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1
Exploring the Complexities of
Tiered Quality Strategies
Judy Collins
National Child Care Information Center (NCCIC)
BUILD Conference CallAugust 19, 2004
Developed by Judy Collins and Tracy Dry, NCCIC
NCCICNCCICA service of the Child Care Bureau
2
Tiered Quality Strategies
Enhancing Quality through Systemic ImprovementsFour Approaches:
Tiered Reimbursement
Rated Licensing
Quality Rating
Combination of StrategiesOverview of Tiered Strategies: Quality Rating, Reimbursement, Licensing (November 2002), by Judy Collins and Tracy Dry, National Child Care Information Center, http://nccic.org/faqs/tieredstrategies.html
3
Tiered Quality Strategies
Tiered Reimbursement
State provides higher rates for child care programs that achieve one of more levels of quality beyond basic licensing
New Mexico- AIM HIGHhttp://www.newmexicokids.org/Resource/Library
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Tiered Quality Strategies
Rated License
Quality criteria for each particular level are embedded in the State’s requirements for obtaining a child care license.
North Carolina: Five-Star Rated License http://ncchildcare.dhhs.state.nc.us/parents/pr_sn2_ov_sr.asp
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Tiered Quality Strategies
Quality Rating
State develops and markets a quality rating indicator for use as a child care consumer guide.
Educare Coloradohttp://www.educarecolorado.org
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Tiered Quality Strategies
Combinations of Strategies
Combining goals and characteristics of tiered reimbursement, rated licensing, and/or quality rating systems
Oklahoma: Reaching for the Starshttp://okdhs.org/childcare/ProviderInfo/provinfo_stars.htm
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Tiered Quality Strategies
36 States* Have Implemented a Tiered Strategy
* Not all of these systems have been implemented Statewide.
8
Tiered Quality Strategies
8 States currently operate a pilot and/or municipality/county option
*
*
*
*Pilot Municipality/County Option
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Tiered Quality Strategies
Type of TQS
Type of TQS
Tiered Reimbursement is the predominant TQS
N=41 TQS in 36 StatesNumber of TQS
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Tiered Quality Strategies
TQS Implementation Dates
Year 1989 1992 1993 1994 199619971998 1999 2000 2001200220032004No. New
TQS1 1 1 1 1 3 5 8 6 4 7 1 1
TQS began in the first State in 1989 as TR In Tiered Reimbursement Rates and Rated Licenses (updated
May 1999), Gwen Morgan reported 16 States paid more for higher-quality care
States are continuing to develop new systems and expand and refine their current TQS
Number of new TQS Implemented Each Year
11
Tiered Quality Strategies
Number of Quality Levels
Number ofTQS
Eighteen TQS have three or more quality levels
N=41 TQS in 36 States NR=No response
Number of Quality Levels
12
Tiered Quality Strategies
Categories of Quality Criteria in Multi-level TQS
Categories of CriteriaNumber of Programs
Professional Development / Qualifications / Training 17Learning Environment/Curriculum 10Licensing Status / Compliance 10Parent / Family Involvement 10Accreditation 9Administrative Policies & Procedures 6Program Evaluation 6Ratios / Group Size 6Program Quality 5Health / Safety / Nutrition 4Personnel / Staffing 4Staff Compensation 4Staff-Child Interaction 4Child Development 2
States were asked to verify the categories of criteria used to assign quality strategies with more than two levels. These categories of criteria did not include the requirements within the components of quality levels. For the purposes of this analysis, the list of 41 categories sent to States for verification were sorted by topic and compiled into the 14 categories listed above.
N=18 Multi-level TQS in 20 States
13
Tiered Quality Strategies
21 States* have implemented a system with more than two levels
* Not all of these systems have been implemented Statewide.
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Tiered Quality Strategies
Categories of Quality Criteria: Learning Environments
Weekly lesson plans that are developmentally appropriate
Space arranged in interest areasChildren read to 15 minutes a day Oklahoma, Reaching for the Stars
http://okdhs.org/childcare/ProviderInfo/StarsProgram/StarCriteria.htm
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Tiered Quality Strategies
Categories of Quality Criteria: Staff Compensation
Salary Scale - Level of education, training, experienceBenefit Options- Paid sick leave, annual increments, paid
vacation, medical insurance, child care benefit, tuition reimbursement, paid family leave, retirement
Pennsylvania, Keystone Starshttp://www.dpw.state.pa.us/ocyf/childcarewks/ccwKeyStars.asp
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Tiered Quality Strategies
Categories of Criteria: Accreditation
Accreditation by a national organization is a common feature of tiered reimbursement systems.
35 States have linked differential reimbursement rates to accreditation.
4 Statewide tiered strategy systems do not include accreditation: North Carolina and Tennessee, MA, CO
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Tiered Quality Strategies
Accreditation Issues
All systems are not created equal.
- What accreditation systems will be recognized in the tiered strategy system?
- How will the accreditation systems that apply for recognition in the system be evaluated?
Overloaded systems
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Tiered Quality Strategies
Issues: Infrastructure
What supports are available for programs to be successful?
What is necessary to administer a tiered strategy system?
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T.E.A.C.H. Early Childhood ®
Oklahoma
The Support Systems in Oklahoma
ScholarsProgram
StarsOutreach
Specialists
Quality Improvement
Grants
R.E.W.A.R.D.™ Salary
Supplement
TrainingVouchers
Director’sTraining
ERSEvaluations
On-SiteTechnicalAssistance
Model Observation
Sites
Support system information: Center for Early Childhood Professional Development, http://www.cecpd.org
Accreditation Support
20
Tiered Quality Strategies
Issues: Expectations
Are the steps (or tiers) between the quality levels too big?
Are the expectations for participation realistic?
21
Tiered Quality Strategies
Why middle levels?
Too big of a step to accreditation
- Few programs accredited Specific for States’ needsTrial grounds for “want to be
standards”Enhance licensing requirements
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Tiered Quality Strategies
Key Questions
Are the goals for implementing the system clearly identified?
Are various stakeholders involved for maximum buy-in?
Are the demographics of your early care and education profession known?
Is there an infrastructure and inter-structure in place to facilitate and support the system?
How will the system be evaluated?
Source: Adapted from Tiered Reimbursement/Quality Rating Systems Questions to Ask, by Judy Collins, National Child Care Information Center.
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Tiered Quality Strategies
Significant Differences
Is the system initiated via legislation or administrative policy?
Is the system voluntary or mandatory?Is licensing the first level?How many areas of quality criteria will be
identified?What quality criteria will be used?Is the quality criteria monitored?
24
Tiered Quality Strategies
More Differences
Will the program be piloted? Who is the implementing and administering
agency? Which agency monitors the child care facility for
compliance with the quality criteria? Is there an identified level of substantial
compliance? Is a particular score on the Environmental Rating
Scale (ERS) required to move to the next level? Does money follow the child or the program?
25
Tiered Strategy SystemsUnanticipated Issues:
Lessons Learned from Oklahoma
Demographic information of the workforce was not good enough.
Staff/directors took time to take advantage of educational supports.
More formal education supports were needed.
Workforce
26
Tiered Strategy SystemsUnanticipated Issues:
Lessons Learned from Oklahoma
How compliant with licensing standards?
- Numerous
- Repeated
- SeriousConsistently contested
Compliance Criteria
27
Tiered Strategy SystemsUnanticipated Issues:
Lessons Learned from Oklahoma
Property right/license versus privilege/contract
- Hearing versus administrative review - Liberty plus; involves reputation and has
economic impactPolitically as difficult as property rightPolicy changes so the level reduction will
not have the effect of a “death sentence”
Loss of Higher Rating
28
Tiered Strategy SystemsUnanticipated Issues:
Lessons Learned from Oklahoma
ClarificationCorrect mistakesFacilitate facility progressAdded another level (One Star Plus)Comply with statute change
Number of Changes
29
Tiered Strategy SystemsUnanticipated Issues:
Lessons Learned from Oklahoma
Numerous policy changesComplexityAllowing facilities to keep enhancement
rate for 4 monthsTwo star facilities that do not look “great” - Even though better than they wereOne star facilities that do look “great”
Attitude of Implementing Staff
30
Tiered Strategy Systems
Lessons Learned from the States
CostFrequencyAttitudes of providersTechnical assistance follow-upWhat does the ERS tell us?
Environmental Rating Scales (ERS)
31
Tiered Quality Strategies
Future Directions: What do we know and what do we not know?
Existing systems are growing, both in the number and complexity of levels.
What are the costs of the systems?What are the barriers?How do you ‘sell it’ in times of budget
crises? What is the impact of changes in
accrediting systems?
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Tiered Quality Strategies
Impact on the Quality of Child Care: North Carolina
“Assessment scores provide valuable insight into the areas of achievement and those areas in need of resources and continuing improvement in child care centers across the state. The findings also provide compelling evidence of an increase in rating scale scores in child care centers* with increasing levels of teacher education.” *Ratings are discussed for preschool classrooms, infant classrooms, school-age classrooms, and family child care homes.
Source: The North Carolina Rated License: A Three-Year Summary of Assessed Facilities: Executive Summary (May 2003), written by Deborah Cassidy, Linda Hestenes, Sharon Mims, and StephenHestenes North Carolina Rated License Assessment Project, pages 5 and 9. http://web.uncg.edu/ncrlap/pdf/ExecutiveSummary_Final_5_15_03.pdf.
33
Tiered Quality Strategies
Impact on the Quality of Child Care:Oklahoma
“The intent of the ‘Reaching for the Stars’ program is to improve the quality of individual centers as well as the overall quality of child care in Oklahoma. The findings … show that this goal is being achieved. More high quality programs are enrolling children subsidized by DHS, global quality ratings have risen, and teacher-child interactions are generally positive.”
Source: “Reaching for the Stars” Center Validation Study Final Report, (November 2003), by Deborah J. Norris, Loraine Dunn, and Lisa Eckert,prepared for Oklahoma Department of Human Services, Division of Child Care by Early Childhood Collaborative of Oklahoma (ECCO), an Oklahoma University/Oklahoma State University Partnership, page 45. http://okdhs.org/childcare.
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Tiered Quality Strategies
ECERS Scores Impact in Oklahoma
Figure 9. ECERS-R of 5 or Higher in 1999 & 2002
0%
20%
40%
60%
80%
100%
One-Star Two-Star Three-Star
Star Status
ECER
S-R
5 or
Hig
her
1999
2002
Source: “Reaching for the Stars” Center Validation Study Final Report, (November 2003), page 20. http://okdhs.org/childcare.
35
Tiered Quality Strategies
Wage Impact in Oklahoma
Source: “Reaching for the Stars” Center Validation Study Final Report, (November 2003), page 26. http://okdhs.org/childcare.
Figure 12. Average Salary By Auspice & Star Status
$0
$2
$4
$6
$8
$10
One-Star One-Star Plus Two-Star Three-Star
Star S tatus
Nonprof it
Prof itSa
lary
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Tiered Quality Strategies
Impact on Subsidized Enrollment
Figure 5. Subsidized Enrollment
0%
10%
20%
30%
40%
50%
60%
70%
One-Star One-P lus Star Two-Star Three-Star
Star Status
Subsidized
NotSubsidized
Source: “Reaching for the Stars” Center Validation Study Final Report, (November 2003), page 9. http://okdhs.org/childcare.
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NCCIC Online Library
38
Phone: 800-616-2242
Fax: 800-716-2242
TTY: 800-516-2242
E-mail: [email protected]
Web site: http://nccic.org
Mail: 243 Church Street NW 2nd Floor Vienna, VA 22180
NCCICNCCICA service of the Child Care Bureau
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