Early Childhood Education Update - June 2010

June 08, 2010 | Child Care & Early Education

In this issue:


A new report from the Government Accountability Office (GAO) examines trends in child care subsidy receipt. The report, Child Care: Multiple Factors Could Have Contributed to the Recent Decline in the Number of Children Whose Families Receive Subsidies, analyzes data from 2006-2008. GAO analysis found that during this period, the average number of children and families served by the Child Care and Development Block Grant (CCDBG) declined by about 170,000 children, or 10 percent. The number served had been fairly steady between 2000 and 2006. However, data varies by state-34 states had declines in children served between 2006 and 2008, while the remaining 17 states had increases. Many states also fund child care assistance through Temporary Assistance to Needy Families (TANF), either directly or through transferring up to 30 percent of their TANF money to CCDBG, and through the Social Services Block Grant (SSBG). GAO found that multiple reasons could contribute to the decline in child care assistance participants. These reasons include:

  • State Policy: States can set child care assistance policies that directly affect resource allocation, such as whether to use other funding streams like TANF and SSBG for child care, what the provider payments are, what family co-payments are, and what the family eligibility levels are.
  • Supply of Child Care: Around half (43 percent) of states reported that the number of regulated child care providers had decreased in their states since 2006. Increased state-level requirements of providers participating in the subsidy program and the economic downturn may have influenced some providers' decisions to no longer offer child care.
  • Demand for Child Care: Factors related to the current economic climate may also be affecting parents' demand for child care. With higher unemployment rates and reduced hours, some parents may not be able to meet work-related eligibility requirements. Changing work schedules, including shifts to work at non-traditional hours, may also cause parents to demand different types of child care or drop out of the subsidy program.

Despite the overall decline during the period from 2006-2008, some states reported taking actions that could help improve access to child care subsidies for low-income children and families. For example, GAO found that 18 states raised income eligibility levels, 14 states improved other factors related to eligibility (such as allowing additional eligible work/educational activities or expanding time allowed for job search), and 9 states decreased parent co-payments.

The Department of Health and Human Services (HHS) provided comments on GAO's findings. HHS notes that there has been a decline in CCDBG inflation-adjusted spending, at the same time that there has been an increase in the cost of child care. With fewer resources available, states must make difficult choices between decreasing the number of children served, reducing the amount of child care subsidies, or reducing quality expenditures. 


The Office of Inspector General (OIG) in the U.S. Department of Health and Human Services investigated the extent to which Medicaid children in nine selected states received required Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings. The investigation also examined state efforts to increase participation among EPSDT-eligible children. Findings from the investigation are available in a new report, Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services. The OIG assessed EPSDT coverage in the nine states by studying the medical records of a sample of 345 children enrolled in Medicaid in 2007. Interviews with state Medicaid staff were also conducted. The EPSDT benefit includes medical, vision, hearing, and dental services. The OIG focused on the provision of services in the first three areas of health. Overall, none of the states provided complete coverage of all the required EPSDT services. Among the OIG's key findings:

  • About three-quarters of children (76 percent) of children did not receive at least one of the required EPSDT medical, vision, and hearing screenings. Forty-one percent of children did not receive any medical screenings, while more than half did not receive vision or hearing screenings.
  • More than half (59 percent) of children that received medical screening services did not receive all five of the required components of the screening. The most neglected component was laboratory tests.
  • All nine states identified strategies that they were taking to improve the completeness of coverage in EPSDT medical screenings and participation in the screenings. Direct communication, outreach, and incentives were the three major strategies used by states.


The Office of Head Start has updated its guidebook on serving culturally and linguistically diverse children and families. The revised guidebook, Revisiting and Updating the Multicultural Principles for Head Start Programs Serving Children Ages Birth to Five, follows in response to major changes that have occurred since the guidebook's original publication in 1991. These changes include revision of the Head Start Program Performance Standards, passage of the Improving Head Start for School Readiness Act of 2007, new research on cultural influences and language acquisition, and a growing population of culturally and linguistically diverse children. The revised guidebook elaborates on 10 principles essential to understanding and being responsive to the cultural contexts in which child growth and development occurs. These principles have been updated from the first edition of the guidebook to reflect current usages of terms and to be consistent with current legislation. For each of the 10 principles, the revised guidebook provides:

  • A general description of the principle,
  • Key points from the research literature related to the principle,
  • Examples of actual policies and practices from Head Start, Early Head Start, American Indian and Alaskan Native, or Migrant and Seasonal Head Start Programs, and
  • Reflective questions and activities to help providers further understand the principle.


The U.S. Administration for Children and Families (ACF) has released new resources to help states and localities develop and implement quality rating and improvement systems (QRIS). These new resources are:

  • QRIS Resource Guide: The National Child Care Information and Technical Assistance Center has launched an online QRIS Resource Guide containing a wide range of information and supports for states and communities on designing and implementing QRIS. The guide includes an overview of QRIS, descriptions of the key components of QRIS, and state-specific resources. Specific topics covered in the guide include:
    • Initial design process
    • Approaches to implementation
    • Standards and criteria
    • Accountability and monitoring
    • Provider incentives and support
    • Data collection and evaluation
    • Cost projects and financing
    • Public awareness
  • QRIS Assessment Project: The Office of Planning, Research, and Evaluation at ACF, in partnership with Child Trends and Mathematica Policy Research, Inc., has released a comprehensive report and state profiles on designing and implementing QRIS. The report, Compendium of Quality Rating Systems and Evaluations, provides detailed information on 26 statewide and pilot QRIS that are at varying stages of development and implementation. Of the 26 QRIS examined in the report, four are presently in a pilot phase; 11 have completed a pilot phase and are now in implementation; and 11 were implemented without a pilot phase. The majority of these QRIS are statewide, while a few are county-based (19 statewide, 3 county-based). Participation is also voluntary in most of the systems (20 of the 26 systems). The report describes the various program and evaluation components of each QRIS, such as the quality standards and rating process, and compiles these details into tables for comparative review. Accompanying the report, the state profiles present further information on individual systems, including contact information for additional follow-up.


Last February, First Lady Michelle Obama launched the Let's Move Campaign to address the growing problem of childhood obesity. As part of this campaign, a White House Task Force on Childhood Obesity was created to develop strategies for eliminating the problem. The task force recently released an action plan, Solving the Problem of Childhood Obesity Within a Generation, that proposes how federal and state agencies as well as local communities can work together to reduce childhood obesity. In this comprehensive plan, the task force outlines steps for cutting the childhood obesity rate to 5 percent, the rate before childhood obesity first began growing, by 2030. The first section of the plan focuses on addressing childhood obesity in the early years. Obesity and overweight problems are increasingly affecting young children as early as six months old. The plan observes that between 1980-2001, the prevalence of overweight infants less than six months old nearly doubled, growing from 3.4 percent to 5.9 percent. Furthermore, more than half of obese children become overweight at or before age two. About one in five children ages two to five are currently overweight or obese. The report presents five overarching steps to address the problem of obesity in early childhood:  

  • Strengthen prenatal care,
  • Promote breastfeeding,
  • Evaluate the impact of chemical influences in the environment,
  • Reduce television screen time, and
  • Improve the quality of early care and education settings to promote healthy child development.

The report offers specific recommendations for moving forward on each step as well as benchmarks for assessing progress. Among the recommendations, the plan identifies federal programs, such as the Child and Adult Care Food Program, and state agencies, such as child care licensing agencies, that can work to promote and support healthy eating and physical activities among young children and their families. The plan also describes the role that health and early care providers can play in supporting the well-being of young children.


The National Association of Child Care Resource and Referral Agencies (NACCRRA) released a new report, Leaving Children to Chance: NACCRRA's Ranking of State Standards and Oversight of Small Family Child Care Homes: 2010 Update. The report is a follow-up to a 2008 review of state licensing policies on oversight and regulation of small family child care (FCC) homes. In the organization's latest review, NACCRRA finds that states can do substantially more to ensure the health, safety, and well-being of children cared for in small FCC homes. NACCRRA scores and ranks states based on 14 standards of oversight and regulation. These standards address key issues, such as provider training and education, FCC home inspections, parent communication, and developmentally appropriate environments. Overall, the average score that states, the District of Columbia, and the Department of Defense received was 63 out of 140 points, less than half of the total possible points. Delaware, Oklahoma, Washington, Massachusetts, and the Department of Defense were the five highest scoring states. The report highlights areas where regulation and oversight of small FCC providers are weak. Among these weak areas, the report finds that:

  • Nine states do not license small FCC homes or allow more than six children (including a providers' own children) to be cared for without regulation.
  • Eight states do not require FCC homes to be inspected or visited before being licensed.
  • About half of states conduct small FCC home inspections once a year or less.
  • Twenty-six states do not have minimum education requirements.
  • Eleven states do not require pre-service training.
  • Only 10 states meet all of the standards for both the health and safety benchmarks.

NACCRRA offers two sets of recommendations, one for states and one for the federal government, to strengthen the regulation and oversight of small FCC homes. These recommendations include cost-effective actions, ideas to improve personal responsibility, and strategies to ensure accountability.


The National Scientific Council on the Developing Child has released a new working paper, Early Experiences Can Alter Gene Expression and Affect Long-Term Development, the tenth of a series focused on the science behind early childhood development. The latest paper explains how environmental factors and early experiences influence which and how genes are expressed and the lasting consequences of these gene expressions. Two key components affect gene expression: the set of genes or "hardware" that parents pass down to their children and the epigenome-the operating system or "software" that controls what functions this hardware performs. Research studies reveal that both early prenatal and postnatal experiences affect how the epigenome develops. Repeated exposure to highly stressful situations can activate certain chemical changes that alter the structure of genes. These altered genes, and the expression of them, can adversely affect children's growth and development, including how the brain forms and children's later ability to respond to stresses in adulthood. On the other end, nurturing, supportive early experiences can trigger epigenetic changes that promote positive, healthy development.

Epigenetic changes that occur early in life can have significant, lasting impacts on the physical and mental well-being of children. Research has found that epigenetic changes typically occur in the cells of organ systems, such as the brain, heart, and kidneys. Brain development in the early years is particularly sensitive to epigenetic changes. In addition to early experiences, various chemicals, nutrients, and drugs can affect the shaping of the epigenome. The paper presents considerations for policymakers on developing policies that have positive, lasting impacts on children. Among them, the paper notes the need to examine safeguards that protect young children from early exposure to toxic environments or situations of adversity.   


In 2007-2008, ten elementary schools in the Montgomery County Public Schools (MCPS) district in Maryland expanded their half-day Head Start programs to full-day Head Start programs using Title I funds. Thirteen classrooms in these Title I schools were converted into full-day classes. MCPS commissioned a study to evaluate whether this change had an impact on children's school performance compared to children attending locally funded half-day Head Start classes and half-day MCPS pre-kindergarten classes. Findings from the study are presented in a new report, Evaluating Lasting Effects of Full-day Prekindergarten Program on School Readiness, Academic Performance, and Special Education Services. Overall, the study found that the full-day Head Start programs had positive impacts on children's reading competency, which lasted through the end of kindergarten. Mathematical understanding, however, remained generally the same among all the groups. Among the report's major findings:

  • Full-day versus half-day Head Start classes: Children in the full-day classes were 44 percent more likely to meet reading proficiency by the end of kindergarten. Overall, children in the full-day Head Start program performed better than their peers in the Head Start half-day program on reading proficiency. The size of this effect was the greatest for African American children as well as male children.
  • Full-day Head Start versus half-day MCPS classes: Children in the full-day classes were 53 percent more likely to meet reading proficiency by the end of kindergarten. Comparing between subgroups: males, children receiving English for Speakers of Other Languages (ESOL) services as kindergartners, African Americans, females, and students enrolled in the Free and Reduced-Price Meals system as kindergartners were more likely to meet reading proficiency when they had attended full-day Head Start compared to their peers who had attended half-day MCPS.
  • Full-day Head Start versus no MCPS pre-kindergarten participation: Children in the full-day classes were 42 percent more likely to meet reading proficiency by the end of kindergarten.
  • Special education services: Children in the full-day Head Start program needed less than half the special education services per week as those who did not attend any MCPS pre-kindergarten program.

The report identifies several areas, such as mathematical instruction and supports for ESOL children, where there was a lack of significant improvements and calls for further study and action in these areas.


Child Trends has launched a new series of policy briefs that summarize the latest research findings on early childhood issues. The first two briefs released in this series focus on Quality Rating and Improvement Systems (QRIS) and Early Head Start (EHS):

  • Quality Rating and Improvement Systems for Early Care and Education - A growing number of states are implementing QRIS as a strategy to evaluate and improve the quality of child care and early education programs. Currently, there are 20 statewide QRIS. This brief describes the key components of a QRIS, which are: quality standards, monitoring process, quality improvement process, financial incentives, and providing information to parents and the public. In addition, the brief reviews the small but expanding research base on the impacts of QRIS. Among the handful of studies that have been conducted, researchers have found promising results on the validity of QRIS as a quality measure, the effect of QRIS on child outcomes, and the long-term impacts of QRIS on child care quality. The brief also discusses three factors important to the process of designing and implementing a QRIS: coordination, evaluation, and unintended consequences.
  • Early Head Start: Research Findings - Multiple research studies have found that Early Head Start has positive impacts on children and families as well as early care providers. This brief highlights key findings from the Early Head Start (EHS) Research and Evaluation Project and other major research studies. Among the key findings:
    • Improved vocabulary, cognitive, and social/emotional development - Children in EHS demonstrate a larger vocabulary and score higher on measures of cognitive development than children not enrolled in EHS. They also show fewer behavioral problems.
    • Long-term effects - In the EHS evaluation project, researchers found that the positive effects of EHS continued two years after a child had participated in the program.
    • Improved parenting - Parents with children in EHS show more positive interactions and practices with their children, such as reading daily to their children, than families not participating in EHS.
    • Improved quality among providers who partner with EHS - Providers that partner with EHS and follow EHS standards are more likely to offer higher-quality care and more parent involvement activities. About 75 percent of EHS programs have partnerships with health care providers; more than 80 percent have partnerships with mental health providers.


In 2009, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), a comprehensive health care bill that included an expansion of the Child Health Insurance Program (CHIP). As a result of the legislation, children from birth to age five who live in households at or above the 200 percent of the federal poverty level (FPL) have access to CHIP and/or Medicaid in all but five states. A new policy brief, Promoting Young Children's Health and Development: Taking Stock of State Policies, from the National Center for Children in Poverty reviews state policies on health care and other related services for young children and their families. Three areas of health policy are examined: access to health care and continuity of care, maternal health care, and preventive screening and assessment. Among the three areas of health:

  • Access to CHIP/Medicaid: In 2009, four states increased the income eligibility level for CHIP/Medicaid to at least 200 percent of FPL, while another 10 states that already had an income threshold at 200 percent FPL raised their limit even further. Among the latter states, New York raised the income eligibility for young children to 400 percent of FPL.
  • Medical homes: More than half of young children with public insurance have a medical home, compared to less than 10 percent of young children with no insurance.
  • Service continuity: Alabama, Louisiana, and New Jersey have Express Lane Eligibility initiatives that automatically enroll children in Medicaid/CHIP when they qualify for other government programs.
  • Maternal health: Pregnant women and pregnant immigrant women at or above 200 percent of FPL qualify for public health insurance in 24 and 18 states, respectively.
  • Well-child visits: Only Georgia, Indiana, North Dakota, Vermont, and West Virginia require 7 well-child visits for children birth to age 1 as recommended by the American Academy of Pediatrics.
  • Newborn screenings: The number of states requiring universal newborn screening for 28 metabolic deficiencies and disorders has increased by 21 states since 2007.
  • Delays and disabilities: Twenty-two states use a broad definition of eligibility for children at risk of serious developmental delays and disabilities.

The brief notes that some of the provisions of the PPACA, such as providing federal subsidies to purchase insurance, will not be fully implemented until 2014. Given this gradual rollout, the brief offers a set of recommendations to ensure that young children will still have access to the health care services they need during the interim.


A new policy brief, Challenges in Serving Rural American Children through the Summer Food Service Program, from the Carsey Institute highlights the underutilization of the Summer Food Service Program (SFSP) in rural communities. The SFSP provides funding to states to help ensure that children continue to receive meals when schools are not in session. Local sponsors, such as nonprofit organizations and local government agencies, contract with states to provide these meals. The brief finds that poverty and food insecurity rates are among the highest in rural communities, yet less than a third of SFSP sites are located in rural areas. Moreover, fewer rural children participate in the program than urban children even when programs are available. To explore the reasons for these low rates of sponsorship and participation, the Carsey Institute conducted interviews and surveys with SFSP state administrators and local sponsors. Transportation was found to be the biggest obstacle to program implementation and participation. Lack of transportation options for children to get to sites, long distances, and high gas and maintenance costs were some of the major issues cited by SFSP sponsors. Among other factors, the brief finds that families' perceptions of the program in terms of its benefits may also affect participation. Some respondents noted a lack of interest by children in leaving home to participate in the program or parents' desire or need for children to stay at home. However, program sites that offered meals as well as other services, such as literacy enrichment, encouraged more families to participate. The use of "local champions" or local liaisons to promote and coordinate programs in communities was also found to be effective in increasing participation. Overall, the brief emphasizes the need for improved strategies on transportation, greater local collaborations, and increased support for local sponsors and programs.




















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