child fatalities, along with increasing need among low-income, working families for quality child care, prompted the state to revamp its monitoring system and enact other licensing reforms. The state passed legislation in 2000 that strengthened the state\'s child care licensing rules. In addition, Tennessee implemented policy that increased the frequency of inspections to better monitor providers and required annual evaluations of providers to improve the quality of care.

Frequency of Inspections

Tennessee has a differential monitoring system in which the frequency of inspections is determined by a provider\'s quality rating. Providers with higher quality ratings receive fewer monitoring visits per year. At minimum, both licensed centers and FCC homes receive four inspection visits per year-three of which are unannounced and one of which is announced. Providers that offer transportation services receive an additional unannounced visit. All licensed child care providers are required to participate in the Child Care Report Card program as part of the licensing process. To renew a child care license, providers must undergo an annual evaluation, the results of which determine their quality rating and are compiled into a report card that must be displayed for parents to see. Report cards can also be viewed online.

According to data from the 2008 Licensing Study published by the National Association for Regulatory Administration (NARA) and the National Child Care Information and Technical Assistance Center (NCCIC), the majority of states require unannounced inspections of child care facilities for routine licensing compliance. However, the most frequent occurrence of routine inspections for child care centers and family child care (FCC) homes is just once a year. Twenty-six states conduct routine inspections once a year for centers, while 15 states require this of small FCC homes and 17 states for large/group FCC homes. Less than a third of states-including Tennessee-conduct inspections at least twice a year.

Licensing Enforcement and Investigation of Complaints

To protect the health and safety of infants and toddlers, child care licensing policies need to be properly implemented and steadily maintained. In Tennessee, child care regulations are monitored and enforced by the state\'s Department of Human Services (DHS), which has 12 local Child and Adult Care Licensing offices that handle licensing issues at the county level. State law authorizes DHS to inspect programs at any time during operating hours for compliance with licensing law and regulations. The department conducts routine inspections of all providers and investigates complaints about specific providers. Complaints may be submitted to a Child Care Complaint Hotline or one of the local licensing offices. The complaints are entered into a database (Regulated Adult and Child Care System) and forwarded to DHS Program Evaluators, who investigate the complaint. The evaluators conduct an unannounced inspection, the results of which are entered into the database. Providers must develop a plan to address any violation cited during an inspection. The plan must be approved by licensing staff, who later check to see that the violation has been corrected. Information about the number and type of substantiated complaints on a provider may be obtained by the general public via their local or regional licensing office.

Licensing/Monitoring Staff - Caseloads  

In order for monitoring to be effectively conducted, licensing staff need reasonable caseload sizes that give them time to conduct monitoring on a regular basis and promptly investigate complaints against providers. NARA, the National Association for the Education of Young Children (NAEYC), and the National Association of Child Care Resource and Referral Agencies (NACCRRA) recommend a caseload of no more 50 cases per licensing staff member. Tennessee has an extensive licensing agency staff that includes 138 Licensing Program Evaluator positions, 17 Licensing Field Supervisor positions, 3 Program Supervisors, 2 Central Office Management Staff and one Licensing Director position. These positions are funded primarily through the Child Care and Development Block Grant (CCDBG) with additional support by general state funds. According to the 2008 Licensing Study, Tennessee maintains the lowest estimated caseload ratio for licensing line staff among all states. On average, 24 cases are assigned per licensing staff member, well below the recommended ratio.

Licensing/Monitoring Staff - Qualifications and Training

Monitoring staff need sufficient knowledge of early childhood development to accurately assess whether a provider is following licensing regulations on the care of young children. Licensing staff in Tennessee are required to have a Bachelor\'s degree. There are two levels of qualifications for licensing/monitoring staff. The first level does not require an early childhood education specialization, while the second level does require such a background. However, those who start at level one are moved up to level two after one year on the job. In addition, they are trained on Tennessee\'s Early Learning Developmental Standards, which address young children\'s development starting from birth. During licensing visits, staff can access the standards via netbook computers and share them with providers.

Monitors must be skilled not only in infant/toddler development and infant/toddler child care regulations, but also must have the skills to observe providers and appropriately interpret the implementation of regulations. Tennessee has a Licensing Manager and Licensing Field Supervisors who work on ensuring that interpretations by evaluators are appropriate and consistent. The supervisors meet with evaluators on a regular basis to review interpretations and offer ideas for improvement. In addition, the licensing division has been assigned a trainer who, among other things, will work on building an infant/toddler development training. Online trainings covering child development are also offered for child care providers. 

Child Care Providers - Evaluation and Assessment

In 2000 and 2001, the Tennessee Child Care Report Card and Star-Quality Programs were launched in response to legislation passed by the state that strengthened child care licensing policies. Among its provisions, the legislation required DHS, in consultation with the Tennessee Commission on Children and Youth, to create and implement a system for evaluating licensed child care providers. The purpose of the requirement was to help parents make informed choices about available child care options and improve the quality of child care. The state created a two-part system: 

  • Child Care Report Card program: All licensed and approved child care providers are required to participate in the Report Card program as part of the licensing process. Child care licenses must be renewed each year. To renew a license, center-based providers must undergo an evaluation that looks at seven areas of quality; FCC providers are evaluated in five areas. The results of the evaluation are compiled into a report card, which providers must display, along with their renewal license, for parents to easily see. The report card summarizes how a provider fares in the various areas of quality as well as the provider\'s compliance with licensing regulations.

One of the key components of the evaluation is an onsite program assessment using one or more of four Environment Rating Scales (ERS). The Infant and Toddler Environment Rating Scale- Revised (ITERS-R) is used for programs serving very young children. Assessors must complete a series of trainings and practice observations on the ERS in order to be determined a reliable user of any ERS. Once an assessor attains reliability status on an ERS they are ready to conduct an actual assessment on their own. Even after attaining reliability status, assessors are supported by Assessment Specialists and Anchors (recognized ERS experts), who provide routinely scheduled reliability checks to help ensure consistency and fairness in the assessor\'s use of the ERS. The frequency of reliability checks depends on the demonstrated expertise level of the Assessor on any particular ERS.  During a reliability check, an Assessment Specialist accompanies an assessor on an observation with both professionals documenting and scoring independently. At the conclusion of the assessment a debriefing process takes place using the documentation from the assessment to determine the accurate score for each item and indicator of the ERS, based on the ERS requirements. In order to be considered reliable, the assessor\'s independent scoring of the assessment must meet a minimum cutoff score when compared to the agreed upon score, based on the ERS requirements. An Anchor provides clarification on items in the ERS and makes a final decision on an interpretation in cases of conflict. As a resource for the assessment staff, the Anchors have created Developmentally Appropriate Practice Statements (DAPs) for each ERS tool, including one for infant and toddler care. The DAPs provide a common definition of best practice for each ERS item that staff can use as guidance.

  • Star-Quality Child Care Program: Child care providers who exceed state licensing standards may be eligible to participate in the Star-Quality program. The Star-Quality program is a voluntary quality rating and improvement system (QRIS) that acknowledges providers who meet higher standards of quality. In the program, providers are rated on a scale of one, two, or three stars with three stars representing the highest quality level. Eligibility for the program is determined by the results of the licensing renewal evaluation. If the standards for at least a one-star rating are met, a provider is automatically enrolled in the program. No further evaluation is required, and no fees are charged to participate in the program. Providers enrolled in the program are given the option to choose not to participate. Participating providers that serve subsidized children receive an increased reimbursement rate of up to 20 percent above the base subsidy rate based on their star rating. DHS maintains an online database of all licensed child care providers in the state that indicates whether or not a provider is participating in the Star-Quality program. For participating providers, the database includes information on how the provider fares in each of the Star-Quality criteria.

Child Care Providers - Technical Assistance

Technical assistance can help to improve provider understanding of practices and standards particularly important to infant/toddler care. In 2000, Tennessee passed legislation that strengthened the state\'s child care licensing rules. The legislation enacted various new licensing requirements ranging from smaller child-to-staff ratios to annual ERS assessments. To help providers comply with these new provisions, the state invested in a variety of technical assistance, trainings, and other services and supports. For example, Tennessee has an infant/toddler specialist network consisting of eight specialists. They help provide intensive training on ITERS-R and targeted technical assistance regarding licensing policy. The state\'s Early Childhood Training Alliance provides orientations to child care professionals. The orientations are each 30 hours long, and one of the hours is devoted specially to the care of infants and toddlers. Participation in these orientations earns child care providers extra credit toward their report card. During this past year, they have held 49 orientations across the state. Additionally, the state implemented a gradual phase-in of regulations, such as smaller child-to-staff  ratios, that were costlier to meet.

Program evaluators work one-on-one with providers on achieving and maintaining licensing compliance. In addition to providing technical assistance on licensing requirements, they are equipped with resources to help enrich providers\' programs. For instance, they have materials provided by United Way\'s Born Learning campaign to promote understanding among parents about the importance of the early years in children\'s development and how to choose quality care. As part of an evaluation of the Report Card and Star-Quality programs and provider support system, the state surveyed providers on the usefulness of their program evaluator. Most respondents found their program evaluators to be knowledgeable, responsive, accessible, and resourceful. Among the survey results, 80 percent of respondents overall agreed that their evaluator was reachable and responded to messages quickly. Another 81 percent agreed that their evaluator was a resource for making their programs better, while 88 percent agreed that their evaluator took time to answer their questions. 

Contact Information:

Joyce Turner
Licensing Program Manager/ Department of Human Services
400 Deaderick Street, Nashville, TN 37243

Jude Vandiver
Licensing Program Coordinator/ Department of Human Services
400 Deaderick Street, Nashville, TN 37243

Gary Smith
Director of Child Care Planning & Development/ Department of Human Services
400 Deaderick Street, Nashville, TN 37243

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