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

4

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

5

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

6

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

7

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

9

Tiered Quality Strategies

Type of TQS

Type of TQS

Tiered Reimbursement is the predominant TQS

N=41 TQS in 36 StatesNumber of TQS

10

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.

14

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

15

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

16

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

17

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

18

Tiered Quality Strategies

Issues: Infrastructure

What supports are available for programs to be successful?

What is necessary to administer a tiered strategy system?

19

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

22

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.

23

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?

32

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.

34

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

36

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.

37

NCCIC Online Library

38

Phone: 800-616-2242

Fax: 800-716-2242

TTY: 800-516-2242

E-mail: info@nccic.org

Web site: http://nccic.org

Mail: 243 Church Street NW 2nd Floor Vienna, VA 22180

NCCICNCCICA service of the Child Care Bureau

39