Education and Care: Early Childhood Programs and Services for Low-Income Families

Published by the Government Accountability Office on 1999-11-15.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                 United States General Accounting Office

GAO              Report to Congressional Requesters

November 1999
                 EDUCATION AND
                 Early Childhood
                 Programs and Services
                 for Low-Income

      United States
GAO   General Accounting Office
      Washington, D.C. 20548

      Health, Education, and
      Human Services Division


      November 15, 1999

      The Honorable Judd Gregg
      Chairman, Subcommittee on Children and Families
      Committee on Health, Education, Labor, and Pensions
      United States Senate

      The Honorable William Goodling
      Chairman, Committee on Education
        and the Workforce
      House of Representatives

      The Honorable Michael N. Castle
      Chairman, Subcommittee on Early Childhood,
        Youth, and Families
      Committee on Education and the Workforce
      House of Representatives

      Billions of federal and state dollars annually support multiple programs to
      address the early childhood care and education needs of low-income
      families. Information from these programs on the availability and
      accessibility of care and services that children receive is of great interest
      for several reasons.1 Recent developments in the 1996 welfare reform
      legislation require more welfare families, including those with very young
      children, to find and keep jobs. Also, much attention has been given to the
      relationship between child care experiences and school readiness. Finally,
      the existence of multiple funding sources for early childhood care and
      education has increased some states’ interest in using program

      Recently, a number of congressional proposals have been made to
      increase federal child care funding. Therefore, you asked us to describe
      (1) programs and services funded at the federal and state levels that
      directly provide early childhood care and education for the general
      population of low-income children up to age 5, (2) state and local
      assessments of the relative difficulty low-income parents face in obtaining
      care for their children, and (3) the collaborative efforts among child care
      officials and early childhood education officials to address these parents’
      difficulties. Much of our data came from a survey of child care

       In this report, “early childhood care and education” includes care that is provided to low-income
      children whose parents are out of the home in work activities and who may be in a center or a home,
      as well as care that is focused on a child’s education, such as care that preschools and Head Start

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                   administrators and departments of education in all 50 states and the
                   District of Columbia and from a survey of all 537 child care resource and
                   referral agencies in the membership database of the National Association
                   of Child Care Resource and Referral Agencies (NACCRRA).2 We also visited
                   Colorado, North Carolina, Ohio, and Oregon, which the National
                   Governors Association had identified as leaders in collaborative efforts for
                   early childhood care and education, and we visited two counties, one
                   mostly rural and one mostly urban, in each of these states. We interviewed
                   program officials at all levels and early childhood researchers, and we
                   reviewed related reports of research organizations. We did work in
                   accordance with generally accepted government auditing standards
                   between August 1998 and October 1999. (See appendix I for more details
                   on our methodology.)

                   The federal government invested about $11 billion in FY 1999 on early
Results in Brief   childhood care and education programs for low-income children through a
                   range of programs and the states invested almost $4 billion for such
                   programs.3 The Department of Health and Human Services (HHS) provides
                   most of the federal support for early childhood care and education, about
                   $8 billion, through the Head Start program and the Child Care and
                   Development Fund (CCDF), which subsidizes the child care expenses of
                   low-income working parents. Other HHS and Department of Education
                   programs provide the remaining funding for early childhood care and
                   education. Thirty-two states reported funding preschool programs, 15
                   states reported providing state money to supplement Head Start, and 19
                   states reported child care programs that provided funding to communities.
                   Our survey results showed that educationally oriented services (for
                   example, numeracy and literacy activities) were the most common
                   services providers offered in centers and homes. Providers were less likely
                   to include other services, such as family social services or medical

                    NACCRRA’s membership database contains 537 of an estimated 800 agencies nationwide.
                    We included only major programs that low-income parents can use to obtain child care. For the total
                   federal funding figure, we included only programs that directly provide (1) child care or education or
                   (2) funds to provide child care and education for low-income children up to age 5. We did not include
                   programs that support but do not provide funding for child care, such as the U.S. Department of
                   Agriculture’s Child and Adult Food program, child care tax expenditures at the federal and state levels,
                   programs with a limited eligibility, or the Stewart B. McKinney Homeless Assistance Act. For a
                   detailed list of other sources of federal funding available for child care, see Federal Child Care Funding
                   (GAO/HEHS-98-70R, Jan. 23, 1998). The $4 billion figure for state funding represents data from our
                   survey on state expenditures. This does not represent the entire state investment but it does reflect
                   state contributions for programs within the scope of our review.

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Although a number of federal and state programs provided significant
funds for early childhood care and education, some types of child care
were still difficult for low-income families to obtain, including infant and
toddler care; care for children who have special needs, such as children
with physical disabilities; and care for children during nonstandard hours
(evenings and weekends). In contrast, a majority of the survey
respondents indicated that care for 3- and 4-year-olds was generally not
difficult to obtain. Child care administrators identified three major barriers
to finding care for low-income children—cost of care, especially for
infants and toddlers; availability; and accessibility, such as transportation
to get to providers, described as more difficult in rural and remote areas.

Some states and localities are using collaborative initiatives to better
bridge child care programs and early childhood education programs as
well as the federal and state programs. During our visits to Colorado,
North Carolina, Ohio, and Oregon, officials at all levels reported that
collaboration among child care and early childhood education program
officials and nonprofit organizations improved the availability of education
and care services for low-income families and enhanced the quality of
care. Officials from these states reported using in these collaborative
efforts similar strategies to provide incentives for local collaboration, such
as additional funding. For example, in Ohio CCDF and Head Start officials
pool resources by sharing staff to add full day care to the half-day Head
Start program and to add Head Start services, such as nutrition and
medical care, to day care programs. All the states we visited reported
increased availability of full-time care for 3-to-5-year-olds as a result of
collaborative efforts and more limited success in increasing the availability
of infant and toddler care or care during nonstandard hours. However,
barriers to collaboration still remain, according to state officials and
survey respondents. Factors they identified as impeding collaboration
included differing eligibility requirements; “turf” issues, such as concerns
about losing program authority; lack of information on different programs;
and the lack of funding to support collaborative activities. These barriers
generally reflect the division between the child care and early childhood
education communities.

The types of care that currently have the greatest need for support are
infant and toddler care, care during nonstandard hours, and care for
children with special needs. In the states we visited, collaborative efforts
have yielded some positive results in addressing child care and education
needs. Information on them may be useful to other states and

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             Early childhood care and education are generally provided in three types
Background   of settings: in the child’s home, in the home of a provider, and in a center
             or other nonresidential setting. Providers in a home setting that are
             regulated by the state are required to meet certain operating standards
             established by state or local governments, such as a maximum number of
             children per staff. Unregulated providers may or may not meet such
             standards. Most care provided in centers is regulated, although some
             states exempt centers if they are sponsored by a religious group or
             government entity. Further, within a particular setting—whether a home
             or a center—the specific services provided can range from solely child
             care assistance to a full continuum of services such as children’s
             educational activities, immunization referrals, and developmental
             assessments and parental literacy and job training, referrals to social
             services, and parenting-skill training.

             Historically, early childhood care programs and early childhood education
             programs have existed as separate systems with different goals. The
             primary goal of child care programs has been to subsidize the cost of care
             for low-income parents who are working or engaged in education and
             training activities. At the federal level, child care is primarily supported by
             CCDF. In contrast, early childhood education programs have generally
             focused on helping children become ready to begin school. The largest
             such program is Head Start. This split is also reflected at the state level in
             child care subsidy programs and preschool programs.

             The Personal Responsibility and Work Opportunity Reconciliation Act of
             1996 (P.L. 104-193) is directed at increasing low-income families’ reliance
             on work rather than welfare. This legislation established Temporary
             Assistance for Needy Families (TANF), a program designed to help welfare
             recipients move into the workforce. Previously, under Aid to Families with
             Dependent Children, most states exempted single parents with children
             younger than 3 from participating in education, training, or work-related
             activities. However, under the new welfare reform legislation, most states
             exempt only single parents with very young children, and most recipients
             are now required to participate in work or work-related activities.4 In
             addition, increased emphasis on moving people off welfare and into work
             activities may result in parents with low skills being employed in

              TANF has no exemption based on the age of children but allows states to exempt parents with
             children younger than 1. Twenty-four states exempt parents with children up to 1 year of age, 15 states
             exempt parents with children 6 months of age or younger, and 4 have no exemption related to
             children’s ages. Two states allow counties to set the exemption age. The 5 other states have
             exemptions at various ages older than 1 year. In addition, the states may not reduce or terminate
             assistance to a single custodial parent of a child younger than 6 who has demonstrated the inability (as
             determined by the state) to obtain needed child care.

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                           evening-shift and weekend work activities. As a consequence, this
                           legislation could increase the demand for some types of child care,
                           specifically infant and toddler care and nonstandard hour care, for both
                           families on welfare and those moving into the workforce.5

                           Concern over the kind of services low-income children receive while their
                           parents work has been underscored by research. Although the relative
                           importance of recent neurological research on early brain development is
                           controversial, a large body of research from child development experts
                           and quality-of-care studies indicates that developmentally appropriate
                           experiences for very young children are beneficial. In addition, concern in
                           many states over the number of children who arrive in school with poorly
                           developed skills necessary for learning, such as fine motor and general
                           cognitive skills as well as social skills, adds to the interest in what kind of
                           care and services are most effective for school readiness.

                           In 1999, the federal government provided approximately $11 billion
Federal and State          through multiple programs administered by HHS and Education to fund a
Government                 variety of early childhood care and education services—mostly targeted to
Programs Fund a            low-income children. In addition, many states support care and education
                           by funding preschool programs and providing grants to communities to
Variety of Early           increase the supply of child care. These programs are often targeted to a
Childhood Care and         specific population, such as children up to 3 or 3- and 4-year-olds from
                           low-income families. Our surveys of state child care administrators and
Education Services         resource and referral agencies provide information on the variety of
                           services offered in home and center settings. These services most often
                           focus on educational activities but also occasionally include meals,
                           immunization referrals, parental support services, and social service

Head Start and CCDF        Of the $11 billion in federal support for early childhood care and education
Provide Most Support for   for low-income children, almost $8 billion is provided through Head Start
Early Childhood Care and   and CCDF, as shown in table 1.

                            See Welfare Reform: Implications of Increased Work Participation for Child Care (GAO/HEHS-97-75,
                           May 29, 1997) and Welfare Reform: States’ Efforts to Expand Child Care Programs (GAO/HEHS-98-27,
                           Jun. 13, 1998), for a more complete discussion of welfare reform and child care.

                           Page 5                                           GAO/HEHS-00-11 Low-Income Childhood Care

Table 1: Major Federal Programs That
Funded Early Childhood Care and                                                                                                 Funding in
Education for Low-Income Children in   Program                               Target age             Department                    millions
Fiscal Year 1999                       Head Start                                                                                      $4,660
                                             Early Head Start                Birth to 3             HHS                                 349.4
                                       CCDF                                  Birth to 12            HHS                                 3,167
                                             Funds transferred to CCDF Birth to 12                  HHS                                  636b
                                             Funds used for child care       Not specified          HHS                                  259b
                                       Social Services Block Grants          Not specified          HHS                                  285c
                                       Title I, part A                       Pre-K through 12       Education                            936d
                                       Individuals with Disabilities
                                       Education Act
                                             Preschool Grants                3 to 5                 Education                            374
                                             Grants for Infants and          Birth to 2             Education
                                             Families with Disabilities                                                                  370
                                       Even Start                            Birth through 8        Education                            135
                                       21 Century Learning Centers All                              Education                            200
                                        According to HHS, it does not track the amount of funds spent by age group, including birth to 5
                                           Figure is for fiscal year 1998.
                                        Total fiscal year 1999 appropriation was $1.9 billion. The states have historically reported
                                       spending on average about $285 million from Social Services Block Grants on child care, or
                                       15 percent.
                                        Total fiscal year 1999 appropriation was $7.8 billion. In previous years, an estimated
                                       $156 million, or 2 percent, supported pre-K programs and $936 million, or 12 percent, supported
                                       pre-K and kindergarten children.

                                       Head Start, established in 1965, focuses on providing early childhood
                                       education and developmental services for low-income preschool children
                                       and their families through grants to local agencies. Specifically, services
                                       for children focus on education (such as literacy activities),
                                       socioemotional development (such as activities developing self-concept),
                                       physical and mental health (such as immunizations), and nutrition (such
                                       as meal and nutrition awareness). The program also provides some
                                       parental support services (such as, referrals to social services). Head Start
                                       primarily serves 3- and 4-year-olds in part-day and full-day programs.6 At
                                       least 90 percent of the children enrolled in a program must come from
                                       families whose income is at or below the federal poverty line or who are

                                        In Head Start Programs: Participant Characteristics, Services, and Funding (GAO/HEHS-98-65), we
                                       reported that 93 percent of the children were in part-day and part-year programs and 63 percent were 4
                                       years old.

                                       Page 6                                                 GAO/HEHS-00-11 Low-Income Childhood Care

receiving public assistance.7 In fiscal year 1999, an estimated 1,520
grantees participated in Head Start, serving slightly more than 831,000
children. Early Head Start, which began in 1995, was designed to enhance
the development of infants and toddlers and to promote healthy family
functioning and healthy prenatal outcomes for pregnant women. For fiscal
year 1999, the Congress earmarked $349.4 million for Early Head Start.
The program reports having served 39,000 infants and toddlers in that

The other major HHS program is CCDF, which in fiscal year 1999 provided
$3.2 billion to states to subsidize child care expenses for children younger
than 13 in low-income working families. Federal law allows the states to
use CCDF to help working families or families preparing for work with an
income of less than 85 percent of the state median income. In practice,
however, many states establish lower income eligibility levels. Federal
regulations also require that the states target a portion of CCDF funds to
welfare recipients working toward self-sufficiency or to families at risk of
welfare dependency and that they use at least 4 percent of their total CCDF
funds for quality improvements and offer additional services to parents.8
CCDF funds subsidize child care through certificates that parents can use to
pay the child care providers they select. Some states also use contracts to
fund slots in child care programs. Preliminary HHS data over the 6-month
period January to June 1997 indicate that voucher use was fairly evenly
split between home and center settings.9

Other HHS and Education programs also support child care and education
in various ways, sometimes with different program goals. For example,
HHS’s TANF program provided about $900 million for child care in fiscal year
1999 to support parents in work activities. In addition, Social Services
Block Grants (SSBG) is a flexible source of funds that the states may use to
support a wide variety of social services, including child care. In
Education, the Even Start program has adult literacy and parenting
education, as well as early childhood care and education for children
through 8 as goals. This program is funded with $135 million and serves

 According to 1999 HHS guidelines, $13,880 per year for a family of three is the federal poverty level for
the 48 contiguous states and the District of Columbia; the level is higher in Alaska and Hawaii.
 Additional services to parents include services such as resource and referral counseling regarding the
selection of appropriate child care. In addition, for fiscal year 2000, the Congress has established
several earmarks above the 4 percent minimum quality expenditure requirement—$173 million for
quality activities, $50 million for improving the quality of infant and toddler care, and $19 million for
child care resource and referral and school-age child care activities.
 Preliminary data on types of care being used by children subsidized by block grants indicate that on
average about 11 percent of the children are cared for in home, 30 percent are with family child care,
4 percent are with group homes, and 55 percent are using centers.

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                                    about 40,000 families. In addition, title I of the Elementary and Secondary
                                    Education Act supports programs and services for educationally
                                    disadvantaged children; funding for early childhood education is estimated
                                    to have been about 12 percent, or $936 million, of the total $7.8 billion in
                                    fiscal year 1999. The Individuals with Disabilities Education Act (IDEA),
                                    another Education program, has a Grants for Infants and Families with
                                    Disabilities program. Services such as speech therapy are provided to
                                    assist the states in creating statewide systems of programs to make
                                    available early intervention services to all children with disabilities aged
                                    birth through 2 years old and their families at home or in whatever early
                                    childhood care or education setting children attend. The IDEA Preschool
                                    Grants program provides states with funding to enable children with
                                    disabilities to receive special education and related services for preschool
                                    children. Finally, 21st Century Community Learning Centers may support
                                    early childhood care and education. The $200 million program funds
                                    school-community partnerships to keep schools open after school and in
                                    summer as a safe haven for enhanced learning.

Most States Fund Early              Forty-three states, including the District of Columbia, reported that in
Childhood Programs                  fiscal year 1999 they provided their own state funding, beyond the
                                    amounts required to match federal contributions, to support early
                                    childhood programs.10 Table 2 provides information on funding and
                                    enrollment in such programs.

Table 2: Types of Programs States
Funded in Fiscal Year 1999                                                                                                 Number of
                                    Type                            Number of statesa Estimated funding                      children
                                    Early childhood education                         32            $1.7 billion               613,000
                                    Child care program
                                    supplements                                       19              1.7 billion              351,000
                                    Head Start supplements                            15            155 million                 48,000
                                     Some states supported more than one type of program, but in total 43 states had at least one.

                                    Thirty-two states reported funding preschool programs that generally
                                    operated as part of the public school system. Also, 15 states provided
                                    funds to supplement the Head Start program by expanding it to serve more
                                    children, by increasing teacher salaries, or by providing transportation to
                                    Head Start facilities. Finally, 19 states administered programs that helped

                                      In order to draw down their federal allotments, the states must meet a maintenance of effort
                                    requirement and contribute matching funds. We excluded programs funded by a state match and
                                    programs with a limited eligibility, such as programs only for teenagers.

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                        fund child care for communities by providing grants to communities to
                        address their child care needs. These funds could be used in a variety of
                        ways, such as for preschools, for child care, to give providers training, and
                        for assistance in meeting licensing requirements. Of the 43 states, 20
                        provided some funding for infant and toddler care, generally through funds
                        to communities. The number of children served by state early childhood
                        care and education programs ranged from several hundred in five states to
                        nearly 140,000 in Texas.

Education Is the Most   Resource and referral agencies reported in responding to our survey that
Frequently Provided     providers in home and center settings offered a range of services, but
Service                 educational programs in centers were by far the most common, as shown
                        in figure 1. The proportion of providers offering other services was much
                        lower. Generally, centers provided more services than were provided in
                        homes. For instance, about 10 percent of the resource and referral agency
                        respondents stated that all or most centers provided parental support
                        services or medical referrals; fewer agencies reported that all or most
                        home care settings provided these same services. According to census
                        data, about 70 percent of low-income families met their child care needs in
                        the home.

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Figure 1: Percentage of Providers That
Offer Services as Reported by
Resource and Referral Agencies                       Education

                                         Referral for Emergency
                                                  Food Supplies

                                          Medical Services and

                                              Parental Support

                                         Family Social Services

                                                                  0      10      20       30      40    50    60    70    80    90


                                                                           Center-Care Settings

                                                                           Home-Care Settings

                                         Similarly, our survey of state child care administrators showed that most
                                         state-funded programs offered educational services. In addition, most also
                                         offered parental support activities, meals for the children enrolled, and
                                         referrals for medical services.

                                         Although the federal and state governments support many programs for
Some Types of Care                       early childhood care and education for low-income children, some types of
Are Difficult to Obtain                  care such as infant and toddler care are still difficult to obtain. State child
                                         care administrators reported that the high cost of care, its unavailability,
                                         and inaccessibility to providers were significant barriers to low-income
                                         families in obtaining the types of care they needed.

                                         Collectively, our surveys, which covered all states and many communities
                                         across the country, showed that obtaining care for infants and toddlers,
                                         for children with special needs, and during certain hours posed the most
                                         difficulty for low-income families. Figure 2 shows the responses on the
                                         difficulty of obtaining different types of care from the resource and
                                         referral agency survey; the responses of the child care administrators

                                         Page 10                                               GAO/HEHS-00-11 Low-Income Childhood Care

identified similar difficulties. Our previous work, based on limited case
studies, also identified obtaining care as a problem for infants and
toddlers.11 Resource and referral survey responses, however, reported that
care for preschool children generally was not difficult to find.12 Slightly
more than half of child care administrators reported that there was
sufficient full-time care for preschoolers. Respondents provided additional
comments on the difficulties in obtaining care. For example, they reported
that finding one place that provided care for children of different ages in
the same family such as an infant and a preschooler was difficult. The
need for infant care and care during nonstandard hours may be
particularly important for TANF recipients. According to a recent study,
more than a quarter of former welfare recipients and a similar proportion
of low-income mothers work night hours.13

 See Welfare to Work: Child Care Assistance Limited; Welfare Reform May Expand Needs
(GAO/HEHS-95-220), and GAO/HEHS-98-27.
  Our survey does not reflect whether or not the care available is considered quality care.
 “Assessing the New Federalism: An Urban Institute Program to Assess Changing Social Policies,”
discussion paper, Urban Institute, Washington, D.C., 1999.
Page 11                                              GAO/HEHS-00-11 Low-Income Childhood Care

Figure 2: Percentage of Resource and
Referral Agencies Reporting That Care       90        Percentage
Is Difficult or Very Difficult to Obtain








                                                                      ek s,















                                                                  We ning

























                                                                              Type of Care

                                           Child care administrators reported that high cost is a barrier, whether
                                           parents are seeking care for preschoolers or care for infants and toddlers.
                                           Care for infants and toddlers is generally more costly than preschool care
                                           mainly because of the higher staff-to-child ratio required. The subsidy
                                           provided in states does not always cover the cost of available care for
                                           infants and toddlers. Resource and referral agencies reported in our
                                           survey that about 80 percent of their centers and 70 percent of their home
                                           care providers accepted children with subsidies. Smaller subsidies allow
                                           states to provide subsidies to more families but can limit the families’
                                           ability to find affordable care. For example, officials in Colorado estimated
                                           that the average child care assistance subsidy is just 62 percent of the cost
                                           of quality care.

                                           Page 12                                       GAO/HEHS-00-11 Low-Income Childhood Care

                             More than half of the state child care administrators cited the
                             inaccessibility of care, often related to transportation difficulties, as
                             another major barrier to low-income families seeking child care.
                             Transportation was especially problematic in rural areas. For preschool
                             care, arrangements sometimes have to be made to move children from a
                             half-day educational program to a supplementary care program for the rest
                             of the day.

                             To address the difficulties in obtaining certain types of care, states and
Collaboration Has            localities are using collaborative initiatives to bring together the different
Positive Outcomes            program authorities involved in funding and providing care, with the goals
but Barriers Remain          of increasing the availability of various types of care and enhancing the
                             services provided. However, according to state officials, collaboration
                             does not eliminate all gaps in care, and collaborative initiatives are
                             sometimes limited because of barriers such as differing eligibility

States Reported That         In Colorado, Ohio, North Carolina, and Oregon, collaborative efforts
Collaborative Initiatives    combined state and federal funds from a variety of sources to increase the
Have Resulted in Positive    availability of child care and education settings available to low-income
                             families. Collaboration was usually accomplished through interagency
Outcomes                     coalitions or organizations that tried to fit together different care and
                             education options to meet communities’ and parents’ needs. These states
                             also offered communities incentives to collaborate, either in the form of
                             waivers to state regulations or as additional funds. Some of the efforts
                             were enhanced by Head Start collaboration grants to local grantees.

Child Care and Education     In Colorado, the state legislature created the Community Consolidated
Collaborative Initiatives    Child Care Pilot Program to encourage communities to design
Implemented in Four States   consolidated programs of comprehensive early childhood care and
                             education services for children in low-income families aged 6 weeks
                             through 5 years old. At a minimum, pilot communities were required to
                             consolidate funding from the Colorado Preschool Program, operated
                             under the authority of local school districts and child care money
                             administered by local boards of county commissioners, thereby
                             encouraging the education and child care systems to come together.
                             Initially, the legislature provided no financial incentives to encourage pilot
                             counties to collaborate; however, in future years, additional funds will be
                             made available to enable the collaborations to further increase child care

                             Page 13                                GAO/HEHS-00-11 Low-Income Childhood Care

The Colorado legislature authorized the state Department of Human
Services to waive state laws or rules that would prevent the pilot
communities from implementing collaborative projects. Waivers included
requiring only a single application for multiple programs and broadening
program eligibility to meet specific community needs. For example, two
pilot counties raised the income eligibility level for the state child care
subsidy so that low-income working parents’ child care expenses would
not increase substantially as their income increased.

North Carolina’s Smart Start initiative provided state funds ($24.4 million
in 1998) to assist communities in improving and expanding their existing
programs for children and families and in designing and implementing new
programs. The primary goal of Smart Start is to ensure that North
Carolina’s children enter school healthy and ready to learn. A prerequisite
for the receipt of Smart Start funds is that representatives from various
community organizations must form local partnerships for children to plan
for and direct the distribution of the funds to local service providers.
Initially funding twelve partnerships, Smart Start partnerships now
operate throughout the state. Local partnerships were funded both to
increase the availability of child care and to improve center or provider

Created in 1992, Ohio’s Family and Children First Initiative focuses a
diverse group of agencies and organizations on achieving better outcomes
for children and their families. The goal is to promote collaboration among
state and local governments, nonprofit organizations, businesses, and
families to ensure that children are ready to learn. Its three key objectives
are making infants healthier, increasing access to quality preschool and
child care, and improving services for family stability. The Early
Childhood Coordination Committee is charged with bringing Ohio’s Head
Start program, Ohio’s public preschool program, and its subsidized child
care program into a coordinated system of care. At the county level, the
initiative has supported the funding and development of councils
composed of several child care organizations, including both child care
programs and education programs. Each county council received a $20,000
state grant for these collaboration activities. Ohio also provided
$181 million in state funds to expand Head Start services to more eligible
families. Further, by combining Head Start with CCDF funds, the state has
enabled children in poor working families to receive a full day of care.

In 1993, Oregon’s legislature created the Commission on Children and
Families to support community-based planning and decisionmaking and to

Page 14                               GAO/HEHS-00-11 Low-Income Childhood Care

                             encourage collaborative partnerships to change the state’s system of
                             delivering services and develop supports for children and families. Local
                             commissions were to include citizens, community groups, businesses,
                             service providers, and government. In 1997, the commission directed
                             $58.4 million, primarily from state and federal government sources, to the
                             local commissions on children and families in each of its 36 counties.
                             Collaboration among different programs operating in the community was a
                             prerequisite for receiving a grant.

Head Start Support for       Collaborative efforts were also being fostered through federal programs.
Collaboration                For example, in 1990, HHS began to award collaboration grants to a few
                             states to promote more integrated service delivery systems and to
                             encourage collaboration between Head Start and other programs. By 1997,
                             all states were funded. The Congress also increased funding for Head Start
                             for fiscal years 1998-99, in part to increase enrollment numbers.
                             Recognizing that an increasing proportion of Head Start families work and
                             that many who receive public assistance are participating in welfare
                             reform initiatives in response to TANF, HHS gave priority to funding more
                             full-day, full-year care. Head Start encouraged programs to consider
                             combining Head Start expansion funds with other child care and early
                             childhood funding sources to deliver services through partnerships such
                             as community-based child care centers. In addition, the 1998 amendments
                             encouraged collaboration and have resulted in a performance indicator,
                             the measure by which Head Start grantees are evaluated, that indicates the
                             extent to which a Head Start grantee is collaborating with other
                             community providers in providing linkages to child care.

Positive Outcomes Reported   As a result of these initiatives, the states reported positive outcomes in
                             terms of increased child care and services. Colorado officials reported a
                             larger increase in the number of children served in pilot counties than
                             elsewhere in the state. For example, according to the director of one pilot
                             collaboration project, the project’s efforts have enabled it to increase child
                             care by 61 percent and to essentially meet the need for care and education
                             for 3- to 5-year-olds. Similarly, Ohio reported that the collaboration
                             between state and federal Head Start and Ohio preschool and child care
                             programs has enabled Ohio to increase not only the amount of care
                             available to low-income children but also their access to Head Start
                             services. The state reported that it currently serves 84 percent of its
                             children who are eligible for Head Start in state or federal Head Start
                             programs, compared with a national average of 38 percent. In North
                             Carolina, an evaluation of the Smart Start program reported a 12 percent
                             increase in credentialed child care providers. Officials in one county

                             Page 15                                GAO/HEHS-00-11 Low-Income Childhood Care

                            credited Smart Start with a 25 percent increase in the number of child care
                            centers meeting the state’s highest standard for center-based care.
                            Likewise, state officials in Oregon identified positive outcomes that have
                            resulted from its collaborative efforts, including increased numbers of
                            preschool programs, licensed providers, and home-based care for infants
                            and toddlers and the initiation of a career development program for
                            providers. Oregon also reported that it increased the number of group
                            homes by 25 percent.

Barriers to Collaboration   Collaboration has, according to state officials, clearly resulted in positive
                            outcomes; however, barriers to collaboration still remain. State program
                            administrators and resource and referral agency respondents identified
                            several barriers, including differing eligibility requirements, “turf” issues or
                            concerns that an official’s authority or power would be lessened,
                            insufficient funds, and lack of information on programs. Program
                            administrators said that the differing eligibility requirements between
                            Head Start and CCDF made collaboration difficult. Head Start’s income
                            eligibility standard requires that 90 percent of enrollments be at or below
                            the federal poverty level, whereas CCDF funds may be used for families
                            with income up to 85 percent of state median income, which generally
                            allows the states to give subsidies to families who make more than the
                            federal poverty level. Thus, collaboration between these programs to
                            achieve objectives, such as full day coverage, might be difficult because
                            some children may be eligible only for CCDF.

                            In citing turf issues as barriers to collaboration, the respondents expressed
                            concern that officials’ power or authority would be reduced and that they
                            would be unwilling to share program funds. These issues often reflected
                            the division of child care organizations from early childhood education
                            organizations. Child care programs were generally administered through
                            human services agencies, whereas preschool education programs were
                            generally administered by the education departments and public school
                            agencies. One state official said that with the separate funding,
                            regulations, and goals, the child care and education offices have not
                            traditionally understood the importance of each other’s role in a child’s

                            Resource and referral agency and state administrator respondents also
                            frequently cited a lack of information on the various programs that fund
                            child care and education as a barrier to collaboration. For example, one
                            respondent commented that a lack of understanding of the different

                            Page 16                                 GAO/HEHS-00-11 Low-Income Childhood Care

                  agencies’ and organizations’ policies and service delivery hindered
                  collaboration. In one state, an official told us that the people who work in
                  child care do not know the requirements for facilities and training that
                  exist in the education department and that are very different from theirs
                  and vice versa.

                  Respondents reported that insufficient funds also hindered their ability to
                  collaborate. Lack of funding to support collaborative initiatives was widely
                  cited as a barrier, with respondents specifically citing a lack of staff,
                  training, and transportation as hampering collaboration with other

                  The implementation of TANF has put more low-income children in care
Conclusions       outside the home and put them in care earlier in their lives. While efforts
                  to provide programs of care for preschool children appear to generally
                  meet the demand for such care, care for infants and toddlers, care during
                  nonstandard hours, and care for children who have special needs are still
                  not available, affordable, or accessible. As a result, these are the types of
                  care most in need of support. Some states and localities have been using
                  collaborative initiatives to increase the number of full-day providers and to
                  enhance the quality of program services, and these have positively
                  addressed families’ and children’s needs. The methods they have used may
                  be helpful to other states and localities as they attempt to address their
                  own needs.

                  We provided Education and HHS with a draft of this report for their review.
Agency Comments   HHS responded with comments that are printed in appendix II. In its
                  comments, HHS wrote that this report will be helpful as it continues its
                  efforts to work with states and communities to meet the needs of
                  low-income preschool children and their families. HHS fully supports our
                  conclusions about the need for care for working low-income families. It
                  provided additional information about the types of care and the adequacy
                  of the care it says is needed, as well as descriptions of various initiatives to
                  support collaborative efforts to meet such needs.

                  At our meeting with Education officials, including representatives from
                  different Education program offices, Education said that it generally
                  agrees with our findings and conclusions. In addition, Education provided
                  us with information about its ongoing and planned efforts to promote

                  Page 17                                 GAO/HEHS-00-11 Low-Income Childhood Care

literacy and coordination with other programs. Where appropriate, we
made technical changes that both departments provided.

We are sending copies of this report to the Honorable Donna E. Shalala,
Secretary of the Department of Health and Human Services; the Honorable
Richard W. Riley, Secretary of the Department of Education; and others
who are interested. We will also make copies available to others upon

If you or your staff have any questions about this report, please contact me
on (202) 512-7215. Other staff who contributed to this report are listed in
appendix III.

Cynthia M. Fagnoni
Director, Education, Workforce, and
  Income Security Issues

Page 18                               GAO/HEHS-00-11 Low-Income Childhood Care
Page 19   GAO/HEHS-00-11 Low-Income Childhood Care

Letter                                                                                             1

Appendix I                                                                                        22

Scope and
Appendix II                                                                                       24

Comments From the
Department of Health
and Human Services
Appendix III                                                                                      29

GAO Contacts and
Tables                 Table 1: Major Federal Programs That Funded Early Childhood                 6
                         Care and Education for Low-Income Children in Fiscal Year 1999
                       Table 2: Types of Programs States Funded in Fiscal Year 1999                8

Figures                Figure 1: Percentage of Providers That Offer Services as                   10
                         Reported by Resource and Referral Agencies
                       Figure 2: Percentage of Resource and Referral Agencies                     12
                         Reporting That Care Is Difficult or Very Difficult to Obtain


                       CCDF         Child Care and Development Fund
                       HHS          Department of Health and Human Services
                       IDEA         Individuals with Disabilities Education Act
                       NACCRRA      National Association of Child Care Resource and Referral
                       SSBG         Social Services Block Grants
                       TANF         Temporary Assistance for Needy Families

                       Page 20                               GAO/HEHS-00-11 Low-Income Childhood Care
Page 21   GAO/HEHS-00-11 Low-Income Childhood Care
Appendix I

Scope and Methodology

                     This appendix contains detail on our surveys of state child care
                     administrators, state departments of education, and members of the
                     National Association of Child Care Resource and Referral Agencies as well
                     as our case studies in four states.

                     We conducted two surveys to obtain information about activities at the
Survey Methodology   state level. We sent questionnaires to the child care administrators in all 50
                     states and the District of Columbia to get information about the funds that
                     states allocate for early childhood programs, the source of the funds, the
                     characteristics of state-administered child care programs—including the
                     types of care and services they provided and their availability of
                     care—difficulties low-income families encounter finding care, how the
                     states attempt to gauge the adequacy of the supply of care, and factors that
                     foster or hinder collaboration among early childhood programs. We also
                     sent questionnaires to the departments of education in each state and the
                     District of Columbia to get information about state-administered early
                     education programs. Of the 51 questionnaires we sent to the child care
                     administrators, 50 were returned—a response rate of 98 percent. Of the 51
                     questionnaires we sent to state departments of education, 49 were
                     returned—a response rate of 96 percent.

                     Because limited information was available on services from most federal
                     programs, we surveyed resource and referral agencies which have access
                     to information on various types of care and services provided through
                     centers and home care providers because of their role in referring
                     low-income parents to potential child care providers. We used the
                     membership list of the National Association of Child Care Resource and
                     Referral Agencies. We sent a questionnaire to each agency listed as a
                     member of the association, excluding 32 members that we sent to agencies
                     that were not resource and referral agencies or that were sublocations of
                     larger resource and referral agencies. The response rate was 80 percent:
                     428 of the 537 questionnaires we sent were returned.

                     According to early childhood care and education experts, a survey of the
                     NACCRRA members was most likely to yield credible local perspectives on
                     child care programs and an acceptable response rate. However, our survey
                     should not be considered to be an overall measure of child care services at
                     the local level. Some resource and referral agencies are not NACCRRA
                     members, and some child care providers may not be registered with their
                     local agencies. According to the association, about three-fourths of child
                     care resource and referral agencies are members.

                     Page 22                                GAO/HEHS-00-11 Low-Income Childhood Care
               Appendix I
               Scope and Methodology

               Our compilation of programs does not include every program with which a
               state addresses early childhood issues. We excluded from our survey
               results any reported programs that did not use state or local funds over
               and above those required by federal maintenance of effort or matching
               requirements. We also excluded funds and any reported programs that did
               not serve children directly.

               We developed in-depth information about early childhood programs,
Case Studies   particularly their collaboration efforts, in Colorado, Ohio, Oregon, and
               North Carolina and two localities within each of those states. We chose
               states that the National Governors Association and others considered to
               have integrated approaches to child care and established frameworks for
               state action. We also selected states to get a mix of geographic regions. We
               met with states’ officials and also visited at least one primarily urban
               jurisdiction and at least one primarily rural jurisdiction. We interviewed
               state officials in the education and human services and social services
               departments. We talked with state officials responsible for preschool
               programs, early childhood education, title I, the Individuals with
               Disabilities Education Act, child care subsidies, and child care provider
               licensing. We also talked with officials of private and nonprofit
               organizations involved in early childhood education or care issues. We
               reviewed documentation on these issues. In the two localities we visited in
               each state, we interviewed officials responsible for similar programs and
               activities at the local level and reviewed documentation about their

               Page 23                               GAO/HEHS-00-11 Low-Income Childhood Care
Appendix II

Comments From the Department of Health
and Human Services

Now GAO/HEHS-00-11.

                      Page 24   GAO/HEHS-00-11 Low-Income Childhood Care
                      Appendix II
                      Comments From the Department of Health
                      and Human Services

Now GAO/HEHS-00-11.

                      Page 25                                  GAO/HEHS-00-11 Low-Income Childhood Care
               Appendix II
               Comments From the Department of Health
               and Human Services

Now page 12.

Now page 11.

               Page 26                                  GAO/HEHS-00-11 Low-Income Childhood Care
               Appendix II
               Comments From the Department of Health
               and Human Services

Now page 15.

               Page 27                                  GAO/HEHS-00-11 Low-Income Childhood Care
               Appendix II
               Comments From the Department of Health
               and Human Services

Now page 16.

               Page 28                                  GAO/HEHS-00-11 Low-Income Childhood Care
Appendix III

GAO Contacts and Staff Acknowledgments

                  Harriet Ganson, Assistant Director, (202) 512-9045
GAO Contacts      Mary Roy, Evaluator-in-Charge, (202) 512-7072

                  In addition to the persons named above, Kopp Michelotti, Martha Elbaum,
Acknowledgments   Margaret Boeckman, and Kelly Mikelson contributed significantly to this

(104930)          Page 29                              GAO/HEHS-00-11 Low-Income Childhood Care
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