Leaving Children to Chance by Child Care Aware® of America

leaving children to chance NACCRRAâ&#x20AC;&#x2122;s Ranking of State Standards and Oversight of Small Family Child Care Homes

Acknowledgements Dr. Beverly Schmalzried oversaw the collection of state data, wrote the extensive literature review included in the appendix and available on the NACCRRA website, worked with the state contacts, and provided expertise and guidance in the development of this report. Several members of the NACCRRA staff, Beverly Houston, Bonnie Storm, and Paula BendlSmith, reviewed and scored the states’ regulations. Each state’s information was reviewed by an individual from the state’s child care resource and referral network or state licensing office or both for accuracy. Mousumi Sarkar compiled the state reports and summary reports. Grace Reef, Linda Smith, and Susan Perry-Manning served as primary authors and editors, and Jan Terhune, Bonnie Storm, Beverly Houston, Caitlin McLaughlin, Mary Beth Salomone, Sheila Holland, Ginnie Pera, Kendra Beasley, and Stacey Minott reviewed and edited the completed document. Patricia Sadiq developed the graphics and final report. The National Association of Child Care Resource & Referral Agencies (NACCRRA) deeply appreciates and acknowledges the Child Care Resource & Referral agencies (CCR&Rs) and state licensing staff who took the time to review NACCRRA’s findings on the state family child care regulations in each state. Without their assistance, this project would not have been possible. Below is a list of the state individuals who helped in some way with the report. Alabama

Mary Davis

Alaska

Michelle Jaeger

Arizona

Betty Hancock

Arkansas

Kathy Stegall

California

Patty Siegel & Donita Stromgren

Colorado

Paula Neth & Sheralee Turley

Connecticut

Sherry Sutera & Tracy E. Zolnik

Delaware

Evelyn Keating

District of Columbia

Julia Castillo & Tanya Woodson

Florida

Brittany Birken, Deborah Rogers and Debby Russo

Georgia

Rick Caldwell, Molly Casey & Renee Parlier

Hawaii

Cynthia Ballard

Idaho

Brenda Breidinger

Illinois

Susan Bass & Janet Maruna

Indiana

Melissa Chalman

Iowa

MariLynn Pierce & Beth Walling

Kansas

Leadell Ediger, Janet Newton & Alice Womack

Kentucky

Amy Booth

Louisiana

Gail Kelso

Maine

Rita Fullerton

Maryland

Phil Koshkin & Steve Rohde

Massachusetts

Sue Halloran

Michigan

Mark Sullivan

Minnesota

Elizabeth Cooper & Ann McCully

Mississippi

Tonya Adkins

Missouri

Corinne Patton & Pamela Speer

Montana

Anne Carpenter & Stephanie Goetz

NACCRRA’s Ranking of State Small Family Child Care Homes

Nebraska

Janet Phelan

Nevada

Marty Elquist

New Hampshire

Roberta Gaudette

New Jersey

Nancy C. Thompson

New Mexico

Pam Sellers

New York

Sage Ruckterstuhl

North Carolina

Francesca Busse

North Dakota

Kristi Asendorf, Sandy Hanretty, & Linda Reinicke

Ohio

Chris Stoneburner

Oklahoma

Mark Lewis, Janice McGlon-Matthews, Linda Whaley

Oregon

Tom L. Olsen

Pennsylvania

Terry Casey

Rhode Island

Palmeira Hall & Brenda Almeida

South Carolina

Bob Howard, Rita Paul, & Billie Green-Smith

South Dakota

Penny Brandt

Tennessee

Lois Barrett-Luke & Elaine Piper

Texas

Sandy Lamm & Sul Ross

Utah

Lisa Barker

Vermont

Karyn Carstensen

Virginia

Sharon Veatch

Washington

Cammey Rocco & Elizabeth Bonbright-Thompson

West Virginia

Melissa Dailey

Wisconsin

Anne Carmody

Wyoming

Jackie Immel

About NACCRRA NACCRRA, the National Association of Child Care Resource & Referral Agencies is the nationâ&#x20AC;&#x2122;s leading voice for child care. We work with more than 800 state and local child care resource & referral agencies to ensure that families in every local community have access to high-quality, affordable child care. To achieve our mission, we lead projects that increase the quality and availability of child care, offer comprehensive training to child care professionals, undertake research, and advocate child care policies that positively impact the lives of children and families. ii

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Table of Contents Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i Foreword from Linda Smith, NACCRRA’s Executive Director . . . . . . . . . . . . . . . . . . . . . . . . 2 About the Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Elements of Quality & NACCRRA’s Scoring System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Overall State Family Child Care Home Rankings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Summary of Findings: State Family Child Care Standards . & Oversight Leaves Much to Chance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 State Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Appendix A: Rationale for the Scorecard Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Appendix B : Definition of Different Types of Regulation . . . . . . . . . . . . . . . . . . . . . . . . . 175 Appendix C : Licensing Small Family Child Care Homes . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Appendix D: State Thresholds for Licensing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Appendix E: Number of States Requiring Visits/Inspections . . . . . . . . . . . . . . . . . . . . . . . . 180 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 End Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

NACCRRA’s Ranking of State Small Family Child Care Homes

Foreword This is the second report issued by NACCRRA on the nation’s child care licensing efforts. The first report, We Can Do Better, released in February of 2007, focused on the states’ regulations for child care centers. The more than 300 news articles generated by that report heightened attention to the need to improve child care center standards and oversight in this country. NACCRRA is aware of efforts in several states to address licensing deficiencies identified in that report. “Leaving Children to Chance: NACCRRA’s Ranking of State Standards and Oversight in Small Family Child Care Homes,” takes an indepth look at small family child care home state standards and oversight. In this report, a small family child care home is a child care setting in which up to six children, including those of the caregiver under age six, are cared for in the home of the provider for compensation. More than 1.7 million children under age six are in family child care homes every week. And yet, for the most part, our research on family child care policies found that most states do little to protect children while they are in family child care homes. Only 12 states begin to license family child care when one unrelated child is cared for in the home. The rest have widely varying thresholds, with South Dakota at the end of the spectrum—only with the existence of the 13th child does South Dakota regulate family child care homes. We chose 14 basic elements of quality child care to review and score the states. No state received the maximum allowable points. Only one state received a score of even 75 percent. Fifteen states scored zero because they do not inspect family child care homes prior to issuing a license, allow more than six children to be present without regulation, or do not license small family child care homes. Of

those states with a score, the average score was 60 out of a possible 140. The requirements for quality child care are really quite simple. Providers being paid to care for children on a regular basis are really a business within the community. And, we ought to treat them as such, but we do not. States grant licenses to providers without inspecting the settings first. States set minimal standards for providers, but then don’t follow up with inspections to see if providers are complying with the standards. Or, if they perform inspections, they are not on a routine basis and are not unannounced. States don’t require training in child development and other critical areas. Although each state has health and safety requirements, they are often insufficient. Only eight states met all 10 basic criteria on both health and safety requirements. Parents expect their children to be safe, but many states do not conduct a complete background check on providers. Safety is one aspect of child care. Early learning is another. Much of the political talk in recent years has been about preparing children to start school ready to succeed. And, yet, there is a large chasm between state early learning standards and the attention given to the quality of child care. Children start learning from birth. Child care is where the majority of children with working parents are during the work week. If as a nation we really want to ensure children start school ready to learn, then it is time to pay attention to (and strengthen) the quality of environments children are in before they are of mandatory school age. There is a movement by the states to expand pre-kindergarten initiatives. But, we can’t wait until children are four years old before we start paying attention to whether they are in a setting that promotes safe and healthy development – not when the children of working NACCRRA’s Ranking of State Small Family Child Care Homes

mothers, on average, are spending 36 hours a week in the care of someone who is not a parent. Parents are a child’s first teacher. But, child care providers, particularly family child care providers who are often the lone adult interacting with children, are their teachers as well. Under the federal Child Care and Development Block Grant (CCDBG), which allocates funds to states for child care, states are required to provide a detailed description in their child care state plans of their licensing standards including how such standards are effectively enforced. In particular, states are required to certify that they have requirements to protect the health and safety of children in child care and procedures are in place to ensure that child care providers comply. The state plans are required to be submitted to the Child Care Bureau within the U.S. Department of Health and Human Services every two years.

What we have found in our review is that efforts are minimal, teetering on nonexistent in too many states. For states with standards, given their lax approach to oversight, the standards have little meaning. In short, we believe that current law has led to “self-certification” by the states, which upon review, leaves too much to chance for children in family child care homes. This report contains several recommendations including a key recommendation to require the Child Care Bureau to not only collect state plans, but also to review the state plans against state regulations. In addition, the Child Care Bureau should be granted the authority to withhold CCDBG funds if state standards and oversight are insufficient. It is our hope that policymakers at the federal and state level will be motivated to protect children’s safety and help ensure their healthy development upon reviewing our report. Together we can make a difference.

Linda K. Smith . Executive Director . NACCRRA

NACCRRA’s Ranking of State Small Family Child Care Homes

About the Report The National Association of Child Care Resource & Referral Agencies (NACCRRA) and individual state and local Child Care Resource & Referral (CCR&R) agencies work within every state to help ensure that families have access to affordable high-quality child care. CCR&Rs are uniquely positioned within communities to not only work with parents, but also with child care providers and state and local governments to strengthen the quality of care. Because state child care standards and oversight vary greatly from state to state, the quality of child care between states also varies greatly.

The information used to score the states was obtained by reviewing each stateâ&#x20AC;&#x2122;s family child care regulations and having the results reviewed by one or more individuals from each stateâ&#x20AC;&#x2122;s CCR&R system. In several states, the resource and referral staff either consulted with state licensing personnel or had the information checked by licensing staff. Because the United States military child care system is often hailed as a model for states and communities to follow, NACCRRA reviewed not just the policies within states, but also the Department of Defense (DoD) policies.

About $11 billion in government funds is used annually by the states for child care. For the most part, funding for child care comes from the Child Care and Development Block Grant (CCDBG), the Temporary Assistance for Needy Families (TANF) program, the Social Services Block Grant (SSBG or Title XX), and state funds. Since the nature of these funds is a block grant, states have wide discretion about how to spend this money. CCDBG is the primary federal program allocating funds for child care, but health and safety requirements in the law are subject to broad interpretation. As a result, each state crafts its own standards and oversight policies.

As we reviewed the criteria for state rankings and compiled the scores, we were disappointed to see how low the bar is set for the quality of care that so many children under age six receive. The total possible points for each state is 140. Fifteen states scored zero points because they either do not inspect small family child care homes prior to issuing a license, they allow more than six children to be present without regulation, or do not license small family child care homes. Of the states with a score, the average was 60. Oklahoma scored the highest with 105 points followed by Washington state with 103 points, Massachusetts with 101 points, and the Department of Defense with 95 points. Only one state (Oklahoma) received 75 percent of the maximum points allowed.

In February 2007, NACCRRA released a report on state child care center standards and oversight. But, center care is only part of the picture. More than 1.7 million children under age six spend time every week in family child care homes. A small family child care home is a child care setting in which up to six children, including those of the caregiver under age six, are cared for in the home of the provider for compensation. The intent of this report is to take an in-depth look at what the states are doing with regard to standards and oversight for small family child care homes.

How are we doing with regard to standards and oversight of small family child care homes in America? We are leaving a great deal to chance.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Executive Summary “Leaving Children to Chance: NACCRRA’s Ranking of State Standards and Oversight in Small Family Child Care Homes,” reviews and ranks state regulations for small family child care homes. A small family child care home is a child care setting in which up to six children, including those of the caregiver under age six, are cared for in the home of the provider for compensation.

six children in the home before applying state regulations.* This means that the children in these states are in a child care setting in which the safety of the home is unknown. Some of these children are receiving state and federal subsidies to help afford the cost of child care, but the government does not know the quality of the environment (let alone the safety of the environment) for which it is paying.

Each week, about 12.5 million children under age six are in some type of child care setting. Of these children, more than 1.7 million are in family child care arrangements. On average, children of working mothers spend about 36 hours each week in child care.

States have many different ways to count the number of children allowed in the home. Some states exempt the provider’s own children. Some states only begin counting children when a certain number of unrelated families are cared for in the home. The actual number of children in the home is important because it affects the safety of the children and impacts the ability of the provider to interact effectively with the children. NACCRRA’s position is that all paid providers caring for one or more unrelated children on a regular basis should be subject to state standards and oversight.

With 14 percent of the children of working mothers in small family child care homes, NACCRRA reviewed the state regulations to gain a better understanding of state standards and monitoring guiding the settings in which these children spend so much time. Unfortunately, what NACCRRA found was that states are leaving children to chance. NACCRRA chose 14 key elements essential for quality small family child care homes. States were assessed, assigned points based on state policies, and ranked based on their performance. The maximum number of points a state could receive is 140. When excluding states that received a zero, the average score was 60. Overall Condition of State Small Family Child Care Home Policies: Fifteen states either do not license small family child care homes, do not conduct an inspection prior to issuing a license, or allow more than

NACCRRA chose 10 different health and safety standards essential for a quality family child care home. Yet, only eight states met each of the ten requirements. Overall, NACCRRA found state standards and monitoring efforts weak at best. The federal government requires states to detail their standards and procedures to monitor their standards in their state plans submitted every two years to the Child Care Bureau within the U.S. Department of Health and Human Services. But, the Child Care Bureau does not have the authority to assess those state plans for content or compliance. Essentially, this means

**To derive the total number of children in care, NACCRRA added one child if the state does not include the provider’s own children in establishing its licensing threshold and one for each family exempted before licensing begins. For example, if a state does not require licensing until children from a second unrelated family are in care, the state was given a threshold of 2.

NACCRRA’s Ranking of State Small Family Child Care Homes

that states are policing themselves and leaving children to chance. Major Highlights

The Top 10 Highest Scoring States Oklahoma, Washington, Massachusetts, the Department of Defense, Alabama, the District of Columbia, Maryland, South Carolina, Colorado, and Connecticut ranked among the top 10 highest scoring states for small family child care home standards and oversight. But, that does not mean that they scored well; it only means that for the purposes of this scorecard, they earned the most points. In fact, only one state, Oklahoma, received 75 percent of the available points. Oklahoma scored the highest with 105 out of a possible score of 140 and Connecticut ranked 10th with a score of only 69 (earning a score of about 50 percent). Given that the criteria for ranking was only basic enough to ensure children’s safety and healthy development, even the top 10 states have much room for improvement. States Scoring Zero Six states (Idaho, Louisiana, New Jersey, Ohio, South Dakota, and Virginia) received zero points because either they do not regulate small family child care homes or permit more than six children (counting the provider’s own children under school-age or other related children) to be present without regulation. For example, in South Dakota providers can care for up to 12 children without being regulated as a family child care home. Nine additional states (Delaware, Florida, Georgia, Iowa, Kansas, Michigan, Montana, Pennsylvania, and West Virginia) received zero points because they do not require family child care homes to be inspected or visited prior to obtaining a child care license.

Weak State Inspection Standards Only two states, Tennessee and New Mexico, received the maximum points for monitoring family child care homes. Both states require an inspection visit before a family child care home is licensed, visits to the home at least four times a year, and visits when there is a complaint against the home. In contrast, Iowa requires visits once every five years and Michigan once every ten years. Fifteen states either do not license small family child care homes or do not conduct an inspection prior to issuing a license. Incomplete Background Checks on Providers Conducting background checks on providers and their family members helps provide some assurance that children are not cared for by individuals with a history of violence or . crimes involving children. While most states . are conducting background checks, only 25 states require federal checks using fingerprints. A background check without a fingerprint check . is of limited value. Weak Minimum Education Requirements for Providers Twenty-nine states have no minimum education requirement for family child care providers. Only 17 states specify a minimum of a GED . or a high school diploma. Weak Pre-Service Training for Providers Eleven states do not require any pre-service training for individuals to become licensed as small family child care home providers. Twenty additional states only require between one and ten hours of pre-service training – too little time to cover both important safety practices, and child development and related topics. Research shows that training makes a difference in the quality of care, particularly given the relatively lower levels of education within the child care workforce.

NACCRRA’s Ranking of State Small Family Child Care Homes

Weak Early Learning Standards Only 13 states require providers to read to children and only nine states require them to offer activities to help children develop premathematics skills such as counting. Only 24 states require family child care home providers to have language and literacy materials. Weak Basic Safety and Health Policies Only eight states met each of the 10 requirements under both health and safety. For example, only 32 states require safe sleep practices to reduce the likelihood of Sudden Infant Death Syndrome (SIDS). More than half of the states do not require family child care home providers to follow universal health precautions related to handling blood and other bodily fluids. Federal and State Accountability State standards and oversight policies vary greatly. The primary source of funding for child care is the federal Child Care and Development Block Grant, which allocates funds to the states for child care and related purposes. While states have a great deal of flexibility to set their own standards, the intent of the law is clear. States are required to have policies in place to protect the health and safety of children and are required to enforce those standards. Both a description of the standards and the procedures the states will use to monitor compliance are required to be certified in the state child care plan of each state. In our review of state regulations and ranking of the states, it is clear that state standards are weak and that states police themselves.

healthy development. Currently, the quality of care and the condition of the setting these children are in are largely unknown. Among NACCRRA’s key recommendations: n

Requirestate regulation for family child care homes in which paid providers regularly care for unrelated children;

Requireall paid providers to undergo a complete background check, including fingerprints;

Requirean inspection or visit prior to a state issuing a license and regular unannounced inspections throughout the year; and,

Grantthe Child Care Bureau the authority to assess state child care plans for content and compliance and to withhold funds from states with insufficient policies and oversight procedures.

For a complete list of NACCRRA’s recommendations, see the recommendations section of this report. We hope this report will encourage states to examine their regulations for small family child care homes and revise them where needed. We are also hopeful that the federal government will require more accountability in how its share of funds for child care are spent. Children ought to be safe in child care. And, child care ought to promote their healthy development and wellbeing. The quality of children’s care (whether their parents are receiving a government subsidy or not) should not be left to chance. We can do better to protect children. Working parents and the next generation depend on it.

Summary & Recommendations

Given that $11 billion in government money is spent on child care subsidies, and about onethird of children receiving subsidies are in a family child care home setting, federal and state governments ought to know whether or not children are in safe settings that promote their NACCRRA’s Ranking of State Small Family Child Care Homes

Introduction Child care is a way of life for millions of American families every day. Each week, about 12.5 million children under age six are in some time of child care setting.1 Of these children, more than 1.7 million are in family child care arrangements.2 On average, children of working mothers spend about 36 hours each week in child care.3 In 2007, NACCRRA looked at standards and oversight for child care centers since center care is the most frequently used option chosen by parents using organized child care settings. In 2008, NACCRRA looked at standards and oversight for small family child care homes because they are the second most frequently chosen option by parents using organized child care arrangements. A small family child care home is defined as a child care setting in which up to six children, including those of the caregiver under age six, are cared for in the home of the provider for compensation. About 14 percent of the children of working mothers are in family child care homes. According to NACCRRA’s 2005 parent focus groups, many parents choose family child care homes because they offer a more personal setting, a more comfortable environment “like home,” or, because family child care tends to be less expensive in many communities and may be the most affordable option. However, what we learned from the focus groups and also NACCRRA’s national parent poll is that the number one concern among parents about child care is the quality of the setting in which their children receive care. (Cost was the second largest concern).4 Parents are and should be concerned about the quality of child care. Young children are particularly vulnerable to illness and injury

and their health and safety must be protected. In addition, brain research has helped us understand the early years of life are critical in children’s social, emotional, physical, and cognitive development. There is increased recognition that the years before school form the foundation for school readiness and later academic achievement. Quality settings help ensure that children start school ready to succeed. In small family child care homes, usually only one adult is present; the quality of children’s care is totally dependent on what this provider knows and does. State Regulation of Family Child Care Homes Varies Greatly Most, but not all, states regulate some types of family child care. Forty-eight states (including the District of Columbia) license some type of family child care; however, three states (Idaho, Louisiana, and New Jersey) do not license small family child care homes.5 Idaho does not license child care at the state level although most of the major municipalities have their own systems.6 Louisiana has a registration process for small family child care homes with no more than six children that is only required if the provider cares for children subsidized by the federal Child Care and Development Block Grant. New Jersey’s registration process for small family child care homes is voluntary.7 NACCRRA reviewed the threshold for licensing because the number of children allowed in family child care homes is important for health, safety, and caregiver interaction. NACCRRA also reviewed the age mix of the children allowed in care because infants and toddlers have different needs compared to older children. Group size limitations are directly related to the ages of children allowed – with NACCRRA’s Ranking of State Small Family Child Care Homes

smaller group sizes recommended for homes with infants and toddlers. In addition, Arizona allows voluntary certification until there are 6-10 unrelated children in the home.8 Mississippi doesn’t require licensing until the provider has six children in care and doesn’t specify whether the provider’s own children are counted in the total number.9 For three other states, (Ohio, South Dakota, and Virginia), the threshold for licensing is above 6 children, which is no longer a small family child care home. States use different approaches for regulating family child care homes including licensing, certification, registration, self-certification, voluntary licensing, voluntary certification, voluntary registration, and voluntary selfcertification. Some states combine approaches. In some cases, the process is called by one name but is defined differently in the regulation itself. In some states, the type of regulation required is linked to how many children are in care, how many different families are served, or other factors. For the definitions of terms used in the varying state approaches as well as more detailed information about state processes, see Appendix B. Most state regulations for family child care address basic health and safety issues; however, since inspection of the homes is minimal in many states, there is little assurance that providers follow the requirements. Most states have little in the way of pre-service training requirements before a provider is allowed to care for children in her home. State requirements on background checks vary widely, with the majority of states not conducting a complete background check (check of state and federal criminal history records, the sex offender registry, the child abuse registry, and a check of juvenile records using fingerprints ). Parents keep their fingers crossed about quality and struggle to afford the cost of child care, which according to NACCRRA’s most recent child care price report ranges between $4,160

NACCRRA’s Ranking of State Small Family Child Care Homes

and $9,508 annually for an infant and $3,536 to $9,002 annually for a preschool age child in a family child care home.10 Parents and policymakers should know the condition of child care in America-- both in child care centers and in family child care homes. This report looks at state regulations for small family child care homes. In order to bring attention to the status of family child care quality, NACCRRA ranked the 50 states, the District of Columbia, and the Department of Defense on their current small family child care home standards and oversight systems. The 50 states, the District of Columbia, and the U.S. Department of Defense (DoD) are hereafter referred to as “the states”. NACCRRA included DoD in the scoring because it has its own set of licensing standards and oversight. The scoring components used were obtained by reviewing each state’s small family child care home regulations. In many states, CCR&R staff either consulted with state licensing personnel or had the information checked by licensing staff. NACCRRA recognizes that the rankings are only as current as the date the information was supplied. State standards and oversight policies vary greatly. The primary source of funding for child care is the Child Care and Development Block Grant (CCDBG), which allocates funds to the states for child care and related purposes with very few rules or restrictions. According to the latest Child Care Development Fund (CCDF) report,11 about one-third (34 percent) of children receiving CCDBG subsidies are in a family child care home setting and the percent is considerably higher in some states. To receive funds from CCDBG, states must have policies in place “designed to protect the health and safety of children that are applicable to child care providers”12 in the following areas: n

The prevention and control of infectious diseases (including immunizations);

Building and physical premise safety; and

Minimum health and safety training appropriate to the provider setting.13

Under the law, states are required to provide a detailed description of their licensing standards including how such standards are effectively enforced in their child care state plans. In particular, states are required to certify procedures are in place to ensure that child care providers are in compliance. The state plans are required to be submitted to the Child Care Bureau within the U.S. Department of Health and Human Services every two years.14 While CCDBG law is broad and states have a great deal of flexibility to set their own standards, the intent of the law is clear. States are required to have policies in place to protect the health and safety of children in child care and are required to enforce those standards. Unfortunately, in view of the performance of the states ranked in this report, most states are not complying with the intent of the law, which has rendered the child care state plans of dubious value. Current law has no consequence for noncompliance with a state plan or for the submission of a weak state plan. Based on actual regulations that states have in place, NACCRRA scored the states on several key components of their licensing standards and oversight system, including health and safety policies and other critical features of a quality child care setting. The benchmarks used for scoring were developed based on the available research in the field and in consultation with key researchers. See Appendix A for a comprehensive literature review.

Meeting each of NACCRRAâ&#x20AC;&#x2122;s benchmarks would yield a perfect score of 140. But no state received a perfect score. In fact, only one state (Oklahoma) received even 75 percent of the maximum points allowed. Fifteen states received zero points because they do not regulate small family child care homes, do not inspect family child care homes before licensing them, or allow more than six children in the home before licensing. These are important points for parents and policymakers to understand. It is simply not possible to know whether a family child care home is safe or whether a quality environment is offered for children if states do not monitor child care operations. Too many children spend too much time in family child care for states to ignore the quality of care. It is not just the states who have a responsibility for the quality of child care. The federal government is using taxpayer dollars to fund child care in states that have not established even basic requirements for providers, exempt large numbers of providers from regulation, and do not monitor providers to ensure compliance with existing state regulations. Hopefully, this report will encourage the states to examine their regulations for small family child care homes and revise them where needed. NACCRRA also encourages the federal government to ensure that federal funds used for child care subsidies protect the health and safety of children and promote their development and well-being. The next section describes the benchmarks NACCRRA used in more detail. As the report reveals, most states fall far short of meeting these benchmarks.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Elements of Quality and NACCRRA’s Scoring System In selecting the standards on which the state’s small family child care regulations would be rated, NACCRRA focused on only the most important factors to ensure the health, safety, and well-being of children. NACCRRA also focused on standards which have been supported by research on family child care quality or are recommended by nationally recognized publications such as the Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-ofHome Child Care Programs, Second Edition15 and the Child Care Bureau publication, 13 Indicators of Quality Child Care.16 In some cases, the standards chosen reflect the current emphasis on school readiness, for example, the recommendation that adults read to children to support literacy development. A summary of the research related to each part of the report can be found in Appendix A.

Fifteen states received a score of zero. Nine of these states received a zero because they do not inspect or visit family child care homes prior to the state granting a license. We have included both the zero score and the score that the state would have otherwise received (had the state conducted an inspection prior to licensing). States receiving a zero were ranked after all other states beginning with the state receiving the most points. Six states received a zero because they either do not license small family child care homes or, they allow more than six children to be cared for in a home.* The total maximum points a state could receive is 140. To rank the states, NACCRRA scored the states on the following aspects of their standards and oversight policies: 1) Inspections prior to licensing, annual inspections, and inspections when there is a complaint

NACCRRA chose 14 key elements essential for quality small family child care homes. States 2) Unannounced routine and complaint were assessed, assigned points based on state inspections policies, and ranked based on their performance. A small family child care home is defined as a 3) People in the household to whom child care setting in which up to six children, background checks apply including those of the caregiver under age six, are cared for in the home of the provider for 4) The types of background checks (state and compensation. States could receive a maximum federal checks of criminal records, juvenile of 10 points for each area scored or partial records, child abuse registries, and sex credit based on state requirements. offender registries using fingerprints) States were ranked based on their total scores, which were adjusted for the number of children allowed in the home before regulation began.

5) Minimum education/training requirements for providers

NACCRRA’s Ranking of State Small Family Child Care Homes

6) Hours of pre-service training required . of providers 7) The subjects required in pre-service training (such as child development, health and safety, child abuse prevention, etc.) 8) Annual training hours for providers 9) Communication and involvement . of parents 10) Toys and materials required 11) Learning activities, including limiting . the use of television 12) Limits on the number of children who can be cared for based on the ages of children 13) Ten critical health areas 14) Ten critical safety areas Scope Of Regulation Research shows that family child care home providers who are licensed provide higher quality child care and are more sensitive to the needs of children than unlicensed providers.17 NACCRRA scored the states’ small family child care home regulations on the threshold for licensing –the number of children in care at which regulation of some type is required. Adjustments were made if a state exempted the provider’s own children not yet old enough for school or if states permitted providers to care for children from one or more unrelated families without being licensed. Quite simply, children count: all children -- related or not. A mother of three young children caring for four others is still responsible for seven children whether or not the state treats some as “invisible.” States which do not regulate small family child care homes or permit more than six children (counting the provider’s own children under school-age) to be present without regulation were given a zero on the scorecard.

NACCRRA Benchmark: All family child care providers caring for unrelated children on a regular basis for pay are required to be licensed. (If certification or registration are equivalent to licensing, then these are accepted). Frequency And Type Of Monitoring Visits Without inspections or monitoring, regulations alone have very limited value. When family child care homes are not inspected (or inspections are not unannounced), it is difficult for a state to enforce its regulations and suspend or revoke the licenses of individuals who are not in compliance. Inspections also give states an opportunity to offer providers technical assistance to strengthen their operations. NACCRRA scored the states’ small family child care home regulations on whether family child care homes must be inspected before being licensed, at least quarterly or four times a year, and when there is a complaint concerning the home. States received partial credit for having any of these requirements and for less frequent annual inspection requirements. If a state allows self-inspection or self-certification only for initial licensure the state was given a zero on the entire scorecard. The states’ small family child care home regulations were also examined to determine if routine and complaint visits were unannounced. If the state allows both announced and unannounced visits the state was given partial credit for requiring unannounced visits. NACCRRA Benchmark: Family child care homes are inspected prior to obtaining a license, at least quarterly, and when there is a complaint. Note: Visits by any agencies (licensing, fire, safety, health, etc. are credited). Family child care home inspections/visits (quarterly and when there is a complaint) should be unannounced.

NACCRRA’s Ranking of State Small Family Child Care Homes

Background Checks The Crime Control Act of 1990 requires a background check for federal government employees who work in federal child care programs. The law requires that the checks be based on fingerprints and that the checks be conducted through the Federal Bureau of Investigation (FBI) and each state’s criminal history records for which an employee lists current or former residence. Federal agencies may deny employment to any individual convicted of “a sex crime, an offense involving a child victim, or a drug felony”.18 The DoD expanded these requirements to include family child care providers, their assistants and substitutes, and their family members age 12 and older. NACCRRA scored the states’ regulations on whether criminal history background checks are required of family child care providers, substitutes and assistants, family members over 12 years of age, and exempt providers receiving subsidies. The latter was included because in some states this is one of few requirements placed on license-exempt providers receiving federal funds for caring for children. States received partial credit depending upon state requirements. States were also scored on which records are checked – criminal history records, juvenile records, child abuse registries, and sex-offender registries—and on whether fingerprints are used in checking state and federal records. States received the maximum of ten points if they require all of these types of background checks and partial credit if they require only some of them. NACCRRA Benchmark: Family child care providers, their substitutes and assistants, family members over age 12, and licenseexempt providers receiving subsidies are subject to a complete background check: background checks are based on fingerprints and include checks of criminal records, juvenile records, child abuse registeries, and sex offender registries. NACCRRA’s Ranking of State Small Family Child Care Homes

Provider Education Research has found that provider education is one of the characteristics that appears to be related to family child care quality. Family child care providers with higher levels of education and more training provide higher quality care. In addition, the research suggests that education and training may be better predictors of quality in family child care homes than other factors such as child:adult ratios – at least in settings where group sizes are small.19 NACCRRA scored state family child care regulations on the amount of provider education required. States earned points if they require family child care providers to have a high school degree or General Equivalent Degree (GED). They earned additional points if they require a state training credential and the maximum number of points if they require providers to have a Child Development Associate (CDA) credential, college courses (any number) in early childhood education, or an Associate’s degree (in any field) initially or within three years of beginning to provide care. This scoring was based on the number of studies that have found a positive relationship between provider education and the quality of family child care and outcomes for children. NACCRRA Benchmark: Family child care home providers have a high school degree or GED, and have a Child Development Associate (CDA) credential, college courses in Early Childhood Education (ECE), or an Associate’s degree within three years of starting to provide child care. Provider Training Research shows that training makes a difference in the quality of child care, particularly given the relatively lower levels of education within the child care workforce.20 Providers with less education and training may have fewer skills to call upon in caring for children and in running a business. This may result in more negative interactions with children and/or lower

income levels, which in turn, may reduce job satisfaction and/or increase job stress.21 Preservice training would help ensure providers have a base of knowledge before beginning to work with children. Pre-service training would also ensure that new providers received training in potentially life-saving practices related to sleep position, first aid, CPR, and warned about the dangers of shaking babies and other hazards such as children swallowing small objects and drowning in small amounts of water.

to-face contact or through written policies. Communication between parents and caregivers is related to more sensitive and supportive provider-child interactions in child care.24 Having a written contract helps parents and providers maintain the business aspect of their relationship with fewer misunderstandings. Parents should have access to their children’s child care settings at all times when their child is in care and be told when their child is going to be cared for by someone else.

Research has also found that providers who had received more recent and higher levels of training offered richer learning environments and warmer and more sensitive care-giving.22 Annual training would ensure that providers receive ongoing training to reinforce and supplement pre-service learning and help keep providers up-to-date on changes in health and safety practices. Annual training could also help to potentially reduce the isolation of providers.

NACCRRA scored each state’s small family child care home regulations on whether providers are required to communicate with and involve parents in the operation of the family child care home. They received points for having the following requirements in their state regulation: requiring providers to have ongoing communication with parents, for example, daily communication about infants and toddlers; requiring providers to have contracts with the parents using their home for care; allowing parents access to the family child care home at all times their children are in care; requiring providers to inform parents when a substitute would be caring for their children; and requiring providers to give parents copies of their written operational policies.

NACCRRA scored the states’ family child care regulations on three aspects of their requirements for training family child care providers – the number of hours of preservice training (including CPR and first aid) required, the content of the pre-service training requirements, and the number of hours of annual training (including CPR and first aid) required. States received partial credit depending upon state requirements. NACCRRA Benchmark: Family child care home providers have at least 40 hours of preservice training in child development, child abuse prevention, learning activities, health and safety, child guidance, business practices, CPR, and first aid. In addition, providers have at least 24 hours of annual training (including renewal of CPR and first aid). Parent-Provider Communication/ Education Communication between parent and caregiver is a critical feature of high-quality child care.23 Communication can be in the form of face14

NACCRRA Benchmark: Family child care home providers communicate with parents about the care of their child, have a contract with parents, allow parents access to the home whenever their child is in care, inform parents on the use of substitutes, and provide a copy of written policies to parents. Learning Environment Toys and materials, home-made or purchased, provide opportunities for children to develop large and fine motor skills, engage in social play with other children, use their creativity, and have fun. They encourage children to use their imagination, explore, experiment, and classify objects. The National Association for Family Child Care (NAFCC) specifies the toys and

NACCRRA’s Ranking of State Small Family Child Care Homes

materials recommended in family child care homes as part of its national accreditation standards.25 Unfortunately, many family child care homes fail to have sufficient toys and materials to promote a quality setting according to several reports. See Appendix A for additional information. NACCRRA scored the states’ small family child care home regulations on whether providers are required to have toys and materials in their family child care home. States received partial credit based on their requirements and additional credit was given for states with regulations suggesting that materials and/or activities should be culturally sensitive. NACCRRA Benchmark: Family child care providers have toys and materials for large and small motor development, language and literacy, art, mathematics, science, and dramatic play. Books are available. Materials and activities are culturally sensitive. Learning Activities And Literacy Opportunities An emerging body of evidence underscores the importance of children’s early experiences, including their child care experiences, for their future development. There is considerable evidence that high-quality preschool experiences have the capacity to enhance children’s development in other areas in addition to literacy.26 Family child care homes have the potential to provide children with a rich and stimulating experience important for promoting healthy child development and school readiness. But, research shows that most family child care providers do not provide the kind of stimulation that has been found to be important to children’s later success in school.27 One study found that children were observed watching television or videos in three-quarters of the homes and in more than 40 percent of the homes, the television was never or rarely turned off.28 If family child care providers are expected to play a role in supporting early childhood NACCRRA’s Ranking of State Small Family Child Care Homes

development, they must be required to include learning and literacy activities as part of their daily program. NACCRRA scored the states’ small family child care home regulations on whether they require learning activities and literacy opportunities for the children in care. States received partial credit based on their requirements. NACCRRA Benchmark: Family child care providers plan a variety of learning activities, read to children, introduce mathematical concepts, offer creative activities and dramatic play, provide daily opportunities for active play, encourage self-help skills, and limit the use of television. Group Size Limitations Based On Age Of Children Research by the National Institute of Child Health and Human Development (NICHD) as well as the National Fire Protection Association Life Safety code recommend limiting both the total number of children and the number of infants and young toddlers in small family child care homes. NICHD found that infant development and caregiving quality improves when group size and child:adult ratios are smaller.29 Other studies have found that group size affects the quality of verbal interactions.30 The total number of children in care and the number of infants allowed in a family child care home should be regulated because both affect the quality of care provided and the safety of children in care. In order to score the states on their group size limitations, NACCRRA considered four factors: the age at which the provider’s own children are counted in determining maximum enrollment, the total number of children (maximum enrollment) allowed, the number of children two years of age and younger allowed if older children (children over two years of age) are present, and the number of children two years of age and younger allowed if no older children (children over two years of age) are present. States received the maximum number 15

of points if they counted the provider’s children under 12 years of age and limited the number of children to six (or eight if the additional two children were of school age). States received the maximum number of points if they allow only two children under 24 months of age when older children (children over two years of age) are present and no more than three children if only infants and toddlers are in care. NACCRRA Benchmark: The total number of children (whether related or not) in family child care is limited based on the ages of children in care. Health Requirements One of the few requirements under CCDBG is that “there are in effect within the state, under state or local law, requirements designed to protect the health and safety of children…”31 While states are free to determine standards based on what they believe will best protect the health and safety of children, NACCRRA chose 10 individual standards to rate the health requirements in state regulations for small family child care homes. Each of these standards is supported by research and recommendations from experts and organizations in child health. For example, several studies have demonstrated that hand washing helps manage the spread of infectious diseases in child care settings.32 While parents value healthy child care environments for their children, there is considerable evidence to suggest that many family child care homes do not follow basic health protection practices.33 See Appendix A for detailed information on the research in this area. NACCRRA scored state family child care regulations on whether or not they require providers to follow basic health protection practices. Partial points were awarded based on state requirements.34 The items on which NACCRRA scored the states were chosen because of their importance to the health of children and their families, providers, and providers’ family members. 16

NACCRRA Benchmark: Family child care home providers are required to offer child care that keeps children healthy. Licensed providers must meet all 10 basic health requirements in these areas: hand washing, meals and snacks, immunizations, exclusion of ill children, universal health requirements, administration of medication, protection from toxic substances, diapering and toileting, home sanitation, and special precautions for weekend and evening care. Safety Requirements NACCRRA chose 10 different standards to rate the safety requirements in state regulations for small family child care homes. Each of these standards is supported by data and recommendations from experts and organizations in child health. Parents expect their children to be safe in child care. For example, one of the standards is outdoor playground surfaces. Most injuries in child care settings occur on the playground.35 Many injuries (18 percent) and more than half of fractures and concussions (51 percent) are due to falls from climbing equipment.36 See Appendix A for detailed information on the research in this area. NACCRRA scored state family child care regulations on whether or not they require providers to follow basic child care safety practices. Partial scoring was possible because states could get points for each of the 10 safety standards if addressed in their regulations. NACCRRA Benchmark: Family child care home providers are required to offer child care that keeps children safe. Licensed providers must meet all 10 basic safety requirements: the prevention of Sudden Infant Death Syndrome (SIDS), discipline techniques, crib safety, electrical hazards, protection from sources of water (e.g., swimming pools, hot tubs, and ponds), outdoor playground surfaces, supervision of children, fire drills and emergency plans, door locks and safety gates, and transportation of children. NACCRRA’s Ranking of State Small Family Child Care Homes

Ranking of State Family Child Care Homes

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

State Family Child Care Home Rankings

top 10 Final Score*

Percent of Total Score

Rank

Number of children when regulation begins**

Visit Before Licensing

Oklahoma

105

75%

Yes

Washington

103

74%

Yes

Massachusetts

101

72%

Yes

Department of Defense

68%

Yes

Alabama

66%

Yes

District of Columbia

62%

Yes

Maryland

61%

Yes

South Carolina

57%

Yes

Colorado

56%

Yes

Connecticut

50%

Yes

State

NACCRRA’s Ranking of State Small Family Child Care Homes (Jan. ‘08)

State Family Child Care Home Rankings

tied for last Final Score*

Percent of Total Score

Rank

Number of children when regulation begins**

Visit Before Licensing

Michigan***

0 (98)

0%(70%)

Delaware***

0 (75)

0%(54%)

Montana***

0 (62)

0%(44%)

Florida***

0 (59)

0%(42%)

Kansas***

0 (48)

0%(34%)

Georgia***

0 (47)

0%(33%)

West Virginia***

0 (46)

0%(33%)

Pennsylvania***

0 (38)

0%(27%)

Iowa***

0 (27)

0%(19%)

Idaho^

Not Applicable

Louisiana^

Not Applicable

New Jersey^

Not Applicable

Ohio^

Not Applicable

South Dakota^

Not Applicable

Virginia^

Not Applicable

State

Total Maximum Points 140 *Final scores reflect an adjustment based on the number of children paid providers could care for before being licensed. States where that number was 7 or higher received zero points. In addition, states that do not inspect or visit family child care homes prior to issuing a license also received zero points. **To derive the total number of children in care, NACCRRA added one child if the state does not include the providerâ&#x20AC;&#x2122;s own children in establishing its licensing threshold and one for each family exempted before licensing begins. For example, if a state does not require licensing until children from a second unrelated family are in care, the state was given a threshold of 2. ***These states received a zero because they do not inspect or visit family child care homes prior to issuing a license. The score these states otherwise would have received is listed to the right of the zero. They are ranked at the bottom of the chart after the 37th state in an order reflecting their total points. For example, Michigan is ranked #38 because of the states receiving zero, Michigan would have received the highest total of points. Delaware is ranked #39 because of the remaining states receiving zero, Delaware would have received the next highest total of points. ^These states either do not license family child care homes or license family child care homes at a level allowing more than 6 children to be present in the home.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes (Jan. â&#x20AC;&#x2DC;08)

State Family Child Care Home Rankings

alphabetical listing of states Final Score*

% of Total Score

Rank

Number of children when regulation begins**

Visit Before Licensing

Alabama

66%

Yes

Alaska

38%

Yes

Arizona

33%

Yes

Arkansas

24%

Yes

California

42%

Yes

Colorado

56%

Yes

Connecticut

50%

Yes

Delaware***

0 (75)

0 (54%)

Department of Defense

68%

Yes

District of Columbia

62%

Yes

Florida***

0 (59)

0% (42%)

Georgia***

0 (47)

0% (33%)

Hawaii

42%

Yes

Idaho^

Not Applicable

Illinois

48%

Yes

Indiana

25%

Yes

Iowa***

0 (27)

0% (19%)

Kansas***

0 (48)

0% (34%)

Kentucky

29%

Yes

Maine

39%

Yes

Maryland

61%

Yes

Massachusetts

101

72%

Yes

0 (98)

0% (70%)

Minnesota

46%

Yes

Mississippi

33%

Yes

Missouri

26%

Yes

0 (62)

0% (44%)

27%

Yes

State

Louisiana^

Michigan***

Montana*** Nebraska

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes (Jan. â&#x20AC;&#x2DC;08)

State Family Child Care Home Rankings

alphabetical listing of states Final Score*

% of Total Score

Rank

Number of children when regulation begins**

Visit Before Licensing

Nevada

24%

Yes

New Hampshire

44%

Yes

New Jersey^

Not Applicable

New Mexico

32%

Yes

New York***

37%

Yes

North Carolina

42%

Yes

North Dakota

26%

Yes

Ohio^

Oklahoma

105

75%

Yes

Oregon

34%

Yes

0 (38)

0% (27%)

Rhode Island

44%

Yes

South Carolina

57%

Yes

South Dakota^

Tennessee

34%

Yes

Texas

41%

Yes

Utah

26%

Yes

Vermont

36%

Yes

Virginia^

103

74%

Yes

0 (46)

0% (33%)

Wisconsin

34%

Yes

Wyoming

30%

Yes

State

Pennsylvania***

Washington West Virginia***

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes (Jan. â&#x20AC;&#x2DC;08)

State Family Child Care Home Rankings

overall ranking Final Score*

% of Total Score

Rank

Number of children when regulation begins**

Visit Before Licensing

Oklahoma

105

75%

Yes

Washington

103

74%

Yes

Massachusetts

101

72%

Yes

Department of Defense

68%

Yes

Alabama

66%

Yes

District of Columbia

62%

Yes

Maryland

61%

Yes

South Carolina

57%

Yes

Colorado

56%

Yes

Connecticut

50%

Yes

Illinois

48%

Yes

Minnesota

46%

Yes

New Hampshire

44%

Yes

Rhode Island

44%

Yes

California

42%

Yes

Hawaii

42%

Yes

North Carolina

42%

Yes

Texas

41%

Yes

Maine

39%

Yes

Alaska

38%

Yes

New York

37%

Yes

Vermont

36%

Yes

Oregon

34%

Yes

Tennessee

34%

Yes

Wisconsin

34%

Yes

Arizona

33%

Yes

Mississippi

33%

Yes

New Mexico

32%

Yes

Wyoming

30%

Yes

Kentucky

29%

Yes

State

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes (Jan. â&#x20AC;&#x2DC;08)

State Family Child Care Home Rankings

overall ranking Final Score*

% of Total Score

Rank

Number of children when regulation begins**

Visit Before Licensing

Nebraska

27%

Yes

Utah

26%

Yes

Missouri

26%

Yes

North Dakota

26%

Yes

Indiana

25%

Yes

Arkansas

24%

Yes

Nevada

24%

Yes

Michigan***

0 (98)

0% (70%)

Delaware***

0 (75)

0% (54%)

Montana***

0 (62)

0% (44%)

Florida***

0 (59)

0% (42%)

Kansas***

0 (48)

0% (34%)

Georgia***

0 (47)

0% (33%)

West Virginia***

0 (46)

0% (33%)

Pennsylvania***

0 (38)

0% (27%)

Iowa***

0 (27)

0% (19%)

Idaho^

Not Applicable

Louisiana^

New Jersey^

Not Applicable

Ohio^

South Dakota^

Virginia^

State

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes (Jan. â&#x20AC;&#x2DC;08)

Summary of Findings: State Family Child Care Standards & Oversight Leave Much to Chance

Overall Scores States could receive a maximum of 140 points on their family child care home standards and oversight. Only one state, Oklahoma, received 75 percent of the possible points. Fifteen states scored zero. Of the 37 states that scored points, the average was 60. Chances are that many of the more than 1.7 million children under age six in family child care are in settings that fail to meet even half of NACCRRA’s basic benchmarks for standards and oversight. The Top 10 Highest Scoring States Oklahoma, Washington, Massachusetts, the Department of Defense, Alabama, the District of Columbia, Maryland, South Carolina, Colorado, and Connecticut ranked among the top 10 highest scoring states for small family child care home standards and oversight. That does not mean that they scored high; it means that they scored highest on our scorecard keeping in mind that only one state received a score of 75 percent. States Scoring Zero Six states (Idaho, Louisiana, New Jersey, Ohio, South Dakota, and Virginia) received zero points because either they do not regulate small family child care homes or their adjusted threshold for requiring licensing (exempting a provider’s own child(ren) or multiple families) exceeds six children. For example, in South Dakota providers can care for 12 children without having to be regulated as a family child care home. Nine additional states (Delaware, Florida, Georgia, Iowa, Kansas, Michigan, Montana, Pennsylvania, and West Virginia)

received no points because they do not require family child care homes to be inspected or visited prior to being licensed. Monitoring of Family Child Care Homes Only two states, (Tennessee and New Mexico), received the maximum points for monitoring family child care homes. Both states require an inspection or monitoring visit before a family child care home is licensed, visits to homes at least four times a year, and visits when there is a complaint filed against a home. Nevada, Oklahoma, and Wyoming require homes to be visited three times per year. In addition to the states that do not regulate small family child care homes, 11 states do not conduct annual inspections. Iowa requires visits only once every five years and Michigan once every ten years. Fifteen states either do not license small family child care homes or do not conduct an inspection or visit prior to issuing a license. Three states (DoD, West Virginia, and Wyoming) do not require family child care homes to be visited when there is a complaint; however, the Child Care Resource & Referral agencies or state licensing personnel in some states reported that this occurs. Thirty-six states require routine inspection visits to be unannounced. Some states allow a mix of announced and unannounced visits. Several states’ regulations are not clear on whether or not complaint visits must be unannounced; however, 41 states specify that they must be unannounced. See Appendix E for additional information.

NACCRRA’s Ranking of State Small Family Child Care Homes

Conducting Background Checks on Providers and Household Members Conducting background checks on providers and their family members helps provide some assurance that children are not being cared for by individuals with a history of violence or crimes involving children. All the states that regulate small family child care homes (46) require a background check on the provider. With the exception of Hawaii, they also require background checks on substitutes and assistants. While some states require background checks on family members, few require checks on family members age 12 and older as required by the DoD. Only 13 states conduct background checks of youth starting at age twelve years. Seven states reported they do not conduct background checks on providers receiving federal/state subsidies who are exempt from licensing requirements. Twelve reported they do not check the criminal records of exempt subsidized providers, and 13 reported they do not check their records for child abuse and neglect reports. Types of Background Checks Required Most states that regulate small family child care homes are conducting background checks of providers. However, only 25 are using federal fingerprints to do so. A “criminal background check” without a fingerprint check is a name check only. It is of limited value since individuals can have very common names or use aliases. Only 10 states specifically mention the need to check juvenile records; some states reported their statutes limit what they can do in this area. It is unfortunate, but there have been cases where a teenage child has abused or tormented a much younger child and upon investigation, the teenage child has had a history of violent behavior. Six states reported they are not required to check the state’s child abuse registry when licensing providers and only 16 said they are required to check the state sex offender registry.

NACCRRA’s Ranking of State Small Family Child Care Homes

Different Types of Background Checks in Small Family Child Care Homes Type of Background Check

Number of States Requiring

Federal fingerprint check

State fingerprint check

Criminal records check

Juvenile records check

Child abuse registry

Sex offender registry

Minimum Education Requirements for Providers Given the current emphasis on highly qualified teachers under the federal No Child Left Behind Act,37 and stronger minimum education requirements now required for Head Start teachers and assistants,38 NACCRRA was interested to see what the states required as a minimum for family child care home providers. Twenty-nine states have no minimum education requirement for family child care home providers. Only 17 states specify a minimum of a GED or a high school diploma. Only Arizona and New Hampshire require providers to have college courses in early childhood education; Mississippi requires providers to earn a state training credential. Minimum Education Requirements for Small Family Child Care Home Providers Requirement

Number of States Requiring

High school degree or GED

Some college courses/CDA*

Training credential

*CDA is a Child Development Associate credential

Pre-service Training Requirements for Providers Eleven states do not require any pre-service training for individuals to become licensed as small family child care home providers. Twenty

additional states only require between one and 10 hours â&#x20AC;&#x201C; in all likelihood, only enough to obtain initial CPR and first aid certification. Only three states require 30 or more hours of training (Alabama, Arizona, and Florida). Thirty states require family child care providers to have pre-service training in CPR. A few states (Alabama, Colorado, DoD, Florida, Maryland, Massachusetts, Oregon, and Rhode Island) help ensure pre-service training is comprehensive by requiring five or more of the topics that NACCRRA recommends for preservice training (child development, child abuse prevention, learning activities, health and safety, child guidance, business practices, CPR, and first aid). Most states do not require specific topics to be addressed in pre-service training. Pre-service Training Requirements for Small Family Child Care Home Providers Number of Hours

Number of States Requiring

None

1-10

11-20

21-30

31-40

41+

Subjects Required in Pre-service Training of Small Family Child Care Providers Subject

Number of States Requiring

Child development

Child abuse prevention

Learning activities

Health and safety

Child guidance

Business practices

CPR

First aid

Annual Training Requirements for Providers Most states have very limited annual training requirements for operators of small family child care homes. In addition to the states that do not regulate small family child care homes, two states (Connecticut and Kansas) do not require annual training of providers. Many states that have annual training requirements require less than nine hours so most of the hours would likely be used for CPR and first aid recertification. Annual Training Requirements for Small Family Child Care Home Providers Number of Annual Training Hours Required

Number of States Requiring

None

1-8

9-16

17-24

25 or more

Parent Communication and Involvement Family child care is characterized as featuring more extensive and intensive parent-provider communication. Yet, only 24 states require providers to communicate on a daily or ongoing basis with the parents of the children in their care. Only 10 states require providers to have written contracts with parents although this practice can help reduce parent-provider misunderstandings. With the exception of Arkansas, Minnesota, and New Mexico, states that license small family child care homes require providers to allow parents to come into their homes whenever their child is present. Only two states (Washington and South Carolina) met all five parent communication and involvement requirements that NACCRRA recommended: daily communication, written contracts, parent access, informing parents about substitutes, and sharing written policies with parents.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Parent Communication and Involvement Requirements for Small Family Child Care Homes Types of Communication/Involvement

Number of States Requiring

Daily communication about the child

Written contract with parents

Parent access to the home

Informing parents of use of a substitute

Sharing written policies

Requiring a Learning Environment and Activities Young children learn through interacting with materials and participating in learning activities including self-directed play and adult-directed experiences. Although this is a generally accepted practice in early care and education, most state regulations do not require family child care providers to have a variety of learning materials nor do they specify the general types of play materials needed. Almost two-thirds (30) of the states require providers to have toys or equipment for physically active play. However, barely half require small family child care home providers to have language and literacy (24), art (25) or dramatic play materials (22). Less than one-fourth specify the need for mathematics (10) and science (12) materials. Only 23 states require small family child care providers to have books for children to look at and read. Only 13 of the states require providers to ensure that either their materials or activities are appropriate for the cultural backgrounds of the children in care.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Learning Materials Required in Small Family Child Care Homes Type of Learning Materials

Number of States Requiring

Motor development

Language and literacy

Art

Mathematics

Science

Dramatic play

Books

Culturally sensitive materials

In some cases states require family child care providers to have materials available for childrenâ&#x20AC;&#x2122;s use but do not require specific types of activities to be offered. Some states specify the types of activities but not the types of materials and some states delineate both in their regulations. Thirty-three states require small family child care home providers to plan learning experiences for the children in their care. However, except for active play, most states are silent about the types of learning activities required. Only 13 states (Arizona, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Washington, and West Virginia) require providers to read to children and even fewer (9) require providers to introduce mathematical concepts. Fewer than half (21) of the states restrict the use of media such as television and videos in small family child care homes.

Learning and Literacy Activities Required in Small Family Child Care Homes Type of Learning Activities

Number of States Requiring

Plan learning activities

Read to children

Introduce mathematics concepts

Offer creative activities

Offer dramatic play

Offer active play

Teach self-help skills

Limit media (TV/videos) use

Limiting Group Size and Composition States have many different ways to determine the number of children the operator of a small family child care home can care for at one time. In several states, the number of children a provider can have in care varies based on the age of the children in the group. Some states have lower maximum enrollments if the provider has infants and toddlers in care as well as children older than age two. Some states have a maximum enrollment for homes with only infants and toddlers and a higher maximum enrollment if the group includes children older than age two. Some states have higher maximum enrollments if only children older than age two are in care. Other states increase the maximum enrollment to permit . the provider to care for school age children . who are out of the home most of the day. In some states the provider’s own children under . a specific age count in determining the maximum enrollment; in other states the provider’s own children do not count regardless of their age. Some of the approaches are so complex that NACCRRA found them hard to understand and expect it likely that providers could be confused by them as well. See Appendix D for additional information.

The chart below provides an overview of NACCRRA’s understanding of the age at which the states consider the provider’s own children to count in determining maximum enrollment. Six states do not count the provider’s own children in determining how many children he or she can have in care and only 12 states are counting all children who need supervision and care (whether related or not, age 12 and under). Age at Which Provider’s Own Children Count in Maximum Enrollment Age in Years of Provider’s Child/Children

Number of States

12 and under

11 and under

10 and under

9 and under

8 and under

7 and under

6 and under

5 and under

4 and under

Not counted

States were placed in the category most closely resembling their approach to limiting enrollment to determine the number of points they would earn on total enrollment. The chart below shows the number of states that were placed in each category on total enrollment. Category

Number of States

Limit total enrollment to 6 or fewer (or 8 if additional two children are in school)

Limit total enrollment to 7 (or 9 if the additional two children are in school)

Permit enrollment of 8 or more children less than six years of age

Almost half the states (23) limit the number of children that can be in care to six or fewer (or eight if the additional children are of schoolage). However, almost 40 percent (18) of the NACCRRA’s Ranking of State Small Family Child Care Homes

46 that regulate small family child care homes, allow providers to care for as many as eight or more children five years of age and younger at one time. Most states have some restrictions on the number of young children for whom a single provider can offer care; however, the states vary in the age limits they use. Some state regulations specify children less than 12 months; others use 18 months and still others use 24 months. A few states do not use months or years in their limitations but consider whether or not the child is “ambulatory”. States that limit the number of infants and toddlers (children 24 months of age and under) that can be in care when older children are present to no more than two children and also limit the number of children when no older children are present to no more than three received the maximum number of points on this part of the scorecard. The chart below shows the number of states that restrict the number of very young children that can be in care using NACCRRA’s scorecard approach. Category

Number of States

Limit the number of children 2 years and younger to no more than 2 if older children are present

Permit three or more children 2 years of age and younger if older children are present

The number of children providers can care for if they only care for infants and toddlers varies among the states. The chart below shows the number of states which allow two or three or more infants and toddlers (children two years and younger) when no older children are present.

NACCRRA’s Ranking of State Small Family Child Care Homes

Number of Children 2 Years and Under Allowed if No Older Children Present

Number of States

6 or more

Protecting Children’s Safety NACCRRA studied the states’ regulations related to protecting children from conditions that could lead to injuries and fatalities. Most states with regulations, except for Kentucky . and Vermont, recognize that supervision can prevent many injuries and address the need for it in their regulations. Harsh discipline can be a form of child abuse or lead to it. Two states (Indiana and South Carolina) do not specifically prohibit corporal punishment. South Carolina prohibits corporal punishment for providers caring for children receiving federal or state subsidies, but does not prohibit corporal punishment in all settings. NACCRRA believes corporal punishment should be prohibited regardless of setting. In spite of a nationwide campaign to inform parents and child care providers of the importance of safe sleeping practices, 14 states do not prohibit unsafe sleeping practices in family child care home care settings. Florida, Nevada, North Dakota, and Vermont do not have regulations related to protecting children from electrical hazards such as damaged electrical cords or uncapped electrical outlets. Although falls are among the leading causes of injury to children on playgrounds, 17 states do not require small family child care home providers to have soft landing materials under outdoor playground equipment. Fifteen states fail to require providers to have safety gates to prevent falls or prohibit the use of door locks that can entrap children inside a bathroom or bedroom.

All of the states, except Iowa and DoD, address the need to keep children in small family child care homes safe while they are being transported in vehicles. Safety Requirements in Small Family Child Care Homes Safety Practices

Number of States Requiring

Safe sleeping practices (SIDS)

Discipline practices/prohibit corporal punishment

Crib safety

Electrical hazards

Protection from water sources

Fire drills/emergency plans

Outdoor playground surfaces

Supervision of children

Door locks or safety gates

Transportation

Note: Two states (Indiana and South Carolina) do not prohibit corporal punishment and therefore score zero on the entire safety element.

and Kansas) do not address this important topic in their regulations. More than half (24) of the states do not require small family child care home providers to follow universal health precautions related to handling blood and other bodily fluids. In a home environment there is the potential for children to access toxic products which can result in injury and death; all states restrict access to toxic products except Nevada. In child care settings, following recommended diapering and toileting practices can reduce the spread of diseases, however, two states (California and Iowa) do not include regulations concerning how it should be done. Although many family child care providers offer weekend and evening care, eleven states do not have regulations related to this type of care. Health Requirements in Small Family Child Care Home Regulations Health Practices

Number of States Requiring

Protecting Childrenâ&#x20AC;&#x2122;s Health Hand washing is generally recognized as one of the most important health practices in child care settings; however, two states (California and Iowa) do not address its importance in their small family child care home regulations.

Handwashing

Meals and snacks

Immunizations

Exclusion of ill children

Universal health precautions

Administration of medications

All of the states except California include requirements in their regulations related to the meals and snacks children should receive while in care.

Toxic substances

Diapering and toileting

Home sanitation

Weekend and evening care

Wyoming does not require children attending small family child care homes to be immunized. Several states that regulate small family child care homes (Kansas, Maine, Massachusetts, New York, and Utah) do not require family child care providers to exclude children with contagious conditions or illnesses. Improper administration of medications can result in accidental poisoning; only two states (California 30

Only eight states met each of the 10 requirements under both health and safety. All states should meet all ten basic requirements under health and safety.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Conclusion More than 1.7 million children under age six are in family child care home arrangements every week. That is about 14 percent of the children of working mothers. On average, these children are spending 36 hours each week in this type of setting. Parents choose family child care homes for a multitude of reasons, but what all parents share in common is that they want their children to be safe and well cared for in child care. Policymakers should want no less. What we know from our review is that states could be doing a much better job at setting the standards for family child care homes and at overseeing or monitoring the homes to ensure providers are complying with their standards. The responsibility for overseeing whether family child care homes meet state standards is too big of a job for working parents alone. Parents can play a role in oversight as a user of child care, but the primary responsibility for setting standards and for ensuring family child care homes comply with basic standards should rest with the state and federal government. Particularly when families are using federal or state subsidies to pay for child care, the government (at whatever level allocating the subsidy) should know what care they are paying for. Too often, this is not the case. The Top 10 Highest Scoring States Oklahoma, Washington, Massachusetts, the Department of Defense, Alabama, the District of Columbia, Maryland, South Carolina, Colorado, and Connecticut ranked among the top 10 highest scoring states for family child care home standards and oversight. But, that does not mean that their scores are within an acceptable range. In fact, only one state received 75 percent of the available points. Oklahoma scored the highest with 105 out of a possible score of 140 and 32

Connecticut ranked 10th with a score of only 69. Given that the criteria for ranking was only basic enough to ensure children’s safety and healthy development, even the top 10 states have much room for improvement. States Scoring Zero Six states (Idaho, Louisiana, New Jersey, Ohio, South Dakota, and Virginia) received no points because either they do not regulate small family child care homes or their adjusted threshold for requiring licensing (exempting a provider’s own child(ren) or unrelated families) exceeds six children. For example, in South Dakota providers can care for up to 12 children without having to be regulated as a family child care home. Nine additional states (Delaware, Florida, Georgia, Iowa, Kansas, Michigan, Montana, Pennsylvania, and West Virginia) received zero points because they do not require family child care homes to be inspected or visited prior to getting a license. It may seem harsh to give these states a zero, but at a minimum, before a child care provider begins caring for unrelated children, someone should check to see whether the environment is safe. The Number of Children Allowed Per Family Child Care Home Varies Greatly Forty states do not begin regulating family child care homes until two or more unrelated children are present. Six states either do not license family child care or allow more than six unrelated children in a home without a license. A license is a not a guarantee that the environment is safe and healthy for children, but it’s a step in the right direction.

NACCRRA’s Ranking of State Small Family Child Care Homes

State Inspection Standards are Lax Fifteen states do not inspect family child care homes prior to granting the provider a license (which includes the six states that do not license small family child care homes) and either assume the provider understands and is in compliance with the regulations or permit providers to self-certify they are. Only 25 states require small family child care homes to be inspected each year. The federal government has no minimum inspection requirements and does not prohibit self-certification of compliance with basic health and safety standards. Even Minimal Regulations are Undercut Without Regular State Inspections Most states have regulations for family child care homes; however, since inspection of the homes is minimal in many states, there is little assurance that providers are following the state requirements. For the most part, this means that even if a state has minimal standards, if states do not perform oversight, then they really have no idea if providers are complying with standards or not. In short, with respect to care paid for by federal or state subsidies, the government has no idea what it is paying for. Background Check Requirements Vary Greatly At a minimum, parents ought to have the peace of mind that child care settings are safe places. Parents need to know that their child care provider does not have a history of abusing children or engaging in violent behavior, does not have a record of violent offenses, does not have a substantiated case of child abuse or neglect, that they arenâ&#x20AC;&#x2122;t sex offenders, or that they have not engaged in other behaviors which mean that they should not be in the business of caring for children. Yet, not all the states require state and federal checks of criminal history records for providers or check the records of others in the home including family members and substitutes. Only NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

about half the states require criminal history background checks to be based on federal fingerprints. A background check without a fingerprint check is often just a name search. Anybody can use an alias. There are many people with both the same first and last name. States must set the bar higher and make sure that they check fingerprints, other adults in the household and teenagers, the state child abuse registry, the sex offender registry, and make sure that children are safe in family child care homes where often only one adult is present. Few States Have Minimum Education or Training Requirements for Providers Despite the increased emphasis in states to ensure that children start school ready to succeed, thirty states have no requirement for a minimum education level for family child care home providers. Only 17 states specify a minimum of a GED or high school diploma. Few states require providers to participate in pre-service training to prepare them for their responsibilities beyond basic CPR and first aid training. Given that children spend so many hours a week in family child care homes, often with a lone provider, 40 hours of basic preservice training should be required in child development, child abuse prevention, learning activities, health and safety, child guidance, and basic business practices. Early Learning Standards are Weak Only 13 states require providers to read to children and only nine require them to offer activities to help children develop premathematics skills such as counting. Only 24 states require family child care home providers to have language and literacy materials. The majority of states do not require providers to have books for children to look at and read. Less than a fourth specify the need for mathematics and science materials. States ought to review their early learning standards and apply them to family child care homes. It makes little sense to ignore the child care settings where the majority of children are for much of the week. 33

Basic Safety and Health Practices are Not Required Only Eight states met each of the 10 requirements under both health and safety. Only 12 states met each of the 10 basic safety requirements that NACCRRA scored. (Safe sleeping practices, discipline practices/prohibits corporal punishment, crib safety, electrical hazards, protection from water sources, fire drills/emergency plans, outdoor play equipment safety, supervision of children, door locks or safety gates, and transportation). For example, basic for infants would be requiring safe sleeping practices to reduce the likelihood of Sudden Infant Death Syndrome (SIDS). Yet only 32 states have requirements related to reducing the incidence of SIDS. All states should require all 10 basic safety provisions. Only 17 states met each of the 10 basic health requirements that NACCRRA scored. (hand washing, nutritious meals and snacks, immunizations, exclusion of ill children, universal health precautions, administration of medications, toxic substances, diapering and toileting, home sanitation, and weekend and evening care). For example, improper administration of medications can result in accidental poisoning, but eight states do not address this in their regulations including those states that do not license small family child care homes. More than half of the states do not require family child care home providers to follow universal health precautions related to handling blood and other bodily fluids. All states should meet all 10 basic health requirements. More Effective Federal Monitoring Needed While states are required to provide a detailed description of their licensing requirements in their child care state plans, including how such requirements are effectively enforced, the plans are worthless if they are not reviewed, assessed, and no entity has authority to impose a consequence for noncompliance or

a consequence for weak content. Current law has led to states policing themselves, which this report shows leaves too much to chance for children in family child care homes. The Child Care Bureau within the U.S. Department of Health and Human Services should be authorized to review the state plans against state regulations. In addition, the Child Care Bureau should be granted the authority to withhold CCDBG funds if state standards and oversight are insufficient. Collecting state plans is not enough. In Summary If we are to ensure that all children are safe and learning in family child care homes, then states cannot ignore family child care settings in their communities. Yet, that is what we have found through our review of state standards. To have standards, but then to either not have regular inspections or not have unannounced inspections, is to render the standards worthless. States simply can’t know if family child care homes are complying with their standards if they don’t check to see. The elements that NACCRRA scored for this report are among the most basic for quality child care. Parents want and expect their children to be safe in child care settings. Parents want their children to learn and ultimately to enter school ready to succeed. Minimum standards and effective state oversight of family child care homes would help. NACCRRA is not calling for national or federal standards for family child care homes. However, given the $11 billion in government funds spent annually by the states on child care, NACCRRA believes that there should be more accountability for the settings in which children spend so much time (whether or not the care is subsidized). We can leave less to chance and protect children’s health and safety and promote their development. At a minimum, the following recommendations would be a step in the right direction.

NACCRRA’s Ranking of State Small Family Child Care Homes

Recommendations One of the primary purposes for NACCRRA preparing this scorecard was to identify ways this country can make child care in small family child care homes better for the children in care and their parents. Ensuring children in small family child care homes are healthy, safe, and receiving care that supports their growth and development

will require the cooperation of many. Parents, states, Congress, and professional organizations including NACCRRA must all play a part in this effort. In concluding this report, we provide recommendations for what states and Congress can do so that children are not left to chance in small family child care homes.

Recommendations for State Policy 1. Require all paid family child care providers caring for one or more unrelated children on a regular basis to be licensed and inspected. 2. Require complete background checks for family child care providers caring for unrelated children, and all providers receiving a government subsidy (CCDBG and TANF). 3. Require all family child care providers to complete 40 hours of pre-service training before opening their doors to unrelated children. Require 24 hours of annual training. 4. Publish family child care regulations that are easy to read and understand and separate from the regulations for other types of child care. 5. Ensure providers are informed about policy manuals or other interpretations of the regulations used by licensing staff. 6. Provide the appropriate number of licensing personnel to ensure family child care regulations are properly enforced. 7. Require the state licensing department to share timely information about family child care home provider status (investigations, violations, revocations, etc) with other organizations, including CCR&Rs, that refer families to child care or deliver training or technical assistance to providers.

Recommendations for Federal Policy 1. Require the Child Care Bureau within HHS to review child care state plans against state regulations. In addition, the Child Care Bureau should be granted the authority to withhold CCDBG funds if state standards and oversight are insufficient. 2. Require all family child care providers who care for one or more unrelated children for pay on a regular basis to have a comprehensive background check, including fingerprints. 3. Require both relative and non-relative providers receiving federal CCDBG or TANF subsidies to be inspected to ensure compliance with basic health and safety practices. 4. Prohibit self-certification of compliance with health and safety standards. 5. Require complete background checks for all providers and prohibit subsidies from CCDBG or TANF to providers who have not undergone a complete background check. 6. Increase CCDBG funding and require states to set aside at least 12 percent of CCDBG funding for quality related activities, including inspections and monitoring of family child care homes. 7. Require all family child care providers caring for unrelated children for pay to have 40 hours of preservice training and 24 hours of annual training. 8. Separate relative care from unregulated friends and neighbor care in all federal regulations. 9. Support research on the regulations that promote quality in family child care.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

Simple, common sense steps taken by the states and Congress can improve the quality of family child care homes. We hope that policymakers will join us in setting the bar higher and stop the practice of leaving children to chance in family child care homes. At a minimum, there

ought to be some accountability for how taxpayer dollars are spent. We can do better to protect the safety of children and promote their healthy development. Working parents and the next generation depend on it.

NACCRRAâ&#x20AC;&#x2122;s Ranking of State Small Family Child Care Homes

National Association of Child Care Resource & Referral Agencies 3101 Wilson Boulevard, Suite 350, Arlington, VA 22201 Phone (703) 341-4100 Fax (703) 341-4101 www.naccrra.org ÂŠ NACCRRA 2008

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