Early Childhood Centers: Services to Prepare Children for School Often
Limited (Chapter Report, 03/21/95, GAO/HEHS-95-21).

Pursuant to a congressional request, GAO reviewed early childhood
services for disadvantaged children, focusing on the: (1) services
disadvantaged children need to prepare for school; (2) extent to which
early childhood centers provide these services; and (3) reasons early
childhood centers may not deliver all the needed services.

GAO found that: (1) disadvantaged children need intellectual
stimulation, parental support, and adequate health care and nutrition to
prepare for school; (2) early childhood centers provide all the
necessary services and also promote developmental activities suitable to
a child's age and individual level of development; (3) most
disadvantaged children do not receive a full range of services from
early childhood centers because of the limited number of centers and
subsidies and narrow program missions; (4) school-sponsored, nonprofit,
and for-profit childhood centers are often less likely to provide a full
range of services than Head Start centers; and (5) despite Head Start's
full range of services, the quality of its services has been uneven.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-95-21
     TITLE:  Early Childhood Centers: Services to Prepare Children for 
             School Often Limited
      DATE:  03/21/95
   SUBJECT:  Head-start programs
             Disadvantaged persons
             Children
             Preschoolers
             School health services
             School lunch programs
             Federal/state relations
             State-administered programs
             Educational programs
             Child care programs
IDENTIFIER:  AFDC
             Child Care and Development Block Grant
             California
             Maryland
             Louisiana
             Michigan
             Aid to Families with Dependent Children Program
             USDA Child and Adult Care Food Program
             HHS Child Development Associate Scholarship Program
             JOBS Program
             Job Opportunities and Basic Skills Training Program
             Special Supplemental Food Program for Women, Infants, and 
             Children
             High/Scope Perry Preschool Program (Ypsilanti, MI)
             Even Start Family Literacy Program
             HHS At-Risk Child Care Program
             AFDC Transitional Child Care Program
             Social Services Block Grant
             Children's Defense Fund
             Head Start-State Collaboration Grants Program
             National School Lunch Program
             General Child Care and Development Program (CA)
             Prekindergarten Program (OR)
             WIC
             
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Cover
================================================================ COVER


Report to the Chairman, Subcommittee on Children and Families,
Committee on Labor and Human Resources, United States Senate

February 1995

EARLY CHILDHOOD CENTERS - SERVICES
TO PREPARE CHILDREN FOR SCHOOL
OFTEN LIMITED

GAO/HEHS-95-21

Early Childhood Programs


Abbreviations
=============================================================== ABBREV

  AFDC - Aid to Families with Dependent Children
  CACFP - Child and Adult Care Food Program
  CCDBG - Child Care and Development Block Grant
  CDA - Child Development Associate's credential
  EEEP - Extended Elementary Education Program
  ESEA - Elementary and Secondary Education Act
  GAO - General Accounting Office
  GED - General Equivalency Degree
  HHS - Department of Health and Human Services
  IDEA - Individuals with Disabilities Education Act
  JOBS - Job Opportunities and Basic Skills
  MECE - Michigan Early Childhood Education
  MSDE - Maryland State Department of Education
  NAEYC - National Association for the Education of Young Children
  OMB - Office of Management and Budget
  USDA - U.S.  Department of Agriculture
  WIC - Special Supplemental Food Program for Women,Infants, and
     Children

Letter
=============================================================== LETTER


B-250917

Letter Date Goes Here

The Honorable Christopher J.  Dodd
Ranking Minority Member
Subcommittee on Children and Families
Committee on Labor and Human Resources
United States Senate

Dear Senator Dodd: 

As you requested, we have examined early childhood services to
disadvantaged children in the United States.  Our report discusses
the services disadvantaged children need to prepare for school, the
extent to which they receive these services from early childhood
centers, and the reasons early childhood centers may not deliver all
the services these children need. 

As arranged with your office, unless you publicly announce the
contents of this report earlier, we plan no further distribution
until 30 days after its issue date.  At that time, we will send
copies of this report to the Secretary of Health and Human Services,
the Secretary of Education, appropriate congressional committees, and
other interested parties. 

If you have any questions about this report, please call me or
Beatrice F.  Birman, Assistant Director, at (202) 512-7014.  Other
GAO contacts and acknowledgments are listed in appendix VII. 

Sincerely yours,

Linda G.  Morra
Director, Education and
 Employment Issues


EXECUTIVE SUMMARY
============================================================ Chapter 0


   PURPOSE
---------------------------------------------------------- Chapter 0:1

More than a third--2.8 million--of the nation's children aged 3 and 4
were from low-income families in 1990, a growth of 17 percent since
1980.  This trend is continuing.  These disadvantaged children often
live in homes that provide little intellectual stimulation, as well
as inadequate health care and nutrition.  Consequently, the
development of these children, including their preparation for
elementary school, is undermined.  Lagging behind their middle- and
upper-income peers when they enter school, many disadvantaged
children never catch up.  These children, more than other children,
are placed in special education classes, repeat one or more grades,
or drop out before completing high school.  But there is help for
these disadvantaged children.  This help includes federal and state
government funding for services in early childhood centers.  Through
these services, centers can prepare children for school, helping them
to overcome their disadvantages. 

Programs that provide these services will be reviewed by the 104th
Congress.  To better understand federal and state early childhood
services provided in centers, the current Ranking Minority Member of
the Subcommittee on Children, Families, Drugs and Alcoholism, Senate
Committee on Labor and Human Resources, asked GAO to answer these
questions: 

What services do disadvantaged children need to be prepared for
school? 

To what extent do disadvantaged children receive these services from
early childhood centers? 

If disadvantaged children do not receive these services from early
childhood centers, why not? 


   BACKGROUND
---------------------------------------------------------- Chapter 0:2

Sometimes families need help in preparing their children for school. 
Such help can be provided in a variety of settings, including early
childhood centers.  Funded by many different federal, state, and
private programs (see app.  I), these centers provide child
development, parent, and health and nutrition services.  Children may
also receive these services from family child care providers--that
is, individuals who, in their own homes, care for one or more
children--and through social service programs. 

To emphasize the importance of preparing all children for school, in
1994 the Congress enacted the Goals 2000:  Educate America Act, which
includes the first national education goal:  "By the year 2000, all
children in America will start school ready to learn." Two other
laws, also enacted in 1994, specifically authorized programs for
disadvantaged children in particular:  (1) the Head Start Amendments
of 1994, which expand and improve early childhood services provided
by the Head Start program, and (2) the Elementary and Secondary
Education Act, which includes programs that provide early childhood
services for disadvantaged children.  In addition, the Congress's
upcoming reauthorization of the Child Care and Development Block
Grant program and Title IV-A child care programs of the Social
Security Act will focus attention on early childhood services for
low-income families. 

To review the services provided in early childhood centers, GAO used
several different methodologies:  consulting with experts; conducting
case studies of early childhood programs and services in four
states--California, Louisiana, Maryland, and Michigan-- as well as
conducting case studies in two low-income census tracts in each of
these states (see app.  II); and analyzing a nationally
representative sample of early childhood centers (see app.  III). 


   RESULTS IN BRIEF
---------------------------------------------------------- Chapter 0:3

Early childhood experts agree that to be prepared for school,
disadvantaged children need intellectual stimulation, parental
support, and adequate health care and nutrition.  Early childhood
centers can help meet these needs by providing a full range of
services--child development, parent, and health and nutrition.  Child
development services encourage developmental
appropriateness--suitable to a child's age and individual level of
development--in all activities; these services also promote the
responsiveness of teachers to the child.  Parent services actively
involve parents in their children's learning.  Health and nutrition
services promote children's physical and mental well-being, which
enhances their ability to learn. 

Most of the nation's disadvantaged children do not attend an early
childhood center.  By contrast, most children in high-income families
do attend these centers.  Of the disadvantaged children who attend
centers, most attend the kinds of centers-- school-sponsored,
nonprofit, and for-profit--that are more likely than Head Start
centers to provide a full range of services.  But despite Head
Start's provision of a full range of services, the quality of its
services has been uneven. 

Most disadvantaged children do not receive services at early
childhood centers because of the (1) limited number of places and
subsidies and (2) narrow missions of programs.  The first problem
precludes the enrollment of many eligible children.  The second
constrains the services offered; however, some states and localities
have initiatives that show how resources can be combined so that
centers can provide the full range of services. 


   GAO'S ANALYSIS
---------------------------------------------------------- Chapter 0:4


      CENTERS CAN MEET CHILDREN'S
      NEEDS BY PROVIDING A FULL
      RANGE OF SERVICES
-------------------------------------------------------- Chapter 0:4.1

Centers can meet children's needs for child development services by
providing teachers who have higher education or specialized training
in early childhood education, a low child-to-staff ratio, small group
size, low teacher turnover, and a curriculum with both daily and
long-range plans for groups of children and individual children. 

Centers can also meet children's needs for parent services by helping
parents become actively involved in their children's learning.  Such
involvement includes opportunities for parents to meet with teachers,
serve as volunteers in the classroom, attend workshops or classes,
and receive home visits from center staff. 

Finally, centers can meet children's needs for health care and
nutrition services by screening for hearing, speech, and vision
problems; making referrals to health care providers; and offering
daily, nutritious meals and snacks.  Centers can also require
preventive health care, such as immunizations and physical
examinations. 


      MOST DISADVANTAGED CHILDREN
      DO NOT RECEIVE A FULL RANGE
      OF SERVICES FROM CENTERS
-------------------------------------------------------- Chapter 0:4.2

Of the nation's disadvantaged children, about 65 percent, as of 1989,
did not attend an early childhood center.  Of those who attended
centers, 59 percent attended school-sponsored, for-profit, and
nonprofit centers, which are less likely than Head Start to provide
the full range of services. 

Child development services, for example, are often inadequate in
for-profit and nonprofit centers:  In for-profit centers, 21 percent
of teachers have minimal qualifications--no more than a high school
diploma or General Equivalency Degree (GED); in nonprofit centers, 11
percent have no more than these minimal qualifications.  In Head
Start and school-sponsored centers, however, almost all teachers have
more than a high school diploma or GED.  In addition, more than 25
percent of for-profit and nonprofit centers have child-staff ratios
higher than 10 to 1, but only 8 percent of Head Start centers have
such high ratios. 

Many centers are less likely than Head Start centers to provide some
types of parent services.  For example, only 45 percent of
school-sponsored centers, 18 percent of nonprofit centers, and 7
percent of for-profit centers provide home visits.  But 98 percent of
Head Start centers provide them. 

Finally, few centers except for Head Start provide health services. 
Less than 10 percent of nonprofit and for-profit centers and less
than 35 percent of school-sponsored centers report providing, or
referring children for, physical and dental examinations.  Most
centers of all kinds, however, do provide daily, nutritious meals. 


      SERVICES UNAVAILABLE BECAUSE
      OF LIMITED NUMBER OF PLACES
      AND SUBSIDIES
-------------------------------------------------------- Chapter 0:4.3

Despite the expansion of the Head Start program in recent years,
there are still only a limited number of places in centers that serve
disadvantaged children.  One explanation for this is that the number
of disadvantaged children aged 3 and 4 has increased from 2.4 million
in 1980 to 2.8 million in 1990.  In addition, Head Start centers,
unlike for-profit and nonprofit centers, are only half-day, making
them unavailable for the children of parents who need full-day care
because they are at work or school. 

In each of the four states GAO visited, early childhood centers had
waiting lists, a rough indicator of limited places.  Even when places
are available, the limited number of subsidies for child care
available to families also makes it difficult for parents to pay for
their children to attend centers. 


      PROGRAMS HAVE NARROW
      MISSIONS THAT CONSTRAIN
      CENTERS' PROVISION OF
      SERVICES
-------------------------------------------------------- Chapter 0:4.4

Generally, the missions of programs emphasize either child
development, which prepares children for school, or child care, so
that parents can work or go to school.  Such narrow missions
influence program standards, resource allocation, and the ease with
which programs can work together.  These three characteristics
constrain centers from providing children with a full range of
services.  Nevertheless, some state and local initiatives, sometimes
with additional private funding, have demonstrated that a full range
of services can be provided by funding the programs that offer more
services; investing state money in Head Start; and locating centers,
services, and children together even when funds come from different
programs. 


   RECOMMENDATIONS
---------------------------------------------------------- Chapter 0:5

GAO is making no recommendations. 


   AGENCY COMMENTS
---------------------------------------------------------- Chapter 0:6

The Department of Education provided written comments on this report. 
Education noted that GAO presents "a wealth of information on early
childhood schooling" and that the report should be widely read.  (See
app.  V for Education's comments and GAO's response.)

The Department of Health and Human Services (HHS) did not provide
written comments on this report; however, HHS officials provided oral
comments on technical points.  Where appropriate, GAO has
incorporated their comments in this report. 


INTRODUCTION
============================================================ Chapter 1

More than a third--2.8 million--of the nation's 3- and 4-year-old
children were from low-income families in 1990, a growth of 17
percent since 1980.\1 An increase in the number of infants and
toddlers living in such families during the same period suggests that
this trend will continue.\2 These disadvantaged children often live
in environments that undermine their development and impair their
ability to benefit from elementary school.\3

Already lagging behind their peers when they enter school, many of
these children fail to catch up.  Consequently, disadvantaged
children, more than other children, are placed in special education
classes, repeat one or more grades, or drop out before completing
high school. 

A recent Carnegie Corporation report characterizes the condition of
some of the nation's youngest children, including the disadvantaged,
as a "quiet crisis." The report documents the importance of
environmental factors on children's development and concludes that
"the quality of young children's environment and social experience
has a decisive, long-lasting impact on their well-being and ability
to learn."\4 According to the report, less than half of the nation's
youngest children receive adequate cognitive stimulation, such as
being read to by their parents. 

To prepare for school, disadvantaged children can benefit from
programs that offer specific features of child development services,
promote parent services, and provide adequate health care and
nutrition services.\5 Such services may be found in early childhood
centers, such as preschools, nursery schools, child care centers, or
early learning centers.\6 Such services also may be found in other
settings, including family child care, or provided by parents
themselves.\7 If disadvantaged children do not receive these
services, their future success in both school and life may be
jeopardized. 

The Congress' inclusion of a school readiness goal as part of the
1994 Goals 2000:  Educate America Act suggests the need for and
importance of helping young children prepare for school.  The act
establishes eight national education goals, the first of which states
that "By the year 2000, all children in America will start school
ready to learn." The goal also articulates the fundamental elements
needed to foster the development of all children, including the
disadvantaged, and to prepare them for school.  These elements
include high-quality,\8 developmentally appropriate\9 preschool
programs (in this report, centers), parents who are involved in their
child's learning, and adequate health and nutrition services. 
However, accomplishing this goal may become an elusive pursuit as
schools receive a continuing stream of disadvantaged children whose
early experiences do not include these fundamental elements needed to
prepare them for school. 

The Congress has also enacted other legislation that addresses the
need for preparing children for school:  the Head Start Amendments
Act of 1994, a part of the Human Services Amendments of 1994, P.L. 
103-252; and the Improving America's Schools Act, P.L.  103-382,
which amended the Elementary and Secondary Education Act of 1965
(ESEA).\10 The Head Start Amendments of 1994 reauthorized and
expanded Head Start, a program that provides some disadvantaged
children--mostly those who are categorized as poor\11 --with all
services needed to prepare for school.  The Improving America's
Schools Act provides, among other educational programs, early
childhood services in some schools with large numbers of
disadvantaged children. 

The provision of early childhood services is also likely to be a key
issue in the debate over welfare reform.  Welfare reforms may result
in an increased demand for child care should those parents who are
unemployed and receiving Aid to Families with Dependent Children
(AFDC) be required to participate in education or employment training
programs. 


--------------------
\1 The 2.8 million children referred to here are those whose family
income is at or below 185 percent of poverty, an eligibility
criterion for some federal programs, such as the Special Supplemental
Food Program for Women, Infants, and Children (WIC).  The Office of
Management and Budget (OMB) defines poverty based on family size and
annual household income.  For example, in 1990, a family of four with
an annual income at or below $12,674 was considered poor.  To
determine the number of children living in low-income families, we
used an annual household income below 185 percent of poverty--or at
or below $23,447 for a family of four.  Of these 2.8 million
low-income children, 1.4 million lived below the OMB poverty
threshold, an increase of 28 percent from 1980 to 1990. 

\2 The growth in the population of disadvantaged infants and toddlers
from low-income families during this period was 13 percent.  Our
April 1994 report provided information on the numbers and
characteristics of the nation's infants and toddlers.  See Infants
and Toddlers:  Dramatic Increases in Numbers Living in Poverty
(GAO/HEHS-94-74, Apr.  7, 1994). 

\3 In this report we use the term "disadvantaged" to refer to
children who live in low-income families, including those who are
poor.  Researchers, as well as federal and state programs, use many
different measures--economic and others, such as educational test
scores--to determine which children are disadvantaged.  We do not
limit ourselves to a single economic measure. 

\4 In 1991, the Carnegie Corporation of New York established the
Carnegie Task Force on Meeting the Needs of Young Children to
"develop a report that would provide a framework of scientific
knowledge and offer an action agenda to ensure the healthy
development of children from before birth to age three." See Carnegie
Task Force on Meeting the Needs of Young Children, Starting Points: 
Meeting the Needs of Our Youngest Children (New York:  Carnegie
Corporation of New York, Apr.  1994). 

\5 Most of the research on the benefits of early childhood programs
reports on the effects of such programs for children living in
poverty.  However, the first national education goal recommends that
all children attend early childhood programs. 

\6 In this report we use the term "early childhood center" to mean
any setting providing education or care outside of the child's home,
or the home of a relative or unrelated person.  Our use of the term
early childhood centers includes those sponsored by schools. 

\7 Family child care is offered by individuals in their homes to a
small number of children--usually fewer than six.  These providers
can be neighbors, friends, or someone families learn about through
friends or advertisements.  This study did not examine services
offered by family child care providers, but we discuss findings from
other studies of family child care in chapter 3.  The Department of
Health and Human Services (HHS) is currently funding 17 demonstration
projects which provide a full range of services to children cared for
in family child care settings. 

\8 The term "high-quality" is generally used to describe environments
in early childhood centers and other settings that support and
enhance children's development.  The interactions between staff and
children are a significant aspect of such environments.  Experts
agree that certain characteristics are associated with high-quality
environments, in part because they foster positive interactions. 
These characteristics include child-staff ratios, group size, staff
qualifications, compensation, and turnover.  In another usage, the
term high-quality refers to both the range of services that a center
makes available to children and their families and the extent to
which children and their families actually receive these services. 

\9 The National Association for the Education of Young Children
(NAEYC) defines developmentally appropriate as those practices that
address a child's developmental needs according to his or her (1) age
and (2) individual growth and maturation.  The teacher selects an
appropriate range of activities and materials for children of a
specific age group, then tailors the general range of activities and
materials to individual children on the basis of each child's growth,
interests, and experiences.  Developmentally appropriate practices
also emphasize the importance of play in children's cognitive,
physical, emotional, and social development. 

\10 Title I of ESEA of 1965, as amended, provides the largest share
of federal assistance to elementary and secondary school students. 
In fiscal year 1994, the federal government provided states with over
$6.9 billion dollars in Title I funds to serve more than 5 million
children in prekindergarten through grade 12.  Prior to the 1994
reauthorization of ESEA, and during the period of our review, Title I
was called Chapter 1.  In this report, we use Title I to refer to
both the newly reauthorized program and its predecessor, Chapter 1. 

\11 The Head Start program uses OMB's definition of poverty, in
addition to other guidelines, to determine a child's eligibility for
services.  (See footnote 1 for a discussion of OMB's definition of
poverty.) OMB's definition of poverty is one of the most stringent
income standards used.  Some federal programs allow higher income
standards to determine children's eligibility.  For example, in order
to be eligible for the Medicaid program, children must be living in
families with an annual income of up to 133 percent of the poverty
line. 


   DISADVANTAGED CHILDREN ARE NOT
   PREPARED FOR SCHOOL
---------------------------------------------------------- Chapter 1:1

To be prepared for school,\12 all children need early childhood
experiences that foster their physical, emotional, social, and
cognitive development.  Children also need relationships with adults
who are responsive to their needs and who foster their development,
parental guidance and support, health care to maintain physical
well-being or correct medical problems, and nutritious diets. 
However, the early childhood experiences of many disadvantaged
children do not include these experiences. 

Family income is an important predictor of children's success or
failure in school; disadvantaged children are more likely to
experience difficulties.  Their early childhood experiences often
hinder their development, leaving them unprepared for school.  Recent
research on infants and toddlers provides compelling evidence of the
environmental deficits--such as too little cognitive stimulation and
inadequate health care--that undermine disadvantaged children's
development.  It also documents the effects of these deficits on
children's school performance and later lives.\13

A 1991 study of children whose families were recipients of AFDC, the
federal welfare assistance program, found that the conditions under
which the nation's most disadvantaged children live are detrimental
to these children's development and undermine their chances for
success in school.\14 Researchers found that children who were from
families receiving AFDC were twice as likely as children of more
economically advantaged families to do poorly in school, repeat a
grade, and become classroom disciplinary problems.  Two-thirds of
these children lived in home environments that did not stimulate
their cognitive growth and where they received insufficient emotional
support from their parents.  The study revealed similar findings for
the children of low-income families that were not receiving AFDC. 

Disadvantaged children have less access to health care and nutrition,
especially preventative health care, than children whose families
have higher incomes.  The same 1991 study of AFDC children found that
children from low-income families were less likely to have visited a
doctor within the last year than children in families with higher
incomes.  Twenty-one percent of the children in low-income families
had not visited a doctor within the last year compared with 14
percent of children in families with higher incomes.  Also, children
in low-income families were more likely to receive care in a hospital
emergency room, which is not an adequate source of preventative
care.\15

Forty percent of the children in low-income families--compared with 7
percent of children in families with higher incomes--received regular
care through a hospital emergency room or clinic.  Poor health can
negatively affect children's ability to perform well in school. 

Other factors associated with low-income families--low parent
educational attainment, single-parenting, and linguistic
isolation--also increase children's risk of doing poorly in
school.\16 None of these factors, however, are insurmountable. 
Research on early childhood development validates the belief that
children can be helped to prepare for school. 


--------------------
\12 The National Education Goals Panel is currently developing
measures to determine children's preparedness at the time that they
begin elementary school.  In the absence of such a measure, this
discussion focuses on research that links children's development with
later school performance. 

\13 The Carnegie Corporation report, Starting Points, summarizes some
of the research on environmental effects on children's development
from birth to age 3 (see part 1).  For a discussion of the
environmental deficits accompanying poverty, see James Garbarino,
"The Meaning of Poverty in the World of Children," American
Behavioral Scientist, Vol.  35 (January/February 1992). 

\14 Nicholas Zill, Kristin A.  Moore, Ellen Wolpow Smith, Thomas
Stief, and Mary Jo Coiro, The Life Circumstances and Development of
Children in Welfare Families:  A Profile Based on National Survey
Data (Washington, D.C.:  Child Trends, Inc., 1991).  Using data from
two large, nationally representative surveys, the National
Longitudinal Survey of Labor-Market Experience of Youth and the
National Health Interview Survey, this study examined AFDC children's
home environments to determine the role of welfare dependency in
children's development and well-being. 

\15 Nicholas Zill, Child Health and School Readiness:  Background
Paper on a National Education Goal (Washington, D.C.:  Child Trends,
Inc., Oct.  1990). 

\16 See Poor Preschool-Age Children:  Numbers Increase but Most Not
in Preschool (GAO/HRD-93-111BR, July 21, 1993). 


   EARLY CHILDHOOD CENTERS CAN
   HELP DISADVANTAGED CHILDREN
   PREPARE FOR SCHOOL
---------------------------------------------------------- Chapter 1:2

Many researchers have found that disadvantaged children can overcome
the environmental deficits they have experienced and become better
prepared for school.  One way disadvantaged children can make these
gains is by attending early childhood centers that provide services
important to promoting school preparedness.  For example, the Perry
Preschool Project, a longitudinal study of the effects of
disadvantaged children's participation in a high-quality preschool,
found significant differences between children who participated in
the preschool program and those who did not. 

Participating children, compared with nonparticipating ones, had
significantly lower rates of placement in special education classes,
were less likely to repeat a grade, and tested higher on IQ tests on
school entry.\17 Other studies have also documented that attendance
in high-quality early childhood centers have positive effects on
children's development and school achievement.\18

However, the research, while generally positive, has documented that
the benefits of such attention are not always long term.  The extent
to which these benefits are maintained appears to be influenced by
other factors, such as the child's experience as he or she makes the
transition from an early childhood program to elementary school or
the way in which the elementary school environment supports young
children's development.\19


--------------------
\17 The Perry Preschool study began in 1962.  The findings of the
effects of preschool on children who participated in the program are
reported in John R.  Berrueta-Clement, Lawrence J.  Schweinhart, W. 
Steven Barnett, Ann S.  Epstein, and David P.  Weikart, Changed
Lives:  The Effects of the Perry Preschool Program on Youths Through
Age 19 (Ypsilanti, Michigan:  High/Scope Educational Research
Foundation, 1984).  A second report relates findings on participating
children through age 27:  Lawrence J.  Schweinhart and H.V.  Barnes,
with W.  Steven Barnett, Ann S.  Epstein, and David P.  Weikart,
Significant Benefits (Ypsilanti, Michigan:  High/Scope Educational
Research Foundation, 1993). 

\18 These other reports include Penny Hauser-Cram, Donald E. 
Pierson, Deborah Klein Walker, and Terrence Tivnan, Early Education
in the Public Schools:  Lessons from a Comprehensive Birth-to-Five
Kindergarten Program (San Francisco:  Jossey-Bass, Inc., 1991);
Cheryl D.  Hayes, John L.  Palmer, and Martha J.  Zaslow, eds.  Who
Cares for America's Children?:  Child Care Policy for the 1990s
(Washington, D.C.:  National Academy Press, 1990); A Report on
Longitudinal Evaluations of Preschool Programs, Sally Ryan, ed., Vol. 
1, DHEW Publication Number (OHD)74-24; and Edward F.  Zigler and
Edmund W.  Gordon, Day Care:  Scientific and Social Policy Issues
(Dover, Del.:  Auburn House Publishing Company, 1982). 

\19 See Transitions to Kindergarten in American Schools, Office of
Policy and Planning, Department of Education (1992). 


   BOTH FEDERAL AND STATE
   GOVERNMENTS FUND DIFFERENT
   TYPES OF EARLY CHILDHOOD
   PROGRAMS
---------------------------------------------------------- Chapter 1:3

The federal government, as well as a majority of state governments,
invests in different kinds of early childhood programs for
disadvantaged children.  The mission of some of these programs is to
promote child development; the mission of other programs is to
provide child care so that parents can work.  Federal responsibility
for administering these programs rests with the Department of
Education and the Department of Health and Human Service (HHS).  All
of these programs fund early childhood centers that can affect the
child's development.  Many of these programs, especially those for
providing child care, also make funds available for other settings. 
For example, children may be cared for in family child care homes,
where groups of children receive services in someone else's home. 
(Detailed descriptions of all these programs appear in app.  I.)


      FEDERAL CHILD DEVELOPMENT
      PROGRAMS TARGET
      DISADVANTAGED CHILDREN
-------------------------------------------------------- Chapter 1:3.1

Early childhood development programs are a key strategy in the
federal government's effort to help disadvantaged children improve
their performance in school.  Head Start, the federal government's
largest such program, is administered by HHS and provides funding
directly to local grantees who, in turn, provide some disadvantaged
children, mostly those who are categorized as poor, with a full range
of early childhood services.  That range includes, but is not limited
to, child development, parent, and health and nutrition services. 

In order to serve more children and improve quality, the federal
government has increased Head Start funding annually since 1989.  In
total, increased funding provided services for an additional 287,000
children from fiscal year 1990 through fiscal year 1993.  Head
Start's funding was $3.3 billion in fiscal year 1994; the Congress
increased the program's appropriation to $3.5 billion for fiscal year
1995.  Legislation reauthorizing Head Start calls for a study of the
need for full-day, full-year Head Start programs; program guidance
encourages centers to provide full-day programs rather than the usual
half-day programs when there is a need among the families served by
the center. 

Other federal programs also provide some early childhood services.\20
For example, the 1994 amendments to ESEA provide funding from the
Department of Education for child development programs that are
operated by schools with high numbers of disadvantaged children.  In
school year 1992-93, Title I served 116,612 children in early
childhood programs; data on the amount of money expended to provide
these programs are unavailable.\21

In addition, Education's Even Start Family Literacy Program is
another example of a program that provides early childhood
development services to disadvantaged children.\22


--------------------
\20 Some disadvantaged children also receive services under the
Individuals with Disabilities Education Act (IDEA).  For example,
IDEA authorizes the Preschool Grants Program.  Under this
authorization, state and local educational agencies receive funding
to help make available a free and appropriate education to children
who are 3 through 5 years old.  Studying programs for children with
disabilities was beyond the scope of this study. 

\21 These are the number of children served in early childhood
programs funded by Title I--referred to as Title I prekindergarten
programs.  School districts are not required to report separately the
level of expenditures for programs that serve children before
elementary school. 

\22 Even Start projects provide families with low incomes an
integrated program of early childhood education, adult basic skills
training, and parenting education.  These services include
instruction for children, literacy training for parents, and
assistance to parents to involve them in their children's schooling. 


      GROWING NUMBER OF STATE
      CHILD DEVELOPMENT PROGRAMS
      ALSO TARGET DISADVANTAGED
      CHILDREN
-------------------------------------------------------- Chapter 1:3.2

Increasingly, state governments are investing in child development
programs.  A 1991-1992 survey by the Children's Defense Fund found
that 32 states use state funds to provide child development programs
to children before they enter elementary school\23 --a threefold
increase among such programs between 1979 and 1991-92\24 increase
since 1979 when only seven states had such programs.  Many of these
programs are administered by state departments of education and
operate through the public schools.  Fourteen states provide
increased funding for Head Start so that more children can be served. 
Some states operate their programs through a variety of providers,
including schools, Head Start centers, and contractors.  In addition,
state funding for early childhood programs, including child
development programs, varied dramatically.\25


--------------------
\23 Gina Adams and Jodi Sandifort, First Steps, Promising Futures: 
State Prekindergarten Initiatives in the 1990s (Washington, D.C.: 
Children's Defense Fund, 1994). 

\24 These are state-funded programs that provide education-related
services, in this report called child development services, to
preschool aged children.  Programs funded by the federal Title I
program are not included, nor are programs funded entirely by local
governments or focused primarily on parents.  See First Steps,
Promising Futures:  State Prekindergarten Initiatives in the 1990s. 

\25 In fiscal year 1990, state funding for child care and early
childhood development programs combined ranged from $.24 to $70 per
child.  These figures were calculated by dividing the total federal
and state expenditures for such programs by the total number of
children under age 14 in the state.  See Gina Adams and Jodi R. 
Sandfort, State Investments in Child Care and Early Childhood
Education (Washington, D.C.:  Children's Defense Fund, 1992). 


      FEDERAL CHILD CARE PROGRAMS
      TARGET DISADVANTAGED
      CHILDREN
-------------------------------------------------------- Chapter 1:3.3

Some federal child care programs provide subsidies for low-income
families to obtain child care in a variety of settings.  These
settings include early childhood centers operated by nonprofit or
for-profit organizations.  The services provided are generally
intended to support parents' employment, but the centers also provide
the early learning experiences that prepare children for school. 

In 1993, HHS spent more than $1.8 billion in programs to improve
access to affordable child care for low-income families.  However,
this amount includes services to children of all ages in all kinds of
child care settings; only a portion of this amount goes to 3- and
4-year-old children in centers.  Welfare reform will increase the
need for child care services if more parents are required to work or
be trained.\26

Among the federal programs that subsidize child care are the Title
IV-A programs of the Social Security Act and CCDBG.  Title IV-A funds
three programs--AFDC Child Care, At-Risk Child Care, and Transitional
Child Care--that provide child care assistance for families who are
working toward economic self-sufficiency or are at risk of welfare
dependency.  (States must provide a match for a portion of the
federal money they receive under the Title IV-A programs.) CCDBG
provides subsidies for child care services, with priority given to
low-income families and children with special needs.  In addition,
states can use Title XX--Social Services Block Grants--to fund a wide
range of social services including child care, particularly for
neglected children. 


--------------------
\26 A feature of welfare reform proposals in the 103rd Congress was
provision of child care for AFDC recipients who would be required to
participate in education or employment training programs.  Welfare
reform proposals introduced in the 104th Congress may contain similar
provisions given the current emphasis on helping families receiving
AFDC to achieve economic independence. 


      QUESTIONS RAISED ABOUT
      CURRENT ARRAY OF PROGRAMS
-------------------------------------------------------- Chapter 1:3.4

Some federal policymakers question whether the current array of early
childhood programs provides the services needed to promote child
development and prepare children for school.  Our 1994 study
identified 34 federal early childhood programs and another 59 federal
programs that either allow or support early childhood education or
care.\27 Multiple programs provide different services to different
subgroups of disadvantaged children, although the children have
similar needs.  As a result, there have been increasing calls for
program coordination, particularly among federal programs. 

The Head Start-State Collaboration Grants program, created in 1990,
is one national effort which seeks to coordinate a major federal
early childhood program, Head Start, with state early childhood
programs and services including health, education, and welfare
service providers.\28 The recent reauthorization of Head Start
permits the Secretary of Health and Human Services to expand these
grants from the 22 states currently participating to all states.  In
addition, the Advisory Committee for Head Start Quality and Expansion
recommended that a study of federal child care be undertaken to
provide direction for increasing the consistency between program
requirements and procedures to facilitate coordination between
programs. 

The Congress has also taken steps to address concerns that have been
raised about the quality of services funded by the array of federal
early childhood programs.  In response to concerns about the quality
of Head Start services, the Congress allows HHS to set aside for
quality improvements 25 percent of the amount of the current-year
Head Start appropriations that exceed appropriations of the preceding
year, including staff salary increases.\29 The 1994 legislation
requires additional measures intended to improve quality, such as
termination of an agency's designation as a Head Start grantee if the
agency fails to correct a deficiency cited by the Secretary of HHS. 

New legislation reauthorizing ESEA requires Title I early childhood
programs to comply with Head Start performance standards by fiscal
year 1997; currently, federal Title I standards do not include
requirements specifically for early childhood programs.  The CCDBG
legislation includes a 25-percent set-aside for quality improvements,
which states can use for a variety of activities such as improving
staff salaries, establishing and expanding child care resource and
referral programs, and training child care providers.  Finally,
proposals for reforming welfare in the last session of Congress
included provisions, for example, that would allow states to use
program funds for increased monitoring and licensing and other
quality improvement activities.  Such changes may be considered when
welfare reform is revisited in the 104th Congress. 


--------------------
\27 Early Childhood Programs:  Multiple Programs and Overlapping
Target Groups (GAO/HEHS-95-4FS, Oct.  31, 1994). 

\28 The Head Start Act, as amended in 1994, requires states receiving
collaboration grants to ensure that Head Start services are
coordinated with health care, welfare, child care, education,
national service activities, family literacy services, and activities
for children with disabilities. 

\29 The Head Start Amendments of 1994 allow the Secretary of HHS to
set aside 25 percent of current-year appropriations in excess of
appropriations of the preceding year to (1) help centers meet or
exceed Head Start performance standards, (2) ensure centers have
adequate, qualified staff who are provided training, (3) ensure that
staff salaries are adequate to attract and retain qualified staff,
(4) use salary increases to improve staff qualifications and to
assist with the implementation of career development programs, (5)
improve community-wide strategic planning and needs assessments, (6)
ensure that the physical environment of centers is conducive to
providing effective services to children and families, and (7) make
other improvements in the quality of such programs. 


   OBJECTIVES, SCOPE, AND
   METHODOLOGY
---------------------------------------------------------- Chapter 1:4

The current Ranking Minority Member of the Subcommittee on Children,
Family, Drugs and Alcoholism, Senate Committee on Labor and Human
Resources, asked us to conduct a review of center-based federal and
state early childhood programs.  We were asked to answer the
following questions:  (1) what services do disadvantaged children
need to prepare them for school (2) to what extent do disadvantaged
children receive these services from early childhood centers; and (3)
if disadvantaged children do not receive services from early
childhood centers, why not? 

In our review of early childhood programs, we used several different
methodologies.  To determine the kinds of services that disadvantaged
children need to prepare them for school, we reviewed literature,
consulted with experts, and reviewed the standards for early
childhood centers developed by a number of professional associations
and government agencies.  We limited our focus to center
characteristics associated with the first national education
goal--child development, parent, and health and nutrition services. 

In order to determine the services that disadvantaged children
receive, we analyzed Mathematica Policy Research's "Profile of Child
Care Settings," a nationally representative sample of early childhood
centers.  This was a 1990 telephone survey of directors of early
childhood centers.  We grouped centers into four categories that
correspond to their sponsors:  (1) Head Start, (2) school-sponsored,
(3) nonprofit, and (4) for-profit.\30 Both nonprofit and for-profit
centers may be sponsored by church, community, and other
organizations.  Nonprofit and for-profit centers may receive funds
through federal or state child care programs, directly or through
subsidies provided to families.  Head Start centers are sponsored by
local nonprofit organizations--including school districts--receiving
federal Head Start funds.\31 School-sponsored centers are sponsored
by local school districts, and are funded by the state and/or local
governments, but may also receive some federal funds.  In addition to
analyzing national data for kinds of centers, we also divided the
centers into three categories according to the poverty level of their
community to determine whether differences exist in the services
provided.\32 We report only those differences between centers that
are statistically significant at the 55-percent confidence level. 

We also conducted case studies of early childhood programs and
services in four states that had multiple early childhood programs
and varying levels of state investment in those programs.  We
judgmentally selected our states on the basis of types of early
childhood programs within the state and the level of state investment
in early childhood programs.  Our in-depth case studies of early
childhood programs and services in California, Louisiana, Maryland,
and Michigan enabled us to look first-hand at services for
disadvantaged children.  Each of these four states has state-funded
child development programs.  The characteristics of these
programs--such as per-child expenditure and services
provided--varied.  In addition, we met with state education and child
care administrators in the four states.  In each state, we also
selected low-income census tracts--one urban and one rural--and
interviewed all center-based providers within these census tracts. 
In total, we interviewed providers in 28 early childhood centers--8
Head Start centers, 12 federal or state school-sponsored programs,
and 8 other providers.  (See app.  II for details about the case
study states and census tracts.)

In order to determine why disadvantaged children did not receive
needed services, we conducted (1) in-person interviews with state and
local administrators in our case study states and (2) telephone
interviews with 11 state administrators of Head Start-State
Collaboration Projects.  These projects are intended to facilitate
Head Start involvement in state policymaking and to build a more
integrated and comprehensive delivery system for early childhood
services.\33 (Additional information on the methodology employed in
this study can be found in app.  III.)


--------------------
\30 Although Head Start and school-sponsored centers are also
nonprofit, throughout this report, the term nonprofit centers
excludes Head Start and school-sponsored centers. 

\31 For the purposes of this report, Head Start centers with multiple
sponsors are classified as Head Start.  For example, if a center
receives both Head Start and state preschool funding, it is
considered a Head Start center.  Because Head Start regulations
require the center to provide comprehensive services, the center
would have characteristics of a Head Start program. 

\32 In this report, we define high-poverty areas are those in which
30 percent or more of the children reside in families whose annual
household income is below the 1990 OMB poverty standard of $12,674
for a family of four.  In those areas we define as low-poverty, less
than 8 percent of the children reside in families with annual family
incomes below the OMB poverty line. 

\33 Head Start-State Collaboration Grants were first awarded in 1990. 
Twelve states received individual grants of up to $100,000.  We
interviewed 11 of the 12 administrators:  because of a change in
administrators in one state, there was no representative to speak
with at the time we conducted these interviews.  Ten additional
states were awarded collaboration grants in 1992.  These 10 states
were not included in our telephone interviews because of the limited
time in which they have participated in the collaboration program. 


      STUDY LIMITATIONS
-------------------------------------------------------- Chapter 1:4.1

This study was limited to the provision of services to preschool aged
children, generally 3 and 4 years old, in early childhood centers. 
We did not examine services provided in family child care settings. 

The Profile of Child Care Settings and our case studies relied
exclusively on self-reports of center personnel.  We did not conduct
on-site observations of interactions between teachers and
disadvantaged children as would be necessary to determine the quality
of a center beyond what services it offered.\34 In addition, the
sample did not allow us to focus our analyses on centers that served
only disadvantaged children.  We were also not able to conduct
analyses comparing the proportions of disadvantaged children
receiving services in different kinds of centers because of small
sample sizes. 

We did our review from October 1992 to September 1994 in accordance
with generally accepted government auditing standards. 


--------------------
\34 Abt Associates, under contract to the Department of Education,
has completed such a review and published its findings in Patricia S. 
Seppanen, Ken W.  Godin, Jeffrey L.  Metzger, Martha Bronson, and
Donald J.  Cichon, Observational Study of Early Childhood Programs
(Washington, D.C.:  Department of Education, 1993). 


      AGENCY COMMENTS
-------------------------------------------------------- Chapter 1:4.2

The Department of Education provided written comments on a draft of
this report.  We have incorporated its comments where appropriate. 
In addition, these comments are presented and evaluated in appendix
V.  The Department of Health and Human Services did not provide
written comments.  We obtained the agency's views in an exit
conference and have incorporated its comments as appropriate. 


DISADVANTAGED CHILDREN NEED FULL
RANGE OF SERVICES TO PREPARE THEM
FOR SCHOOL
============================================================ Chapter 2

As stated in chapter 1, the first national education goal articulates
the fundamental elements--high-quality, developmentally appropriate
preschool, (in this report, early childhood centers); parents who
support their children's learning; and adequate health care and
nutrition--that are needed to prepare all children for school. 
Experts also have documented that these elements are important in
preparing disadvantaged children for school. 


   DEVELOPMENTALLY APPROPRIATE,
   HIGH-QUALITY SERVICES HELP
   PREPARE CHILDREN FOR SCHOOL
---------------------------------------------------------- Chapter 2:1

Child development services that are appropriate to the child's age
and individual level of development should promote relationships
between the child and adults.  Long-term relationships with adults
who are responsive to the child's needs and provide a stimulating
environment for the child are crucial to development.  In particular,
a child's language and social development are dependent on his or her
relationships with adults.  By encouraging verbal expression, adults
can foster such development.\35 Children's relationships with adults
other than their parents, such as early childhood teachers, provide
important opportunities for their development.  Early childhood
centers can provide the kind of environment that encourages these
kinds of relationships and developmentally appropriate practices. 

Certain features foster such relationships and practices:  teachers
with higher education or specialized training in early childhood
education, a low child-to-staff ratio, small group size, and low
teacher turnover.\36 A curriculum that includes daily and long-range
plans for groups of children and individual children is another
important feature. 


--------------------
\35 Studies of the importance of adult-child relationships in
children's language development are reported in Jerome Bruner,
Child's Talk (New York:  Norton Publishers, 1983).  See also
Developmentally Appropriate Practice in Early Childhood Programs
Serving Children From Birth Through Age 8, NAEYC, Sue Bredekamp, ed. 
(Washington, D.C.:  1987); and National Research Council, Who Cares
for America's Children?  (Washington, D.C.:  National Academy Press,
1990). 

\36 Experts refer to these features as "structural characteristics."
Research indicates that these characteristics (1) can help create an
environment that generally fosters children's development and (2) may
have implications for specific aspects of a child's development, such
as language development.  For a discussion of the specific effects of
structural characteristics on child development and on center
quality, see Who Cares for America's Children?  (1990) and Quality in
Child Care:  What Does the Research Tell Us?  Deborah A.  Phillips,
ed.  (Washington, D.C.:  NAEYC, 1987). 


      CHILD DEVELOPMENT FOSTERED
      BY TEACHERS WITH MORE
      EDUCATION OR SPECIALIZED
      TRAINING
-------------------------------------------------------- Chapter 2:1.1

Higher levels of education or specialized training in child
development is a characteristic strongly related to the quality and
frequency of a teacher's interaction with the child.\37

Teachers who have had postsecondary education and those with
specialized training in early childhood education better encourage
child development.  For example, teachers with more training are less
directive, more responsive to children's needs, and encourage
children's expressiveness.  Teachers can obtain training in early
childhood development as part of a college or university program, or
they can obtain a Child Development Associate's credential (CDA).\38


--------------------
\37 Who Cares for America's Children? 

\38 The U.S.  Office of Child Development, now the Administration for
Children, Youth, and Families, initiated the Child Development
Associate program in 1971 in response to the need for qualified staff
for early childhood programs, especially Head Start.  Individuals who
have accumulated 480 hours working with children in the last 5 years
and who have 120 hours of postsecondary training in early childhood
education or development may qualify for the credential. 


      CHILD DEVELOPMENT FOSTERED
      BY LOW CHILD-TO-STAFF RATIO
-------------------------------------------------------- Chapter 2:1.2

Generally, experts recommend a ratio of no more than 10 children to 1
staff person in early childhood centers for children aged 3 and 4. 
Some researchers have found that low child-to-staff ratios facilitate
good caregiving behaviors, such as use of developmentally appropriate
practices and increased interactions between adults and individual
children.\39


--------------------
\39 Findings on the effects of low child-to-staff ratios are
inconclusive, with some studies finding positive effects for some age
groups but not others.  For example, the National Day Care Study
found that smaller child-to-staff ratios were important to the
practices of providers caring for infants and toddlers but did not
have significance for older preschoolers.  Other studies, however,
have found that child-staff ratio is an important factor in
children's and caregivers' behavior in center-based programs.  See,
for example, C.  Howes and J.  Rubenstein, "Determinants of Toddlers'
Experiences in Daycare:  Age of Entry and Quality of Setting," Child
Care Quality, 14:140-151 and Deborah Phillips, "Thresholds of
Quality:  Implications for the Social Development of Children in
Center-Based Child Care," Child Development, Vol.  63 (1992), pp. 
449-460. 


      CHILD DEVELOPMENT FOSTERED
      BY SMALL GROUP SIZE
-------------------------------------------------------- Chapter 2:1.3

Small group size is also generally recognized as a feature
contributing to the development of the child.  For example, some
studies have found that smaller group sizes are associated with more
positive interactions between staff and children.\40

Recommended group sizes vary according to the age of the children. 
For children aged 3 and 4, experts recommend a group size of no more
then 20 children.\41


--------------------
\40 See C.  Howes, "Caregiver Behavior and Conditions of Caregiving,"
Journal of Applied Developmental Psychology, Vol.  4 (1983) pp. 
99-107 and "Thresholds of Quality:  Implications for the Social
Development of Children in Center-Based Child Care," pp.  449-460. 

\41 This is the criterion established by NAEYC for early childhood
programs seeking accreditation.  See Accreditation Criteria and
Procedures of the National Academy of Early Childhood Programs
(Washington, D.C.:  NAEYC, 1984). 


      CHILD DEVELOPMENT FOSTERED
      BY LOW TEACHER TURNOVER
-------------------------------------------------------- Chapter 2:1.4

Continuity in the adult-child relationship is important to foster
child development; researchers use staff turnover as one measure of
continuity.  The research has demonstrated that children develop best
in centers where there is low teacher turnover.  Low turnover is
related to teacher compensation:  teachers are more likely to remain
in centers where they receive adequate salaries and benefits.  While
estimates of average teacher turnover vary, a 1992 study reported an
average turnover rate of 26 percent between 1991 and 1992 in early
childhood centers nationwide.\42

We previously found that high-quality centers had, on average, a 25
percent teacher turnover rate.\43 In order to capture these
dimensions, a curriculum needs to be written, according to experts. 


--------------------
\42 The National Child Care Staffing Study Revisited (Oakland,
California:  Child Care Employee Project, 1992), found this 26-
percent rate, much lower than the 41 percent it found in its 1988
National Child Care Staffing Study.  The study included very few
school-sponsored centers and no Head Start centers. 

\43 See Early Childhood Education:  What Are the Costs of
High-Quality Programs?  (GAO/HRD-90-43BR, Jan.  24, 1990).  In this
report, high-quality centers were those that met accreditation
standards of the National Association for the Education of Young
Children. 


      CHILD DEVELOPMENT FOSTERED
      BY A CURRICULUM
-------------------------------------------------------- Chapter 2:1.5

A curriculum, including daily and long-range plans for both groups of
children and individual children, is a feature that fosters child
development.  Studies have shown that children develop better when
their activities are planned to include a balance between those that
are teacher-directed and child-initiated; structured and
unstructured; small group, large group, and individual; and quiet and
active.\44


--------------------
\44 See Who Cares for America's Children? 


   PARENT SERVICES HELP PREPARE
   CHILDREN FOR SCHOOL
---------------------------------------------------------- Chapter 2:2

Encouraging parents to become actively involved in their children's
learning can lead to more supportive interactions between parents and
children; enhance the parental role as the principal influence in the
children's education and development; and have positive impacts for
both parents and child, according to experts.  Children who receive
encouragement and support from their parents are more likely to
develop confidence and an expectation that they can succeed,
attitudes that sustain an interest in learning.\45 In addition,
parental involvement in children's learning experiences is an
especially important element in preparing children for school. 
Children whose parents read to them and engage them in conversation
are more likely to do better in school.\46

Parent practices are important in children's preparation for school,
researchers have found.  Parent services at centers can facilitate
parental involvement by offering meetings with parents, involving
parents at their child's center, supporting the parent's own
development through general education or training opportunities, and
visiting the child's home to help the parent expand on the child's
center experience. 

Because more parents work today, researchers and early childhood
providers have begun to view full-day programs as a critical parent
service.  This service is necessary because it enables the parent to
work and, at the same time, addresses the child's need for safe care
that potentially helps her or his development.  With welfare reform
potentially requiring many more parents to work, full-day child care
will almost certainly continue to be a pressing need. 


--------------------
\45 "Zero to Three," Heart Start:  The Emotional Foundations of
School Readiness (Virginia:  National Center for Clinical Infants
Program, 1992). 

\46 Ernest L.  Boyer, Ready to Learn:  A Mandate for the Nation (New
York:  Carnegie Foundation for the Advancement of Teaching, 1991). 


   HEALTH CARE AND NUTRITION
   SERVICES HELP PREPARE CHILDREN
   FOR SCHOOL
---------------------------------------------------------- Chapter 2:3

The literature on early childhood development documents the
importance of health care and nutrition to children's well-being,
including their development and school achievement.  Children who are
in poor health may be absent from school more often or unable to
perform in class, or they may exhibit disruptive behavior.  In
addition, untreated injuries or health problems can lead to permanent
disabilities that impair a child's cognitive abilities.  Finally,
appropriate health care during the early childhood years can detect
and treat conditions that affect a child's performance in school,
such as learning disabilities.\47

Numerous studies have also shown that poor nutrition adversely
affects children's ability to learn.  For example, children who are
not well-nourished "perform poorly on problem solving and
psychological, cognitive, verbal, and visual tests." Poor nutrition
can also result in "apathy, inattentiveness, problems interacting
with others, and other learning problems."\48

The health services that early childhood centers can provide range
from (1) requiring a physician's statement about the child's general
health and immunization record; (2) screening for hearing, speech,
and vision to identify problems; and (3) providing access or referral
to health care providers to address the problems identified.  For
example, medical and dental examinations are a type of health service
a center might provide or refer families to.  Some centers may
provide health care services to all children routinely, some only
when the need arises.  Providing regular, nutritious meals and snacks
is another important way centers can support a child's health. 


--------------------
\47 Nicholas Zill, Child Health and School Readiness.  Researchers
believe that many disadvantaged children have conditions that go
undetected during their early childhood years.  Reported rates of
chronic health conditions that impair a child's activity are much
higher for school-aged disadvantaged children--9.6 percent--than for
those under age 5. 

\48 Office of the Surgeon General, Parents Speak Out for America's
Children:  Report of the Surgeon General's Conference (Washington,
D.C.:  1992). 


MOST DISADVANTAGED CHILDREN DO NOT
RECEIVE SERVICES FROM EARLY
CHILDHOOD CENTERS THAT PREPARE
THEM FOR SCHOOL
============================================================ Chapter 3

Early childhood centers do not provide most disadvantaged children
the full range of services--child development, parent, and health and
nutrition--that they need to be prepared for school.  The majority of
disadvantaged children do not attend early childhood centers to help
them prepare for school, in spite of the first national education
goal that all children have access to high quality, developmentally
appropriate preschool. 

Many of these children stay at home or in family child care homes,
where high-quality services can be provided but a full range of
services is often unavailable.  Of the disadvantaged children who do
attend centers, most attend centers less likely than Head Start
centers to provide the full range of services.  Even Head Start
centers, however, vary in the quality of services provided and in the
percentage of children actually receiving services, according to
recent studies. 

Of the disadvantaged children who do attend early childhood centers,
most attend school-sponsored, nonprofit, or for-profit centers.  All
centers provide nutrition services through regular meals and snacks. 
However, school-sponsored centers are less likely than Head Start to
provide parent and health services; and for-profit and nonprofit
centers are less likely than Head Start to provide child development,
parent, and health services. 


   MOST DISADVANTAGED CHILDREN DO
   NOT ATTEND EARLY CHILDHOOD
   CENTERS
---------------------------------------------------------- Chapter 3:1

Disadvantaged children, who are most likely to face difficulties upon
entering school and who would benefit most from attending early
childhood centers, are the least likely to attend them.\49

According to our analysis of the 1990 decennial census, about 65
percent of disadvantaged children--a total of 1.8 million
children--did not attend early childhood centers in 1989.  By
contrast, only about 40 percent of children in high-income
families--those who earn above $63,370 for a family of four--did not
attend early childhood centers (see fig.  3.1).\50

   Figure 3.1:  Most Disadvantaged
   Children Do Not Attend Early
   Childhood Centers

   (See figure in printed
   edition.)

In all states, the majority of disadvantaged children--from 55 to 74
percent--do not attend early childhood centers.  In 16 states, 70
percent or more do not attend (see fig.  3.2).\51

   Figure 3.2:  Majority of
   Disadvantaged Children in All
   States Do Not Attend Early
   Childhood Centers

   (See figure in printed
   edition.)

Although Head Start funding almost doubled from $1.6 billion in 1990
to $2.8 billion in 1993,\52 Head Start served only an estimated 29
percent of all eligible 3- and 4-year-old children in 1993.  In
addition, many disadvantaged children are in families whose income is
not low enough to qualify for Head Start, although it is low enough
to qualify for other forms of public assistance. 

Instead of attending early childhood centers, many disadvantaged
children stay at home or in another's home, either a relative's or
nonrelative's.  A recent study of child care use among families with
low incomes found that 51 percent of the children aged 5 and younger
of employed single mothers were either cared for in a relative's home
or in family day care.  Recent family child care studies have
identified successful efforts that improve the quality and extend the
services offered in family child care.\53

Though some family child care providers offer high-quality services,
family child care often lacks features that foster child development
and does not offer parent or health services.\54 Recent research on
children, including the disadvantaged, who are cared for in homes
other than their own found that while a minority of providers gave
care that fostered children's development, most providers provided
"adequate care" that neither helped nor hindered children's
development.\55

Family child care providers who are also low income often encounter
difficulties providing disadvantaged children with a full range of
services to prepare them for school.  These providers also face
significant barriers in obtaining information and resources,
including training, to enhance the quality of care they provide. 
While recent efforts by both federal and state governments aim to
improve the quality and extend the kinds of services provided in
family child care, family child care providers are still highly
decentralized and among the "most isolated of child care services."

MANY DISADVANTAGED CHILDREN ATTEND CENTERS THAT PROVIDE
LIMITED SERVICES

Of disadvantaged children who attend early childhood centers, our
analysis of national data indicates 59 percent attend centers that
are less likely than Head Start centers to provide the full range of
child development, parent, and health services (see fig.  3.3).\56
These disadvantaged children attend nonprofit centers (30 percent) or
for-profit centers (11 percent), both of which are less likely than
Head Start centers to provide any of these services; others attend
school-sponsored centers (18 percent), which may not provide parent
and health services but are likely to provide child development
services. 

The remaining disadvantaged children attend Head Start centers (41
percent).  Although Head Start centers generally provide a full range
of services, the quality of services does vary as does the percentage
of children actually receiving services, according to recent studies. 
A 1993 report of the Office of Inspector General, HHS, found that the
percentage of Head Start children actually receiving health services
was not as high as reflected in HHS reports and databases.\57 In
addition, the quality of Head Start services was a key issue for the
Advisory Committee on Head Start Quality and Expansion, created in
1993 by the current administration to aid in the recent Head Start
reauthorization.\58 In response to such concerns, the 1994
reauthorizing legislation amended the program to require, for
example, that HHS terminate an agency's designation as a Head Start
grantee, after determining a program is deficient, if the grantee
agency fails to promptly address the deficiency.\59

   Figure 3.3:  Many Disadvantaged
   Children Are in Centers Other
   Than Head Start

   (See figure in printed
   edition.)


--------------------
\49 Disadvantaged children in this database refer to those identified
as receiving some form of public assistance, including AFDC, food
stamps, or Special Supplemental Food Program for Women, Infants, and
Children (WIC) benefits. 

\50 See Poor Preschool-Aged Children:  Numbers Increase but Most Not
in Preschool (GAO/HRD-93-111BR, July 21, 1993).  These children are
disadvantaged because they live in families with an annual household
income at or below 185 percent of OMB's definition of poverty.  The
1990 census, which we used for this tabulation, has a number of
limitations.  First, it captures responses to a question that asked
whether or not a child is enrolled in school and specified "nursery
school" as an example.  Thus, answers to this question may be
difficult to interpret, given the variety of early childhood settings
and the terms used to describe them.  Second, this census data may be
an underestimate since enrollments at all levels of education were
underreported by 5 percent, according to Census officials.  Our
finding, however, is supported by another database, the 1991 National
Household Education Survey, National Center for Education Statistics,
Department of Education (Washington, D.C.:  Feb.  1993), which is
based on responses to a series of questions designed to capture the
full range and variety of children's experiences in nonparental care. 
This survey reports fewer disadvantaged children not attending early
childhood centers, but similar patterns across income levels.  For
example, this survey found that about 55 percent of children in
families with incomes below $30,000 per year did not attend an early
childhood center, compared with 20 percent of children whose families
earn more than $75,000 per year. 

\51 In the District of Columbia, a lower percentage of disadvantaged
children--49 percent--do not attend early childhood centers compared
with the 50 states. 

\52 The expansion of Head Start continues with fiscal year 1994
appropriations of $3.3 billion and fiscal year 1995 appropriations at
$3.5 billion. 

\53 See Using Federal Funds to Expand and Improve Child Care:  Focus
on Family Day Care, National Center for Children in Poverty, Family
Day Care Initiative Brief (May 1991).  Innovative programs, funded by
federal and state governments and private organizations, are designed
to link family child care providers with one another and other
services to facilitate their providing a full range of services to
children.  For example, see our recent study, which reports on 11
such efforts, Child Care:  Promoting Quality in Family Child Care
(GAO/HEHS-95-36, Dec.  7, 1994). 

\54 As mentioned previously, some states are now focusing efforts on
improving the quality of care in family child care settings.  See
Family Child Care:  Innovative Programs Promote Quality
(GAO/HEHS-95-43, Dec.  7, 1994). 

\55 Ellen Galinsky, Carollee Howes, Susan Kontos, and Marybeth Shinn,
The Study of Children in Family Child Care and Relative Care (New
York:  Families and Work Institute, 1994).  The findings of this
study are not nationally representative but reflect care outside the
home in three communities in which low-income and minority areas were
oversampled. 

\56 The distribution of disadvantaged children attending the various
center types was estimated using data on the percentage of children
receiving public assistance as reported in the Mathematica survey. 
Although some children may attend more than one kind of center, we
believe that number is small.  For a detailed methodology of the
analyses, see appendix III. 

\57 Evaluating Head Start Expansion Through Performance Indicators
Office of Inspector General (Washington, D.C.:  HHS, 1993). 

\58 HHS has undertaken several new initiatives to improve Head Start
quality in response to the Advisory Committee's recommendations. 
Among these initiatives are the development of partnerships with
other federal programs such as WIC to increase Head Start families'
access to services, an extensive national assessment of Head Start
grantees' training and staff development needs, and the establishment
of seven workgroups that are focusing on developing strategies for
implementing quality improvement initiatives.  For example, the
workgroup on Performance Standards and Performance Measures has held
a series of focus groups on how Head Start performance standards
should be revised.  The workgroup is now rewriting the standards. 

\59 Agencies receiving Head Start funds to operate programs are known
as grantees and are authorized to subcontract with separate
organizations--delegate agencies--to carry out Head Start programs. 
Grantees provide both administrative and programmatic support to
their delegate agencies.  HHS has identified 125 grantees as "poor
performers," and the appropriate regional offices are now working
with these grantees to improve their performance.  Of the identified
poor performers, six grantees have had grants terminated or
voluntarily relinquished their grants. 


      FOR-PROFIT AND NONPROFIT
      CENTERS ARE MORE LIKELY TO
      LACK FEATURES OF CHILD
      DEVELOPMENT SERVICES
-------------------------------------------------------- Chapter 3:1.1

Although some for-profit and nonprofit centers may be model centers
because they offer all features of child development services, others
lack these features.  Our analysis of national data indicates that,
overall, for-profit and nonprofit centers are more likely to lack
features of child development services compared with school-sponsored
or Head Start centers, according to center directors (see fig.  3.4). 

To determine whether or not a center provides child development
services, we looked at features that foster child development.  As
described in chapter 2, these features include teachers with more
than a high school diploma or General Equivalency Degree (GED), a
ratio of 10 children or fewer to one staff member, a group size of 20
or fewer, teacher turnover no higher than 25 percent annually, and a
written curriculum.  These features can help create an environment
that enhances the teacher's capacity to be more responsive to the
needs of the child, thereby promoting the child's development.  In
addition, for-profit and nonprofit centers received lower ratings in
a recent observational study of interactions between teachers and
children.\60

   Figure 3.4:  For-Profit and
   Nonprofit Centers More Likely
   to Lack Features of Child
   Development Services

   (See figure in printed
   edition.)


--------------------
\60 This study used multiple instruments to measure interactions
between teachers and children, the behavior of both teachers and
children in the classroom, and the overall classroom environment. 
See The Observational Study of Early Childhood Programs, Development
Assistance Corporation (Washington, D.C.:  Department of Education,
1993). 


      FOR-PROFIT AND NONPROFIT
      CENTERS
-------------------------------------------------------- Chapter 3:1.2

For-profit and nonprofit centers are more likely to lack features of
child development services compared with other kinds of centers, even
though many do provide such services (see fig.  3.4).  For example,
our analysis indicates that for-profit and nonprofit centers are more
likely to employ teachers with only a high school diploma or GED.  In
for-profit centers, more than 1 in 5 teachers (21 percent) has earned
no more than a high school diploma or GED; in nonprofit centers, more
than 1 in 10 teachers (11 percent) has earned only a high school
diploma or GED.  In high-poverty areas, a greater percentage of
teachers in for-profit and nonprofit centers have only a high school
diploma or GED compared with low-poverty areas.\61 By contrast,
virtually all teachers in both Head Start and school-sponsored
centers have more than a high school diploma or GED.\62

More than a quarter of for-profit and nonprofit centers (35 and 25
percent, respectively) have child-to-staff ratios higher than 10 to
1--at least three times the percentage among Head Start centers (8
percent).  Only with regard to group size are for-profit and
nonprofit centers about the same as other kinds of centers; 14
percent of for-profit and 15 percent of nonprofit centers have large
groups of more than 20 children. 

For-profit and nonprofit centers also reported high rates of
turnover.  About a third of for-profit centers and nonprofit centers
lost more than one in four of their teachers during the previous
year.  However, Head Start centers reported high turnover rates as
well.  With regard to written curriculum, for-profit (14 percent) and
nonprofit (17 percent) centers are more likely to have no written
curriculum than Head Start centers (7 percent). 

When comparing for-profit and nonprofit centers to each other,
differences emerge.  According to the national data, for-profit
centers are less likely than nonprofit centers to have features of
child development services.  For example, for-profit centers were
more likely to employ teachers with only a high school degree or GED
and to report child-to-staff ratios above recommended levels. 

The nonprofit and for-profit centers that we visited varied in their
child development services.  While many had features that conformed
to the recommendations of child development experts, some did not. 
For example, a nonprofit center in Michigan and a for-profit center
in California had teachers with no training beyond a high school
diploma.  With regard to group sizes, a Michigan nonprofit center
served children aged 2-1/2 to 12 in a group as large as 40 children,
although the group size fluctuated because some children were served
part time and after school or on an drop-in basis.  Similarly, a
nonprofit center in California had a group of 36 children aged 2 to
5. 


--------------------
\61 Our analysis of the Mathematica database by poverty area revealed
that 29 percent of the for-profit centers in high poverty areas had
teachers with no more than a high school degree or GED compared with
13 percent in low-poverty areas.  Seventeen percent of nonprofit
centers in high-poverty areas had teachers with no more than a high
school degree or GED compared with 5 percent in low-poverty areas. 

\62 The vast majority of teachers in school-sponsored centers (87
percent) have a bachelor's or graduate degree. 


      SCHOOL-SPONSORED CENTERS
-------------------------------------------------------- Chapter 3:1.3

School-sponsored centers provide children with most features of child
development services.  Compared with for-profit and nonprofit
centers, school-sponsored centers are less likely to lack features of
child development services.  Our analysis of national data indicates
that virtually all teachers in school-sponsored centers (98 percent)
have at least some college or an associate's degree; 87 percent have
a bachelor's or graduate degree.\63 Few directors of school-sponsored
centers reported high rates of turnover:  only 16 percent of these
centers have a turnover greater than 25 percent. 

In addition, directors of nearly one-fifth (19 percent) of
school-sponsored centers reported a child-to-staff ratio exceeding
the recommended 10 to 1.  There are no significant differences
between school-sponsored centers and other kinds of centers in terms
of group size:  14 percent have large groups of more than 20
children.  School-sponsored centers (14 percent) are about as likely
as nonprofit (17 percent) and for-profit centers (14 percent) not to
use a written curriculum. 

In all four states, school-sponsored centers we visited had features
that were generally consistent with expert recommendations for child
development services.  Almost all teachers in the school-sponsored
centers we visited had bachelor's or master's degrees in education;
most of these degrees were in early childhood education, and many of
the teachers also had earned other forms of early childhood
certification.  All of the school-sponsored centers we visited
maintained child-to-staff ratios and group sizes within limits
recommended by experts.  For example, two Michigan centers maintained
lower child-to-staff ratios and group sizes than recommended by
experts and served groups of 18 children, with one staff member to
every 9 children. 


--------------------
\63 Unless the teacher specifies child development associate's
degree, the Mathematica database does not specify whether or not a
teacher's education is in a child development-related field. 


      HEAD START CENTERS
-------------------------------------------------------- Chapter 3:1.4

Head Start centers generally exhibit the features important to child
development.  Virtually all teachers--99 percent--have at least some
college or an associate's credential; 45 percent have a bachelor's or
graduate degree.\64 Head Start centers are less likely than all other
kinds of centers to have a child-to-staff ratio greater than 10 to 1;
only 8 percent of Head Start center directors reported higher ratios. 
Although only 9 percent of Head Start centers exceed the recommended
group size of 20 children, that is not a significant difference from
other kinds of centers.  As for written curriculum, only 7 percent of
Head Start centers do not use one compared with 17 percent of
nonprofit and 14 percent of for-profit centers. 

However, in one area, Head Start centers do little better than
nonprofit centers.  Children in some Head Start centers are likely to
experience a lack of continuity in care that comes from high staff
turnover.  Head Start center directors reported turnover rates close
to those experienced by nonprofit centers; a quarter of Head Start
centers had lost more than one in four staff members during the
previous year. 


--------------------
\64 Head Start centers are unique in the high proportion of teachers
with a child development associate's credential.  While 29 percent of
Head Start teachers have this credential, a much lower proportion of
teachers in other kinds of centers have it.  Beginning September 30,
1996, each Head Start classroom will have to have a teacher who has
the child development associate's or comparable credential. 


      PARENT SERVICES LESS LIKELY
      TO BE AVAILABLE IN CENTERS
      OTHER THAN HEAD START
-------------------------------------------------------- Chapter 3:1.5

Although involving parents in a child's learning has been shown to
positively influence child development, parent services were less
likely to be available in school-sponsored, nonprofit, and for-profit
centers than in Head Start centers.\65 According to our analysis of
national data, the only exception was meetings with parents of each
child; directors of a majority of all kinds of centers reported that
these meetings were regularly scheduled, as illustrated in figure
3.5.  Centers other than Head Start, however, were less likely to
involve parents in other activities, for example, as classroom
volunteers or in governance efforts such as selecting staff or
reviewing budgets.  Head Start centers were more likely to get
parents to attend workshops or classes and send staff to visit each
child's home.  A substantial proportion of school-sponsored center
directors reported involving parents in all of these activities.  Our
analysis of the Mathematica database by poverty area revealed no
statistically significant differences between high and low poverty
areas in terms of any of the parent services. 

   Figure 3.5:  Parent Services
   Less Likely to Be Available in
   Centers Other Than Head Start

   (See figure in printed
   edition.)

All three for-profit centers that we visited offered only limited
parent services.  For example, a for-profit center in Louisiana
offered individual parent conferences only when there was an extreme
discipline problem.  Some nonprofit centers we visited, however, were
able to provide more extensive parent services.  A Michigan nonprofit
center, for example, offered more parent services, including GED
classes for parents; the center was sponsored by a community center
that made such services available.  One nonprofit center we visited
in California provided referrals to services on the basis of a needs
assessment done for each parent.  A parent advisory committee meets
monthly and, according to the center director, virtually all parents
volunteer in some fashion. 

The school-sponsored centers we visited typically offered more parent
services than the for-profit and nonprofit centers.  Although
school-sponsored centers did not have paid parent coordinators, as
did Head Start centers, one school-sponsored center used a volunteer
parent as a liaison to encourage other parents to get involved in
center activities.  Some school-sponsored centers also offered
training in better parenting and, sometimes, referred parents to
education or training opportunities to support the parent's own
development.  Directors of some school-sponsored centers reported
that staff visited children's homes; however, in some cases this was
done only if a child was experiencing problems. 

Recognizing the importance of parent involvement, some
school-sponsored centers we visited were attempting to expand parent
services.  For example, a center in Louisiana was planning to hire an
early childhood facilitator to design parent workshops, according to
school officials.  A Michigan center was trying to strengthen the
commitment of parents to the center by having them sign a contract at
the beginning of the year pledging to (1) volunteer at least once a
month and (2) help children with learning activities at home. 

The Head Start centers we visited took an active approach to parent
involvement, combining a range of services with frequent parent
contact.  These centers sometimes employed a parent coordinator, who
might be shared with several other centers through the grantee or
delegate agency.  Coordinators worked directly with parents to help
involve them at the center and to help them gain access to other
services.  Almost all centers offered individual conferences with
parents at least twice a year; in two Head Start Centers, conferences
took place once a month.  In the centers we visited, center directors
reported that home visits were conducted routinely for each child,
sometimes several times a year.  All Head Start centers also offered
a range of activities to parents, from serving on the center's policy
council to training in how to be a better parent, as well as literacy
and GED classes. 


--------------------
\65 The Mathematica survey asked center directors if parents
regularly participate in each of a number of activities.  The survey
also asked if staff regularly schedule meetings with parents or do
home visits.  The data do not reflect the number of parents that
actually participated in each activity. 


      HEALTH SERVICES LESS LIKELY
      TO BE PROVIDED IN CENTERS
      OTHER THAN HEAD START
-------------------------------------------------------- Chapter 3:1.6

Although good health is important to a child's preparedness for
school, centers other than Head Start were not likely to provide many
health services, according to our analysis of national data (see fig. 
3.6).\66 Nonprofit and for-profit centers were least likely to
provide health services; in only about half of these centers,
according to directors, were screenings for hearing, speech, and
vision problems provided; provision of physical or dental
examinations was rare.  School-sponsored centers almost always
provided screenings for hearing, speech, and vision problems, but
less than a third offered physical or dental examinations.  However,
school-sponsored centers in high-poverty areas were more likely to
offer dental examinations than were those in low-poverty areas.\67
Head Start centers provided more health services or referrals to
these services than other kinds of centers.  Directors of the vast
majority of Head Start centers reported providing physical
examinations and dental examinations, as well as screenings for
hearing, speech, and vision problems. 

   Figure 3.6:  Health Services
   Less Likely to Be Provided in
   Centers Other Than Head Start

   (See figure in printed
   edition.)

In the states we visited, all nonprofit and for-profit centers
required statements from physicians about the status of the child's
health, including immunizations.  However, some of the nonprofit and
for-profit centers we visited offered few health services beyond such
protections.\68 A Louisiana for-profit center, for example, was
unable to offer any health services other than to alert social
workers to a serious health problem that a parent was neglecting. 

In two states, some nonprofit centers that we visited went beyond
this minimum, however.  In California, centers funded by the state
were required to identify the health needs of children, refer them
for services, and provide follow up.  In Michigan, several centers we
visited also provided some health-related screenings and had staff
make referrals and follow-up to help ensure children received
services.  The existence of several children's initiatives in
Michigan--including vision and hearing screening programs--made it
possible for these centers to gain access to the additional services
for their children.  Unlike Head Start centers, however, these
centers in Michigan and California did not employ health coordinators
to provide or refer children to health services, nor did these
centers have funds to pay for treatment if no other source of funding
was available. 

The school-sponsored centers we visited often provided more health
services than nonprofit and for-profit centers.  For example,
school-sponsored centers generally screened all children for health
problems.  In centers we visited in Louisiana, Maryland, and
Michigan, affiliation with the public school system helped these
centers obtain some health services.\69 As part of the school system,
some school-sponsored centers had access to health staff, such as
nurses and social workers.  School-sponsored centers could also refer
children to schoolwide teams to (1) determine whether a child was
eligible for special education services because of a disability or
(2) make referrals to a community service or private medical
provider.  However, staff in two centers said these school system
services were spread thinly across all children in a school or
several schools.  Therefore, some health services were not provided
routinely but only when a need arose.  In California,
school-sponsored centers were required to refer children to health
providers and then follow up on the problems that were identified by
the screenings. 

Head Start centers we visited devoted staff and other resources to
help ensure that all children received the health services, including
screenings and treatment, required by Head Start performance
standards.  Some Head Start centers had coordinators, shared with
other centers through the grantee or delegate agency, to provide or
refer children to health services.  The coordinator in one center we
visited was a nurse.  In addition, a few centers had a health aide to
ensure that each child received care.  Some centers hired other
health care providers, such as child psychologists, through the
grantee.  All Head Start centers can use Head Start funds to help pay
for health care if no other source is available to the child. 


--------------------
\66 The Mathematica survey asked center directors whether their
centers "provide" specific health services.  Our case studies show
that some centers may "provide" these health services by referring
the child to another agency instead of delivering the service
directly.  The data do not reflect whether or not children actually
received health services. 

\67 Our analysis of the Mathematica database by poverty area revealed
that 39 percent of school-sponsored centers offered dental exams in
high-poverty areas compared with 12 percent in low-poverty areas. 
While a greater percentage of school-sponsored centers offered other
types of health services (physical exams and screenings for hearing,
speech, and vision) in high-poverty areas compared with low-poverty
areas, the differences were not statistically significant. 

\68 Basic health and safety protections guard against the spread of
contagious disease, help providers meet emergency and other health
needs of sick children, and protect against fire and other disasters. 
These protections do not include the provision of screenings for
hearing, speech, and vision problems; physical and dental exams; or
referral and follow-up to promote children's general health. 

\69 The school-sponsored centers we visited in California were
colocated with Head Start centers and followed Head Start standards. 
All children attending these centers--most of whom were also Head
Start-eligible--received all health services typically offered
through Head Start. 


      NUTRITION SERVICES PROVIDED
      BY MOST CENTERS
-------------------------------------------------------- Chapter 3:1.7

Most centers of all kinds provide nutrition services through regular
meals and snacks, according to our analysis of national data.  Head
Start centers generally fund meals and snacks through the U.S. 
Department of Agriculture (USDA) food assistance program, called the
Child and Adult Care Food Program (CACFP), which provides cash
reimbursement and donated food.\70

School-sponsored, nonprofit, and for-profit centers are much less
likely than Head Start centers to participate in CACFP.  (See fig. 
3.7.) However, nonprofit and for-profit centers participate at higher
rates in high-poverty areas compared with low-poverty areas.\71

   Figure 3.7:  Most Centers Offer
   Regularly Prepared Meals and
   Snacks

   (See figure in printed
   edition.)

Most school-sponsored centers that we visited funded meals through
CACFP or the National School Lunch Program, another USDA food
assistance program.\72 Although all nonprofit and some for-profit
centers we visited are eligible to participate in CACFP, two
for-profit centers had to supply their own food because they
experienced difficulties qualifying for the program.  For-profit
centers are allowed to participate in CACFP only if 25 percent of
enrolled children or 25 percent of the center's licensed child
capacity is eligible to receive compensation under Title XX of the
Social Security Act.\73

Given the increased availability of federal child care funding from
sources other than Title XX, some states may decide to allocate fewer
Title XX dollars to child care.  This would result in fewer centers
being eligible for USDA food programs.  USDA has undertaken a pilot
project to test expanding the eligibility of for-profit centers for
CACFP; under the pilot project, for-profit centers qualify if 25
percent of children are from families whose incomes are at or below
185 percent of the federal poverty level.  In part because of the
cost implications of increasing participation among centers, CACFP
has not yet been expanded to include more for-profit centers by using
this eligibility criterion. 


--------------------
\70 CACFP is one of many USDA food assistance programs.  In addition
to serving elderly or impaired adults in adult care centers, its
purpose is to provide nutritious meals and snacks to children by
providing cash and commodity foods to maintain nonprofit meal
services in nonresidential institutions such as child care centers. 

\71 Our analysis of the Mathematica database by poverty area revealed
that 52 percent of nonprofit centers participated in CACFP in
high-poverty areas compared to 20 percent in low-poverty areas. 
Sixteen percent of for-profit centers in high-poverty areas
participated in CACFP compared to 3 percent in low-poverty areas. 

\72 The National School Lunch Program provides cash and commodity
foods through schools, both public and private nonprofit. 

\73 States have the discretion to use Title XX funding for a variety
of social service-related purposes, including child care, and are
allowed to set their own eligibility requirements. 


LIMITED PLACES AND SUBSIDIES, AS
WELL AS NARROW PROGRAM MISSIONS,
IMPEDE CENTERS' EFFORTS TO PROVIDE
SERVICES TO DISADVANTAGED CHILDREN
============================================================ Chapter 4

We found two key reasons why many disadvantaged children may not
receive the full range of needed center services.  First, many
disadvantaged children are unable to enroll in early childhood
centers because of either the limited slots available or limited
subsidies.  Second, programs that fund these centers have
historically had narrow missions that constrain the provision of
needed services so that even those disadvantaged children who attend
centers do not necessarily receive the full range of services they
need to be prepared for school. 

Such constraints in the provision of services result from (1) program
standards, (2) the allocation of scarce resources, and (3) barriers
to collaboration between centers so that they can expand services. 
Nevertheless, some state and local initiatives have demonstrated how
a full range of services can be provided to disadvantaged children;
such initiatives have required added resources and substantial
efforts by program administrators to overcome differences between
programs. 


   LIMITED PLACES AND SUBSIDIES
   CONTRIBUTE TO LOW PARTICIPATION
---------------------------------------------------------- Chapter 4:1

Low participation of disadvantaged children in early childhood
centers appears to result, at least partially, from lack of slots
available in early childhood centers.  Even with the expansion of
Head Start, the growing number of disadvantaged children means that
there are not enough places in centers for all the children whose
parents want them to attend.  The number of disadvantaged 3- and
4-year-old children, according to our analysis of the 1990 decennial
census, increased from 2.4 million in 1980 to 2.8 million in 1990, a
17-percent increase.  Even Head Start--the largest federal child
development program--is funded at a level that permits serving only
752,000 children in fiscal year 1995.  Information on the number of
3- and 4-year-old children enrolled in other federal and state-funded
early childhood programs is limited.\74

The gap between the number of disadvantaged children and the number
served by early childhood centers, however, is not an accurate
indicator of the demand for center places.  Parents may not seek to
enroll their children in centers because they prefer other
arrangements, such as care in their own home or in family child care,
or their access to centers may be impeded by inconvenient hours of
operation, as discussed later in this chapter, or by high costs. 

In every low-income census tract that we visited, we found at least
one center that had a waiting list, indicating there may not always
be enough places within centers to meet demand.  Several centers
reported that children on waiting lists were placed quickly.  In
three centers, however, staff said some parents enrolled their child
more than a year before the child was old enough to attend in order
to ensure the child would get a place at the center.  Of the four
states we visited, some of the longest lists we found were for
centers in California.  For example, one nonprofit center in
California served 46 children in the 1992-93 school year.  During the
year, however, 148 children were placed on the center's waiting lists
and remained there throughout the year, center staff reported.  A
center sponsored by both Head Start and the public school system in
California served 185 children in the 1992-93 school year, but 182
children were on its waiting list that same year.  Waiting lists,
however, are an imperfect measure of the need for services.\75

Even when places are available, limited subsidies for families to
obtain child care can also make it difficult for children to enroll
in early childhood centers.  Many eligible parents are unable to
obtain subsidies under federal and state child care programs, state
officials reported.\76 Louisiana officials claimed that the parents
of 6,000 eligible children were waiting for CCDBG subsidies because
of inadequate funding.  In our May 1994 study of federal child care
programs, we also reported that many parents were waiting for
subsidies in five of six states visited--California, Illinois,
Massachusetts, New York, and Texas--because of limited funding.\77
Parents of an estimated 40,000 children were waiting for subsidies in
Texas.  Also in the May 1994 study, we cited a 1991 survey of those
waiting for subsidized care in California, which found approximately
255,000 children who were not yet served.  Michigan--the only other
state included in that study--did not track the numbers of parents
waiting for subsidies. 


--------------------
\74 These other programs are Title I, AFDC/JOBS Child Care,
Transitional Child Care, At-Risk Child Care, and CCDBG, as shown in
appendix I.  No counts at all are available for the Title XX-Social
Services Block Grant program.  The Children's Defense Fund estimated
that 270,000 children attended state child development programs in
the 1991-92 school year. 

\75 Qualifications concerning waiting list numbers are well known.  A
waiting list may overstate interest when it is not regularly updated,
or when it includes parents that place a child's name on more than
one waiting list.  In addition, a longer waiting list might simply be
a reflection of the popularity of a center.  In contrast, a waiting
list may understate interest when it does not include the names of
children whose parents were discouraged by the length of the wait, or
when a center restricts the number of children's names on waiting
lists. 

\76 As discussed in chapter 1, federal child care programs primarily
provide subsidies for low-income families to obtain child care. 
Under CCDBG, Title IV-A At-Risk, or state child care programs,
parents might have to wait for subsidies.  The remaining Title IV-A
federal child care programs--AFDC Child Care and Transitional Child
Care--are entitlements to recipients or families.  All federal child
care programs provide subsidies for low-income families to obtain
care in settings of the parent's choice, not limited to care provided
in an early childhood center.  For example, these programs might fund
care in a family child care home.  We did not examine whether or not
parents wait for subsidies under Title XX. 

\77 Child Care:  Working Poor and Welfare Recipients Face Service
Gaps (GAO/HEHS-94-87, May 13, 1994).  Further limiting the access of
working poor, nonwelfare families to child care is the fact that some
states are using CCDBG funds to meet AFDC Child Care entitlements. 


   NARROW PROGRAM MISSIONS
   CONSTRAIN PROVISION OF SERVICES
---------------------------------------------------------- Chapter 4:2

The programs that fund many early childhood centers have historically
had narrow missions that constrain centers' provision of the full
range of services.  The services provided by all types of centers
appear to be most often related to the missions of the funding
programs.  These missions are reflected in variations in programs'
standards, allocation of scarce resources, and differences in
programs that create barriers to collaboration. 


      MISSION OF FEDERAL CHILD
      CARE PROGRAMS FOCUSED ON
      NEEDS OF PARENTS
-------------------------------------------------------- Chapter 4:2.1

The mission of the federal programs that subsidize care in nonprofit
and for-profit centers is primarily focused on providing child care
so that parents can work or attend school or training for employment. 
For example, the legislation for Title IV-A of the Social Security
Act and CCDBG authorize federal funds to assist parents purchasing
child care services while they work or attend training for
employment.  Because these programs place emphasis more on parental
employment and less on child development, parents are free to use
subsidies to obtain care in any setting, regardless of whether it
provides a full range of services for the child.  Some experts have
expressed concern that the subsidies provided to parents under these
programs are generally too low to meet the cost of centers that, at a
minimum, have features of child development services.\78 As a result,
parents may be forced to enroll their children in centers they can
afford, which may offer fewer services, rather than in centers that
provide a full range of services. 

Parents may also be forced to choose centers that do not provide the
full range of services because they need full-day care for their
children.  Nonprofit and for-profit centers are much more likely to
offer full-day care than other kinds of centers.  According to our
analysis of the Mathematica database, few Head Start and
school-sponsored centers (less than 35 percent) provide full-day
care, but most nonprofit and for-profit centers do (see fig.  4.1). 
Nonprofit and for-profit centers are even more likely to offer
full-day care in high-poverty areas than in low-poverty areas.\79
Unfortunately, as we discussed in chapter 3, for-profit and nonprofit
centers are less likely than other kinds of centers to provide the
full range of child development, parent, and health services.  Our
case studies also reflect this problem.  According to staff in a
California center sponsored by Head Start and the public school
system, about half of the parents work full time and have told center
staff they need full-day services.  A survey conducted by a panel of
advisers convened in 1989 by the National Head Start Association
revealed that the greatest need of Head Start parents is for full-day
services. 

   Figure 4.1:  Full-Day Care Not
   Provided by Most Head Start and
   School-Sponsored Centers

   (See figure in printed
   edition.)

Another result of the federal mission of child care programs being
parental employment is that parents may not be entitled to, or could
lose, their child care subsidy for reasons that have little to do
with the child's need for services.  For example, a parent on welfare
is entitled to a child care subsidy, but a low-income nonwelfare
parent is not.  Our state case studies illustrate how parents can
lose their subsidy, regardless of their continued need for child care
and the fact that the child's needs are unchanged.  California's
continued economic recession means less job stability among program
participants, state officials said.  Because federal requirements for
the At-Risk Child Care program do not permit subsidizing child care
during a period of job search, children's care is disrupted when
parents who lose their jobs.  Administrators in California reported
struggling with how to meet child care needs while parents undertake
a job search.\80 Proposed HHS regulations, as well as welfare reform
proposals, attempt to eliminate some of these problems, for example,
allowing the provision of child care during temporary gaps in
employment and training. 


--------------------
\78 Nancy Ebb, Child Care Tradeoffs:  States Make Painful Choices
(Washington, D.C.:  Children's Defense Fund, Jan.  1994).  This study
finds that while AFDC children can and should benefit from more
comprehensive child care and preschool programs, limited funds and
federal policy directives increase the possibility that these
children will get low-quality care.  Needed improvements include
allowing states to pay more reasonable rates; creating opportunities
for AFDC children to benefit from Head Start; strengthening
protections for AFDC child care; and restoring funding for
AFDC-linked quality improvements such as licensing, monitoring, and
training. 

\79 Our analysis of the Mathematica database by poverty area revealed
that 97 percent of for-profit centers operated 8 hours or more in
high-poverty areas compared to 85 percent in low-poverty areas. 
Eighty-seven percent of nonprofit centers operated 8 hours or more in
high-poverty areas compared to 55 percent in low-poverty areas. 

\80 Gaps in the delivery of child care subsidies to the low-income
population because of different federal program requirements, coupled
with resource constraints, are discussed in detail in GAO/HEHS-94-87. 


      MISSION OF SCHOOL-SPONSORED
      PROGRAMS FOCUSED ON CHILD
      DEVELOPMENT
-------------------------------------------------------- Chapter 4:2.2

Because the mission of these programs is shaped by the schools
sponsoring them, school-sponsored programs do not always provide a
broad range of parent or health services.  The mission of
school-sponsored programs focuses primarily on child development. 
Many of these programs have been instituted over the last decade to
improve school performance among children who are at risk of school
failure. 

However, we found evidence that the mission of school-sponsored
programs is changing.  In the four states we visited, school
officials recognized the importance of providing the full range of
services and, in some cases, are emphasizing more cooperative efforts
between schools, children's homes, and community services to increase
the range of services children receive.\81 However, program officials
in the states we visited reported that they face difficulties in
providing a broader range of services. 


--------------------
\81 Schools' traditional lack of emphasis on health and other
nonacademic services may be changing, as described in our two recent
reports, Education Reform:  School-Based Management Results in
Changes in Instruction and Budgeting (GAO/HEHS-94-135, Aug.  23,
1994) and School-Linked Human Services:  A Comprehensive Strategy for
Aiding Students at Risk of School Failure (GAO/HRD-94-21, Dec.  30,
1993).  In School-Linked Human Services, we reviewed 10 comprehensive
school-linked programs attempting to improve the educational
performance and well-being of at-risk, school-age children by
addressing their multiple needs in a coordinated manner at school
sites. 


      MISSION OF HEAD START
      PROGRAM FOCUSED ON ALL OF
      CHILD'S NEEDS
-------------------------------------------------------- Chapter 4:2.3

In contrast to the mission of federal child care and school-sponsored
programs, the mission of the Head Start program focuses on addressing
the many needs of the most disadvantaged children and their families. 
But, as already mentioned, individual Head Start centers may vary in
the quality of services provided and in the percentage of children
actually receiving services, according to recent studies. 


      VARIATION IN PROGRAM
      STANDARDS REFLECTS NARROW
      MISSIONS
-------------------------------------------------------- Chapter 4:2.4

Program standards often reflect the narrow missions of their sponsors
and vary by type of center.\82 In order to be eligible for federal
child care subsidies, for-profit and nonprofit centers are required
to follow only applicable state and local licensing standards.\83 In
the states we visited, licensing standards for child care did not
require a full range of child development, parent, health, and
nutrition services, but they did include some basic health and safety
protections.\84 Standards for school-sponsored centers in the states
we visited have some basic requirements for health services, but more
for parent services.\85 The standards of school-sponsored centers for
child development, however, are detailed and conform to, and
sometimes exceed, the recommendations of experts.  The standards for
Head Start centers are the most extensive--requiring centers to
provide child development, parent, and health and nutrition services. 
(See app.  IV for detailed summaries of standards that apply to all
kinds of centers.)


--------------------
\82 By program standards, we refer to requirements that have the
force of law.  Head Start centers must follow performance standards
which are contained in federal code (45 C.F.R.  1304, updated in
October 1992).  School-sponsored centers must adhere to the standards
of the education code of the state in which the center is located
and, in some states, state child care licensing standards. 
School-sponsored centers funded with federal Title I dollars must
follow federal code (34 C.F.R.  Part 75 et al., May 19, 1989), which
will be updated as a result of the recent reauthorization of ESEA. 
For-profit and nonprofit centers must adhere to state child care
licensing standards when applicable. 

\83 In some states, certain centers may be exempt from state child
care licensing standards.  For example, centers sponsored by
religious organizations may be exempt.  Centers sponsored by public
schools may also be exempt, although standards developed by state
education departments may exist in that state.  In this study, we did
not examine local standards. 

\84 Basic health and safety protections differ from health services
offered by centers as referred to in our national data analysis and
case studies.  Health and safety protections guard against the spread
of contagious disease, help providers meet emergency and other health
needs of sick children, and protect against fire and other disasters. 
These protections do not include the provision of health services
such as screenings for hearing, speech, and vision problems; physical
and dental exams; or referral and follow-up to promote children's
good health. 

\85 In The State of America's Children:  Yearbook 1994 (Washington,
D.C.:  Children's Defense Fund, 1994), state school-sponsored
programs are credited for recognizing the importance of early
childhood education experiences.  However, this report finds that
many state programs do not address the health, nutrition, and family
problems that limit children's ability to succeed, or involve parents
in their children's learning. 


      FOR-PROFIT AND NONPROFIT
      CENTERS
-------------------------------------------------------- Chapter 4:2.5

In the states we visited--California, Louisiana, Maryland, and
Michigan--child care licensing standards, which for-profit and
nonprofit centers must follow in order to receive federal child care
subsidies, did not require the full range of services that children
need to prepare for school.  Because of the emphasis among the Title
IV-A and CCDBG programs on protecting parents' flexibility in
choosing from a wide variety of child care providers, there are
generally no minimum federal standards, just the state standards.  If
state child care licensing standards do not offer basic health and
safety protections, CCDBG does require such protections by centers
serving children whose care is subsidized by this program, but the
CCDBG also does not require that centers provide a full range of
services.\86

Although child care licensing standards differed among the states we
visited, the standards permitted features that do not meet the
recommendations of child development experts.  For example, in
Louisiana and Michigan, there are no preemployment educational
requirements for teachers in nonprofit or for-profit centers, only
for center directors; Louisiana allowed child-to-staff ratios greater
than 10 to 1; and California and Michigan did not regulate group
size. 

For parent services, standards for all four states only required
centers to allow parents to visit the center at any time or to
provide information about center services.  For health services, the
requirements were also limited in all four states:  a center had to
have a physician's statement of general health, including
immunization, and the center had to keep this statement. 

One exception to such minimal requirements was the standards
governing nonprofit and for-profit centers that participate in the
General Child Care and Development Program in California; these
standards were extensive.  These centers were required to provide a
wide range of parent and health services.\87 For example, one center
we visited in California offered a wide range of parent services. 
According to the center director, this was because of additional
requirements imposed on centers receiving state funding--such as
holding regular group meetings of parents with program staff and
establishing parent advisory committees. 


--------------------
\86 While the Title IV-A program only requires that centers meet
applicable state and local licensing standards for child care, CCDBG
requires the states to ensure that child care providers, including
centers, are subject to requirements designed to provide basic health
and safety protections even if state standards do not include such
requirements.  Proposed regulations for CCDBG and Title IV-A programs
issued by HHS in May 1994 would allow states under any of these
programs to reimburse licensed centers at higher rates than
previously allowed and require children receiving services funded by
these programs to be immunized. 

\87 Centers funded by California--either participating in the State
Preschool or General Child Care and Development Program--must follow
more extensive standards that require a wide range of parent and
health services.  Referred to as Title 5 standards, these are the
same as those detailed in table IV.2 for California school-sponsored
centers. 


      SCHOOL-SPONSORED CENTERS
-------------------------------------------------------- Chapter 4:2.6

In all of the four states we visited, school-sponsored centers were
generally required to follow standards for child development services
that conformed to the recommendations of experts, and in several
instances, exceeded those recommendations.\88 For example, all four
states we visited required that teachers either be state certified,
or have post-secondary education with specialized training, in early
childhood education. 

In three of the states--Louisiana, Maryland, and
Michigan--school-sponsored centers had only basic standards for
health services, ranging from maintaining a health record to
providing hearing and vision screenings.  California had more
extensive standards, however, which required that centers identify
the health needs of children, refer them for services, and provide
follow-up.  Standards governing parent services differed across the
states, with California and Michigan requiring more parent services
and Louisiana and Maryland fewer.  School-sponsored centers funded
with federal Title I money are not subject to any standards for child
development or health services, only parent services.\89 New
legislation reauthorizing ESEA requires Title I early childhood
programs to comply with Head Start performance standards by fiscal
year 1997. 


--------------------
\88 An exception to this was the lack of a group size requirement in
California.  However, the two school-sponsored centers we visited
were colocated with Head Start and followed Head Start standards. 

\89 Title I parent involvement requirements apply to all Title I
programs, not just early childhood programs.  The local education
agency is required to develop written policies for parent
involvement, convene an annual meeting with parents, conduct
parent-teacher conferences to the extent practical, and offer
activities such as parent conferences and training.  Although federal
standards require only parent services, the three Title I centers we
visited offered all features of child development services. 


      HEAD START CENTERS
-------------------------------------------------------- Chapter 4:2.7

Head Start centers are required to follow detailed performance
standards that conform to the recommendations of experts for child
development services.\90 For child development services, each center
must have an education services plan that specifies children's
activities.  For health services, each center is responsible for
health screenings and for obtaining or arranging for treatment of all
health problems detected.  Required parent services include parent
policy groups, activities to promote the development of parenting
skills, identifying opportunities for continuing education, and at
least two home visits per year. 


--------------------
\90 As recommended by the Advisory Committee for Head Start Quality
and Expansion and as required by Head Start reauthorization
legislation, Head Start standards must be reviewed and updated by May
1995 so that better information is available on program outcomes. 


      ALLOCATION OF SCARCE
      RESOURCES REINFORCES NARROW
      MISSIONS
-------------------------------------------------------- Chapter 4:2.8

One of the reasons often cited by administrators for not providing
the full range of services is the scarcity of resources.  The
scarcity may include both the lack of resources and their allocation
by centers.  Each center tends to devote resources to those aspects
of children's needs related most closely to its mission. 

Several for-profit and nonprofit centers we visited faced
difficulties supporting basic services--not including parent or
health services--under current funding amounts.  According to the
director of one nonprofit center in Michigan, limited resources
threatened her ability to keep the center open at all.  Even when
center administrators stated an intent to fulfill a broader mission,
limited resources sometimes prevented them from doing so.  A
for-profit center in Louisiana wanted to hire a professional with
either an education or psychology background in order to provide
child development services but, according to the director, did not
have sufficient funds. 

Scarcity of resources is often reflected in low staff salaries which
can explain high teacher turnover rates among for-profit and
nonprofit centers, according to past research.  The 1992 update of
the National Child Care Staffing Study reported an average annual
turnover rate of 26 percent among teaching staff in nonprofit and
for-profit centers; 70 percent of teaching staff in 1988 had left
their jobs by 1992.  Those earning $5 per hour or less in 1988 left
at a rate of 77 percent compared with a 53- percent turnover of
teaching staff earning over $7 per hour.\91

The director of a Louisiana for-profit center we spoke with
attributed turnover the center had experienced in previous years to
the fact that she can only pay her teachers, at most, $5 an hour, and
is unable to provide any fringe benefits. 

Resources in school-sponsored centers did not appear to support a
full range of services for all disadvantaged children.  Even though
school-sponsored centers can draw on school district staff (such as
nurses, speech therapists, and social workers), these staff are
shared among children of all grades and, sometimes, more than one
school, staff from two centers said.  For example, in one Louisiana
center we visited, one part-time social worker was serving an entire
school of 700 children, even though referrals to mental health
services were increasing.  State funding is sometimes not even
adequate to cover teacher salaries or classroom materials, a
Louisiana school district official said, and on-site, state
monitoring of local programs was recently curtailed for lack of
funding. 

Several state administrators of the school-sponsored programs we
visited wanted to offer more services, but resource scarcity
prevented them from providing services not traditionally found in
schools, they said.  For example, in spite of an initiative in
Maryland to form teams of health and social services professionals in
schools and districts to help children experiencing developmental
difficulties, a school district official said the state lacks the
resources needed to systematically provide these services to all
children.  In Michigan, the state per-child allocation for its
school-sponsored program is too low to support the full range of
services that the program is intended to provide, a state official
said. 

The Head Start centers we visited also faced resource scarcity, even
though their mandate is to meet all needs of children served.  Head
Start grantees' inability to offer competitive salaries and benefits
packages, particularly in urban areas, is in part responsible for
high rates of staff turnover, according to a 1993 review by the HHS
Inspector General.\92 Furthermore, because communities were under
greater economic distress, several center directors said, centers
were unable to draw upon the community-based medical providers and
social service agencies they had depended on in the past.  Results of
our recent survey of Head Start grantees and delegates showed that
Head Start administrators viewed the limited availability of
community resources as a major challenge.\93

Head Start centers sometimes had coordinators who referred families
to providers within the surrounding community when the center could
not offer a needed service.  In general, we found that other kinds of
centers, faced with resource scarcity or with a narrow view of their
mission, did not allocate resources to hire coordinators.  Two
Maryland school-sponsored centers that we visited, however, made
efforts to link up with community-based services that enabled each
center to provide additional health services to its children, even
though these centers did not have coordinators.\94

The scarcity of resources can also lead to competition between
different kinds of centers for facilities, staff, funding, and
children, according to Head Start-State Collaboration Grant
administrators.  For example, as states increase funding for their
own early childhood programs, school districts are taking back space
that was once given to Head Start programs.  All kinds of centers
compete with each other for trained staff, with the school-sponsored
centers having the greatest advantage in the salaries and benefits
offered.  There is competition for funding, for example, as Head
Start looks to sources of funding, such as CCDBG, traditionally used
by child care centers.  Different kinds of centers may also compete
for state funding in order to deliver services.  Particularly as
states expand their early childhood programs, centers may compete
with each other because they target the same children.  Several
collaboration grant administrators said there was competition for
children among early childhood programs in their states. 


--------------------
\91 The National Child Care Staffing Study Revisited:  Four Years in
the Life of Center-Based Care (Child Care Employee Project, 1993) and
The National Child Care Staffing Study (Child Care Employee Project,
1988).  The centers examined in the original study and its update
represent both nonprofit and for-profit centers.  The study's
classification of nonprofit centers includes school-sponsored
centers, although these centers represent only 3 of the 227 centers
sampled.  Head Start centers were not included in the sample.  The
levels of education and training that teaching staff had completed as
of 1988 also predicted turnover, although to a much smaller extent
than staff salaries. 

\92 Head Start Expansion:  Grantee Experiences, Office of Inspector
General, HHS (May 1993). 

\93 Early Childhood Programs:  Local Perspectives on Barriers to
Providing Head Start Services (GAO/HEHS-95-8, Dec.  21, 1994).  We
conducted a survey of a nationally representative sample of 870
grantees and delegates from a universe of 1,898 programs.  Over 90
percent of Head Start directors responding to our survey reported
experiencing at least one of the following barriers:  (1)
insufficient qualified staff to meet the complex needs of the
children and families, (2) a limited availability of health
professionals in the community willing to help Head Start staff in
providing services, and (3) difficulties getting suitable facilities
at reasonable costs. 

\94 The activities of these school-sponsored centers are, in part, an
outgrowth of site-based management.  Under the site-based management
plan, the principal is granted more autonomy to manage a school and
is responsible for developing linkages with community-based services
to expand the range of services available to children in the school. 
State officials said that principals are given authority to determine
how to implement such linkages. 


      DIFFERENCES IN PROGRAMS THAT
      REFLECT NARROW MISSIONS ARE
      BARRIERS TO COLLABORATION
      BETWEEN CENTERS
-------------------------------------------------------- Chapter 4:2.9

Differences in early childhood programs that reflect their narrow
missions create barriers for one center trying to establish a
collaborative relationship with another in order to broaden the range
of services each provides.  Collaboration refers to combining
centers, services, or programs in innovative ways that provide
children access to additional services.\95

For example, several Maine Head Start centers have faced difficulty
providing full-day programs for children of parents participating in
the AFDC Child Care program.  In order to extend the center day for
these children, funding from Head Start and the AFDC Child Care
program were combined.  Thus, the children were provided full-day
care by Head Start teachers in Head Start centers.  However, this was
difficult because Head Start teachers were paid at a rate that
reflected their teacher qualifications, but the level of funding for
AFDC Child Care was not sufficient to cover their salaries. 
Additional state and local funds had to be raised in order to pay
these teachers at the Head Start salary. 

Oregon has faced difficulties in its efforts to bring the full range
of services to disadvantaged children in nonprofit and for-profit
centers.  On an experimental basis, the state is allowing parents of
children eligible for the Oregon Prekindergarten Program\96 --which
is modeled after Head Start--to place their children in any center
convenient to their home or work, and the state ensures the children
receive Head Start-like services. 

Visiting staff from the Oregon Prekindergarten Program help the
center meet standards for child development equivalent to Head Start
so that all children in the center benefit.  Through home visits,
Oregon Prekindergarten Program staff provide health and other
services to only those children participating in the experimental
program.  But the rate centers charge for each child--that is, the
center's standard rate--has been inadequate to support the higher
level of child development services, according to the administrator
of the state's Head Start collaboration grant.  As a result, some
centers have experienced difficulties meeting program standards.  In
response, the state may restrict participating centers in the future
to those that are already offering better child development services
based on a school district evaluation of the center through the
Oregon Prekindergarten Program. 

In our case study work in Louisiana, we found that administrators of
school-sponsored centers encountered difficulties simply trying, in a
given center, to provide services in one classroom to children funded
under different programs so that more children could be served.  For
example, if a child dropped out of a classroom, according to a state
administrator, the budget had to be revised unless a new child was
found who met the same eligibility requirements of the program under
which the original child was funded. 

Even when centers successfully develop collaborative relationships,
the collaboration is difficult and burdensome to administer. 
Rigidity of funding streams and regulations inhibit the development
and ongoing management of programs attempting to meet the needs of
parents and communities, concluded New York State's subcommittee on
collaboration, part of the state's Interagency Committee on Early
Childhood Programs.  The subcommittee based its findings on
interviews with administrators who led initiatives attempting to link
different programs.  Among the barriers identified were disparity in
per-child funding provided to school-sponsored, Head Start, and child
care programs; marked differences in salaries and benefits between
teachers with equal credentials; and variations in programs and
missions. 


--------------------
\95 Although experts make distinctions between different levels of
interaction between centers, we use the term collaboration broadly to
refer to programs combining centers, services, or programs in order
that children are provided more services than either program could
provide individually.  Colocation is one way centers, services, or
programs can be combined.  See Lynn Kagan, United We Stand: 
Collaborations for Child Care and Early Education Services (New York: 
Teachers College Press, 1991), for an in-depth discussion of the
different types of interactions between early childhood centers and
other types of social service providers. 

\96 A variety of entities are eligible for state funding under the
Oregon Prekindergarten Program, including Head Start centers, school
districts, child care centers, and other community-based
organizations.  Participating centers must follow program standards,
which are the same as Head Start standards. 


   STATE AND LOCAL INITIATIVES
   EXPAND THE RANGE OF SERVICES
   PROVIDED
---------------------------------------------------------- Chapter 4:3

Some state and local initiatives have expanded program missions in
order to provide the full range of services.  These initiatives
include collaborative efforts that were successful because they
overcame the problems program differences often pose.  Each of these
initiatives, however, involved a substantial investment of resources
and the ongoing efforts of program administrators to overcome
barriers imposed by differences between programs.  In some cases,
resources invested in these initiatives included private funding. 

California's State Preschool Program and General Child Care and
Development Program, for example, require centers all to offer a wide
range of services and to establish links with health and social
service agencies.  California has long recognized the importance of
helping children prepare for school while allowing parents to work or
get an education, as reflected in the California Child Development
Act of 1972.  This act brought all state early childhood programs
together under the Department of Education.  With both the State
Preschool and General Child Care and Development Programs, agencies
other than school districts are eligible for state funding to operate
centers as long as state standards are met.  California has also
encouraged school-sponsored centers to colocate with Head Start
centers; in two colocated centers we visited, all children received
Head Start services.  To support the State Preschool Program and the
General Child Care Program, the state invested over $300 million in
fiscal year 1993 alone. 

Other states have invested state money to expand Head Start or
modeled their programs after the Head Start program.  For example,
Ohio, which already provides state support to expand the Head Start
program, will double its allocation from $40 million to $97 million
for the period 1993 through 1995.  Also in 1995, Ohio will follow
Head Start performance standards so that state funds will support
programs that meet children's developmental needs.  The Oregon
Prekindergarten Program already follows Head Start performance
standards, and centers participating in either Head Start or this
state-funded program are jointly monitored by a team of Head Start
and Oregon Prekindergarten Program staff.  As of 1992, 14 states
invest directly in Head Start so that more children can be provided
the full range of services. 

Some states and localities have launched initiatives that assist
centers in overcoming barriers that prevent them from collaborating
in order to broaden the range of services centers provide.  These
collaborative initiatives include locating centers, services, and
children together although they are funded by different programs. 
Other collaborative initiatives include delivering additional
services to disadvantaged children in centers in which these services
are typically unavailable. 

In Maryland, several counties combine Head Start and child care
services.  In Baltimore City, a child care resource and referral
agency coordinates an initiative in which Head Start classrooms are
created within child care centers.  This enables (1) Head
Start-eligible children to receive full-day care and (2) the child
care center to benefit from the teacher training and other resources
it shares with Head Start.  Both Frederick and Charles counties also
provide Head Start and child care services on-site together. 

In other states, standards and professional development are the
centerpiece of collaborative efforts.  For example, in Virginia,
several child care centers that serve Head Start-eligible children
and agree to meet Head Start performance standards receive technical
support from Head Start staff. 

Some collaboration initiatives have been supplemented with private
funds.  For example, several centers were created in Kansas City,
Missouri, to provide the full range of services to children funded
under different early childhood programs, including Head Start and
federal and state child care programs.  Private donations and local
community moneys help to supplement the cost of care. 

In Kentucky, a partnership joining the state and local governments
and private agencies funds a statewide education reform effort that
was launched in 1990.\97 The reform effort includes an early
childhood initiative in which state officials have arranged for Head
Start to provide "enhanced" services--such as health and social
services--to Head Start-eligible children enrolled in
school-sponsored programs.  Eventually, the state plans to provide
such services to all children in its school-sponsored program through
special state-funded family resource centers located within
lower-income school districts. 


--------------------
\97 The Annie E.  Casey Foundation has helped fund the Kentucky
education reform effort.  Other private foundations and businesses
have invested funds to improve early childhood programs.  For
example, the American Business Collaboration, a consortium of 137
U.S.  companies set up by IBM, has raised over $25 million to
increase the supply and improve the quality of child care services in
25 states.  Johnson and Johnson, Inc., funds a management training
program for Head Start directors.  Other private foundations which
have funded initiatives to improve early childhood programs include
the United Way and the Pew Charitable Trust. 


CONCLUSIONS
============================================================ Chapter 5

The first national education goal, "by the year 2000, all children
will enter school ready to learn," sets a bold vision for the
nation's future.  Yet many disadvantaged children are unlikely to
meet this goal.  Like all children, disadvantaged children need a
stimulating environment, parental guidance and support, adequate
health care, and nutritious diets.  Many of these children, instead,
are subjected to multiple environmental deficits--too little
cognitive stimulation, inadequate health care, and poor
nutrition--which often impair their ability to function successfully. 
Many are doomed to school failure before they even enter school.  As
the number of disadvantaged children increases, centers are likely to
continue to fall short in preparing all children for school. 

Despite knowledge that early childhood centers--if they provide a
full range of child development, parent, and health and nutrition
services--can successfully prepare disadvantaged children for school,
most of these children do not attend such centers.  Disadvantaged
children, whose needs are similar, receive different services
depending on the kinds of centers they happen to attend. 

Providing all disadvantaged children with a full range of services
will involve considering (1) increasing funding from federal, state,
and private sources for early childhood programs so that more
children can participate and (2) broadening program missions to offer
the full range of services that children need. 

Each of these approaches, however, will involve extraordinary
difficulties.  Increasing state and federal funding for early
childhood programs that serve disadvantaged children will be
difficult because the nation is already concerned that federal,
state, and local government spending is too high. 

Broadening program missions will involve considerable efforts by
program administrators and policymakers to reconcile major program
differences regarding, for example, which children are eligible and
what services are provided.  Such efforts will pose challenges to
those who are committed or accustomed to programs as they now exist. 

However, without such changes, the condition of the nation's
disadvantaged children will remain a "quiet crisis," and the bold
vision embodied in the first national education goal will not be
realized. 


DESCRIPTION OF SELECTED FEDERAL
PROGRAMS THAT PROVIDE EARLY
CHILDHOOD SERVICES
=========================================================== Appendix I

                    FY 93                       Eligibility      FY 93 children
Program         expenditure\a   Purpose         criteria             served
--------------  --------------  --------------  --------------  ----------------
Head Start      $2,776,289,600  Provide         Children            713,903
                                comprehensive   living in
                                child           poverty as
                                development     defined by OMB
                                services,       or in a family
                                including       that receives
                                parental        AFDC.
                                involvement.

Title I (early       Not        Improve the     Children            116,614
childhood)       available\b    educational     living in
                                opportunities   Title I
                                of              attendance
                                educationally   areas who are
                                deprived        below the age
                                children by     or grade level
                                helping them    at which a
                                succeed in      local
                                school, attain  education
                                grade level     agency
                                proficiency,    provides free
                                and improve     education.
                                achievement in
                                basic and more
                                advanced
                                skills.

AFDC/JOBS       470,352,807\c   Subsidize       Children in        339,238\d
Child Care                      child care for  AFDC families
                                AFDC families   whose parents
                                to the extent   are working or
                                that it is      attending
                                necessary for   approved
                                employment or   training
                                state-          including
                                approved        those in JOBS.
                                education and
                                training.
                                State matching
                                funds
                                required.

AFDC            112,703,846\c   Provide up to   Children            84,682\e
Transitional                    12 months of    living with
Child Care                      child care to   working parent
                                working AFDC    whose AFDC
                                recipients      eligibility
                                upon loss of    has ceased due
                                eligibility     to increase in
                                for AFDC due    hours of or
                                to an increase  income from
                                in hours of or  employment,
                                earnings from   for up to 12
                                employment.     consecutive
                                State matching  months
                                funds           beginning with
                                required.       the first
                                                month of
                                                ineligibility.

At-Risk Child   269,843,393\c   Provide child   Children in        219,057\e
Care                            care to non-    low-income
                                AFDC working    families who
                                families who    need child
                                would be at     care in order
                                risk of AFDC    to work and
                                dependency if   would be at
                                child care      risk of
                                were not        becoming
                                provided.       eligible for
                                State matching  AFDC. States
                                funds           define "low
                                required.       income" and
                                                "at-risk" (if
                                                different from
                                                low income).

Child Care and  329,035,314\f   Increase        Children           755,904\g
Development                     availability    living in
Block                           and             families who
                                affordability   are working or
                                as well as      attending
                                help states     education or
                                provide,        training
                                expand, and     activities,
                                improve the     whose income
                                quality of      does not
                                child care for  exceed 75
                                all families.   percent of
                                                median state
                                                income for a
                                                family of the
                                                same size.

Title XX-            Not        Among other     Each eligible    Not available
Social           available\h    purposes,       jurisdiction
Services Block                  prevent,        determines the
Grant (child                    reduce, or      services that
care)                           eliminate       will be
                                dependency;     provided and
                                achieve or      the
                                maintain self-  individuals
                                sufficiency;    that will be
                                prevent         eligible to
                                neglect,        receive
                                abuse, and      services.
                                exploitation
                                of children
                                and adults;
                                prevent or
                                reduce
                                inappropriate
                                institutional
                                care.
--------------------------------------------------------------------------------
Note:  Early Childhood Programs:  Multiple Programs and Overlapping
Target Groups (GAO/HEHS-95-4FS, Oct.  31, 1994) provides fiscal year
1992 budget authority for 34 federal programs that provide education
and child care to children below age 5.  We report a total of 90
federal programs that provide, allow, or support the provision of
some type of early childhood activity not limited to education and
child care. 

\a In this table, expenditures for fiscal year 1993 are reported for
all programs except the Child Care and Development Block Grant
(CCDBG).  CCDBG expenditures cover the report period from September
7, 1991, through September 30, 1992. 

\b National data on the amount of Title I funds spent in fiscal year
1993 on early childhood programs are unavailable.  However, in
response to a GAO survey, the Department of Education provided an
estimate of the total budget authority for fiscal year 1992 of
$537,972,848 for prekindergarten and kindergarten, representing less
than 10 percent of the total Title I budget for children of all ages
which was more than $6 billion (see GAO-HEHS-95-4FS). 

\c Expenditures for children of all ages in any child care setting. 
Data for preschool children in centers are unavailable.  These
expenditures represent the federal share only; the AFDC Child Care,
Transitional Child Care, and At-Risk Child Care programs all require
a state match. 

\d This is the average monthly total of children of all ages
receiving child care in any child care setting whose parents receive
AFDC and participate in the Job Opportunities and Basic Skills (JOBS)
program--the employment,education, and training program for AFDC
recipients established by the Family Support Act.  These data also
include children served whose parents are AFDC recipients and are
employed or in an approved education and training program other than
JOBS. 

\e This is the average monthly total of children of all ages
receiving child care in any setting.  Data for preschool children in
centers are not available. 

\f These expenditures represent funds spent from September 30, 1991,
through September 30, 1992, for children of all ages in any child
care setting. 

\g These participant data are the number of children of all ages
whose care was subsidized in whole or in part with CCDBG funds
between October 1, 1992, and September 30, 1993. 

\h Expenditure data are unavailable because states are now required
to report this information to HHS.  However, using state estimations
of expected expenditures under this program for fiscal year 1993, HHS
estimates fiscal year expenditure of $520,000,000. 

Sources:  Unless otherwise noted, the sources for data reported in
this appendix and in appendix II are as follows:  expenditure and
participation data for Head Start, AFDC Child Care, Transitional
Child Care, At-Risk Child Care, and CCDBG were obtained from the
Administration for Children and Families in HHS. 


CASE STUDIES OF EARLY CHILDHOOD
PROGRAMS IN FOUR STATES
========================================================== Appendix II

We reviewed early childhood programs in California, Louisiana,
Maryland, and Michigan.  These states were selected because each has
a state-funded child development program, and there is variation
between these states in terms of per child expenditure and services
provided under these programs.  For each state, we (1) profile all
early childhood programs--both state- and federally funded, (2)
examine state licensing standards applicable to all kinds of centers,
and (3) describe some initiatives the state has undertaken to improve
early childhood programs. 


   CALIFORNIA'S PROGRAMS
-------------------------------------------------------- Appendix II:1

California has multiple early childhood programs, including the
state-funded programs:  the State Preschool and the General Child
Care and Development Programs.  Two state standards exist--one
applies to all centers, the other is more extensive and applies only
to those centers that receive state funding.  California has
undertaken several initiatives to improve early childhood programs,
including efforts to colocate centers in order to share costs and
provide families better access to services.  In addition, California
was awarded a Head Start-State Collaboration Grant in 1992. 


      MULTIPLE EARLY CHILDHOOD
      PROGRAMS
------------------------------------------------------ Appendix II:1.1

Two departments--the California Department of Education and the
Department of Social Services--administer the early childhood
programs in California.  In addition, in 1991, California created the
cabinet-level Office on Child Development and Education to advise the
governor on a variety of children's issues.  In California,
center-based programs that serve preschool children are among 12
child care and development programs funded by the state for children
from different populations and age groups, including preschool- and
school-aged children. 

The California Department of Education's Child Development Division
administers the State Preschool Program and the General Child Care
and Development Program.\98 Under both state-funded programs, school
districts, other public agencies (including local governments and the
university system), and private nonprofit agencies are eligible to
compete for state awards to operate centers funded by these programs,
as well as to subcontract with other agencies.  Under both programs,
school districts receive most of the funds.  However, many private
nonprofit agencies also participate, some under subcontract to the
school district.  Although for-profit agencies can compete for
General Child Care and Development funds, few choose to because of
state audit requirements that prevent centers from making a profit
with state funds.  Funding for both programs is distributed to
counties on the basis of demographic factors such as number of
children on AFDC, women in the workforce, and existing child care
resources.  The Department of Education oversees the licensing of
centers funded by these state programs. 

The State Preschool Program has been operating since 1965, and serves
3- to 5-year-old children whose families' incomes are at or below 60
percent of the state median income.  In fiscal year 1993, the State
Preschool Program, funded at $84.3 million, served almost 40,000
children. 

Unlike many state-funded programs, the General Child Care and
Development Program is a full-day program for children from birth to
age 13 whose families have incomes up to the state median income and
are employed, seeking employment, or in training.  This program began
as the 1943 Wartime Child Care program, although contracts with
private nonprofit and for-profit agencies were not initiated until
1972.  The General Child Care and Development Program, funded at
$224.2 million in fiscal year 1993, served over 50,000 children from
birth to age 13; no information is available about how many preschool
children were served. 

The Department of Education also administers the federal Title I
early childhood program and a state-funded compensatory education
program, which is modeled after the federal Title I program. 
Together, these programs served 2,113 preschool children in fiscal
year 1993; no information is available on the amount of money spent
on preschool children in either the federal Title I or state-funded
compensatory education program. 

Two of the federal child care programs--the CCDBG and the At-Risk
Child Care programs--are administered by the Department of Education. 
The Department of Social Services administers the other federal child
care programs--the AFDC Child Care and the Transitional Child Care
programs.  The Department of Social Services is also responsible for
the licensing of all child care centers.  However, centers receiving
funding from the Department of Education--which include State
Preschool and General Child Care and Development centers--must follow
an additional set of child care licensing standards enforced by the
Department of Education.  California does not use Title XX--Social
Services Block Grant for child care. 

See table II.1 for additional information on state and federal early
childhood programs in California. 



               Table II.1

State and Federal Programs That Provide
 Early Childhood Services in California


--------------------
\98 The General Child Care and Development Program also provides
funding to family child care homes, which typically have six or fewer
children being cared for in the home of the provider, who may be a
relative. 

