Child Care: Promoting Quality in Family Child Care (Letter Report,
12/07/94, GAO/HEHS-95-36).
Many initiatives nationwide seek to improve the quality of family child
care. These initiatives are financed both from public and private
sources, and many receive funding from more than one source. Most of
the $8 billion in federal support available in fiscal year 1993 went to
subsidies to help parents pay for child care, but GAO estimates that
about $156 million was available for efforts to improve the quality of
care. Among the 195 family child care quality initiatives GAO
identified, two federal sources were used most often: the Child Care and
Development Block Grant run by the Department of Health and Human
Services and the Child and Adult Care Food Program run by the
Agriculture Department. GAO's on-site visits found that the initiatives
used the money from both private and public sources to fund a variety of
programs to enhance the quality of family child care, including training
providers; supplying them with equipment, educational materials,
financial aid, and other support; and linking them to resources and
professional associations. Many welfare reform proposals are being
discussed, most of which would require large numbers of welfare mothers
to participate in education, training, and work programs. This will
likely increase the use of family child care, making the enhancement of
the quality of care even more urgent. GAO summarized this report in
testimony before Congress; see: Family Child Care: Innovative Programs
Promote Quality, by Leslie G. Aronovitz, Associate Director for Income
Security Issues, in a field office hearing in Portland, Oregon, before
the Subcommittee on Regulation, Business Opportunities, and Technology,
House Committee on Small Business. GAO/T-HEHS-95-43, Dec. 9, 1994
(eight pages).
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-95-36
TITLE: Child Care: Promoting Quality in Family Child Care
DATE: 12/07/94
SUBJECT: Child care programs
Preschoolers
Day care centers
Aid to families with dependent children
Disadvantaged persons
Cost sharing (finance)
Welfare recipients
State-administered programs
Consumer education
Health care services
IDENTIFIER: Community Development Block Grant
AFDC/JOBS Child Care Program
AFDC
Child Care and Development Block Grant
USDA Child and Adult Care Food Program
Maternal and Child Health Block Grant
Dependent Care Tax Credit
Social Services Block Grant
Transitional Child Care Program
HHS At-Risk Child Care Program
Job Opportunities and Basic Skills Training Program
JOBS Program
USDA Cooperative Extension System
Save the Children's Neighborhood Child Care Network
Family-to-Family Project
Oregon Child Development Fund
California Child Care Initiative
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Cover
================================================================ COVER
Report to the Chairman, Subcommittee on Regulation, Business
Opportunities, and Technology, Committee on Small Business, House of
Representatives
December 1994
CHILD CARE - PROMOTING QUALITY IN
FAMILY CHILD CARE
GAO/HEHS-95-36
Family Child Care Quality
Abbreviations
=============================================================== ABBREV
AFDC - Aid to Families With Dependent Children
APHA - American Public Health Association
CCDBG - Child Care and Development Block Grant
DOD - Department of Defense
HHS - Department of Health and Human Services
USDA - U.S. Department of Agriculture
Letter
=============================================================== LETTER
B-257209
December 7, 1994
The Honorable Ron Wyden
Chairman, Subcommittee on Regulation,
Business Opportunities, and Technology
Committee on Small Business
House of Representatives
Dear Mr. Chairman:
During the last 20 years, the demand for child care has steadily
increased. In that time, the percentage of working women with
children under age 6 doubled from 30 percent in 1970 to 60 percent in
1991. Care outside of a child's home enables parents to work or
attend school or job training to secure the economic well-being of
their families. Among the primary child care arrangements parents
use, family child care--care in the home of someone not related to
the child--plays a significant role in meeting the child care needs
of families, particularly those with very young children and those
who are poor.
The demand for family child care is expected to grow given the
welfare reform proposals that include education or job training
requirements for more mothers of children receiving Aid to Families
With Dependent Children (AFDC), particularly the younger mothers (who
tend to have younger children). However, questions have been raised
about the quality of the care provided in these settings. A recent
study of family child care, which documented that a significant
number of providers were giving inadequate care, has further
highlighted these concerns. As a result, you asked us to (1)
identify public and private initiatives to enhance the quality of
family child care and determine how the initiatives are financed, (2)
describe the federal role in supporting quality initiatives, and (3)
discuss the implications of our findings for welfare reform.
RESULTS IN BRIEF
------------------------------------------------------------ Letter :1
Many initiatives nationwide seek to improve family child care
quality. These initiatives are financed both from public and private
sources, and many receive funding from more than one source.
Federal support is provided through seven major funding streams that
made approximately $8 billion available in fiscal year 1993. Most of
this $8 billion went to subsidies to help parents pay for child care,
but we estimate that approximately $156 million was available for
efforts to improve the quality of care. Among the 195 family child
care quality initiatives we identified, we found that two federal
sources were used most often: the Child Care and Development Block
Grant (CCDBG) administered by the Department of Health and Human
Services (HHS) and the Child and Adult Care Food Program (the food
program) administered by the Department of Agriculture (USDA).
Our site visits showed that initiatives use money from a variety of
private and public sources in an array of approaches to enhancing the
quality of family child care, including training providers; supplying
them with equipment, educational materials, financial assistance, and
other support; and linking them to resources and professional
associations. For example, one Oregon program gives family care
providers access to ongoing health promotion, protection, and
education as well as home safety assessment tools and child safety
items such as smoke alarms and socket plugs. Research shows that
these kinds of activities are critical to enhancing the quality of
care in all types of child care settings.
Research shows that quality child care is particularly important to
poor children. Since the use of family child care is expected to
grow given most welfare reform scenarios, the initiatives we
identified can provide information on ways to improve quality in
family child care settings.
BACKGROUND
------------------------------------------------------------ Letter :2
CHILD CARE SETTINGS
---------------------------------------------------------- Letter :2.1
Child care outside the home can take place in different settings:
centers, family child care homes, and relatives' homes. Centers are
usually large facilities that typically care for more than 13
children and are located in schools, churches, office buildings, and
the like. In contrast, 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. Relative care is care
provided by a person related to the child other than a parent.\1
The flexibility of family child care makes it an attractive choice
for parents. In contrast to most centers, family child care
providers accept infants and young toddlers. Approximately 23
percent of employed women use family child care for children between
the ages of 1 and 2, while 20 percent of employed women use it for
children under 1.\2
Family child care providers also usually have longer hours, may
provide weekend and evening care, and may accommodate the hours of
parents working shifts. They are also more likely to offer part-time
care. These features are important to many lesser skilled and lower
paid employees who tend to work shifts or other untraditional
schedules. Part-time care is useful for those in the type of
job-training activities in which AFDC mothers participate. Hence,
family child care is a frequent choice among low-income families.
Between 18 and 20 percent of children under age 5 of poor, single,
working mothers are in family child care.\3
--------------------
\1 Sometimes, however, the line between relative care and family
child care is blurred because relatives may care for unrelated
children as well as related children in their homes.
\2 S. Hofferth, A. Brayfield, S. Deitch, and others, National
Child Care Survey, 1990 (Washington, D.C.: Urban Institute Press,
1991), p. 50.
\3 S. Hofferth, A. Brayfield, S. Deitch, Caring for Children in
Low-Income Families: A Substudy of the National Child Care Survey,
1990 (Washington, D.C.: Urban Institute Press, 1991), p. 23.
ELEMENTS OF QUALITY CARE
---------------------------------------------------------- Letter :2.2
Whether provided in centers or in family child care settings, quality
care is care that nurtures children in a stimulating environment,
safe from harm. Research has documented the elements of care that
are associated with quality. They include providers trained in areas
such as early childhood development, nutrition, first aid, and child
health; small groups and low child-to-staff ratios; low staff
turnover; a variety of age-appropriate materials; space that is safe
and free from hazards; and settings that are regulated. Experts
believe that characteristics such as these are good predictors of
whether quality care is being provided. While only a small
proportion of the research conducted in this area has focused
specifically on quality in family child care settings, researchers
believe that the same characteristics apply to any setting.
IMPORTANCE OF QUALITY CHILD
CARE
---------------------------------------------------------- Letter :2.3
For many years, researchers have known that child care quality,
regardless of the setting, is important to all aspects of children's
development--physical, cognitive, emotional, and social. The quality
of these settings in preschool years also has implications for
children's development and success later in school. However, new
research documents to an even greater degree that how individuals
function from preschool through adulthood "hinges, to a significant
extent, on their experiences before the age of three."\4
Research has also shown that quality child care can be most
beneficial to economically disadvantaged children. Factors
associated with low-income families--minimal parental education,
linguistic isolation, single-parenting--increase a child's risk of
doing poorly in school. Quality child care settings can help poor
children overcome some of the environmental deficits they experience.
--------------------
\4 Starting Points: Meeting the Needs of Our Youngest Children (New
York: Carnegie Corporation of New York, Apr. 1994), p. 6.
DIFFICULTIES IN ACHIEVING
QUALITY IN FAMILY CHILD CARE
---------------------------------------------------------- Letter :2.4
While family child care providers in the United States generally have
low child-to-staff ratios, they work in isolation from others, are
generally not trained in early childhood development, and tend to be
unregulated. Hence, the quality in family child care is considered
by experts to be quite variable. A study done by the Families and
Work Institute, which found 35 percent of the family care providers
in their sample were giving inadequate care, recently highlighted
these concerns about quality.\5
Although family child care is used by many employed mothers with
young children, states and localities generally do not regulate it as
they do center care. One study estimated that approximately 82 to 90
percent of family child care is unregulated in the United States.\6
Hence, many family child care providers operate legally but do not
have to meet any standards to protect the children's safety and
health. Experts believe that meeting at least some minimal child
care standards as a precondition to providing care is an important
step in building quality into all child care settings.
If a family child care provider wants to become registered or
licensed, the process can sometimes be intimidating and costly,
especially relative to the low wages most providers earn. Incentives
to become registered or licensed are few and providers may encounter
barriers and be uncertain that they can charge parents higher fees if
they meet requirements that help them provide higher quality of care.
Family child care providers also have difficulty getting the
information and resources they need to run a successful business and
to enhance the quality of care they provide. For instance, family
child care providers may be unaware of child care training available
in their communities because they usually are not part of a
professional organization or linked to other networks that would keep
them informed of training opportunities. If they do learn of such
training, barriers may prevent them from participating, especially if
they are low-income providers. Barriers include the cost of the
training, training schedules that conflict with providers' hours of
operation, training tailored to center care rather than family child
care, or language differences. As a result, while training, like
regulation, is seen by experts as a critical element in improving the
quality of child care, it can be difficult for family child care
providers to obtain.
--------------------
\5 E. Galinsky, C. Howes, S. Kantos, and others, The Study of
Children in Family Child Care and Relative Care: Highlights of
Findings (New York: Families and Work Institute, 1994), p. 4.
\6 B. Willer, S. Hofferth, E. Kisker, and others, The Demand and
Supply of Child Care in 1990: Joint Findings from the National Child
Care Survey 1990 and a Profile of Child Care Settings, National
Association for the Education of Young Children, U.S. Department of
Education, U.S. Department of Health and Human Services (Washington,
D.C.: National Association for the Education of Young Children,
1991), p. 60.
A VARIETY OF ORGANIZATIONS
WORK TO IMPROVE THE QUALITY
OF FAMILY CHILD CARE
---------------------------------------------------------- Letter :2.5
Many organizations sponsor initiatives to improve the quality of
family child care. While their goals, purposes, and approaches to
working with providers may differ, an overarching goal of all these
efforts is to support providers by developing their professionalism
and enhancing the quality of care they provide. Organizations
involved with this work include resource and referral agencies,\7
community-based nonprofit organizations, cooperative extension
agencies,\8 and public agencies, to name a few. Some focus on one or
two activities, such as training, connecting providers to information
and resources about health issues, or helping providers get licensed.
Others weave together many activities into a more comprehensive
network of support. As discussed later in this report, the
organizations put together funding from different sources, both
private and public, to support their activities.
--------------------
\7 Resource and referral agencies match parents looking for child
care with providers. Typically, the agencies are funded by state or
local child care agencies, private employers, or both. In addition
to helping parents find care, resource and referral agencies provide
services such as training or provider orientation classes.
\8 Cooperative extension agencies are entities found in every land
grant university in the United States and conduct community outreach
and education efforts. They are funded by USDA's Cooperative
Extension Service.
SCOPE AND METHODOLOGY
------------------------------------------------------------ Letter :3
Since we could not identify a single database that provided a
comprehensive listing of initiatives targeted at improving the
quality of family child care, we developed one through discussions
with experts, literature review, and an information request on
Internet. Our database, which consists of 195 family child care
quality initiatives, was built primarily on the work conducted by the
National Center for Children in Poverty, the Families and Work
Institute, the National Council of Jewish Women, and MACRO
International. By putting together these different information
sources and adding information on other initiatives we found, we
believe that we have constructed the largest single database of
family child care quality improvement initiatives. However, we could
not determine the extent to which our database represents the
universe of initiatives nationwide. While the database contains
information on a number of the initiatives' characteristics, we used
it primarily to determine the funding sources for each initiative.
However, while all the initiatives identified their sources of
funding, very few provided the amount of funding from each source.
We conducted site visits at 11 initiatives in three states: Georgia,
Oregon, and California. The sites, which were highlighted in the
literature we reviewed or in our discussions with experts, were
judgmentally selected. We also visited family child care programs
for three branches of the military--the Army, Navy, and Air Force--at
installations in Maryland and Washington, D.C.
In addition, we (1) interviewed experts and officials from the
Administration for Children and Families, the Head Start Bureau, and
the Maternal and Child Health Bureau at HHS; the Department of
Defense (DOD); and the Food and Nutrition Service at USDA; (2)
reviewed the literature about issues in family child care; and (3)
analyzed funding data gathered for our database.
We performed our work between April and October 1994 in accordance
with generally accepted government auditing standards.
DIFFERENT APPROACHES USED TO
IMPROVE QUALITY OF FAMILY CHILD
CARE
------------------------------------------------------------ Letter :4
Our analysis of the 11 initiatives we visited showed three approaches
used to foster quality care: (1) support networks; (2) training,
recruitment, and consumer education initiatives; and (3) health
initiatives. Regarding the last two categories, the initiatives
described here employed more than one activity in working with
providers; however, we designated them according to their key or
primary activities. Appendix I describes each of the 11 initiatives
we visited in detail. Characteristics and activities of the 195
initiatives in our database are shown in figures 1 and 2 (the number
of providers participating in the initiatives and the services
provided by the initiatives, respectively), and table 1 (the
initiatives' funding sources).
Figure 1: Number of Providers
Participating in Family Child
Care Initiatives
(See figure in printed
edition.)
Note: Of the 195 initiatives in our databases, information on the
number of participating family child care providers was available for
112.
Figure 2: Services Provided by
Family Child Care Initiatives
(See figure in printed
edition.)
Notes: "Special emphasis" means that the initiative focused on a
particular population such as working with low-income providers or
serving children with special needs.
Because initiatives provide multiple services, the percentages add to
more than 100 percent.
Table 1
Funding Sources Used by Family Child
Care Quality Initiatives
(Total initiatives: 195)
Initiatives
that Percentage
received of total
Source funds initiatives
------------------------------ ------------ ------------
Federal
Child Care and Development 80 41
Block Grant
Child and Adult Care Food 58 30
Program
Other 43 22
State 38 19
Local 38 19
Private 107 55
Private only 43 22
----------------------------------------------------------
Note: Because initiatives had more than one funding source, column
totals will exceed 195 initiatives and 100 percent.
SUPPORT NETWORKS
---------------------------------------------------------- Letter :4.1
Five initiatives we visited seek to create a support network for
providers.\9 Typically support networks are part of an organization
that, through a coordinator and staff, provides resources, support,
and ongoing training to a group of family child care providers. For
example, the Foundation Center for Phenomenological Research in
California enrolls all of its family child care providers in the
Montessori Teacher Education program. This program leads to the
completion of requirements for the American Montessori Society
diploma. Similarly, DOD's family child care system has an extensive
entry-level and ongoing training system.
Support network staff usually make regular visits to provide
technical assistance, bring supplies and toys, or conduct training.
The network also assists providers in becoming registered or
licensed. In addition, all five initiatives link their providers to
USDA's food program, which provides federal subsidies for nutritious
meals and snacks served in child care facilities, including family
child care homes, as long as the providers are state registered or
licensed. The food program also provides regular training and
monitoring visits. The five network initiatives also help or
encourage providers to become members of local family child care
associations or informal support groups. Given the large number of
family child care providers, the development of associations--seen by
experts as an important way to reach, support, and help train
providers--is a key strategy in many initiatives focused on family
child care.
Research on child care quality shows that the types of activities
support networks conduct contribute to enhancing the level of
professionalism of the provider and, thus, improve the quality of
child care.
The funding for these initiatives comes from a full range of sources:
private, state, and federal. Two of the initiatives we visited were
solely federally funded: the Oakland Head Start Family Child Care
Demonstration Project and DOD's child care system.
--------------------
\9 These initiatives were the Neighborhood Child Care Network,
Atlanta; Foundation Center for Phenomenological Research, Sacramento;
Oakland Head Start Family Child Care Demonstration Project,
California; Head Start of Lane County, Oregon; and DOD's child care
system. (See app. I for descriptions of these programs.)
TRAINING, RECRUITMENT, AND
CONSUMER EDUCATION
INITIATIVES
---------------------------------------------------------- Letter :4.2
Three of the initiatives we visited--the Family-to-Family project,
the California Child Care Initiative Project, and the Oregon Child
Development Fund--focus on a combination of training and recruitment
activities or training and consumer education. Additionally, the
California and Oregon projects contain explicit and well-developed
components for fundraising and disbursing money to various family
child care projects across their states. (See app. I.)
The Family-to-Family project focused on improving the quality of care
in family child care settings in 40 communities nationwide (see app.
I). The initiative was sponsored by the Dayton Hudson Foundation,
the philanthropic arm of the Dayton Hudson corporation, which fully
funded--typically through 2- and 3-year grants--all 40 sites and
committed over $10 million to the effort.
The initiative was built on a model that incorporated the following
strategies: offering training to providers that was specifically
tailored for family child care, promoting and supporting provider
accreditation and professional associations, and contributing to
local consumer education about selecting child care. The initiative
identified an organization in each community that would be
responsible for implementing and institutionalizing the strategies in
the community during the life of the grant. It also launched a
nationwide consumer education campaign to help parents recognize
quality child care. In doing this, the initiative wanted to create a
demand for quality care, thereby prompting the child care market to
supply it.
We visited one of the initiative's first sites, located in Salem,
Oregon. Staff involved with the project told us that before the
Family-to-Family initiative, little work had been done with family
child care in the state. For example, Oregon had only a voluntary
registration system for family care providers, and provider
associations were not very strong or active. According to the staff,
the initiative acted as a catalyst in building supports for family
child care as evidenced by the birth of the Oregon Child Development
Fund, development of a statewide resource and referral system, and
state enactment of minimum requirements for family child care
settings.
The California initiative and the Oregon fund also focus on training
and recruitment and, as mentioned earlier, have successful
fundraising components. These initiatives use a five-part model that
consists of assessing community child care needs, recruiting
providers to meet those needs, offering technical assistance so
providers can become licensed, providing ongoing training to
providers, and giving them ongoing support. These components are
implemented by a statewide resource and referral system. However, it
became apparent early in the initiatives' development that more
funding was essential to carry out the model, particularly to support
the recruitment, training, and networking activities of the various
family child care projects. By continually developing funding
partnerships with local and nationwide businesses, foundations, and
governments, the California initiative has raised $6.8 million in the
last 9 years to fund its family child care projects. The Oregon
Child Development Fund, which is a replica of the California
initiative, was first funded in 1990. Currently, it has raised
$500,000, which it leveraged into an additional $1 million for family
child care projects in the state.
HEALTH INITIATIVES
---------------------------------------------------------- Letter :4.3
Three of the initiatives we visited were health initiatives that
focus on family child care.\10 While their purposes encompass a
number of specific goals and objectives, in the broadest sense, all
aim at increasing the health and safety practices in family child
care homes. Two of the three also have increasing the immunization
rates of children in family child care as one of their objectives.
All three initiatives plan to use an education strategy to inform
providers of health and safety practices and to help link them to
other resources. For example, an initiative we visited in Hood
River, Oregon, uses two county health departments and the local child
care resource and referral agency to provide consultations on health,
nutrition, and other related issues to family child care providers in
those counties. The health departments provide a public health nurse
who makes home visits to providers, answers questions over the
telephone, and conducts training sessions on health and nutrition
issues.
Two of the health initiatives are funded with federal grants from the
Maternal and Child Health Services Block Grant. The block grant is
administered by the Maternal and Child Health Bureau in HHS. The
third initiative receives CCDBG money to fund most of the project; it
also uses some immunization planning funds that states receive from
the Centers for Disease Control and Prevention, which is part of HHS.
--------------------
\10 The three health initiatives were the Atlanta Family Child Care
Health and Safety Project, the Oregon APHA Project (APHA stands for
the American Public Health Association), and the Family Day Care
Immunization Project of San Francisco. (See app. I for details
about the initiatives.)
FAMILY CHILD CARE QUALITY
INITIATIVES ARE FINANCED WITH
PUBLIC AND PRIVATE FUNDS
------------------------------------------------------------ Letter :5
FEDERAL CHILD CARE FUNDS ARE
PRIMARILY FOR SUBSIDIES
---------------------------------------------------------- Letter :5.1
The federal government's role in child care has been primarily one of
helping parents pay for child care. For example, of the seven major
sources of federal support for child care, six have the primary
purpose of subsidizing the cost of care for parents. The seven
programs are the (1) Dependent Care Tax Credit, (2) Social Services
Block Grant, (3) Child and Adult Care Food Program, (4) Child Care
for AFDC, (5) Transitional Child Care, (6) At-Risk Child Care, and
(7) CCDBG. Total federal support for these programs amounted to
approximately $8 billion in fiscal year 1993. Of the $8 billion,
approximately $156 million was for quality support activities, such
as training and monitoring, in all types of child care settings.\11
(How much of this amount goes exclusively to quality initiatives for
family child care could not be determined.) The largest amount of
indirect federal support for child care is provided through the
Dependent Care Tax Credit--$2.4 billion in fiscal year 1993--and is
provided through the tax code to working individuals. The remaining
programs provide direct federal funding to states for child care to
be used for the allowable activities established by each funding
stream.
Table 2
Major Federal Funding Sources for All
Child Care Settings for Fiscal Year 1993
Amount
Funding source (millions) Purpose Agency
-------------- ---------- ---------------------- ------
Dependent Care $2,450\a To provide child care Treasu
Tax Credit subsidies in the form ry
of a limited tax
credit\b
Social 2,800\c To provide funding for HHS
Services Block state social service
Grant activities, including
child care subsidies\d
Child and 1,226\e To provide federal USDA
Adult Care subsidies for meals
Food Program served in child and
adult care
facilities\f
Child Care and 863\g To provide child care HHS
Development subsidies for low-
Block Grant income families and to
improve the overall
quality of child care
for families in
general
AFDC Child 470\e To provide child care HHS
Care subsidies to AFDC
recipients who are in
training or working
At-Risk Child 270\e To provide child care HHS
Care subsidies to families
at risk of going on
welfare
Transitional 113\e To provide child care HHS
Child Care subsidies for up to a
year to families who
have left AFDC
----------------------------------------------------------
\a Projected amount of credit claimed for fiscal year 1993.
\b The Dependent Care Tax Credit is also allowed for other dependents
such as an incapacitated spouse. The Internal Revenue Service
estimates that for 1992 tax returns, approximately 98 percent of the
returns claiming this credit had child dependents. However, the
extent to which the credit is used to offset child care costs as
opposed to costs for care of other dependents is unknown.
\c Appropriated amount for fiscal year 1993. Expenditure data are
not available.
\d An HHS official stated that prior to the program becoming a block
grant, the percentage of the funds used for child care had been
approximately 20 percent. Since that time, the actual percentage is
unknown. However, block grant funds spent for child care are used to
subsidize the cost of care for eligible families.
\e Expenditures for fiscal year 1993.
\f According to an official of the Food and Nutrition Service,
approximately $1.1 billion of the $1.2 billion expended in 1993 went
to child care facilities (centers and homes) as opposed to adult care
facilities. The amount of money going to family child care homes for
meal subsidies was approximately $610 million for 1993, while the
amount going for administrative costs (which support training and
monitoring activities) was approximately $113 million. However, the
administrative costs figure includes expenditures for both centers
and family care homes.
\g Obligations for fiscal year 1993. Complete expenditure data are
not available.
While the tax credit is primarily used by families earning above
$20,000 a year, four of the recent federal programs are aimed at poor
families: AFDC Child Care, Transitional Child Care, At-Risk Child
Care, and CCDBG. These programs are designed to help welfare
recipients and working poor families achieve economic
self-sufficiency by giving them assistance with child care. Enacted
through the 1988 Family Support Act and the 1990 Omnibus Budget
Reconciliation Act, these programs made approximately $1.7 billion
available to the states in fiscal year 1993. Again, the primary
purpose of these programs is to subsidize the cost of child care.
The primary purpose of USDA's Child and Adult Care Food Program is to
subsidize the cost of nutritious meals for children in various care
settings. It also provides other support such as training and
monitoring to providers who become licensed or registered. Unlike
the other federal child care programs, USDA food program subsidies
received by family child care providers are not exclusively for poor
children.
--------------------
\11 We derived this estimate by calculating 5 percent of the total
CCDBG fiscal year 1993 obligation figure and adding $113 million for
administrative costs for USDA's food program in 1993. (See table 2.)
However, this figure may be underestimated for two reasons. First,
while CCDBG requires that 5 percent of total funds be used for
quality improvement activities as defined by statute, states may
spend an additional 12.5 percent of total funds for administrative
costs, availability of services (increasing the supply of child
care), or quality activities upon petitioning HHS to do so. If all
states spent the additional 12.5 percent on activities to improve
quality, it would raise our total estimate to approximately $264
million. Second, we found a few initiatives that received money from
the AFDC Child Care program. The money they received was mostly used
to pay for care of children of AFDC recipients or those in the Job
Opportunities and Basic Skills program. But they also used a small
percentage of the money for administrative costs, some of which
included quality activities to support their providers. However, we
could not calculate the amount of money they used for quality
activities.
CCDBG IS THE FEDERAL FUNDING
USED MOST
---------------------------------------------------------- Letter :5.2
The most frequently used source of federal funds to support quality
enhancement initiatives in family child care was CCDBG. Eighty of
the 195 initiatives in our database, or 41 percent, received CCDBG
funds. Unlike other federal child care funding, which only provides
subsidies, CCDBG sets aside a small amount of money--5 percent of a
state's total CCDBG grant--that the state is required to spend on
quality improvement activities in all types of care settings. For
1993, this would have amounted to approximately $43 million.\12 The
allowable activities include some of those provided by the
initiatives we visited: training providers, supporting resource and
referral agencies, improving licensing and monitoring activities,
improving compensation for providers, and helping providers meet
state and local child care regulations. While CCDBG quality
improvement money must be used for these activities, it is money that
is flexible (that is, it is not targeted for a certain population)
and accessible to many organizations (that is, different types of
groups can apply for it).
--------------------
\12 States are allowed to spend up to an additional 12.5 percent of
their total block grant money on administrative costs, availability
of services, or quality improvement activities.
USDA'S FOOD PROGRAM IS THE
SECOND MOST FREQUENTLY USED
FEDERAL FUNDING SOURCE
---------------------------------------------------------- Letter :5.3
The other federal funding source most often used to support quality
initiatives for family child care was USDA's Child and Adult Care
Food Program. Fifty-eight of the 195 initiatives in our database, or
about 30 percent, received food program money. In addition to
providing subsidies to family child care providers for nutritious
meals and snacks, the program also provides administrative money to
the organizations that sponsor the providers.\13 This money goes to
supporting staff who train providers on the required nutritional
guidelines children's meals must meet under the program, make
periodic monitoring visits, and provide technical assistance to plan
menus and fill out reimbursement paperwork. Providers must be state
licensed or registered to participate. Because of its unique
combination of resources, training, and oversight, experts believe
the food program is one of the most effective vehicles for reaching
family child care providers and enhancing the care they provide.\14
--------------------
\13 A family child care provider must go through a food sponsor and
cannot apply directly to the USDA program.
\14 The administration's welfare reform legislation, which was
introduced in the last Congress, proposed changing USDA's food
program to a means-tested program; this means meal subsidies to
providers would be reduced if the children they served did not meet
certain income eligibility requirements. Currently, the food program
does not have income requirements for families of children served in
family child care homes. If these changes are enacted by the 104th
Congress, some experts and advocates are concerned they may cause
providers to drop out of the program and undercut the program's
current quality support activities for family child care providers.
OTHER FEDERAL FUNDING
SOURCES EXIST, BUT ARE USED
LESS FREQUENTLY
---------------------------------------------------------- Letter :5.4
While federal sources other than CCDBG and USDA's food program were
used by different initiatives for promoting quality in family child
care, these sources were used less frequently. We found 43 out of
195 initiatives--22 percent--received funding from other federal
sources. These funds were from at least five different programs:
the AFDC Child Care program money authorized under the Family Support
Act and administered by HHS; the Community Development Block Grant
and Public Housing Demonstration Grants administered by the
Department of Housing and Urban Development; the Cooperative
Extension Service,\15 a USDA program; and the Maternal and Child
Health Services Block Grant administered by HHS. These funds tend to
be more restricted than CCDBG and USDA food program funds. For
example, we found a few initiatives using the AFDC Child Care program
money to support their activities, but most of the money was used to
subsidize the cost of child care and was only available to these
particular initiatives because they served children of AFDC
recipients. Similarly, the Community Development Block Grant money
for family child care quality initiatives is only available in
communities that receive funds from that block grant and then only if
the communities have targeted family child care as a priority.
--------------------
\15 The Cooperative Extension Service is not a funding stream per se;
organizations cannot apply for money to support their family child
care initiatives. But the Service conducts outreach and education
efforts in the communities it serves, including some that focus on
work with family child care providers.
PRIVATE FUNDING PLAYS A
MAJOR ROLE IN SUPPORTING
INITIATIVES
---------------------------------------------------------- Letter :5.5
In addition to federal money, private dollars have played a major
role in funding these initiatives. Private funding came from a
variety of sources, including foundations, endowments, businesses,
charities, fundraising, and user fees. Of the 195 initiatives in our
database, 107, or almost 55 percent, received money from at least one
private source; 43 initiatives, or approximately 22 percent, received
money only from private sources. For example, two initiatives we
visited--the Neighborhood Child Care Network and the Family-to-Family
initiative--were originally funded by a large foundation and a
private business, respectively. Two other initiatives mentioned
earlier, the Oregon Child Development Fund and the California Child
Care Initiative, built and manage a funding supply for family child
care initiatives in these states. The Oregon fund is financed
entirely with private dollars, and only 7 percent of the $6.8 million
that the California initiative raised in the last 9 years was federal
money.
IMPLICATIONS FOR WELFARE REFORM
------------------------------------------------------------ Letter :6
There is growing evidence that the environment in which children grow
plays a vital role in supporting or impeding their healthy
development. Research shows that children learn from birth--long
before they are actually in a classroom--and that their success or
failure in that classroom can be, in part, tied to their early
environment. Given that many children, especially very young
children, are spending significant parts of their day in child care,
communities, experts, and policymakers are asking questions about the
quality of that care.
Experts have had long-standing concerns about the quality of child
care in the United States for all types of settings. In light of
these concerns, the initiatives we found were engaged in strategies
and activities to improve the quality of family child care by
providing networks of support and other resources. They gave family
child care providers ongoing training, linked them to information and
resources, helped them to become registered and to join the USDA food
program, provided access to toy-lending libraries, and supported them
with staff who made home visits to provide various types of help.
Again, research tells us that such activities can significantly
enhance the quality of care children receive.
Many welfare reform discussions outline plans to require more AFDC
recipients to either work or be in education or training programs to
help them acquire basic skills for supporting their families. As a
result, the number of children needing child care--particularly very
young children--is predicted to grow. Since family child care is the
choice of a significant proportion of poor families with infants and
toddlers, its use is also predicted to grow under various welfare
reform scenarios. Given that research shows that quality child care
settings particularly benefit poor children, the need for quality in
this care will also grow.
---------------------------------------------------------- Letter :6.1
At your request, we did not obtain written agency comments. However,
we discussed our findings with agency officials who generally agreed
with the information presented in this report.
We are sending copies of this report to the Secretary of Health and
Human Services, the Secretary of Agriculture, and to other interested
parties. We will make copies available to others on request.
Major contributors to this report are listed in appendix II. If you
have any questions concerning this report or need additional
information, please call me on (202) 512-7215.
Sincerely yours,
Leslie G. Aronovitz
Associate Director
Income Security Issues
EXAMPLES OF QUALITY INITIATIVES
FOCUSED ON FAMILY CHILD CARE
=========================================================== Appendix I
This appendix contains brief descriptions of the 11 initiatives we
visited, including information on the strategies used, the sponsoring
organization, the amount of funding received, and the number of
providers served by the initiative. The 11 descriptions are
categorized as support networks; health initiatives; and training,
recruitment, and consumer education initiatives.
SUPPORT NETWORKS
--------------------------------------------------------- Appendix I:1
NEIGHBORHOOD CHILD CARE
NETWORK
------------------------------------------------------- Appendix I:1.1
The Neighborhood Child Care Network, an initiative sponsored by Save
the Children in Atlanta, started as a national demonstration project
funded by the Ford Foundation. The Network's goal is to improve the
quality and availability of family child care for low-income parents.
It has set out to demonstrate what urban communities can do to
address child care issues through community organizing and formal and
informal training of providers.
The Network supports 60 family child care providers in the
communities it serves. The Network's support includes lending
libraries from which their providers can borrow books, equipment, and
toys; regular home visits from child care specialists who conduct
one-on-one training with providers, discuss relevant child care
topics such as child development and safety and health issues;
assistance with joining the USDA food program, record keeping and
other business aspects; monthly training workshops and newsletters
that list other training opportunities; scholarships to attend
training conferences; and assistance in forming family day care
provider associations and obtaining national accreditation.
In 1992, the Network expanded its activities to include services for
the parents in its family child care network. Through a grant from
A.L. Mailman Family Foundation and Primerica, its Parents Service
Project uses family child care homes as the parents' point of entry
for delivery of various social services.
The Network was funded from 1987 through 1990 with grants from the
Ford Foundation that totaled approximately $300,000. Since then, it
has received a total of approximately $120,000 in CCDBG money, which
has required the Network to curtail some services.
Save the Children is an international nonprofit organization whose
mission is to improve the lives of poor children and their families.
It was founded in 1932 and works in Appalachia, in several southern
states, and selected inner-city areas as well as in 43 other
countries.
FOUNDATION CENTER FOR
PHENOMENOLOGICAL RESEARCH
------------------------------------------------------- Appendix I:1.2
The Foundation Center for Phenomenological Research is a nonprofit
organization formed in 1974 to help small community organizations
strengthen their operations. In 1980, it won its first contract to
run a state-funded child care program; currently it runs child care
programs in approximately two dozen locations, primarily in
California. The site we visited was its Sacramento Delta and Ilocer
Migrant and Seasonal Farmworker Family Child Care Project, which
supports 20 providers serving approximately 160 children from migrant
agricultural workers' families.
The goal of the Foundation Center is to provide quality child care to
infants, toddlers, and preschoolers and their families and to improve
the children's school readiness and long-term academic achievement.
The Foundation Center provides health services to the children and
their families and a full-day education program for the children, and
also supports family child care providers. The Foundation Center
gives providers employment benefits, including sick and vacation
leave, and health insurance; recruits and places eligible children in
providers' homes, helping to complete paperwork requirements for
child care funding and USDA's food program; provides training in the
providers' native languages using the Montessori curriculum so that
providers can earn the American Montessori Society teaching
credential; and equips each provider's home with culturally and
developmentally appropriate furniture, materials, and toys.
Additionally, all children and their families receive free yearly
health exams, immunizations, medications, referrals, and follow-up,
and are linked to other social services they may need.
The Foundation Center's family child care projects are funded with
state dollars through California's General Child Care funds. The
only federal assistance the Foundation Center receives is as a food
sponsor through USDA's food program. It receives a total of
approximately $9 million a year from these sources to serve 2,300
children at 20 sites, including family child care projects, in 9
California counties.
OAKLAND HEAD START FAMILY
CHILD CARE DEMONSTRATION
PROJECT
------------------------------------------------------- Appendix I:1.3
In 1992, HHS began a demonstration project to determine if family
child care could be a viable way to deliver the comprehensive
services that are required of Head Start programs. Currently, HHS
has funded, for 3 years, 17 Head Start Family Child Care
Demonstration Project sites across the country. The demonstration,
which includes only 4-year-olds, requires family child care providers
to meet the Head Start Performance Standards.
At the project site in Oakland, California, the low-income families
who participate must be working or in an education or training
program, thus requiring more than the half-day services traditionally
provided by Head Start centers. All providers in the family day care
project offer full-day and year-round care, a primary reason that
Oakland applied for the demonstration project. City officials were
finding that more and more of the child care needs of their
low-income families could not be met with centers that operated only
half the day. The 7 providers participating in the Oakland project
care for approximately 40 children.
Head Start family child care providers participating in the Oakland
demonstration received 40 hours of preservice training in 1993 and 80
hours in 1994. After the preservice training, they attend training
once a month. In addition, providers receive weekly visits from a
child care specialist. These visits, which last from 20 minutes to a
few hours, allow the specialist to observe the provider and children,
deliver supplies and materials, link the provider with the other Head
Start coordinators, and support the provider in other ways.
Head Start is a fully federally funded program administered by the
Head Start Bureau at HHS.
HEAD START OF LANE COUNTY
------------------------------------------------------- Appendix I:1.4
While Head Start of Lane County is a federal Head Start grantee, its
family child care model--which uses family child care providers to
serve Head Start-eligible children--is funded by the Oregon
Pre-Kindergarten Program. The state program, which is a replica of
the federal Head Start program, was begun in 1990 as a way to serve
more low-income children in a Head Start model. Lane County Head
Start officials decided to use family child care providers when they
identified a need to provide Head Start services in two rural areas
of their county where no Head Start centers were located. At the
time of our visit, the program had 20 providers serving 80 children
between the ages of 3 and 5. For 1993-94, Lane County Head Start
received a state grant of approximately $292,000 to administer the
program.
While this model is funded with state dollars, the family child care
providers are treated as Head Start teachers and, as in the Oakland
Head Start Demonstration Project, the care they provide must meet
Head Start standards. During 1993-94, each family child care
provider received approximately 75 hours of training. Providers also
receive visits at least once a week from their Head Start trainer who
works with the providers and the children in the providers' homes.
And, because they are part of the Head Start program, the providers
are linked with all the Head Start specialists who work with the
children and parents enrolled in the center program.
The family child care model will not be continued in 1994-95,
however. This is due to a reorganization by the grantee, which needs
time to focus on its center-based program. However, Lane County Head
Start officials told us that they hope to resume the program in the
future.
DOD'S FAMILY CHILD CARE
SYSTEM
------------------------------------------------------- Appendix I:1.5
As the largest employer in the United States, the military has
experienced the same demographic trends in its workforce as other
employers: increases in both the number of married personnel with
spouses in the workforce and the number of single parents. Because
of its flexibility to support the varying work hours of service
personnel and to accommodate parental deployment with long-term care,
family child care was seen as a viable way to meet the needs of
military families. As a result, the four service branches have
developed a comprehensive family child care system.
DOD's family child care model contains the same elements other
support network initiatives do--ongoing training for providers;
visits by home monitors; placement of children; and access to
equipment, supplies, and other resources. However, DOD's system has
notable differences, too: the huge organization that sponsors it;
the large number of providers it supports (over 12,000 worldwide);
the amount of authority it has to screen and monitor providers
because they reside in military housing; and the full federal funding
it receives.
Intensive screening of potential providers and extensive ongoing
training for those accepted into DOD's network are two components of
its model that stand out. Orientation sessions are held for
prospective providers to familiarize them with the requirements for
providing family child care on a base or installation. After the
orientation session, the military begins its process of certifying
both the provider and the provider's home. This involves yearly
background checks on the provider and members of the household over
the age of 12; in-home interviews with the provider and family
members; a health, fire, and safety inspection of the home; and
quarterly home monitoring visits.
Training for providers includes orientation, initial, and annual
training requirements. Orientation training must be completed by
providers before working with children and covers topics such as
child health and safety, age-appropriate discipline, and applicable
child care regulations. Once hired as a family child care provider,
an individual must complete a minimum of 36 hours of initial training
within 6 months of being hired. This training provides more in-depth
coverage of topics such as nutrition, cardiopulmonary resuscitation,
and child development. After this, providers must complete a minimum
number of hours of ongoing training each year; the requirements
differ for each service branch.
HEALTH INITIATIVES
--------------------------------------------------------- Appendix I:2
ATLANTA FAMILY CHILD CARE
HEALTH AND SAFETY PROJECT
------------------------------------------------------- Appendix I:2.1
The Atlanta Family Child Care Health and Safety Project, conducted by
Save the Children's Child Care Support Center, is a 3-year project
running from October 1993 through September 1996 that is designed to
address the increased health and safety risks faced by children in
family child care. HHS is providing $300,000 for the project through
the Maternal and Child Health Services Block Grant administered by
the Maternal and Child Health Bureau.
The project's first goal is to improve the existing system of
training and support for child care providers. To accomplish this,
project staff will refine an existing health and safety checklist for
child care providers and develop educational materials for parents
and child care providers that discuss, among other things, safety and
health issues in a family child care setting. In addition, project
staff will conduct a study of a group of family child care providers
to identify barriers they face in meeting health and safety standards
as well as identifying barriers to training and other support. Staff
will also explore methodologies for collecting information on injury
and illnesses occurring in family child care settings. (Currently
injury and illness data in child care settings are gathered only for
center care.) This research will provide useful information for
designing training programs and educational materials on health and
safety issues specifically tailored for family child care.
The second goal, which is not exclusively focused on safety and
health issues, is to bring unregistered family child care providers
into the system of registration, training, and support. Project
activities related to this goal include increasing provider
registration, particularly through registering providers who take
care of subsidized children; enrolling providers in USDA's food
program; listing providers with child care resource and referral
services; assisting providers in meeting health, safety, and training
requirements; and encouraging participation in professional provider
associations.
OREGON APHA PROJECT
------------------------------------------------------- Appendix I:2.2
Oregon is one of the four states selected to pilot the implementation
of guidelines developed by the American Public Health Association
(APHA) in conjunction with the American Academy of Pediatrics.\16 A
1-year demonstration project, the Oregon APHA Project, is funded with
$20,000 in CCDBG money provided by the state Child Care Division and
$10,000 in Immunization Grant money provided by the state Department
of Human Services, Health Division. The Immunization Grant is
provided to states by HHS' Centers for Disease Control and Prevention
to help states plan and execute community immunization plans.
The dual objectives for the demonstration project are to (1) form
strong links with public health and other community organizations to
establish a planned public health strategy to improve the overall
health of children in child care settings and (2) increase the
immunization rates of children in such settings.
Three Oregon counties, Hood River, Sherman, and Wasco, are involved
in the pilot. While the initiative has a number of objectives, those
related to family child care include facilitating provider access to
ongoing health promotion, protection, and education and giving child
care providers home safety assessment tools and necessary child
safety items such as safety latches, smoke alarms, and socket plugs.
The project is using two county health departments and the local
resource and referral agency to carry out the initiative. Through
connections made by the resource and referral agency, a part-time
public health nurse from the health departments consult with family
child care providers on health and safety topics through home visits,
phone calls, and training sessions organized by the resource and
referral agency.
--------------------
\16 See Caring for Our Children: National Health and Safety
Performance Guidelines for Out-of-Home Child Care Programs
(Arlington, Va.: National Center for Education in Maternal and Child
Health, 1992).
FAMILY DAY CARE IMMUNIZATION
PROJECT
------------------------------------------------------- Appendix I:2.3
The Family Day Care Immunization Project, sponsored by the Center for
Health Training in San Francisco, is a 3-year demonstration project
running from October 1993 through September 1996 funded by the
Maternal and Child Health Bureau. Annual project funding is
$100,000.
The specific project goal is to improve immunization rates of
children, especially low-income and ethnic minorities, from a sample
of family day care homes. Objectives include (1) increasing the
knowledge and practice regarding immunization screening for at least
24 health care consultants by September 30, 1994, and (2) developing
and testing at least three distinct educational interventions with up
to 120 providers to determine their effectiveness in increasing
immunization rates and their comparative costs by September 30, 1996.
Regarding the first objective, the Center plans to "train the
trainers" to conduct training and site visits. Trainers are being
recruited from agencies such as the Red Cross and California's
Department of Social Services. The interventions proposed for the
second objective will use three control groups: (1) one that will
receive only notification letters of state immunization requirements,
(2) one that will participate in a 3-hour training session, and (3)
one that will receive a 1- to 2-hour site visit to provide
information about immunizations. The project will determine which
method is the most cost-effective for implementing California's new
law requiring immunizations in family day care settings.
The Center is a private, nonprofit company that does health research
and training, and provides consultant services
TRAINING, RECRUITMENT, AND
CONSUMER EDUCATION INITIATIVES
--------------------------------------------------------- Appendix I:3
CALIFORNIA CHILD CARE
INITIATIVE PROJECT
------------------------------------------------------- Appendix I:3.1
The California Child Care Initiative Project was begun in 1985 to
increase the supply of quality family child care statewide.
Originally designed and initiated by the BankAmerica Foundation, the
project is a public-private partnership that includes over 473
foundations, corporations, local businesses, and public sector
funders. It has raised over $6 million for its mission.
The project's purpose is to fund community-based child care resource
and referral agencies to (1) recruit and train new family day care
providers and (2) provide start-up and ongoing assistance to help
them stay in business. The California Child Care Resource and
Referral Network oversees the project's daily operations and manages
its publicity and fundraising activities. The project's successful
and effective fundraising component makes it unique among the
initiatives we visited. The Network continually raises funds in the
private and public sectors and also coordinates the state of
California's contribution of up to $250,000 per year, matching $1 for
every $2 raised from private businesses and federal and local
governments.
Overall, the project has recruited 3,887 new, licensed family child
care homes, making 15,303 new child care spaces available for
children of all ages. Since the initiative began, over 25,891 family
child care providers have received basic and advanced training in
providing quality child care. Because of its success, the project is
being replicated in Oregon (see the next section), Illinois, and
Michigan.
OREGON CHILD CARE
INITIATIVE, OREGON CHILD
DEVELOPMENT FUND
------------------------------------------------------- Appendix I:3.2
The Portland-based Oregon Child Care Initiative, which is a replica
of the California Child Care Initiative, was incorporated to solicit
funds from corporate, foundation, and private sources to encourage
solutions to family child care issues in Oregon. The primary mission
at its inception was to increase access to stable and quality family
child care. Efforts to accomplish this broad goal included using
proven provider recruitment, training, and retention programs first
developed under the California model. In 1992, the initiative
evolved into the Oregon Child Development Fund with a broader mission
of increasing access to stable, high-quality child education and
child care services by concentrating fund raising and distribution in
four areas: training and recruitment, consumer education, capital
expansion, and accreditation scholarships.
As with the California initiative, the Oregon project's funding
mechanism is one of its distinctive components. The Oregon project
was originally funded by the Ford Foundation in 1990 with actual
start-up in 1991. Currently, it has raised $500,000 in grant
funding, which it has leveraged into an additional $1 million in
local and state support. According to a representative of the fund,
the project is entirely supported by private or business donations.
Between 1990 and 1993, the initiative recruited 3,000 family child
care providers, trained 3,400 family child care providers, created
18,000 child care slots, and awarded 21 scholarships to providers
seeking National Association of Family Child Care accreditation or
Child Development Associate credentialing.
FAMILY-TO-FAMILY INITIATIVE
------------------------------------------------------- Appendix I:3.3
The Family-to-Family initiative was funded by the Dayton Hudson
Foundation, the philanthropic arm of the corporation that owns
Mervyn's and Target department stores throughout the midwest,
northwest, and California. In 1988, the corporation executives
became concerned about the difficulty employees were having in
finding quality family child care and the limited information parents
had to identify quality child care. Through its corporate
foundation, Dayton Hudson initiated a nationwide campaign to address
these issues. The strategy was to promote training, accreditation,
and consumer education at selected sites through a collaborative
effort with community-based organizations so that these efforts would
continue after the initiative ended.
The first four sites funded by the initiative were in Oregon; we
visited the Salem site. With a $250,000, 2-year grant from Dayton
Hudson and through two partners in the community--a community college
and the local resource and referral agency--the initiative
established a structured training program for family child care
providers, promoted and assisted with accreditation, and began a
statewide consumer education campaign. In addition, the initiative
established a provider council and toy- and equipment-lending
libraries for providers. The council was important to help develop
provider leadership in the community and to create a forum at which
family child care issues could be discussed and strategies could be
developed to address them. Toy- and equipment-lending libraries
helped subsidize the cost of operation for providers, especially for
those caring for infants who needed cribs and other more expensive
equipment.
One of the most critical and lasting effects of the Family-to-Family
initiatives was to establish a structured provider training program
at community colleges, resource and referral agencies, USDA community
colleges, and other organizations throughout Oregon to make it
accessible and transferrable no matter where providers took courses.
The courses were designed to satisfy requirements leading to a child
development associate's degree.
MAJOR CONTRIBUTORS TO THIS REPORT
========================================================== Appendix II
Lynne Fender, Assistant Director, (202) 512-7229
Janet L. Mascia
Alexandra Martin-Arseneau
Diana Pietrowiak