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During the 1990s, the demand for quality infant and toddler child care grew significantly due to demographic trends and federal legislative policy change.

Working mothers with children under the age of 1 composed the fastest-growing group in the labor force, and approximately 50% of mothers with infants were employed in the labor force. Research findings on the importance of early brain development were widely publicized and resulted in unprecedented attention to the needs of infants and toddlers. Welfare reform legislation was passed, and the Childcare and Development Fund (CCDF), a block grant, was created by blending the four major federal child care programs. States were given considerably greater resources and latitude in programming and spending to promote quality infant and toddler care and were also required to set aside 4% of their grants specifically for quality improvement efforts (known as the “earmark”).

These trends were accompanied by an increase in the demand for quality infant and toddler care, because data clearly show that the quality of care is linked to developmental outcomes (National Research Council and Institute of Medicine, 2000). With the increased demand for quality infant and toddler care came greater awareness and attention to problems facing the child care field. Studies conducted during the 1990s raised serious questions about quality in both formal and informal care. This entry reviews data on quality care, assessment, and applications for child care improvements.

Data on Quality Care

Concerns about infant and toddler child care have centered on all aspects of quality care, including health and safety, developmental appropriateness of the environments, and adult-child interaction. What is known about quality in child care settings is generated by observational rating scales (e.g., ITERS, FDCERS), interviews, and questionnaires of parents and providers, as well as information gathered by regulators and licensors. More is known about the quality of care in formal or licensed settings than in informal settings (family, friend, and neighbor care). Data have suggested that safety violations are common in both licensed centers and family child care homes. Observational ratings of the quality of care provided in centers, in family child care homes, and by family, friends, and neighbors have shown that approximately 35% to 40% of those settings offered inadequate or poor quality care (Helburn, 1995; Kontos, Howes, Shinn, & Galinsky, 1995). Caregivers offered limited language and cognitive stimulation and interacted with infants in moderately or highly detached ways (National Institute of Child Health and Human Development, 1998).

There is a dearth of knowledge about the quality of informal care. This data vacuum is causing increasing concern, as at least 25% of children in the United States are cared for by family, friends, or neighbors. State regulatory standards for informal care vary quite a bit, and there are no quality standards specified by the federal government for informal caregiving subsidized by federal welfare reform dollars.

Quality Improvement

Quality improvement efforts are attempting to address the challenges of providing quality care: meeting health and safety standards, offering sensitive and responsive caregiving, and providing developmentally appropriate and stimulating environments. To that end, caregivers need ongoing emotional support, developmental knowledge, and concrete support to best provide sensitive and responsive caregiving, as well as livable wages. Current quality improvement initiatives fall into three categories: professional development, community collaboration, and technical assistance.

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