Child Care

Federal grants to states to help subsidize child care centers and promote quality care require assurances that providers are meeting minimum health and safety standards, but tight fiscal conditions have weakened the ability of many states to enforce standards and improve the quality of care. In particular, tight budgets in several states have reduced on-site monitoring, a key oversight activity. Many states are looking into less costly ways of ensuring compliance with standards and influencing the quality of care, but little is known about their effectiveness. The Child Care and Development Block Grant Act of 1990 seeks to help states subsidize child care services for low-income families and to improve the overall quality of child care. Because the legislation is still in the early stages of implementation, however, it is too soon to know how it will affect the quality of child care. Yet many states are already concerned that funds for quality improvement may fall short. Moreover, they expect an influx of new child care providers under the program that could boost their caseloads and undermine their ability to regulate providers. Most state officials believe that their own enforcement efforts could be improved with technical assistance and more information about promising approaches in other states. HHS could help states evaluate their enforcement of child care standards. In addition, HHS should assess how well states expand the amount of service--and improve quality--given the states' current resources. If necessary, HHS should modify its regulations to prevent states from expanding quantity at the expense of quality.

GAO found that: (1) state-sponsored regulatory activities include screening child care providers, conducting on-site monitoring, and imposing sanctions; (2) states screen child care providers to determine suitability, conduct on-site monitoring to determine standard compliance, and impose sanctions for failure to comply with standards; (3) on-site monitoring was the most effective regulatory means of ensuring provider compliance with state standards; (4) due to budget constraints and increased case loads, states conducted fewer on-site visits than required; (5) states attempt to curtail spending on monitoring resources by prioritizing inspections on providers with poor compliance histories, streamlining visits and focusing on a limited number of standards, providing specialized sexual and physical abuse training for inspectors, and creating automated data information systems; (6) budget cutbacks, staff shortages, and increased numbers of providers are major reasons states have difficulties in conducting on-site monitoring; (7) to supplement screening, monitoring, and sanctioning efforts, states educate consumers, train providers, maintain and publicize hotlines, and require liability insurance; (8) states want the Department of Health and Human Services (HHS) to collect and disseminate other licensing and regulatory information and provide technical assistance in developing child care information systems; and (9) most CCDBG funds pay for child care services, and states are unsure whether CCDBG funds targeted for quality improvements would improve child care quality.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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