Child Care:

States Face Difficulties Enforcing Standards and Promoting Quality

HRD-93-13: Published: Nov 20, 1992. Publicly Released: Dec 7, 1992.

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Pursuant to a congressional request, GAO provided information on states' efforts to ensure and promote quality child care through enforcement of state standards, focusing on: (1) state-sponsored activities to ensure that providers meet state child care standards; (2) states' problems in conducting these activities; and (3) how the Child Care and Development Block Grant Act of 1990 (CCDBG) affects state efforts to improve the overall quality of child care and the enforcement of state standards.

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

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: The 104th Congress passed legislation that consolidated the four major federal child care programs, including the program discussed in this report, the Child Care and Development Block Grant (CCDBG). This action eliminates CCDBG, and thus negates the recommendations contained in this report concerning its implementation.

    Recommendation: The Secretary of Health and Human Services should assess state efforts to enforce their child care standards and improve quality of care while expanding child care services and, if necessary, modify HHS regulations that restrict state spending on quality.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: HHS has, through its contractor, completed a study looking at key state standards (which relate to quality) and is undertaking a study looking at enforcement practices particularly concerning legally exempt care being purchased with CCDBG money. In its last annual conference, it presented state speakers to discuss and share with participants effective ways they had found for ensuring compliance with standards in different child care settings.

    Recommendation: The Secretary of Health and Human Services should lead and support efforts to determine the effectiveness of various ways to ensure compliance and promote quality among different types of child care settings.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: To date, HHS has held two conferences for states to provide technical assistance. It has also awarded an RFP to determine promising practices in states. Through its contractors, it has also completed studies on promising practices in states which it has presented at its conferences.

    Recommendation: The Secretary of Health and Human Services should collect and disseminate information to states through newsletters, hotlines, or national conferences about activities that are working well in other states.

    Agency Affected: Department of Health and Human Services


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