September 2008

by Rachel Schumacher and Elizabeth Hoffmann[1]

Recommendation #14

Promote stable, quality care for babies and toddlers through subsidy policy. Use state child care subsidy policies to support stable, continuous access to the highest-quality providers and caregivers for infants and toddlers in low-income families.

Content:

What does the research say about babies and toddlers and this recommendation?

• High-quality child care with responsive providers and caregivers supports babies’ development, with greater impacts for disadvantaged children.
• Stability of care supports the development of babies and toddlers.
• Low-income parents need child care but may have difficulty ensuring stable, quality care for their babies.
• Child care subsidies may help low-income families access more care options in the child care marketplace.

How can state child care subsidy policies affect this recommendation for babies and toddlers?

• States can take into account the potential impact of subsidy policies on babies and toddlers whose families receive child care subsidies.
• States can provide adequate funding to providers and caregivers serving subsidized children to support the costs of quality infant/toddler care.
• States can set family income eligibility, enrollment, and duration policies to support stable subsidy receipt, which in turn can make it easier for low-income parents to maintain stable child care arrangements.

 

What policies can states use to move toward this recommendation?

• Subsidy

 

What are some other recommendations that affect this issue for babies and toddlers?

 

Online tools and resources for state policymakers 

• Resources for state child care subsidy administrators
• Examples of state-sponsored analysis of subsidy policies and costs of infant/toddler care

 

References/Endnotes

 

 

Recommendation #14

Promote stable, quality care for babies and toddlers through subsidy policy. Use state child care subsidy policies to support stable, continuous access to the highest-quality providers and caregivers for infants and toddlers in low-income families.

“Families have to do far more to keep their subsidies than has generally been recognized.”
—Gina Adams, Kathleen Snyder, and Jodi R. Sandfort, Getting and Retaining Child Care Assistance: How Policies and Practice Influence Parents’ Experiences.[2]

 

The consistency and sensitivity of early care relationships is critical to the quality of babies’ and toddlers’ experiences. Providers and caregivers who are attuned to each child’s unique needs and personality can support, nurture, and guide the child’s growth and development.[3] A good attachment relationship between the infant and the caregiver can complement the relationship between parents and young children and facilitate early learning and social development.[4] Research has shown that in general, high-quality child care supports long-term child development and is linked to higher vocabulary scores, math and language abilities, and success in school. Further, this research found that negative impacts of low-quality care are more likely felt among disadvantaged children.[5]

Frequent changes in care arrangements are stressful for babies and toddlers. For example, research shows that transitions from their child care room to the next age group’s room are associated with higher levels of distress and negative behavior, especially among very young children.[6] Another study observed higher rates of problem behavior among babies and toddlers in child care centers who experience less regular contact with their primary nonparental provider in the average day, as well as among very young children who experience multiple care arrangements in addition to the center.[7] Some research suggests that because children take many months to form attachments to nonparental providers and caregivers, frequent changes in caregiver arrangements may mean that they are less likely to form secure attachments.[8] Research has found that infants with secure attachment relationships with their providers are more likely to play, explore, and interact with providers in their child care setting.[9]

Children under age 3 of employed mothers who are living in poverty spend an average of 21 hours per week in nonparental care.[10] Stable care promotes healthy development, but low-income babies and toddlers may experience multiple caregiving arrangements and may move in and out of these arrangements.[11] A study of single, low-income mothers moving from public assistance to work in New York City found that the majority of their young children experienced five or more primary child care arrangements in their first four years. Most of the primary care arrangements among those children lasted less than six months. The mothers attributed the instability to poor-quality care, providers who decided to stop caregiving, and conflicts with providers. The last was less prevalent with centers and family child care than with family, friend, and neighbor care[12]—which is a more common arrangement for lower-income babies and toddlers than for higher-income children.[13]

Low-income parents’ decisions about who cares for their babies are influenced by preferences, but also by significant constraints—such as financial resources, employment schedules and stability, transportation issues, and supply of care choices in their neighborhoods,[14] as well as problems accessing and maintaining child care assistance.[15] Poor families spend approximately 29 percent of their income on weekly child care costs, compared to 6 percent for families at or above the federal poverty level.[16] Some child care programs are cost prohibitive for lower-income families without help; one study found that the average price of full-time, center-based infant child care in states across the country ranged from $4,542 to $14,591 in 2007 and was rising faster than the rate of inflation.[17]

The availability of subsidies influences low-income parents’ choices about work and child care. Some studies have found a larger proportion of low-income families with subsidies use center-based child care than those without,[18] although center-based care is not necessarily higher quality than other arrangements. An analysis of data on children birth through age six from the 2001 Early Childhood Program Participation Study of the National Household Education Survey Program (NHES) found that among children living in families below 150 percent of poverty, the use of center-based care as a primary care arrangement was more common among those with a subsidy (57 percent) than those without (39 percent).[19] Other research using National Survey of America’s Families (NSAF) data estimated that a child care subsidy increases a single mother’s probability of working and using child care by 15 percentage points (after controlling for other demographic factors) and increases her probability of working and using center-based child care by 33 percentage points.[20] Still, it is not clear which choice comes first—the choice to seek a subsidy or the choice of a child care provider or caregiver. For example, some low-income families may choose not to seek a subsidy because they already have decided to use a caregiver who does not wish to be involved with the state subsidy system.

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More than one-fourth (28 percent) of the children served in state child care subsidy programs funded by the Child Care and Development Block Grant (CCDBG) are under age 3.[21] Thus, at least half a million babies and toddlers are already being reached by states—and presumably more, since many states also fund child care directly through the Temporary Assistance for Needy Families (TANF) block grant. (Information on the number of infants and toddlers who receive child care assistance through TANF funds is not available). CCDBG data from FY 2006 (the latest year for which data are available) show that the proportion of children receiving subsidies who are under age three varies across states, from 55 percent in Arkansas to 19 percent in California.[22]

The options these families have for their children’s care are affected by subsidy policies, many of which are set at the state level. Infants and toddlers in low-income families that receive child care assistance are more likely than those in low-income families overall to be in center-based care: 53 percent of infants and 60 percent of toddlers receiving CCDBG are cared for in centers.[23] Thirty-five percent of infants and 29 percent of toddlers receiving CCDBG are cared for in family homes, including licensed and license-exempt providers and caregivers.[24] CCDBG also includes $100 million for states to spend to improve the quality and supply of care for infants and toddlers; states are using these dollars for a range of activities, including promoting emotionally supportive care, health and safety, professional development, and better quality rankings or accreditation.[25] A survey of state CCDBG administrators found that these federal quality funds are the primary source of dollars states are using to improve quality of infant/toddler care.[26]

States determine how much to pay providers and caregivers in the subsidy system, and the amount of funding made available to pay for a baby’s or toddler’s care has been linked to the quality of care the child receives.[27] The more funding a child care center provider is paid per child, the more dollars that provider can use to attract and retain qualified staff to work with young children and to finance other quality features. Higher payments may also attract and maintain a greater number of qualified family child care providers in the subsidy system. High-quality licensed infant and toddler care is more expensive for providers to offer,[28] because of key features such as more child care providers per child, more space per child, special equipment such as cribs, and additional health and safety requirements such as sanitary areas for diaper changing.

Under federal law, states have flexibility to determine how high a rate will be paid to child care providers and caregivers participating in the subsidy system; regulations recommend rates be set such that subsidy-using families can access 75 percent of care available in their communities (the 75th percentile) and require states to certify that the payment rates are sufficient to ensure equal access for eligible families to child care services comparable to those provided to ineligible families.[29] Eighteen states set their maximum payment rates for a one-year-old in a child care center at 20 percent or more below the amount that would allow parents access to 75 percent of infant/toddler care.[30] Setting payment rates low means that parents have less access, for at least two reasons. First, providers have less incentive to accept children receiving subsidies, in turn restricting the ability of parents using a subsidy to choose from the full range of quality child care options in their community. Second, parents may have to pay the difference between the provider’s charge and the state’s maximum rate as well as pay their copayment (in states that allow providers to charge parents for this gap), making care too expensive even if the provider is willing to accept a subsidy.[31]

State subsidy policies can determine the extent to which families have a full choice of child care options in their community, when and how a family may receive a subsidy or be put on a waiting list, how often families are required to recertify their eligibility, and how changes in job and family status affect eligibility—each of which has ramifications for parents’ ability to access high-quality, continuous care for their children.[32] Qualitative researchers have found evidence that subsidy policies tied closely to current parental work hours and requiring significant paperwork may increase child care instability, as parents’ frequent changes in eligibility status and related loss of subsidy lead to changes in arrangements.[33]

Data on the duration of subsidy receipt across states may also support a connection between policies and stability. A study of five states’ subsidy policies found that average subsidy duration in a state ranged from three to seven months. The study also found that in states with longer median subsidy duration spells, children receiving a subsidy were more likely to retain the same child care provider or caregiver throughout.[34] Another study examined welfare and employment programs in 20 states in which some programs offered expanded child care assistance. The research showed a relationship between more generous subsidy policies (including features such as higher rates and direct payments to providers) and longer periods of consecutive months of care with the same provider or caregiver, as well as a higher percentage of children in licensed care among babies and toddlers.[35] In Rhode Island, a state which guarantees child care subsidies for all families under a certain income level, the average subsidy duration is 10 months.[36] In communities that experimented with ensuring steady, timely provider payments and supports, family child care providers were more willing to provide slots for babies and toddlers from low-income families.[37]

Under CCDBG regulations, states can set subsidy eligibility and re-determination policies to encourage longer duration of care for babies and toddlers within certain parameters.[38] Several states have implemented new policies that make it easier for families to access and maintain subsidies and perhaps to choose more stable care arrangements.[39] For example, when Massachusetts found that 86 percent of families were still eligible for subsidies at the time of their required six-month determination, the state concluded that the policy was not cost effective and switched to 12-month re-determination for most families.

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To move toward this recommendation, states may use multiple policy levers, starting from different points. Potential state policies include the following:

• Work toward increasing child care subsidy payment rates—through vouchers, contracts, or bonuses—to account for the higher costs of providing infant and toddler care of the quality desired by the state, rather than using current market rates (which research has shown are not adequate to support high-quality care for low-income babies and toddlers).
• Provide ongoing funding for subsidized slots tied to high-quality standards, such as those of Early Head Start, national accreditation, or state Quality Rating and Improvement Systems (QRIS), directly to providers through grants or contracts, in order to care for eligible infants and toddlers in underserved communities.
• Pay higher subsidy rates to infant and toddlers child care providers who work toward meeting and sustaining high-quality program standards (such as those in the state QRIS or national accreditation). Higher subsidy rates can also attract high-quality providers into the child care subsidy system.
• Allow family, friend, and neighbor caregivers receiving child care subsidies to participate in the federal Child and Adult Care Food Program (CACFP), and put in place policies that make it easier for all providers and caregivers to have continuous access to the program.
• Allow eligible families to qualify for child care subsidies uninterrupted for at least six months, preferably 12 months. During the interim period, require only minimal reporting and do not require re-determination.
• Make it easier for families with babies and toddlers to access child care subsidies by coordinating the application and re-determination processes for child care subsidies with other social service programs, such as Food Stamps, TANF, and Medicaid.
• Make it easier for families with babies and toddlers to maintain their subsidies by simplifying the recertification process and minimizing chances families will lose their subsidy during periods of change in family circumstances.
• Allow eligible pregnant women to be placed on the waiting list for subsidy.
• Provide subsidy payments to providers and caregivers for all days when babies and toddlers are absent due to illness, in order to remove disincentives to caring for infants and toddlers.
• Improve accessibility of the child care subsidy system for limited English proficient (LEP) providers and parents by translating information, regulations, and applications; hiring bilingual staff; and using qualified interpreters.
• Ensure that subsidy recertification notification is provided to LEP parents in the appropriate language.
• Identify families in the subsidy system that make frequent changes in child care arrangements, and provide them with intensive counseling about child care choices and the importance of stability for their children’s well-being.

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• States can help educate providers, caregivers, and parents about the importance of continuity of care for children under age 3. (See Recommendation #3: Support continuous relationships between providers and caregivers and the children they care for from when they enter child care to age three.)
• States can attract a greater number of skilled providers to care for babies and toddlers—and retain them longer—by using a variety of strategies to help augment their compensation. (See Recommendation #4: Promote competitive compensation and benefits for infant and toddler providers.)
• Another critical issue that limits the ability of parents to use a subsidy to access high-quality care is the lack of supply in some communities within a state. (See Recommendation #13: Build the supply of high-quality child care.)
• All parents need help finding the best care for their children. (See Recommendation #15: Provide all parents with linguistically and culturally appropriate child care information in order to choose the best possible care for infants and toddlers.)

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• CLASP’s report Ensuring Quality Care for Low-Income Babies: Contracting Directly with Providers to Expand and Improve Infant and Toddler Care examines how states are using contracts for quality, subsidized child care slots for babies.
• In Designing Subsidy Systems to Meet the Needs of Families: An Overview of Policy Research, the Urban Institute studied ways that subsidy administrators can help families access and maintain subsidies—such as linking subsidies to other programs; improving customer service; simplifying application, recertification, and reporting processes; and minimizing inadvertent termination of subsidies due to temporary changes in families’ circumstances.
• The National Infant and Toddler Child Care Initiative provides technical assistance on infant and toddler policy issues to state CCDBG administrators.
• The National Child Care Information Center provides technical assistance through consultants and general information tracking and posts links to state administrative rules.
• The Food Research and Action Center has materials explaining CACFP and how state administrators can use the program to provide nutritious meals and snacks and training/monitoring in all child care settings, including family, friend, and neighbor settings. Geraldine Henchy is the director of nutrition policy and early childhood programs.
• The costs to the Department of Defense of the military child care system, renowned for its quality, have been analyzed by RAND in a report and in a research brief.

• A Massachusetts report Keeping the Promise: A Study of the Massachusetts Child Care Voucher System found data that informed the state’s switch to 12-month determination for most families.
• Massachusetts also conducted a state cost, quality, and outcomes study focused on infant and toddler care.

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