Constructing Quality Care
By Janet G. Chisholm
Community Nursing and Day Care Division
Bureau of Health Systems Regulation
Connecticut Department of Public Health and Addiction Services

Thanks to new research and advocacy efforts, we hear increased public concern about child care quality. This is an opportunity we can seize to become more effective in the public policy area if we communicate more clearly to parents, friends and legislators about what quality means and what quality costs, and if we describe the important role played by our licensing regulations.

THE FLOOR
One way to approach a discussion of child care quality is to describe the licensing regulations as the very first level of quality, or the floor. Regulations help prevent future harm to our most vulnerable citizens; they form a protective barrier for children's health, safety and welfare. They are only basic standards, involving background screenings, inspections, program assessment, a records review, brief interviews and observations.

Parents often ask why regulations differ for family child care, school-age programs and child care centers. As professionals, we can honestly explain that the different social and physical environments of these three environments require slightly different measures and means for reducing risks to children. The licensing regulations create the "bottom line," or minimum standard.

The public policy agreed upon by the people in each state has been set forth in law; it is a minimum-quality standard, or a legal ground floor. The public process for continually revising the regulations has allowed a variety of groups and individuals to express their own opinions and to consider others'. It has involved all of us: caregivers, parents, health professionals, fire marshals, building inspectors, child advocates, social workers, educators, licensers and legislators. Our challenge has been to balance what is ideal for children with what programs can practically do and what parents can reasonably afford. There have been many dangers: Will regulations prove too costly for providers, resulting in higher fees for parents? Will most providers comply with new requirements and find the resources they need (approved first aid courses, for example?) Or will caregivers drop out of the system, ceasing operation or choosing to operate illegally as part of the "underground?" The regulations have been a product of our on-going dialogue-but the dialogue continues-and requires more listening and better communication, especially about the concept of "quality."

THE CEILING
We acknowledge that, as a practical matter, licensing regulations have tended to be observable standards that are relatively quick and easy to monitor. And we understand that licensers may visit a program only once every two or three years and then for only a few hours. Although the licensers may be able to determine objectively if a program on a given day has met requirements for health and attendance records, staff ratios, water temperature, safe play equipment, developmentally-appropriate materials and activity plans, and napping arrangements; they would have difficulty assessing some other important aspects of program quality.

Thankfully, many providers have voluntarily devised higher standards for themselves, in essence establishing a voluntary ceiling for quality child care. These providers have chosen to require more staff training; have joined local associations for professional consultation, education resources and support; and have submitted to rigorous professional accreditation processes. And many parents have increased the demand for quality and raised the ceiling. They have visited and observed programs to identify those which meet and exceed minimum licensing standards. Looking beyond cost and convenience, parents have looked for programs with positive, intensive child-caregiver interactions; developmentally-appropriate environments, stability of teaching staff, commitment to parent communication, culturally-sensitive materials and activity areas, smaller group size, and commitment to on-going staff training.

THE FLOOR IS NOT THE CEILING!
Are we seizing the new opportunity we have to increase parents' and legislators' understanding and support of the levels of quality in child care? Our effective communication in the public policy arena about the levels of quality will be vital to maintaining the floor and to raising the ceiling!

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