Child Care:

State Efforts to Enforce Safety and Health Requirements

HEHS-00-28: Published: Jan 24, 2000. Publicly Released: Jan 31, 2000.

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Pursuant to a congressional request, GAO provided information on states' efforts to ensure the safety and health of children in child care settings, focusing on: (1) the most critical licensing and enforcement activities that help states ensure the safety and health of children in child care; (2) the extent to which states conduct these critical activities for their regulated providers; and (3) how states ensure that nonregulated providers receiving block grant funds meet the law's safety and health requirements.

GAO noted that: (1) experts and the literature cite a number of licensing and enforcement activities important to helping states ensure that providers comply with state child care requirements; (2) they recommend that states conduct these activities for all types of care provided in a setting other than the child's home, except for care provided by relatives; (3) key among these are: (a) completing state, and sometimes federal, criminal background checks as well as child abuse registry checks on prospective providers to screen them for suitability for working with children; (b) conducting frequent and unannounced monitoring visits to providers; and (c) having an array of sanctions available, so that providers who consistently or flagrantly violate requirements for protecting the safety and health of children can be prohibited from providing care to children; (4) to effectively and consistently carry out these critical activities, experts and the literature recommend that licensing staff be adequately trained in child care or related fields and have at least 24 hours per year of ongoing training; (5) licensing offices should have sufficient numbers of staff to maintain caseloads at about 75 providers for each licensing staff person; (6) most states' policies for conducting background checks and monitoring visits are generally consistent with recommended enforcement practices; (7) states' reported success in following the recommended practices for visits appears to be related to increases in full-time-equivalent staff and budgets for licensing offices; (8) most states reported having an array of sanctions to use to bring providers into compliance, and all stated that they had the authority to revoke a license; (9) approximately half of the states require staff to have education and experience in child care or a related field as well as ongoing training; (10) only two states reported regulating all types of care outside the child's home; (11) the enforcement activities a state conducts under its normal licensing processes for regulated providers also satisfy the safety and health requirements of the block grant; (12) for providers that states have chosen not to regulate, some states conduct activities usually reserved for regulated providers; (13) many states provide self-certification packets to nonregulated providers informing them of requirements they must meet and ask them to certify they will comply with the requirements; and (14) relying on self-certification has the potential to reduce costs to parents and states but does not afford assurance that requirements are being met.

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