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Quality in Norwegian childcare for toddlers using ITERS-R Elisabeth Bjørnestad and Ellen Os
Abstract:
The purpose of this study was to explore the quality of toddler childcare in Norway using the
Infant Toddler Environment Rating Scale Revised (ITERS-R; Harms, Cryer, and Clifford
2006), drawing on a sample of 206 toddler groups. Possible associations between quality (as
assessed using ITERS-R) and selected structural features in toddler classrooms were
investigated. Those features are as follows: ownership, the presence of qualified teachers, the
staff-to-child ratio, and group organization. According to the results, Norwegian toddler care
scored at the minimal level of quality. The presence of qualified teachers, high staff-to-child
ratios, and small and stable groups all seemed to have positively impacted quality. Detailed
analyses revealed that Norwegian toddler classrooms did not fulfil the ITERS-R requirements
for hygiene, safety, and access to play materials. Because of the good reputation Norwegian
childcare enjoys, these results were unexpected and suggest the need to enhance the quality of
Norwegian toddler care.
Keywords: group organization; ITERS-R; play materials; preschool teacher, quality; staff-to-
child ratio; toddler childcare
Author: Elisabeth Bjørnestad, Department of Early Childhood Education, Oslo and Akershus University College of Applied Sciences. Corresponding authors e-mail: [email protected] Co-author: Ellen Os, Department of Early Childhood Education, Oslo and Akershus University College of Applied Sciences.
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Quality in Norwegian childcare for toddlers using ITERS-R 1 Elisabeth Bjørnestad2 and Ellen Os3
Introduction
The Nordic model of early childhood education and care (ECEC) enjoys a reputation for providing
high-quality care to children (OECD 2006). Internationally, Norway’s holistic approach to children’s
well-being, learning, and development – along with structural aspects of its ECEC – seems to be
highly regarded (OECD 2015). Nevertheless, questions concerning the excellence of the Norwegian
ECEC system have been raised, both nationally and internationally (OECD 2015; Whitepaper 19
2015-2016).
In recent years, access to ECEC in Norway has increased rapidly, with nearly every Norwegian child
entering childcare in the second year of life. Norwegian ECEC has undergone structural changes that
have occurred simultaneously with this growth in enrolment. Traditionally ECEC centres have been
relatively small, consisting of few groups and only 3 or 4 classrooms, but this period of growth has led
to a shift towards larger centres (Vassenden, Thygesen, Bayer, Alvestad, and Abrahamsen 2011). At
the same time, changes related to group composition have taken place, resulting in a movement from
the traditional units of small and stable groups to larger and more flexible groups (Riksrevisjonen
2009).
No research to date has monitored the rapid growth in Norway of ECEC attendance by toddlers and
the accompanying structural changes (OECD 2015). As a result, knowledge concerning current
Norwegian ECEC quality is limited. In addition, research in ECEC is mainly based on qualitative, in-
depth studies. Even if these qualitative studies contribute to valuable knowledge, there is a lack of
large-scale research (Bjørnestad, Pramling Samuelsson, Bae, Gulbrandsen, Johansson, Løberg, and Os
2012; OECD 2015). A recently published OECD report (2015, 58-60) recommends the initiation of
large-scale studies of ECEC in Norway to monitor the quality of care using reliable and valid
instruments such as the Infant/Toddler Environment Rating Scale (ITERS-R) (Harms, Cryer, and
Clifford 2006).
1 Support for this research was provided by The Research Council of Norway (BePro 220570/ Searching for Qualities 218322). 2 This study is a part of the Better Provision for Norway’s Children in ECEC (BePro) project with the following Key Investigators: Elisabeth Bjørnestad, Jan Erik Johansson and Lars Gulbrandsen (Oslo and Akershus University College); Marit Alvestad and Eva Johansson (University of Stavanger); Liv Gjems and Thomas Moser (University of Southeast Norway); Edward Melhuish (Oxford University) and Jacqueline Barnes (Birkbeck University of London). 3 This study is a part of the Searching for Qualities project with the following Key Investigators: Leif Hernes, Ellen Os, Nina Winger, Brit Eide and Tona Gulpinar (Oslo and Akershus University College), Torill Vist (University of Stavanger), Anne Myrstad and Toril Sverdrup (The Arctic University of Stavanger).
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This article is based on results from two ongoing research projects, ‘Better Provision for Norway’s
Children in ECEC4’ and ‘Searching for Qualities5’, both of which aim to explore different aspects of
quality in toddler day care. Both projects comprise several studies with a variety of thematic and
methodological approaches in small, in-depth studies as well as large-scale studies. As a part of the
large-scale studies, the international tool ITERS-R6 has been utilized for the first time to investigate
quality in Norwegian toddler care. To our knowledge, this is the most extensive observational study of
the quality of Norwegian ECEC ever undertaken.
The aims of this study is to explore:
a) the features that characterize quality in ECEC for toddlers in a Norwegian context, as assessed
using ITERS-R
b) possible associations between quality assessed using ITERS-R and selected structural features
in toddler classrooms: ownership, presence of qualified teachers, staff-to-child ratio, and
group organization.
Quality toddler childcare Debates concerning quality in ECEC have taken place since the 1970s. While the concept of quality
appears to be the subject of endless debate, the general consensus holds that quality is related to
processual and physical characteristics (Bjørnestad et al. 2012; Kontos, Burchinal, Howes, Wisseh,
and Galinsky 2002; Sanders and Howes 2013). Processual aspects of care such as interactions both
between staff and children and among children seem to contribute directly to children’s development.
Structural characteristics such as group size, staff-to-child ratio, organization, and materials work
more indirectly, through their impact on processual aspects: ‘Structural dimensions predict process
dimensions, not children’s development’ (Sanders and Howes 2013, 358). Some studies (Kontos et al.
2002; Kontos and Keyes 1999) expand the concept of quality by explicitly including content as an
aspect of bidirectional relations.
In Norwegian, Nordic, and international research in general, there is a lack of knowledge concerning
the quality of centre-based care for toddlers (Bjørnestad et al. 2012). Most research related to childcare
quality and children’s development, for example, the EPPE project (Sylva, Melhuish, Sammons, Siraj-
Blatchford, and Taggart 2004), has focused on children of preschool age.
4 «Better Provision for Norway’s Children in ECEC” (BePro) (in Norwegian, “Gode barnehager for barn i Norge” (GoBaN) is a longitudinal project following children from 2.6 years until 5 years. BePro assesses quality in ECEC obtained by both ITERS-R and ECERS-R. 5 “Searching for Qualities” (in Norwegian, “Blikk for Barn”) focus mainly on children aged 0–3 years and their everyday life in different group compositions obtained by both ITERS-R and qualitative approaches. 6 Baustad (2012) piloted ITERS-R in a few groups in her master thesis.
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Bjørnestad et al. (2012) sum up some of the key factors that go into high-quality toddler care. The
most important factors are sensitive interactions and good relationships between staff and children and
between children within a given group. High-quality centres are described as settings with high staff-
to-child ratios, staff stability, small group sizes, and well-trained staff members. For infant and toddler
groups, 1:3 is regarded as the optimal staff-to-child ratio, and the optimal group size for children under
the age of 2 seems to be 6–8 children per group. The combined effects of process quality and
structural quality are important for the overall quality in toddler care.
Recent and ongoing Norwegian and Nordic research have paid attention to what consequences
organization and group size may have for children’s learning environments. Organization in large,
flexible, or open groups gives those groups a home base while they share interest centres and areas for
routines and care with other groups. The interest centres are often housed in areas that are located at a
distance from the home base. Flexible groups involve a changing mix of children and caregivers
across various rooms that might undermine interactions between children and staff and between the
children. Almost all studies researching group organization find the same tendencies. Small, stable
groups seem to be crucial for high-quality learning environments that promote children’s interaction
and communication as well as their learning and development. In bigger and more flexible groups,
children seem less likely to have close relationships with the staff because the latter must care for
many children. Larger group size may also have implications for peer interactions and children’s
involvement in relation to materials and activities (Alvestad, Bergem, Eide, Johansson, Os,
Pálmadóttir, Pramling Samuelsson, and Winger 2014; Pramling Samuelsson, Williams, and Sheridan
2015; Seland 2009; Sheridan, Williams, and Pramling Samuelsson 2014; Skalická, Belsky, Stenseng,
and Wichstrøm 2015; Vassenden et al. 2011). Skalická et al. (2015, 960-961) underscore: ‘…, it
would seem more difficult for children experiencing large spaces, different rooms, and flexibly
changing staff to develop close relationships with their teachers, relative to children who experience a
“smaller” – and perhaps more intimate social world.’
Another question raised in ECEC quality debates concerns the potential effects of attending childcare
institutions on children’s development and learning (Melhuish 2001). Studies examining the combined
structural, process, and content dimensions of quality have demonstrated associations between high
ECEC quality and children’s short-term and long-term developmental outcomes in social, emotional,
and cognitive development (Belsky, Vandell, Burchinal, Clarke-Stewart, McCartney, and Owen 2007;
Burchinal, Roberts, Nabors, and Bryant 1996; Sylva, Melhuish, Sammons, Siraj-Blatchford, and
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Taggart 2011; Vandell, Belsky, Burchinal, Steinberg, and Vandergrift 2010)7. Research also calls
attention to the impact experiences in toddlerhood have on school readiness (La Paro, Williamson, and
Hatfield 2014; McCartney, Dearing, Taylor, and Bub 2007). Fenech (2011) reports that classrooms
measured with ITERS-R have lower total scores than classrooms measured with ECERS-R. The low
ITERS-R scores indicate that it is necessary to gain knowledge about quality in toddler childcare in
order to make improvements.
In recent years some European countries have included ITERS-R in their studies related to quality in
ECEC. A study from the UK (Karemaker, Mathers, and Singler 2012) assesses the quality level of
toddler care as minimal (M=4.0). Studies from Portugal (Barros and Aguiar 2010) and the Netherlands
(Helmerhorst, Riksen-Walraven, Deynoot-Schaub, and Fukkink 2015) score the quality level of
toddler care in those countries as inadequate (respectively M=2.8 and M=2.9). An ongoing study in
the UK (Melhuish and Gardiner 2017) reports an increase in the UK quality rating from minimal in
2012 to good (M=5.3) in 2017. The scores for both the Netherlands and Portugal are minimal in the
area of Interaction and inadequate in the categories Activities and Personal Care Routines*. The UK
(2017) receives a good score for Interaction (M=5.6), Personal Care Routines (M=5.3), and Activities
(M=4.8) (see tables 1 and 3).
Table 1: Overview of ITERS-R scores for UK (2012, 2017), Netherlands (2015), and Portugal (2010
UK 2012 Netherlands Portugal UK 2017
N = 247 N = 55 N = 160 N = 402
M (SD) M (SD) M (SD) M (SD)
Space and Furnishings 3.9 (.90) 2.7 (.63) 3.3 (.74) 5.5 (1.06)
Personal Care Routines 3.6 (1.2) * 1.7 (.53) 5.3 (1.15)
Listening and Talking 4.6 (1.1) 3.5 (1.09) 3.4 (.98) 5.1 (1.25)
Activities 3.5 (1.0) 2.3 (.56) 2.44 (.56) 4.8 (1.01)
Interaction 5.1 (1.2) 3.8 (1.25) 3.7 (1.10) 5.6 (1.14)
Program Structure 4.5 (1.3) 3.5 (1.18) 2.56 (.65) 5.4 (1.24)
Total 4.0 (.90) 2.9 (.60) 2.8 (.48) 5.3 (.99)
Note: *In the Dutch study, the category Personal Care Routines is excluded
7 Most of the studies mentioned focus on children from the age of 3 and day care quality measured with ECERS-R or equivalent tools.
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Infant/Toddler Rating Scale – Revised (ITERS-R) ITERS-R, designed by Harms et al. (2006), measures the quality of childcare for children aged 6
weeks to 30 months. Together with ECERS-R, ITERS-R is perhaps the most widely used instrument
for measuring quality in childcare settings (Vermeer, van IJzendoorn, Cárcamo, and Harrison 2016).
ITERS-R covers different aspects of quality: physical arrangement, materials and activities, routines,
supervision, interactions, and schedule. Because of its wide scope, ITERS-R can be regarded as a tool
for investigating global quality (Hestenes, Cassidy, Hegde, and Lower 2007) even if the authors of the
scale refer to ITERS-R as a tool for measuring process quality (Harms, Cryer, and Clifford 2006).
ITERS-R is based on research from relevant fields such as health, development, and education; it also
takes into account professional views of best practices (Harms, Cryer, and Clifford 2006, 1).
Although ITERS-R is highly regarded, like ECERS-R, it is met with considerable criticism.
Developed in the United States, the rating scale’s relevance in non-American cultural settings has been
questioned (Dickinson 2006; Mathers, Singler, and Karemaker 2012). Further, the scale’s global
approach might imply that the measurement is superficial and lacks clarity as to which aspects of
quality constitute its focus (Dickinson 2006; Fenech 2011). Another criticism of the ITERS-R is that it
places too much weight on the structural aspects of childcare (Sanders and Howes 2013, Vermeer, van
Ijzendoorn, de Kruif, Fukkink, Tavecchio, Riksen-Walraven, and van Zeijl 2008) and fails to observe
and assess in depth the interactions that are considered key aspects of quality in childcare (Bisceglia,
Perlman, Schaack, and Jenkins 2009; Cassidy, Hestenes, Hegde, Hestenes, and Mims 2005;
Helmerhorst, Riksen-Walraven, De Kruif, Vermeer, Fukkink, and Tavecchio 2014). The hierarchic
organization of the quality scales, with basic needs at low levels and more educational and
interactional aspects at higher levels, has been criticized, as has the stop-scoring procedure (Gordon,
Hofer, Fujimoto, Risk, Kaestner, and Korenman 2015). The stop-scoring approach means that
requirements on lower levels must be met before scoring higher levels. When a classroom fails to meet
requirements, the observer stops scoring. This procedure limits information about classroom
weaknesses and strengths; if requirements for basic needs are not met, information about interactional
aspects, which are scored at higher levels in the scale, will not be gathered. Further, the highest level
measured in the ITERS-R scale, excellent, may not always reflect true excellence according to some
research (Mathers, Linskey, Seddon, and Sylva 2007; Os and Bjørnestad 2016). Lambert, Williams,
Morrison, Samms‐Vaughan, Mayfield, and Thornburg (2008) find that ITERS-R is appropriate for
measuring quality in childcare settings at or below the medium level, but the scale is not suitable for
distinguishing between settings at higher levels. Combining ITERS-R with more specific, in-depth
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measures might be a way of making the most of the advantages of ITERS-R while compensating for
its weaknesses (Farran and Hofer 2013; Mathers et al. 2007; Sanders and Howes 2013) 8.
Despite this critique, ITERS-R does have advantages. First, ITERS-R is designed to give an overall
evaluation of the quality of children’s learning and developmental environments. The evaluation is
based upon observations of the whole setting, not individual children. Second, the extended use of
ITERS-R in an international context offers opportunities to make comparisons between countries.
Third, because the scale’s time efficiency it is suitable for large-scale research that is highly needed in
Norway (OECD 2015; Whitepaper 19 2015-2016; Whitepaper 24 2012-2013; Whitepaper 41 2008-
2009).
Method
Sample The sample in the current study includes 206 classrooms with 2811 children from 93 centres selected
using stratified random selection (SRS) and self-recruitment in 4 counties in Norway. The distribution
is representative of the Norwegian population. A minimum of 1 staff member in all but 3 of the
classrooms held a bachelor’s degree or higher in early childhood education and care. After several
requests based on SRS and self-recruitment, the distribution consisted of 63% municipal and 37%
private centres. However, an independent sample t-test showed no significant differences in the total
ITERS-R scores between municipal and private centres (municipal M= 3.93, SD= .78, private
M=3.81, SD= .81, t(204)=1.03, p=0.304). These analyses confirmed that our data is not skewed by
the overrepresentation of municipal centres. The sample was also divided between small and stable
groups with their own classrooms (8–19 children) and more flexible groups of 20–56 children that
share classrooms and interest centres (known as “basebarnehager”). The sample’s breakdown is 25.3%
large and flexible groups and 74.7% small and stable groups.
Measurement ITERS-R is organized along seven subscales: Space and Furnishings, Personal Care Routines,
Listening and Talking, Activities, Interaction, Program Structure, and Parents and Staff (Parents and
Staff is not a part of this study). Distributed among the subscales are a total of 39 items, each of which
in turn consists of several indicators. Each item is rated on a scale from 1 to 7 (1= inadequate, 3=
minimal, 5= good, and 7= excellent). The ratings are based on 3–4 hours of observation followed by
8 In our study, we use the Dutch tool CIP to examine/measure the interaction quality.
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an interview with the class teacher to gain information about aspects the observer was not able to
observe during the visit.
The original scoring procedure in ITERS-R has a “stop-scoring” approach. Low-level indicators must
first be met before scoring indicators for higher levels. In the current study, all indicators were scored
even if the groups did not meet the requirements at lower levels; this approach gives a more nuanced
picture of classrooms’ strengths and weaknesses. However, this alternative scoring procedure does not
affect the ITERS-R scores; it just gives more information. For discussions concerning indicator levels,
see Os and Bjørnestad (2016).
Before analysing the data with descriptive statistics, the researchers checked the internal consistency
of the subscales and items. Following the practice of most studies using ITERS-R, we report
Cronbach’s alpha. However, the power and limitations of Cronbach’s alpha have been questioned
(Raykov 2004). The small number of items in each subscale may cause low Cronbach’s alpha.
Therefore, Raykov’s Composite Reliability has also been computed.
Table 2: Cronbach’s alpha and Raykov’s Composite Reliability for ITERS-R items and subscales
N # of items α rho
All items* All Subscales
Space and Furnishings
206 206
206
30 6
5
.87
.84
.52
.87
.86
.52
Personal Care Routines 203 6 .52 .54
Listening and Talking 206 3 .66 .73
Activities* 206 9 .56 .55
Interaction 206 4 .81 .82
Program Structure* 205 3 .56 .58
Note: Cronbach’s alpha and Raykov’s Composite Reliability are reported in this table for the ITERS-R subscales. *Item 23 and 32 are excluded due to missing values.
Coefficients for the full scale were α .87 and rho .87, using 30 items (excluding items 23 and 32), and
α .84 and rho .86 for all subscales. Considering variations in the organization of Norwegian childcare,
these results are acceptable. Computing Cronbach’s alpha and Raykov’s Composite Reliability for
each defined subscale resulted in coefficients that were lower than reported in the ITERS-R scoring
manual. Table 2 shows a low α and rho for all subscales except Interaction (α .81 and rho .82). Both
tests indicate the same reliability level in all subscales except Listening and Talking, where the rho
(.73) is higher than α (.66). With low α and rho in most of the subscales, it is necessary to proceed
with caution in analyses on subscale level.
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Training and data collection Both authors (the leading researchers) were certified through an ITERS-R online course at ersi.info,
followed by an intensive training and reliability check with Debby Cryer. The reliability score
received was 96%. The procedures prescribed by ERSI9 were also followed in training the Norwegian
data collectors. Due to variances in organizational settings, it was decided to have few observers (2–4
in each region, for a total of 12 observers). The interrater agreement within one scale point for all
observers was 87.5. Data collection ran from October 2013 to April 201510 in a total of 206
classrooms.
Adaptations and clarifications Given the cultural bias in the ITERS-R scale, it has been adapted for use in a Norwegian context.
Some of the adjustments take the form of clarifications concerning how indicators express themselves
in Norwegian ECEC. Other minor adjustments have to do with Norwegian cultural beliefs concerning
childhood (e.g. an emphasis on outdoor play and sleeping outside regardless of weather conditions,
along with the expectation that every Norwegian child should appreciate nature from a very young age
(Tandberg og Kaarby 2017). For further information about details concerning clarifications and
adaptations, see www.goban.no for the ITERS-R addendum11.
Results and discussion
Overall Classroom Quality The average total ITERS-R score in Norway is 3.9, defined as a minimal level of quality. Of all
classrooms, 8.75% scored 5 or above (good). None of the classrooms scored at the high levels of 6 or
7 (excellent). The highest total score was 5.9. The vast majority of the classrooms (78.15%) scored in
the minimal range, from 3–4.99. Out of all classrooms, 13.1% scored below 3 (inadequate quality).
A comparison of ECEC quality in Norway versus some other European countries indicates that
Norwegian ECEC is at the same level (minimal) reported in the UK in 2012. However, although
Norway (with a score of 3.9) has a total score close to that of the UK (with a score of 4) and higher
than the ITERS-R total score for the Netherlands (2.9) and Portugal (2.8), compared to the new results
from the UK´s SEED study (Melhuish and Gardiner 2017), Norway’s quality is ranked much lower.
One of the reasons for the increase in quality in the UK between 2012 and 2017 might be that ITERS-
R has been highlighted at the practical, research, and policy levels in the UK (Mathers et al. 2007;
9 ERSI (Environment Rating Scale Institute) 10 During the period from mid-June to mid-August, Norwegian day care centres close for the summer holidays, and from mid-August to mid-September most centres are busy enrolling new children. We therefore chose not to collect data during those periods of adjustment to avoid interference. 11 Only in Norwegian
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Mathers, Linskey, Woodcock, and Williams 2013; Mathers, Singler, and Karemaker 2012; Ofsted
2015).
Quality in Norwegian toddler groups at subscale level
Table 3: Descriptive Statistics for ITERS-R Subscales - Norway N Mean SD Min Max Skewness Kurtosis
Space and Furnishings 206 3.8 .90 1.80 6.40 .13 -.15
Personal Care Routines 203 3.5 1.00 1.17 6.50 .41 .11
Listening and Talking 206 4.3 1.37 1.00 7.00 -.24 -.72
Activities* 205 3.5 .77 1.78 5.44 .18 -.20
Interaction 206 4.7 1.50 1.00 7.00 -.30 -.84
Program Structure* 205 4.4 1.31 1.67 7.00 .06 -.70
ITERS-R total score 206 3.9 .80 1.64 5.9 -.11 -.07
Note: *Excluded items: item 23 in subscale 4 (Activities) and item 32 in subscale 6 (Program Structure)
Quality at subscale level in Norwegian ECEC, as presented in table 3, ranges from an average score of
3.5 for both Personal Care Routines and Activities to a score of 4.7 for Interaction. None of the
subscales achieve scores of 5 or above. This indicates minimal quality at subscale level. However,
almost all the subscales have a wide distribution. Three subscales, Listening and Talking, Interaction,
and Program Structure, have scores ranging from the maximum score (7) to the minimum (1). The
subscale Activities has the most restricted range: no classrooms scored above 5.44.
The Norwegian results at subscale level show the same patterns as results from the UK, the
Netherlands, and Portugal, where the subscales Interaction and Listening and Talking scored the
highest and Activities and Personal Care Routines scored the lowest. Norway and the UK (Karemaker,
Mathers, and Singler 2012) have similar scores for all subscales, with the exception of the subscale
Interaction, for which the UK scored in the good quality level range while Norway scored in the
minimal quality level range. Both Dutch (Helmerhorst et al. 2015) and Portuguese ECEC (Barros and
Aguiar 2010) scored in the inadequate range in relation to the subscale Activities, and Portugal scored
in the inadequate range in Personal Care Routines.
These patterns indicate that all countries face challenges related to the quality of their ECEC when it
comes to Personal Care Routines and Activities.
To explain the results in Norwegian ECEC at subscale level, it is necessary to take a closer look at the
results at item level, and to a certain degree at indicator level as well.
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Quality at item level Few studies report results at item level; it is therefore difficult to compare what causes the results at
subscale level and what in turn accounts for total ITERS-R scores in different studies. The current
study addresses this problem by examining results at item level to highlight factors that constitute the
total ITERS-R scores and also subscale-level scores. This approach is designed to reveal the strengths
and weaknesses in the care provided in Norwegian toddler classrooms (See table 4: Descriptive
Statistics for ITERS-R Item scores (appendix a) for results at item level).
At item level the scores for Norwegian ECEC range from 2.0 (the item Blocks) to 5.9 (the item
Greeting/departing) 12. Five of thirty items have scores under 3, which means that the quality in these
items is considered inadequate according to the ITERS-R standard (see table 4). Twenty-one items
have a score that falls within the minimal range (from 3.0 to 4.99). At the level characterized as good
(from 5 to 6.99) there are only 4 items (Greeting/, Helping children use language, Sand and water
play, and Staff-child interaction). A closer look into the details regarding different items reveals that
Norwegian ECEC faces some challenges concerning quality when it comes to sanitary procedures,
safety, and materials for activities and play.
Five of the six items in the subscale Personal Care Routines have a mean score of 3.5 or below. The
common denominator seems to be lapses in sanitary procedures. Hand washing procedures connected
to meals and diapering or use of the toilet are often insufficient. The alternate scoring in this study
reveals that many groups met the requirements of higher indicators related to interactions and
education in these items (see Vermeer et al. 2008).
Children’s safety is considered in several indicators in the items: Room arrangement (3.5), Nap (3.5)
and Safety practices (3.1). Regarding these items, the staff does not appear to fulfil the requirements
related to supervision, despite adjustments designed to make these requirements achievable in a
Norwegian context (e.g. using classrooms that consist of several rooms). The supervision during
naptime and play was inadequate. Sometimes children played out of their caretakers’ sight for up to 20
minutes.
The scores for items within the subscale Activities were surprisingly low. Three of nine items – Art,
Music and movement, and Blocks – all scored in the inadequate range. Only one item, Sand and water
play, scored in the good range (5.5), while the rest of the items in this subscale, except for Active
physical play (4.8), scored in the lower part of the minimal range (<4). It is worth noting that the
activities scoring highest were to a large extent outdoor activities, which are highly regarded in
12 Items 23 and 32 are excluded.
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Norway. The reason for the low scores for activities is mainly tied to children’s minimal access to toys
and materials. Lack of materials also affected the scores for Provision for relaxation and comfort:
requirements for soft toys often went unmet. The same is true of the score for Using books because
many groups failed to meet requirements for access to books. Sometimes the groups had the required
materials but stored them out of the children’s reach. Vermeer et al. (2008) report that the particular
emphasis on materials for learning and play is the main factor responsible for low ITERS-R scores in
the Activities subscale in the Netherlands. According to their study, the ITERS-R requirements that
certain quantities of materials must be made available to children are US standards of toddler care that
may not be appropriate in a Dutch context. But it is also possible that the lack of materials in
Norwegian toddler groups has other reasons, such as the way the centres are organized (see below)
and ideas about toy-free environments in Norwegian ECEC (Kjørholt 2016).
Items related to language and interactions received relatively high scores, but it is worth noting that
Helping children use language and Staff-child interaction did not score higher than 5 (good) despite
the relatively low requirements for this score in these items (Fenech 2011; Mathers et al. 2007; Os and
Bjørnestad 2016). In their analysis of the item Peer interaction in the subscale Interaction, Os and
Bjørnestad (2016) found that the requirements for achieving an excellent rating were rather low. This
may account for the relatively high scores on items related to language and interactions; in other
words, this high rating may not indicate high interactional quality in Norwegian ECEC.
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Qualified teacher present in the classroom
Table 5: Independent Group T-test between grouped variable for preschool teacher present during observation vs. no preschool teacher present and ITERS-R total score and subscales
A comparison of classrooms – those without qualified teachers present and those in which at least one
teacher with a bachelor degree in ECEC was present during observations – indicates that this factor
does not influence the total ITERS-R score. However, the presence of qualified teachers was
significantly associated with differences in the Interaction subscale scores (qualified teachers present
M=4.78 SD=1.49 non-qualified staff present M=3.87 SD=1.33, t[204]=2.361 p=0.01). There were no significant
differences in the other subscales, except for Talking and Listening which differed slightly across the
groups – albeit only borderline significantly (qualified teachers present M=4.39 SD=1.37 non-qualified staff
present M=3.79 SD=1.24, t[204]= 1.871, p=0.06).
As shown in table 5, three out of four items in the subscale Interaction show significant differences
concerning qualified teachers’ presence. Only Supervision of play and learning shows no significant
differences, probably because this item emphasizes supervision connected to children’s safety and not
only educational supervision. The presence of educated staff in the classroom is also significant in
relation to Helping children to understand language. These results might indicate the importance of
educated staff especially for the core aspect of quality – interactions between staff and children and
between children (Bjørnestad et al. 2012; Dalli, White, Rockel, Duhn, Buchanan, Davidson, Ganly,
Preschool
teacher(s)
present
N=190
No preschool
teachers present
N=16
t(df)
M (SD) M(SD) Cohens’ D Effect size(r )
Interaction 4.80 (1.48) 3.75 (1.43) 2.72*(204) .72 .34
Item 25 – Supervision of play and
learning 4.38 (2.23) 3.50 (2.31) 1.51 (204) .39 .19
Item 26 – Peer interaction 4.94 (1.68) 3.75 (1.77) 2.70* (204) .69 .33
Item 27 – Staff-child interaction 5.05 (1.81) 3.94 (1.95) 2.34*(204) .59 .28
Item 28 – Discipline 4.84 (1.70) 3.81 (1.28) 2.35*(204) .68 .32
Listening and Talking
4.99 (1.57)
4.13 (1.93)
2.08*(204)
.78
.37 Item 12 – Helping children
understand language
Note: M=Mean. SD=Standard Deviation. ITERS-R variables are measured in a range from 1–7, where 1 indicates the
lowest score and 7 indicates the highest score. *p<0.05; **p<0.001
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Kus, and Wang 2011; Melhuish and Gardiner 2017). Because of the small number of classrooms
without a qualified teacher present (n=16), the results should be interpreted with caution.
Staff-to-child ratio Comparing classrooms with a staff-to-child ratio of 1:3 or higher (e.g 1:2) with classrooms that have
ratios lower than 1:3 (see table 6) yields significant differences in quality. The differences are evident
in the total ITERS-R scores (ratio >1:3 M 3.99, SD=.79, ratio <1:3 M= 3.76 SD=.78, t(204) =2.066 p=0.04), and in
the subscales Listening and Talking (ratio >1:3 M=4.52 SD=1.34, ratio <1:3 M=4.10 SD 1.37, t(204)= 2.212
p=0.02) and Interaction (ratio >1:3 M=5.02 SD 1.45, ratio < 1:3 M=4.33 SD=1.48, t(204)=3.416, p=0.00).
TABLE 6: Independent Group T-test between grouped variable staff-to-child ratio and ITERS-R total score and subscales.
Staff-child Staff-child ratio ≥ 1:3 ratio < 1:3
N=116 N=90
M (SD) M (SD) t (df) Cohens’
D
Effect
size (r)
Total ITERS-R 3.99 (.79) 3.76 (.78) -2.06* (204) .29 .14
Space and Furnishing 3.88 (.93) 3.69 (.86) -1.57 (204) 0.22 .11
Item 4 Room arrangement 3.67 (1.51) 3.16 (1.48) -2.39* (204 .33 .17
Item 5 Display 4.28 (1.32) 3.85 (1.19) -2.40* (204) .34 .17
Interaction 5.03 (1.45) 4.32 (1.48) -3.42**(204) .48 .23
Item 25 – Supervision of play and learning 4.67 (2.16) 3.84 (2.27) -2.66* (204) .37 .18
Item 26 – Peer interaction 5.18 (1.67) 4.41 (1.68) -3.27* (204) .46 .22
Item 27 – Staff-child interaction 5.22 (1.82) 4.63 (1.83) -2.27* (204) .32 .16
Item 28 – Discipline 5.03 (1.64) 4.40 (1.70) -2.71* (204) .38 .19
Listening and Talking 4.52 (1.34) 4.10 (1.37) -2.21* (204) .31 .15
Item 12 – Helping children understand
language 5.18 (1.50) 4.59 (1.70) -2.66* (204) .37 .18
Note: M=Mean. SD=Standard Deviation. ITERS-R variables are measured in a range from 1–7, where 1 indicates the
lowest score and 7 indicates the highest score. *p<0.05; **p<0.001
These results are in line with existing research (de Schipper, Riksen-Walraven, and Geurts 2006; Iluz,
Adi-Japha, and Klein 2016) and correspond to traditional staff-to-child ratio norms for Norwegian
ECEC (Bekkhus, Rutter, Maughan, and Borge 2011), where lower staff-child ratios are associated
with lower quality levels in toddler care (see Bjørnestad et al. 2012).
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Group organization
Table 7: Independent Group T-test between organization and ITERS-R total score and subscales
Fixed groups
N=154
Flexible groups
N=16
M (SD) M (SD) t(df) Cohens’ D Effect size (r)
ITERS-R total 4.05 (.75) 3.44 (.78) 4,98**(204) .70 .33
Space and Furnishings 3.88 (.88) 3.56 (.93) 2.23*(204) .31 .15
Personal Care Routines 3.54 (.95) 3.34 (1.14) 1.26 (201) .18 .09
Language 4.63 (1.29) 3.47 (1.23) 5.71**(204) .80 .37
Activities 3.61 (.74) 3.14 (.76) 3.98**(203) .56 .27
Interaction 4.99 (1.41) 3.90 (1.49) 4.75**(204) .66 .32
Program Structure 4.60 (1.27) 3.64 (1.15) 4.81**(203) .68 .32
Note: M=Mean. SD=Standard Deviation. ITERS-R variables are measured in a range from 1–7, where 1 indicates the
lowest score and 7 indicates the highest score. *p<0.05; **p<0.001
A comparison of quality in stable groups versus flexible groups shows that stable groups score higher
than flexible groups, both on the total ITERS-R score and at subscale level (table 6). An independent
t-test shows a significant difference in total ITERS-R scores between the two forms of organization
(i.e. for the stable groups M= 4.05, SD= .75, flexible groups M=3.44, SD= .78, t(204)=4.98, and
p=0.00). With the exception of the subscale Personal care routines, the differences are significant and
have high effect sizes on all subscale scores.
The distributions among the total ITERS-R scores for stable and flexible groups show that 11% of the
stable groups and only 1 flexible group (1.9%) score above 5. Almost half of the stable groups
(44.8%) and only 23.1% of the flexible groups score between 4 and 4.99. Most of the flexible groups
(46%) are placed in a range from 3 to 3.99, while 36.7% of the stable groups have scores in this range.
Only 7.5% of stable groups have scores indicating inadequacy (below 3), while the scores for 28.8 %
of the flexible groups are rated inadequate.
The most striking differences between flexible and stable groups appear in subscales connected to
interactions, language, and program structure. Norwegian and Nordic research find that children in
flexible groups experience less communication and involvement with staff (Alvestad et al. 2014;
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Pramling Samuelsson, Williams, and Sheridan 2015; Seland 2009; Sheridan, Williams, and Pramling
Samuelsson 2014: Skalická et al. 2015; Vassenden et al. 2011).
Flexible groups also score lower on activities. Equipment for play and learning in flexible groups is
often located in various rooms far away from children’s home base. Accessibility depends on the
staff’s capacities to accompany children to different interest centres and the centres not being occupied
by other groups.
Concluding remarks The current study using ITERS-R to research the quality of Norwegian ECEC for toddlers reveals
some surprising results. First of all, the total ITERS-R score falls within the minimal quality range
(3.9). This result is in line with ITERS-R scores in other European contexts and also throughout the
rest of the world (Vermeer et al. 2016).
At subscale level, Norwegian ITERS-R scores follow the same patterns as scores from the
Netherlands, Portugal, and the UK in 2012. Personal care routines and activities scored the lowest
while Interaction scored the highest. The overall scores were at a minimal quality level (Barros and
Aguiar 2010; Helmerhorst et al. 2015; Karemaker, Mathers, and Singler 2012). However, since each
subscale contains several items that focus on different aspects of quality childcare, results on subscale
level give only a superficial impression concerning features of overall ECEC quality and have limited
value when it comes to comparing ITERS-R results and also informing the field about how to improve
those results. Different studies might report the same total scores and subscale scores, but in reality,
the qualitative aspects of childcare that underlie these scores are hidden. This is, as we see it, one
major weakness in discussions about quality care that are based upon ITERS-R measurement.
This article uses reported results at item level for its analysis of what is behind subscale scores, and
this analysis is in turn supported by information about which requirements are met at the level of
indicators. Our findings are that Norwegian toddler care faces challenges connected to a lack of
adequate materials for play and learning, inadequate hygiene, and insufficient safety supervision. Lack
of adequate materials may impact processual features like interactions between children and between
children and staff.
One aim of this article was to explore possible associations between quality as measured with ITERS-
R and selected structural features of toddler care. The study finds no differences between municipal
and privately owned centres. However, the presence of qualified teachers during observations, a higher
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staff-to-child ratio (>1:3), and division into small and stable groups all appeared to positively impact
the quality of toddler ECEC. Classrooms with no qualified teachers present, with lower staff-to-child
ratios (<1:3), and with classrooms organized in large, flexible groups had lower ITERS-R scores.
These results to a large extent accord with results from other studies (Alvestad et al. 2014; Pramling
Samuelsson, Williams, and Sheridan 2015; Seland 2009; Sheridan, Williams, and Pramling
Samuelsson 2014; Skalická et al. 2015; Vassenden et al. 2011). The impact of these factors appears
especially strong in relation to core aspects of quality in toddler care: the interactions between staff
and children and among children. The associations between processual aspects of care (such as
interaction) and the structural features (such as ratio, presence of qualified teachers, and organizational
forms) confirm the presumption that structural aspects might have an indirect impact on processual
features (Kontos et al. 2002; Kontos and Keyes 1999; Sanders and Howes 2013). On the other hand, in
our study, educated teachers’ presence during observations is not associated with children’s safety. An
assumption based on these results might be that having qualified educators is not necessary to ensure
toddlers’ safety but nevertheless has consequences for ensuring children’s well-being, development,
and outcomes – all of which to a great degree relate to processual features of quality. Regarding
flexible organizational structures, these face some challenges regarding quality. The logistics in these
classrooms are challenging due to children’s opportunities for sensitive interactions (Eide, Winger,
Wolf, and Dahle 2017).
The quality of Norwegian ECEC is not as good as we had expected, nor is it in line with Norway’s
reputation for quality childcare. The latest results from the UK (Melhuish and Gardiner 2017) show
that they have pulled ahead of the rest of Europe with a considerable increase in ITERS-R scores over
the last few years. This might be a result of the field adjusting to ITERS-R standards after repeated
assessments of quality using this scale (Karemaker, Mathers, and Singler 2012: Mathers et al. 2007;
Mathers, Singler, and Karemaker 2012). On the other hand, repeated assessments in the Netherlands
from 1995 to 2015 with ITERS-R have coincided with decreasing ITERS-R scores (Helmerhorst et al.
2015). In order to understand what causes changes in toddler care quality in particular countries
relative to one another, it is necessary to have extensive insights into the values, policies, and practices
in those different national contexts.
Based on the results from ITERS-R in Norwegian toddler care, improvement is needed, and the
Nordic model has to be challenged further through more in-depth studies as well as monitoring the
quality over time (OECD 2015).
The results from the current study should provide useful information to practitioners and policymakers
and help inform the Norwegian debate about quality childcare for toddlers. We would like to stress the
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importance of closely monitoring the quality of toddler care using ITERS-R. But because of the
limitations of the ITERS-R scale, future research should combine ITERS-R with other approaches to
quality research (cf. Helmerhorst et al. 2015). ITERS-R can help provide an overall picture and a point
of departure for more in-depth studies related to quality aspects.
Limitations ITERS-R represents one view of quality. It is not objective, and it has a cultural bias. Other
approaches to evaluating Norwegian toddler care might yield different results. ITERS-R provides a
broad evaluative overview of care without going into depth or details about the different aspects of
care. This limitation applies in particular to the core aspect of high quality ECEC: interactions.
Acknowledgment Thanks to research assistant Maren Meyer Hegna and PhD student Erik Eliassen for statistical
support and analysis.
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Appendix a
Table 4: Descriptive Statistics for ITERS-R Item scores
N Mean SD Min Max Skewness Kurtosis
Space and Furnishings 206 3.80 .90 1.80 6.40 .13 -.15
1. Indoor space 206 3.82 1.53 1 7 .65 .05
2. Furniture for routine care and play 206 4.53 2.06 1 7 -.33 -1.39
3. Provision for relaxation and comfort 206 3.11 1.22 1 7 1.21 1.88
4. Room arrangement 206 3.45 1.52 1 7 .23 .003
5. Display for children 206 4.10 1.28 1 7 1.01 .21
Personal Care Routines 203 3.49 1.00 1.17 6.50 .41 .11
6. Greeting/ departing 206 5.88 1.74 2 7 -1.30 .21
7. Meals/snacks 206 3.33 1.73 1 7 .81 -.28
8. Nap 203 3.51 2.42 1 7 .61 -1.44
9. Diapering/toileting 206 2.56 1.71 1 7 1.19 .24
10. Health practices 206 2.64 1.53 1 7 1.44 1.69
11. Safety practices 206 3.05 1.78 1 7 .52 -.65
Listening and Talking 206 4.34 1.37 1 7 -.24 -.72
12. Helping children understand language 206 4.92 1.61 1 7 -.52 -.38
13. Helping children use language 206 4.97 1.74 1 7 -.26 -.1.24
14. Using books 206 3.13 1.97 1 7 .50 -.99
Activities 205 3.49 .77 1.78 5.44 .18 -.20
15. Fine motor 206 3.32 1.43 1 7 .51 .18
16. Active physical play 205 4.80 1.94 1 7 -.11 - 1.29
17. Art 206 2.91 2.04 1 7 .70 -.76
18. Music and Movement 206 2.37 1.07 1 7 1.03 1.00
19. Blocks 206 2.00 1.44 1 7 1.41 1.15
20. Dramatic play 206 3.27 1.85 1 7 .36 -.90
21. Sand and water play 206 5.46 1.92 1 7 -.96 -.65
22. Nature/science 206 3.92 1.46 1 7 .82 -.17
24. Promoting acceptance of diversity 206 3.44 1.25 1 7 .65 1.34
Interaction 206 4.72 1.50 1 7 -.30 -.84
25. Supervision of play and learning 206 4.31 2.24 1 7 -.06 -1.52
26. Peer interaction 206 4.84 1.71 1 7 -.47 -.52
27. Staff-child interaction 206 4.96 1.85 1 7 -.30 -1.22
28. Discipline 206 4.76 1.69 1 7 -.27 -.80
Program Structure 205 4.34 1.31 1.67 7.00 .06 -.70
29. Schedule 206 4.61 1.62 1 7 .16 -.65
30. Free play 206 3.75 1.53 1 7 .48 .04
31. Group play activities 205 4.70 2.16 1 7 -.20 -1.52
ITERS-R total score 206 3.89 .80 1.64 5.9 -.11 -.07
Excluded items:
32. Provisions for children with disabilities 24 6.75 .74 4 7 -.31 9.37
23. Use of TV, video, and /or computer 22 4.59 2.01 1 7 -.34 -1.27
Note: this table depicts the summary of each subscale of the ITERS-R followed by the items in each scale and the total score.
This version of the article has been accepted for publication by Taylor and Francis in
EECERJ Volume 26 Issue 1, 2018
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